ASLI MENTAL HEALTH INTERPRETING BEST … Mews Derngate, Northampton. NN1 1UE Phone: 08714740522 Fax: 08451708061 E-Mail: [email protected] Web: ASLI MENTAL HEALTH ... ASLI MENTAL

Derngate Mews Derngate, Northampton. NN1 1UE Phone: 08714740522 Fax: 08451708061 E-Mail: [email protected] Web: www.asli.org.uk

ASLI MENTAL HEALTH INTERPRETING BEST PRACTICE

By Esther Thomas

ASLI MENTAL HEALTH INTERPRETING BEST PRACTICE 2016

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© 2015 - Association of Sign Language Interpreters – Legal Interpreting Standards Group (LISG)

Official Publication of the Association of Sign Language Interpreters (ASLI) © 2015. This project was led by the ASLI Mental Health Working Group and the author was Esther Rose Thomas. Permission is granted to copy the materials enclosed herein, provided that Association of Sign Language Interpreters (ASLI) and authors are credited as the source and referenced appropriately on any such copies.


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Table of contents

Overview of the Best Practices Document .................................................................................. 4

Background and Acknowledgements ......................................................................................... 5

Best Practice 1: Registered Qualified Interpreters and Legal Obligations ......................................... 6

Best Practice 2: The Interpreter working in Mental Health ............................................................. 7

Best Practice 3: Preparation .................................................................................................. 8

Best Practice 4: Boundaries and Supporting Guidance ................................................................... 9

Best Practice 5: Safety ........................................................................................................ 10

Best Practice 6: Language Considerations .............................................................................. 11

Best Practice 7: Debriefing and Reflective Practice .................................................................... 12

Best Practice 8: Confidentiality and information sharing .............................................................. 13

Definition of Terms ............................................................................................................ 15

References ...................................................................................................................... 19

Other sources ................................................................................................................... 20


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Overview of the Best Practices Document This document has been written to guide and prepare interpreters for working in Mental Health bookings. Interpreting in this domain can be physically, emotionally and mentally demanding (Cokely, 1992, Moser-Mercer 1998). Interpreters may be traumatised by highly aroused and distressing sessions (Harvey 2003, Tribe & Morrissey 2003).

Due to the nature of the work, interpreters require a different skill set, such as being transparent about idiosyncrasies in communication, affect, or mannerisms. This document provides general guidance for interpreting in mental health settings. It hopes to arm the interpreter with questions to think about before accepting the booking and things to be mindful of whilst in the booking.

In addition to reading this document and attending training, interpreters are strongly encouraged to engage in supervision and reflective practice. With an extensive background of interpreting in the community, the interpreter should have developed an ability to deal with the variants that this domain brings.

The Top Key Points are:

• Interpreters must be qualified and registered before working in this domain (it is a legal requirement in the Mental Health Act)

• If your client uses a sign language other than BSL or if their BSL is dysfluent, Interpreters can recommend a Qualified Registered Deaf Interpreter should also be booked at the next session. These same guidances apply to Deaf Interpreters

• Be aware of the potential vicarious trauma caused by interpreting highly distressing conversations

• The interpreter should have ongoing supervision and opportunities for reflection • The interpreter should meet with the clinician before the session to explain their role

in this domain • The interpreter and clinician should discuss the plans for the session and any issues or

jargon or tools that may be used in the session • The interpreter should be transparent about any idiosyncrasies in the language or

mannerisms during the session • The interpreter and clinician should debrief at the end of the session • The interpreter should not be left alone with a client


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Association of Sign Language Interpreters The Association of Sign Language Interpreters (ASLI) was established in the United Kingdom in 1987 as a forum for professional discussion on all issues relating to sign language interpreting and the provision of interpreting services. From the beginning our aims have been simple - to encourage good practice in sign language interpreting and to support our fellow professionals. We have sought to achieve this by:

