Lost in translation

Working with their patients through interpreters has become a frequent requirement for psychiatrists, particularly in inner-city areas. The increase in immigration, which includes people in need of mental healthcare, has meant that many psychiatric assessments cannot be conducted without such assistance (Tribe & Ravel, 2002). Treatment is invariably based on the trust that patients have, or not, in mental health professionals. An interpreter, who may be someone that patients have never seen before or may never see again, could represent an unknown person that may not be trusted. One additional emerging problem that we have been encountering at our practice is that some ‘interpreters’ may have agendas of a political nature that lie outside their contractual remit within the mental health services.

We have been referred many patients who have fled persecution in their native countries and suffer from sequelae of trauma, including torture. Both the assessment and treatment of these patients depend on the disclosure of their experiences. If they are unable to communicate in English, the assistance of a trustworthy interpreter is necessary. However, their countries of origin may regard such information as politically sensitive and potentially damaging, and would prefer for it to remain undisclosed. Our own experience, and that of other colleagues, indicates that there may be some interpreters with apparent links to such regimes. There is a growing concern not only that these particular interpreters may not always accurately translate, but also that they may breach confidentiality. Moreover, health services other than mental health services may rely on interpreters for communication with patients under their care. Dissemination of confidential information to third parties can potentially have serious consequences for patients should they decide to return to their native countries, as well as for their relatives and friends back home.

Many interpreters are recruited through agencies that may not be in a position to fully ascertain their credentials or qualifications. In the circumstances, it is preferable to rely on well-known and appropriately referenced interpreters whenever possible in order to ensure confidentiality and safety for this patient group. A practical alternative may be to use the services of translators who are either established in the UK or who originate from a different country but are proficient in the patient's language.