Advertisement

Journal of Immigrant and Minority Health

, Volume 16, Issue 6, pp 1238–1246 | Cite as

Language Barriers in Mental Health Care: A Survey of Primary Care Practitioners

  • Camille Brisset
  • Yvan LeanzaEmail author
  • Ellen Rosenberg
  • Bilkis Vissandjée
  • Laurence J. Kirmayer
  • Gina Muckle
  • Spyridoula Xenocostas
  • Hugues Laforce
Original Paper

Abstract

Many migrants do not speak the official language of their host country. This linguistic gap has been found to be an important contributor to disparities in access to services and health outcomes. This study examined primary care mental health practitioners’ experiences with linguistic diversity. 113 practitioners in Montreal completed a self-report survey assessing their experiences working with allophones. About 40 % of practitioners frequently encountered difficulties working in mental health with allophone clients. Few resources were available, and calling on an interpreter was the most common practice. Interpreters were expected to play many roles, which went beyond basic language translation. There is a clear need for training of practitioners on how to work with different types of interpreters. Training should highlight the benefits and limitations of the different roles that interpreters can play in health care delivery and the differences in communication dynamics with each role.

Keywords

Mental health Primary care Migrants Linguistics barriers Interpreters 

Notes

Acknowledgments

This study was funded by the CIHR (No. PHE 101540) and the FRSQ (No. 22031). Our special thanks to the participating HSSCs (de la Montagne, de Bordeaux-Cartierville-Saint-Laurent, de la Pointe de l’Île, de Saint-Léonard et de Saint-Michel, du Cœur de l’Île, d’Ahuntsic-Montréal-Nord) and crisis centers (Le Transit, Ouest de l’Île, Tracom). Thank you also to the decision-maker authorities involved in the project (Ronald McNeil from the MHSS, Isabelle Hemlin from the Montreal HSSA, Nicole Lachance from the Quebec City HSSA, and Marlène Yuen from the de la Montagne HSSC), to Nadine Forget-Dubois for statistical advice, to John Kingma for proofing the manuscript and to the students who helped in the collection and capture of data (Alexandra Matte-Landry, David-Emmanuel Hatier, Guillaume Rodrigue and Jean-François Caron).