• Providing a forum for professional discussion on all interpreting related issues • Promoting the raising and maintenance of standards in interpreting • Encouraging training and other initiatives • Supplying information to interpreters and consumers • Promoting research into areas of relevance to interpreters or interpreting services • Advising and cooperating with others interested in sign language interpreting

Background and Acknowledgements The Association of Sign Language Interpreter UK would like to acknowledge the contributions and support from: Rachael Hayes, Vicci Ackroyd, Haylee Lee Wilson, Elvire Roberts, Dr Jim Cromwell, Dr Nicoletta Gentilli, Monica Cherryson, Clare Shard, Ali Hetherington, Isobel Higgins, Ays Young, Robert Skinner, Trisha McMaster, Esther Thomas (main author).


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Best Practice 1: Registered Qualified Interpreters and Legal Obligations

When knowingly entering this complex domain, British Sign Language (BSL) Interpreters must be qualified members of the Registering body. The National Registers of Communication Professionals working with Deaf and Deafblind people (NRCPD), and The Scottish Association of Sign Language Interpreters (SASLI), will ensure that their members are qualified in both BSL and interpreting, have the appropriate insurance and hold a Disclosure and Barring Service Check (DBS).

1.A Mental Health services and practitioners are able to check online (or by the interpreters registration card) whether the interpreter is currently a member of the register. The interpreter should wear their registration ID card. If there are be legal proceedings involved, the clinician may take a copy of it.

1.B This provides a good quality interpreting services to Deaf consumers with

recourse to a complaints procedure via the registration body. 1.C The legal obligation is detailed in The Mental Health Act 1983, revised 2007,

see Section 4, 107-108, which states: The AMHP involved in the assessment should be responsible for booking and

using registered qualified interpreters with expertise in mental health interpreting, bearing in mind that the interpretation of thought- disordered language requires particular expertise. Relay interpreters (interpreters who relay British Sign Language (BSL) to hands-on BSL or visual frame signing or close signing) may be necessary, such as when the deaf person has a visual impairment, does not use BSL to sign or has minimal language skills or a learning disability. Reliance on unqualified interpreters or health professionals with only limited signing skills should be avoided. Family members may (subject to the normal considerations about patient confidentiality) occasionally be able to assist a professional interpreter in understanding a patient’s idiosyncratic use of language. However, family members should not be relied upon in place of a professional interpreter, even if the patient is willing for them to be involved.

http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_087073.pdf


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1.D There is also a legal obligation in the NHS England Accessible Information Standard 2016, Section 11.5.1, which states:

Organisations MUST ensure that communication professionals (including British Sign Language interpreters and deafblind manual interpreters) used in health and adult social care settings have: appropriate qualifications; Disclosure and Barring Service (DBS) clearance; signed up to a relevant professional code of conduct…Organisations SHOULD ensure that communication professionals working with d/Deaf and deafblind people (including British Sign Language interpreters and deafblind manual interpreters) are registered with the National Registers of Communication Professionals working with Deaf and Deafblind People (NRCPD). Registration confirms they hold suitable qualification(s), are subject to a Code of Conduct and complaints process, have appropriate insurance, hold an enhanced disclosure from the Disclosure and Barring Service, and engage in continuing professional development.

https://www.england.nhs.uk/wp-content/uploads/2015/07/access-info-implmntn-guid.pdf

Best Practice 2: The Interpreter working in Mental Health

The interpreter is a non-clinical member of the multi-disciplinary team. They may be Deaf or hearing. They should be familiar with the therapeutic environment where there may be conversations about psychiatric assessment procedures, psychometric tools, medication, mental illness, and the Mental Health Act. The bookings vary and may include a simple business meeting, an aroused family therapy meeting, or a psychiatric emergency where someone is volatile and in need of rapid tranquillisation. 2.A Registered sign language interpreters interested in the Mental Health domain

should demonstrate a high level of interpreting skill and have a wealth of experience working within the community since attaining RSLI status. They should be able to manage working in a wide variety of clinical meetings and therapeutic sessions.

