anguage is the universal means of communication among humans. We use it every day to convey information, exchange ideas, and express emotions. People are taught their native tongue from birth, and they often revert to it when placed in a stressful situation, including accessing mental health services.
As of 2022, the United States had over 20 million immigrants over the age of five who were conversant in their native tongue but spoke English “less than very well.” According to the Migration Policy Institute, this is 46% of all foreign–born people living in the United States. When anyone from this group tries to access mental health services in the U.S., language is the primary barrier. From initial contact and assessment to treatment and ongoing support, the individual does not have the opportunity to effectively communicate in their preferred language—leading to misunderstandings, misdiagnoses, and a general lack of access to appropriate care.
This barrier is particularly pronounced in mental health services, where clear communication about feelings, symptoms, and experiences is crucial. The effectiveness of psychotherapeutic interventions depends primarily on the basis of understanding between clinician and service user, and even in psychopharmacology, adhering to a treatment regimen depends on language—written or spoken.
Complexity of language and culture
Language differences can obstruct the clear expression of symptoms, health history, and emotional distress—all crucial for accurate diagnosis and effective treatment planning. This barrier can lead to misdiagnosis, which could sometimes escalate to involuntary commitment and the development of the wrong treatment plan and prescribing the wrong medication—leaving the primary issue unresolved and potentially giving rise to other adverse effects.
In the U.S, there are legal mandates—those outlined in Title VI of the Civil Rights Act of 1964 and others—that prohibit discrimination based on national origin, which has been interpreted to include language. However, in practice, this varies vastly across the country since only some states require providers to implement these mandates to address linguistic services in healthcare. Providers choose to do this in their own way. Sometimes, a language line—an over–the–phone or video interpretation service where practitioners can instantly connect with medically trained, professional interpreters—is used; others will directly hire professional interpreters; and some use informal interpreters such as existing staff members, family members, or friends of clients who may or may not be fluent in the other language.
The use of untrained, informal interpreters is illegal and unethical. It could also lead to misinterpretation of clinical terminology and compromise the quality of care. Professional interpreters, those who are highly proficient in both languages, are able to remain impartial and accurately and idiomatically turn the message from the source language into the target language. However, they do not always receive behavioral health interpreter training. Peripherally linked to language barriers are barriers related to culture. Effective communication across cultures is rarely taught, yet it is crucial for avoiding conflicts that stem from miscommunication. Based on the culture an individual hails from, there could be vast differences in nuances related to body language and perceptions of mental illness.
For instance, in several cultures, faith healers hold a respected position within their communities—serving as spiritual authorities and counselors. Several people visit faith healers before choosing to come to a mental health facility. However, the westernized view of mental health does not encompass this holistic view of wellbeing and healing and occasionally treats these interventions as problematic.
Solutions and strategies
Overcoming linguistic barriers to accessing mental health services is a multifaceted challenge that demands legislative and policy interventions. The best solution is to build a multilingual clinical workforce which should include psychiatrists, psychologists, social workers, licensed professional counselors, and volunteers. Furthermore, people in recovery who speak multiple languages could become peer specialists. Eventually, a multilingual administrative team for mental health agencies should also be built.
The second recommended solution would be for states to offer flexibility in the licensing process for already qualified professionals to facilitate their participation in the mental health workforce. Many immigrants have degrees in mental healthcare from their home country, but when they come to the U.S., they are unable to practice since every state has different licensing rules and are often required to complete another master's degree in the U.S.—an unaffordable and unrealistic expectation. They’re the ones who will help us take care of the 20 million foreign–born individuals living in the U.S. who do not speak English well enough to understand a complex medical behavioral health system or communicate their culture–specific requests.
While the data, problems, and solutions are focused on the U.S., the same issues occur in other countries where immigration is common, and these solutions can work everywhere. Moving forward, it is imperative to prioritize these solutions to ensure equal access for everyone, regardless of language proficiency or cultural background, to the mental health services they need. This endeavor is not just an investment in the wellbeing of millions of individuals, but also a step toward a more compassionate and equitable healthcare system worldwide.
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Overcoming linguistic barriers to accessing mental health services
Image by Tiyo Prasetyo from Pixabay.