References

  1. 1.
    Oxford English dictionary online. Allophone, n.2. In: Oxford University Press; 2013. Google Scholar
  2. 2.
    Statistics Canada. Linguistic characteristics of Canadians: language, 2011 census of population. Ottawa: Minister of Industry; 2012.Google Scholar
  3. 3.
    Laforce H. Personal communication. 2010.Google Scholar
  4. 4.
    Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19:60–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Morrison TB, Wieland ML, Cha SS, Rahman AS, Chaudhry R. Disparities in preventive health services among Somali immigrants and refugees. J Immigr Minor Health. 2012;14:968–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Jacobs E, Chen AH, Karliner LS, Agger-Gupta N, Mutha S. The need for more research on language barriers in health care: a proposed research agenda. Milbank Q. 2006;84:111–33.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Ministry of Health and Social Services. Quebec’s mental health action plan 2005–2010. Quebec City: Ministère de la Santé et des Services sociaux; 2005.Google Scholar
  8. 8.
    Habermas J. The theory of communicative action. Oxford: Polity Press; 1991.Google Scholar
  9. 9.
    Leanza Y, Miklavcic A, Boivin I, Rosenberg E. Working with interpreters. In: Kirmayer L, Rousseau C, Guzder J, editors. Cultural consultation: encountering the other in mental health care. New York: Springer; 2014. p. 89–114.CrossRefGoogle Scholar
  10. 10.
    Kirmayer LJ, Weinfeld M, Burgos G, du Fort GG, Lasry JC, Young A. Use of health care services for psychological distress by immigrants in an urban multicultural milieu. Can J Psychiatry. 2007;52:295–304.PubMedGoogle Scholar
  11. 11.
    Snowden LR, Yamada AM. Cultural differences in access to care. Annu Rev Clin Psychol. 2005;1:143–66.PubMedCrossRefGoogle Scholar
  12. 12.
    Chen AW, Kazanjian A, Wong H. Why do Chinese Canadians not consult mental health services: health status, language or culture? Transcult Psychiatry. 2009;46:623–41.PubMedCrossRefGoogle Scholar
  13. 13.
    Sadavoy J, Meier R, Ong AY. Barriers to access to mental health services for ethnic seniors: the Toronto study. Can J Psychiatry. 2004;49:192–9.PubMedGoogle Scholar
  14. 14.
    Vissandjee B, Hemilin I, Gravel S, Roy S, Dupéré S. La diversité culturelle montréalaise : Une diversité de défis pour la santé publique [Montreal’s cultural diversity: a variety of challenges to public health]. Santé Publique. 2004;17:417–28.CrossRefGoogle Scholar
  15. 15.
    Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42:727–54.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62:255–99.PubMedCrossRefGoogle Scholar
  17. 17.
    Bauer AM, Alegria M. Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review. Psychiatr Serv. 2010;61:765–73.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Bischoff A, Tonnerre C, Eytan A, Bernstein M, Loutan L. Addressing language barriers to health care, a survey of medical services in Switzerland. Soc Prev Med. 1999;44:248–56.CrossRefGoogle Scholar
  19. 19.
    Kuo DZ, O’Connor KG, Flores G, Minkovitz CS. Pediatricians’ use of language services for families with limited English proficiency. Pediatrics. 2007;119:920–7.CrossRefGoogle Scholar
  20. 20.
    Hsieh E. Interpreters as co-diagnosticians: overlapping roles and services between providers and interpreters. Soc Sci Med. 2007;64:924–37.PubMedCrossRefGoogle Scholar
  21. 21.
    Leanza Y. Roles of community interpreters in pediatrics as seen by interpreters, physicians and researchers. Interpreting. 2005;7:167–92.CrossRefGoogle Scholar
  22. 22.
    Brisset C, Leanza Y, Laforest K. Working with interpreters in health care, a systematic review and synthesis of qualitative literature. Patient Educ Couns. 2013;91:131–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Dodd W. Do interpreters affect consultations? Fam Pract. 1984;1:42–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Eytan A, Bischoff A, Rrustemi I, et al. Screening of mental disorders in asylum-seekers from Kosovo. Aust N Z J Psychiatry. 2002;36:499–503.PubMedCrossRefGoogle Scholar
  25. 25.
    Bischoff A, Tonnerre C, Loutan L, Stalder H. Language difficulties in an outpatient clinic in Switzerland. Soc Prev Med. 1999;44:283–7.CrossRefGoogle Scholar
  26. 26.
    Flores G, Torres S, Holmes LJ, Salas-Lopez D, Youdelman MK, Tomany-Korman SC. Access to hospital interpreter services for limited english proficient patients in New Jersey: a statewide evaluation. J Health Care Poor Underserved. 2008;19:391–415.PubMedCrossRefGoogle Scholar
  27. 27.
    Torres ME, Parra-Medina D, Bellinger JD, Johnson AO, Probst JC. Rural hospitals and Spanish speaking patients limited english proficiency. J Healthc Manag. 2008;53:107–20.PubMedGoogle Scholar