2.B The interpreter should have a clear understanding of the different clinical roles

in a multi-disciplinary team and that Deaf clinicians may also work with hearing or Deaf patients.


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2.C The interpreter should be familiar with psychiatric terminology and medication.

2.D Where appropriate, interpreters may advise or comment on issues relating to language use, communication difficulties, Deaf cultural norms and the interpreting process.

2.E Supervision and reflection are necessary to work effectively in this domain. 2.F The demands vary when working with inpatients, children, adults and forensics.

Some Trusts and services have their own interpreting policies, communication profiles and contractual arrangements. It is advisable to become familiar with these local resources.

2.G

Best Practice 3: Preparation

Interpreters should should take appropriate steps to prepare for the assignment. The interpreter and clinician should meet just prior to the session to discuss how they will work together, to enable an effective therapeutic relationship with their client. 3. A The interpreter should explain that they will inform the clinician of any unusual

features in communication (see BP6).

3.B When working with children and families, the interpreter should explain to the clinician that everything said or signed in the session will be interpreted. The clinician should ensure that all attendees are aware that throw-away comments or uttered secrets will be interpreted. If this is a concern, discuss it during the pre-session meeting, so you can decide how to work together in these sensitive moments. 3.C The interpreter should determine the following:


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• The clinician’s aim(s) and the nature of the session

• If this is the first session or part of a series of sessions

• Relevant information, such as, issues or concepts that may be raised, background, diagnosis, name and type of medication. For children this may include school, important teachers, friends etc.

• Therapeutic techniques that may be used, such as, being deliberately provocative e.g. a family therapist may tell the interpreter to stop mid-session, in order to observe the family’s response

• Specific linguistic challenges, such as, psychometric testing and asking open/closed questions

• Risk history may be relevant. Consider seating arrangements so there is a clear exit route

3.D You may also need to discuss lighting, seating and breaks

Best Practice 4: Boundaries and Supporting Guidance

The interpreter should consider some boundaries whilst maintaining to the standards set out by their regulating body.

4.A Ideally the same interpreter(s) would work in a series of sessions to allow for continuity.

4.B It is advisable to avoid work with the Deaf client in another setting whilst

engaged in the therapeutic process and for at least 6 weeks after it has ceased.

4.C ASLI has Guidance for Mental Health Practitioners, which would be worth providing them with if they have not seen it yet. (when available LINK here)

4.D Trusts, private hospitals, forensic services and children services may have specific instructions and guidance that you will need to be aware of.


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4.E The interpreter must maintain the highest standards of professionalism and in- tegrity and seek to reflect credit on their profession as well as continually maintaining and developing their professional skills and knowledge. ASLI en- courages interpreters in mental health to maintain the spirit outlined in the interpreter’s code of conduct.

4.F All registered interpreters are expected to abide by a code of conduct stipulated by their registering body. For example:

Click here to see the NRCPD’s code of conduct

Click here to see the NRCPD’s national occupation standards

Click here to see the NRCPD’s Professional Standards Advisors

Click here to see the SASLI’s code of conduct

Best Practice 5: Safety

As working in Mental Health is varied, the majority of bookings will not become volatile. However, it is important to remain aware that there is an element of risk in this domain, so interpreters must be cautious and take note of panic alarms or easy ways to quickly exit the room, if necessary. The interpreter should ask the clinician before hand if there are any risks, particularly when working in a hospital, with both adults or children.

3.A If the interpreter feels unsafe at any time, they can leave the session, even if the clinician remains

3.B The interpreter should not be left alone to supervise a client, and should leave when the clinician leaves


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3.C They should not assist in physically restraining a client, although they may be required to interpret the discussions and instructions

3.D They should complete training in safety techniques, such as breakaway training

Best Practice 6: Language Considerations

Some Deaf clients may use BSL in an unusual way, this is commonly called idiosyncratic language. Some deaf children use a dual mode of communication, speaking and signing, incorporating idiosyncrasies. Many specialist Deaf Mental Health Services have communication profiles and work with Deaf professionals who can advise on the client’s use of language, e.g. specific signs/words they use. 6.A. When working with a client who is not able to communicate in BSL, it is best

practice to recommend the clinician books a Qualified Registered Deaf Interpreter for the following sessions.