May 18, 2024
Overcoming linguistic barriers to accessing mental health services is a multifaceted challenge that demands legislative and policy interventions, writes Dr. Pierluigi Mancini.
L
anguage is the universal means of communication among humans. We use it every day to convey information, exchange ideas, and express emotions. People are taught their native tongue from birth, and they often revert to it when placed in a stressful situation, including accessing mental health services.
As of 2022, the United States had over 20 million immigrants over the age of five who were conversant in their native tongue but spoke English “less than very well.” According to the Migration Policy Institute, this is 46% of all foreign–born people living in the United States. When anyone from this group tries to access mental health services in the U.S., language is the primary barrier. From initial contact and assessment to treatment and ongoing support, the individual does not have the opportunity to effectively communicate in their preferred language—leading to misunderstandings, misdiagnoses, and a general lack of access to appropriate care.
This barrier is particularly pronounced in mental health services, where clear communication about feelings, symptoms, and experiences is crucial. The effectiveness of psychotherapeutic interventions depends primarily on the basis of understanding between clinician and service user, and even in psychopharmacology, adhering to a treatment regimen depends on language—written or spoken.
Complexity of language and culture
Language differences can obstruct the clear expression of symptoms, health history, and emotional distress—all crucial for accurate diagnosis and effective treatment planning. This barrier can lead to misdiagnosis, which could sometimes escalate to involuntary commitment and the development of the wrong treatment plan and prescribing the wrong medication—leaving the primary issue unresolved and potentially giving rise to other adverse effects.
In the U.S, there are legal mandates—those outlined in Title VI of the Civil Rights Act of 1964 and others—that prohibit discrimination based on national origin, which has been interpreted to include language. However, in practice, this varies vastly across the country since only some states require providers to implement these mandates to address linguistic services in healthcare. Providers choose to do this in their own way. Sometimes, a language line—an over–the–phone or video interpretation service where practitioners can instantly connect with medically trained, professional interpreters—is used; others will directly hire professional interpreters; and some use informal interpreters such as existing staff members, family members, or friends of clients who may or may not be fluent in the other language.
The use of untrained, informal interpreters is illegal and unethical. It could also lead to misinterpretation of clinical terminology and compromise the quality of care. Professional interpreters, those who are highly proficient in both languages, are able to remain impartial and accurately and idiomatically turn the message from the source language into the target language. However, they do not always receive behavioral health interpreter training. Peripherally linked to language barriers are barriers related to culture. Effective communication across cultures is rarely taught, yet it is crucial for avoiding conflicts that stem from miscommunication. Based on the culture an individual hails from, there could be vast differences in nuances related to body language and perceptions of mental illness.
For instance, in several cultures, faith healers hold a respected position within their communities—serving as spiritual authorities and counselors. Several people visit faith healers before choosing to come to a mental health facility. However, the westernized view of mental health does not encompass this holistic view of wellbeing and healing and occasionally treats these interventions as problematic.
Solutions and strategies
Overcoming linguistic barriers to accessing mental health services is a multifaceted challenge that demands legislative and policy interventions. The best solution is to build a multilingual clinical workforce which should include psychiatrists, psychologists, social workers, licensed professional counselors, and volunteers. Furthermore, people in recovery who speak multiple languages could become peer specialists. Eventually, a multilingual administrative team for mental health agencies should also be built.
The second recommended solution would be for states to offer flexibility in the licensing process for already qualified professionals to facilitate their participation in the mental health workforce. Many immigrants have degrees in mental healthcare from their home country, but when they come to the U.S., they are unable to practice since every state has different licensing rules and are often required to complete another master's degree in the U.S.—an unaffordable and unrealistic expectation. They’re the ones who will help us take care of the 20 million foreign–born individuals living in the U.S. who do not speak English well enough to understand a complex medical behavioral health system or communicate their culture–specific requests.
While the data, problems, and solutions are focused on the U.S., the same issues occur in other countries where immigration is common, and these solutions can work everywhere. Moving forward, it is imperative to prioritize these solutions to ensure equal access for everyone, regardless of language proficiency or cultural background, to the mental health services they need. This endeavor is not just an investment in the wellbeing of millions of individuals, but also a step toward a more compassionate and equitable healthcare system worldwide.
