The Role of the Medical Interpreter in Identifying Potential Mental Disorders

The role of the medical interpreter is always critical, and particularly so in mental health interpreting.  The interpreter’s ability to remain fully faithful to the register, language form, and linguistic content of the source message ensures the patient is appropriately diagnosed, treated, and offered benefits when available.  Sometimes, however, an interpreter may find themselves in a situation in which their interpretation into the target language is inadequate to properly convey a particular facet of the source message and this happens more often in mental health interpreting.

Often times, language within the context of culture is a key component to the screening tests for certain mental disorders. As Linda Pollack-Johnson and Dr. Eric J. Hardt describe in an article about screening for dementia, nuances in the target language can skew results if the interpreter and provider do not take the time to discuss these potential difficulties prior to the encounter.  For an interpreter who is new to the field, pre-session meetings with the treating team are vital to set expectations and to understand the goal of each screening tool.  However, these are not the only scenarios in which a medical interpreter may encounter mental health.

Providers are trained to be able to identify markers or symptoms of mental disorders and refer a patient for further screening. In some cases, these symptoms can be overlooked during an interpreting encounter if the symptoms are not clearly reflected in the interpretation. Consider the following scenario:

While interpreting for a patient in an initial oncology screening setting, I noticed the patient was unable to answer simple questions such as her home address, social security number, and became very agitated when prompted to discuss her medical condition. I decided immediately this was not a language barrier since she was able to discern linguistic and conversational cues such as when to answer a question versus reply with a statement, but I noticed she was often times distracted to the point of being unable to and unwilling to participate in her care coordination.

What would you do in this situation? It is important that interpreters feel comfortable making observations in the context of their role when it is appropriate. In this particular scenario, the interpreter states:

At first I opted to clarify and reinterpret the provider’s questions, all while exercising transparency; however, communication continued to breakdown. As the interpreter and a member of the treatment team, I communicated these concerns to the attending physician in context of the linguistic difficulties I was experiencing in facilitating communication.

The physician was then able to make the decision to coordinate psychiatric evaluation ultimately leading to the diagnosis of schizophrenia.

Interpreters should never offer their opinions regarding a patient’s potential condition, but they should feel comfortable communicating any linguistic challenges or barriers they encounter and in turn empower the providers to make their own observations.  Although the provider is ultimately responsible for identifying these markers, under the bilingual/bicultural model of interpreting, we too are responsible for ensuring that all aspects of communication are delivered, including any non-communication.  In this setting, the interpreter clarified to the provider that the patient’s inability to answer the simple questions was not because of a linguistic barrier such as a difference in dialect, which gave the provider all of the information necessary to decide how to proceed.

As part of the treatment team, it is our mission and our responsibility to facilitate the appropriate diagnosis, treatment, and applicable benefits through communication. All medical interpreters should be prepared to incorporate all information including non-communication into the encounter whenever appropriate.  Furthermore, interpreters who frequent psychiatric hospitals should specialize in Mental Health Interpreting and become comfortable with the formality of the screening tools used in diagnosing mental disorders.