6.B When there is a lot of information that needs unpacking, it may be best to use

consecutive interpretation. This also allows the client a better opportunity to contribute to the discussion.

6.C It may be necessary to use other strategies to make communication more effective, such as drawing, using pictures, toys and role-play.

6.D When unpacking information, be aware that giving examples may lead or

mislead the client. If you do give an example, let the clinician know, at the time, or after the session. This may be worth discussing with the clinician or reflecting with a supervisor.

6.E When a client uses idiosyncratic language it may be difficult to interpret. In those cases, interpreters may be tempted to try to make sense of what is being said and render it into clear grammatical sentences. However, the clinician needs the interpretation to be transparent and as near to the source message as possible, so that they are aware of possible language disorder, dysfluency or


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psychosis. Covering up any language idiosyncrasies can cause the client to remain undiagnosed or to be misdiagnosed.

6.F During the session or reflection time afterwards, the interpreter must tell the

clinician if they observe any unusual communication features, such as:

• Copying, repetition, speed, signing space, pauses, signing style, eye gaze, movements, sounds, etc.

• Changes in the client’s communication, e.g. signing/speech has accelerated or the client’s affect seems to have altered, e.g. has become muted or flat.

Best Practice 7: Debriefing and Reflective Practice

As often as possible, the interpreter should reflect on their practice. This can initially be with the clinician, straight after the session, to review how it went. This is an opportunity to briefly discuss any concerns that arose during the session, and consider things to be mindful of for the following session.

In addition, interpreters should also have supervision to reflect on their working practice.

7.A After the session the interpreter and clinician should debrief, to discuss these issues, if they are relevant to the session:

• Language or translation issues and Deaf cultural norms

• If distressing material was raised, as this can cause vicarious trauma, or be a negative trigger for the interpreter

• Therapeutic concerns, such as transference or projection that may have occurred, as this could be helpful to the clinician


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• Improvements for the following sessions. The interpreter may want to inform the clinician of language needs (e.g Deaf Interpreter) or available resources 9 e.g. Research on Deaf people hearing voices)

7.B Staff interpreter’s in mental health services should have the opportunity for regular supervision to reflect on their practice (Dean & Pollard, 2001). Free lance interpreters should also have support.

7.C Regular continuing professional development should be accessed to help

interpreters reflect and improve on current practice. 7.D Interpreters should consider their work-balance and include less emotive

interpreting bookings. (Bower, K. 2015). 7.E Take time to consider the implications of working in a triad and how this may

affect the therapy. Issues such as trust, power and dependence may be a concern for all involved.

Best Practice 8: Confidentiality and information sharing

Interpreters are to keep information about their clients’ mental health and sessions strictly confidential. However there are a small number of situations where it is safe to disclose the minimum amount of information.

8.A Examples of safe disclosure:

• To reflect on their practice in a supervision session, however, they should not reveal any identifying information

• With the clinician, after the session the interpreter may discuss any of the issues in BP.6.

• If a client is trying to contact the interpreter or asking for clinical advice, the interpreter should direct them to their clinician. If possible, inform the


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clinician of this contact. Boundaries may be an issue with some clients and the clinician will need to be made aware of this

• If the interpreter is exposed to information that suggests a risk to a child’s safety and wellbeing, the case holder for the child must be informed or in their absence, contact the clinician’s manager

• If there are concerns that an adult may cause harm to themselves or others, disclose this to the clinician. If that is not possible, they should seek advice about how to report the concern to the local safeguarding team, in social services


