Shared learning database

Mothertongue Counselling and Listening Service
Published date:
September 2011

Increasingly Mental Health Services have to call on the support of interpreters in order to treat patients. Clinicians and interpreters have become aware that interpreting in a mental health context differs from interpreting in other contexts. As a result, a dedicated training scheme and Mental Health Interpreting Service has been established by Mothertongue multi ethnic counselling service.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

Patients will be able to have access to appropriately trained interpreters and so experience equity of access to mental health services. Patients in mental health services (the use of interpreters is specifically mentioned in the NICE guidelines also for treating patients with schizophrenia, depression and dementia) will experience a better quality of care when accessing interpreters. Clinicians and interpreters will feel more confident about working together and will provide a much more effective service for patients, for whom, otherwise there would be no opportunity to access help in this way. 1) Provide a dedicated local service of trained Mental Health Interpreters (MHI) in the main languages needed locally to work in pre planned clinical appointments so that access to a trained pool of interpreters will ensure that there is consistency of the interpreter being used for a series of consultations with individual patients. 2) Train clinicians to work effectively with interpreters 3) Fundraise for the service so that it is fully funded and involves no cost for the clinician's service or the patient 4) Ensure that guidelines are agreed to and followed by all clinicians and interpreters 5) Develop a system for ongoing learning 6) Support and supervise the interpreters so that they are able to reflect on their work and remain fit to practise

Reasons for implementing your project

The NICE Guidelines for GAD, Schizophrenia, Depression and Dementia indicate the following: 1.1.1 Where appropriate, all services should provide written material in the language of the person, and appropriate interpreters should be sought for people whose preferred language is not English (CG 113). At Mothertongue multi ethnic counselling service, we identified a need for qualified interpreters to work in a mental health context. Our counsellors and patients fed back to us dissatisfaction with interpreters provided by agencies. This was echoed by other clinicians working in the NHS locally. We saw that there was a need for a dedicated team of Mental Health Interpreters (MHIs) and for a training course to prepare them for the work. We were aware that the clinicians would also need to be trained to work with the interpreters. There are language requirements for MHIs with respect to terminology and the need to understand mental health structures. But there are further demands on the MHI in terms of understanding and working with the complexities of therapeutic relationships. Doherty et al (2010) found that interpreting in a mental health context was perceived to be significantly more demanding and emotionally intense than when interpreting in other contexts. The stressors they listed included: working with distressed clients; the emotional impact due to the interpreters resonance with the client's story; containing their own emotional responses; not having an outlet for their own emotional distress; maintaining boundaries; possible violent clients; Child Protection cases; feeling uncomfortable with silence. Furthermore, we were aware of the cost implications of using interpreters piecemeal from agencies, often with last minute cancellations and re arrangements. We wanted to address this by the way in which the processes for the booking and usage of interpreters was designed to maximise efficiency, not compromising the quality of care the patient received.

How did you implement the project

Costs were a significant barrier. We set up meetings with the local PCT, Berkshire West, regarding funding. Berkshire West PCT agreed to fund the 6-month pilot which included 200 hours of interpreting, supervision of the interpreters, travel costs and administration of the pilot. We achieved block funding so that individual service managers would not be put off by cost from accessing the service. We set up processes to maximise efficiency. A very simple, effective booking process was devised alongside a booking form. Sent together, they showed what the booker needed to do and how the appointment would be confirmed. We ensured that all clinicians and interpreters worked to the same Code of Practice. Agreement to work to the Code was signed off by the clinician before the booking was confirmed. All appointments were logged for funder reporting and to ensure effective communication. We implemented a training programme and recruited from the training group into the service. The training included: mental health issues, pathways of care, terminology; the ways of working therapeutically as a triad rather than as a dyad; the extent, limitations and professional boundaries of each person's role and the nature of therapeutic change. We produced a set of guidelines and developed a training DVD for mental health interpreters and clinicians working together, demonstrating a series of nightmare scenarios that could be avoided by the implementation of the guidelines. We embarked on a series of promotional tours, visiting clinical teams to promote and to train them in working with interpreters. We trained new entrants into the professions including IAPT trainees at Reading University, Clinical Psychology trainees at the Universities of Oxford and Southampton and Social Workers and trainees at Reading and Brunel Universities. We established a national Forum for Bilingual Therapists and Mental Health Interpreters to share learning and improve standards and practice.

Key findings

From the booking forms we captured information about clients (ethnicities, languages, age, gender)and the practitioner (organisation, discipline). We targeted those organisations that have not yet accessed the service. The service was provided free of charge which made the process very appealing to many practitioners. To discourage poor communication, cancellations made with less than 24 hours notice were chargeable. This encouraged practitioners to communicate and rearrange appointments. With our booking process, practitioners booked the interpreter immediately and confirmed with their patient in tandem, making the process seamless for patients. Practitioners were able to book the same interpreter for subsequent appointments ensuring continuity. From working well together, less time was required in appointments as all were clear on their roles, thus reducing costs. The target was to provide quality mental health interpreting. Cost savings were clearly positively welcomed. We designed an invoice form with an integral comment section for interpreters and clinicians. We regularly have high satisfaction ratings from clinicians and interpreters are able to comment on areas that have given them cause for concern. We have regular supervision sessions with the interpreters to reflect on concerns to see what we need to learn and whether Mothertongue needs to feedback our concerns to the clinician involved. Where this has happened it has proven to be very fruitful with improvements being made for the benefit of the patient. Patients have fed back that they feel they have been treated with respect in the process. We have identified that travel costs increase the cost of interpreting disproportionately. We are currently developing a model of Mental health interpreting via Skype or other forms of video conferencing which we are delivering a paper on to the University of Alcala, Spain, in April of this year. The PCT have agreed to continuation funding for the service.

Key learning points

Although we are not in the position of Holland where recently the Dutch Minister of Health (2011) banned all use of interpreters, we know that cost savings need to be made. We have continued to develop training on Mental Health interpreting via Skype. These workshops developed from an initial attempt to try to resolve the issue of the lack of interpreters locally with specific languages. Workshops were trialled on Mental Health interpreting via the telephone. These were not very successful. Because of the nature of mental health consultations, the dual disadvantages of remoteness and of having no visual communication between the three parties made the effectiveness of any meaningful clinical intervention impossible. The advantage of Skype is that all the parties can see each other. One other advantage that should not be underestimated is that it is free. We are currently discussing with an IAPT Service in the South of England about piloting a Skype interpreting service with them. It has been shown that it is possible to do very effective clinical work with the use of interpreters. This requires the clinician and the interpreter to prepare together and to work as a collaborative team. In training, when participants are asked to imagine the fears of working with an interpreter in a therapeutic context, both interpreters and therapists regularly cite anxiety about their role in the therapeutic relationship and about being able to trust in the other professional. However, consultations through an interpreter the only way to access mental health services. The need is clearly there. and for a relatively small input in terms of cost, training and management a service can be set up. Important things to bear in mind: check the main languages needed in your area; design a good training programme; recruit carefully; provide good quality supervision for the interpreters. They need the personal and the professional development and support

Contact details

Beverley Costa
Chief Executive Officer
Mothertongue Counselling and Listening Service

Is the example industry-sponsored in any way?