  28. 28.
    Bradshaw M, Tomany-Korman S, Flores G. Language barriers to prescriptions for patients with limited english proficiency: a survey of pharmacies. Pediatrics. 2007;120:225–35.CrossRefGoogle Scholar
  29. 29.
    Campbell D, Brislinm R, Stewart V, Werner O. Back-translation and other translation techniques in cross-cultural research. Int J Psychol. 1970;30:681–92.Google Scholar
  30. 30.
    Miller KE, Martell ZL, Pazdirek L, Caruth M, Lopez D. The role of interpreters in psychotherapy with refugees: an exploratory study. Am J Orthopsychiatry. 2005;75:27–39.PubMedCrossRefGoogle Scholar
  31. 31.
    Raval H, Smith JA. Therapists’ experiences of working with language interpreters. Int J Ment Health. 2003;32:6–31.Google Scholar
  32. 32.
    Rosenberg E, Leanza Y, Seller R. Doctor-patient communication in primary care with an interpreter: physician perceptions of professional and family interpreters. Patient Educ Couns. 2007;67:286–92.PubMedCrossRefGoogle Scholar
  33. 33.
    Lowry R. Calculator 3: significance of the difference between the results of two separate polls. 2008. Available at: http://faculty.vassar.edu/lowry/polls/calcs.html#ca3. Accessed 28 Aug 2013.
  34. 34.
    Papic O, Malak Z, Rosenberg E. Survey of family physicians’ perspectives on management of immigrant patients: attitudes, barriers, strategies, and training needs. Patient Educ Couns. 2011;86:205–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Bischoff A, Hudelson P. Access to healthcare interpreter services: where are we and where do we need to go? Int J Environ Res Public Health. 2010;7:2838–44.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Hudelson P, Vilpert S. Overcoming language barriers with foreign-language speaking patients: a survey to investigate intra-hospital variation in attitudes and practices. BMC Health Serv Res. 2009;9:187.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Edwards R, Temple B, Alexander C. Users’ experiences of interpreters: the critical role of trust. Interpreting. 2005;7:77–95.CrossRefGoogle Scholar
  38. 38.
    Leanza Y, Boivin I, Rosenberg E. Interruptions and resistance: a comparison of medical consultations with family and trained interpreters. Soc Sci Med. 2010;70:1888–95.PubMedCrossRefGoogle Scholar
  39. 39.
    Diamond LC, Schenker Y, Curry L, Bradley EH, Fernandez A. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2008;24:256–62.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Bischoff A, Denhaerynck K. What do language barriers cost? An exploratory study among asylum seekers in Switzerland. BMC Health Serv Res. 2010;10:248.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Hampers LC, McNulty JE. Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. Arch Pediatr Adolesc Med. 2002;156:1108–13.PubMedCrossRefGoogle Scholar
  42. 42.
    Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants’ perceptions of using interpreters in health care. Int Nurs Rev. 2009;56:461–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Nailon RE. Nurses’ concerns and practices with using interpreters in the care of Latino patients in the emergency department. J Transcult Nurs. 2006;17:119–28.PubMedCrossRefGoogle Scholar
  44. 44.
    Gerrish K, Chau R, Sobowale A, Birks E. Bridging the language barrier: the use of interpreters in primary care nursing. Health Soc Care Community. 2004;12:407–13.PubMedCrossRefGoogle Scholar
  45. 45.
    Centre de recherche et de formation. Formations en interculturel [Cross-cultural trainings]. CSSS de la Montagne, Montreal.Google Scholar
  46. 46.
    Alliance des Communautés Culturelles pour l’égalité dans la Santé et les Services Sociaux. Formations destinées au réseau de la santé [Training for the health care system]. ACCÉSSS, Montreal.Google Scholar
  47. 47.
    Carnevale FA, Vissandjee B, Nyland A, Vinet-Bonin A. Ethical considerations in cross-linguistic nursing. Nurs Ethics. 2009;16:813–26.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Camille Brisset
    • 1
  • Yvan Leanza
    • 1
    Email author
  • Ellen Rosenberg
    • 3
  • Bilkis Vissandjée
    • 2
  • Laurence J. Kirmayer
    • 4
  • Gina Muckle
    • 1
  • Spyridoula Xenocostas
    • 5
  • Hugues Laforce
    • 5
  1. 1.École de PsychologieUniversité LavalQuebecCanada
  2. 2.Faculté des sciences infirmièresUniversité de MontréalMontrealCanada
  3. 3.Department of Family MedicineMcGill UniversityMontrealCanada
  4. 4.Division of Social and Transcultural Psychiatry, Department of PsychiatryMcGill UniversityMontrealCanada
  5. 5.Centre de santé et de services sociaux de la MontagneMontrealCanada

Personalised recommendations