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Definition of Terms The following terms are either used in this document or are relevant to the subject of interpreting in this domain. Definitions are provided to establish the meaning of terms as used within this document and may not be in everyday use. Assessment: When someone is unwell, health care professionals meet with the person to talk to them and find out more about their symptoms so they can make a diagnosis and plan treatments. This is called an assessment. Family members should be involved in assessments, unless the person who is unwell says he or she does not want that Association of Sign Language Interpreters (ASLI): A professional association of qualified and trainee sign language interpreters covering England, Wales, Northern Ireland and Scotland (see introduction on page 4). British Sign Language (BSL): A visual-spatial language created by deaf people. BSL is not English. It has all of the elements of any spoken language. Its grammar and conversational rules are different from spoken English but, like all languages, it comprises a set of abstract symbols agreed upon by those who use it.

Best Practice: A best practice is a technique or methodology that, by way of experience through application by practitioners and/or research, has proven to lead reliably to a desired result. A commitment to using the best practices in any field is a commitment to using all the knowledge and technology at one's disposal to ensure success. Care Plan: Mental health professionals draw up a care plan with someone when they first start offering them support, after they have assessed what someone’s needs are and what is the best package of help they can offer. People should be given a copy of their care plan and it should be reviewed regularly. Service users, and their families and carers, can be involved in the discussion of what the right care plan is. Care Programme Approach (CPA): A way of assessing the health and social care needs of people with mental health problems, and coming up with a care plan that ensures people get the full help and support they need. Client: This is the service user; they may also be referred to as consumer, patient, etc. The client may be Deaf or hearing. They may be an adult, a child, young person or members of the family.


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Child and Adolescent Mental Health Services (CAMHS): CAMHS provide individual and family work helping children and young people under the age of 18 who experience emotional difficulties or mental health problems Clinician: They may also be referred to as therapist, professional, doctor, nurse, counsellor etc. The clinician may be Deaf or hearing.

Consecutive Interpreting: The process whereby an interpreter waits until a complete thought or group of thoughts has been spoken or signed, in order to understand the entire segment before beginning the interpretation, resulting in a very high standard of accuracy in the interpretation. (Russell, p. 52) Deaf: Refers to an individual who is part of a linguistic and cultural minority, whose preferred language is a signed language. Deaf interpreter: A registered Sign Language Translator who meets all of the expectations as the interpreter. Deaf Interpreters have knowledge of working within both Deaf and hearing cultures. In mental health appointments, they work with clients who use idiosyncratic sign language as a result of mental ill health and/or socio-linguistic factors. Other clients who benefit from working with a Deaf Interpreter are: those with a language disorder, visual difficulties, communication problems or use sign languages other than BSL.

Effective Interpretation: The production of an interpretation from one spoken or signed language into another that is functionally equivalent and meaningful for all participants. Hearing: A term used to refer to an individual who is not deaf. Interpretation: The unrehearsed, transfer of meaning from a spoken or signed message within one language into another language. Interpreter: A British Sign Language (BSL)/English interpreter who works in mental health must be experienced in this domain, qualified, registered with the NRCPD, hold a Disclosure and Baring Service Check (DBS) and have undertaken mental health training for interpreters.


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On-going structured supervision and reflection are necessary for these interpreters. Interpreters may be hearing or Deaf. Mental Health Act (1983): The Mental Health Act is a law that allows for the compulsory detention of people in hospital for assessment and treatment of a mental illness.

Mental health: Someone’s ability to manage and cope with the stress and challenges of life, and to manage any diagnosed mental health problems as part of leading their normal everyday life. Mental health domain: Any situation in which a mental health professional is attending to a client’s emotional and mental wellbeing. Multi-disciplinary team (MDT): A team made up of a range of both health and social care workers combining their skills to help people. National Registers of Communication Professionals working with Deaf and Deafblind People (NRCPD): A national regulatory body for BSL/English interpreters in the UK (NRCPD website). Psychosis: A mental state in which someone may show confused thinking, think that people are watching them, and see, feel, or hear things that other people cannot. Relay Interpreters: Are Deaf and are now called Registered Qualified Deaf Interpreters.

Registered Sign Language Interpreter (RSLI): A category of registration that signifies the practitioner has met the National Occupational Standards in interpreting by demonstrating interpreting knowledge and skills that have the potential to meet the needs of consumers in a broad range of general interpreting assignments. The Mental Health Act and the NHS England Accessible Information Standard legally requires that interpreters working in mental health should be registered at this level with the NRCPD (or equivalent body). NB: In the UK this is currently the highest level of registration available. Many interpreters will have attended post-qualification training courses to acquire skills and knowledge in a variety of


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specialist domains, however, as yet, there is no professional certification available to denote a “mental health interpreter” for the language combination of BSL and English.

Scottish Accidentally deleted this- need to add it back in Sectioning-Whensomeoneissectioneditmeanstheyarecompulsorilyadmittedtohospital.

Session: This may be one of a variety of meetings, assessments or therapy sessions where the interpreter is booked to interpret for clients and clinicians. During these sessions the interpreter is an integral part of the multi-disciplinary team.

Simultaneous Interpretation: The process whereby an interpreter begins the interpretation whilst the speaker is still speaking or signing, thereby overlapping the original message or source with the interpretation simultaneously. (Russell, p 52)

Supervision: There are three advised supervision types: peer supervision, clinical interpreting supervision (for space to reflect on interpreting practice/models and cases) and management supervision (if they are part of the staff team).


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References Mental Health Act 1983(Revised 2007) Code of Practice, Section 4.107 to 4.108 http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_087073.pdf Michael A. Harvey, Shielding Yourself From the Perils of Empathy: The Case of Sign Language Interpreters, Journal of Deaf Studies and Deaf Education 8:2 Spring 2003 Thomas, Esther, Association of Sign Language Interpreters Code of practice, 2014 The British Psychological Society, 2008 ASLI Terms and conditions guidance 4.1, ?? Rogers,K, et al, The British Sign Language Versions of the Patient Health Questionnaire, the Generalized Anxiety Disorder 7-Item Scale, and the Work and Social Adjustment Scale, Journal of Deaf Studies and Deaf Education Cokely, D. (1992). Interpretation: A sociolinguistic model. Burtonsville, MD: Linstok Press. Moser-Mercer, B., Kunzli, B., & Korac, M. (1998). Prolonged turns in interpreting: Effects on quality, physiological and psychological stress. University of Geneva, École de Traduction et d’Interprétation. Interpreting, 3(1), p. 47-64. John Benjamins Publishing Co. Sign Language Interpreter Guidelines, European Union of the Deaf, 2012 Atkinson Joanna R, (2006) The Perceptual Characteristics of Voice-Hallucinations in Deaf People: Insights into the Nature of Subvocal Thought and Sensory Feedback Loops, Oxford University Press Cromwell, J. (2005) Deafness and the art of psychometric testing, The British Psychological Society Dean, R. K. & Pollard, R. Q (2013). The demand control schema: Interpreting as a practice profession. North Charleston, SC: Create Space Independent Publishing Platform (Russell, p. 52) (in the glossary under consecutive and simultaneous interpreting)

(Dean & Pollard, 2001). (BP 7.B)


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(Bower, K. 2015) - I'm not sure though if this is relevant to MH or not though… I took it from the VIS BP, in respect to interpreters should mix up VRI and on-site work, so Im not sure if that fits with the 7.D in this guideline or not. (BP 7.D)

Other sources The link for the British Society for Mental Health and Deafness is here: www.bsmhd.org.uk

Documents

ASLI MENTAL HEALTH INTERPRETING BEST … Mews Derngate, Northampton. NN1 1UE Phone: 08714740522 Fax: 08451708061 E-Mail: [email protected] Web: ASLI MENTAL HEALTH ... ASLI MENTAL