How do we engage with people who don’t speak English and are not computer literate?

[Donte]

This morning I bumped onto one of my neighbors who is elderly and non-English speaking. We usually gesture hello to each other but our communication is very limited due to language differences. She hardly speaks any English and her disabled son lives with her. I’m assuming that she’s his carer. After some basic gestures and smiles we once again went our separate ways. (We met in the lift of our apartment block).

Upon getting into my car to leave for work the following thoughts were triggered in my mind and I’d like to hear your views on these:

How do we increase awareness of mental illness and reduce stigma and misunderstanding within culturally and linguistically diverse communities?

How do we introduce the notion of recovery from mental illness and increase awareness of the support services for non-English speaking people and their families or carers?

How do we improve access to information in a variety of languages and available support services within the diverse communities?

How can we engage communities who don’t access computers and internet and develop people’s interest and participation in the delivery of education around mental health and well-being?

How do we provide confidential space similar to these forums for carers and families to express themselves and share their experiences if they don’t access the internet and won’t visit this website?

If you have any ideas please share...

[Peppermintbach]

Hi Donte’,

What a thoughtful anecdote about your elderly, non-English speaking neighbour. I can’t really say that I know for sure what it must be like for her as I’m not her. But I would think, unless she has a good support network who can speak her native language, it must be a pretty lonely existence.

I’m glad you were able to exchange smiles with her though. Body language is a language itself, I suppose. I include smiles in this 🙂

Great questions...I’ll just pick one to answer.

How do we introduce the notion of recovery from mental illness and increase awareness of the support services for non-English speaking people and their families or carers?

This is a tricky one as I feel you’re dealing with multiple issues here. I’ll just mention a couple here...

Firstly, I think it depends on the culture and its perception of mental illness e.g. is it viewed from a Western Psychology lens, a religious lens, etc. Also perhaps encouraging influential members of a particular community to open up about mental health might be helpful.

But as a starting point, I would suggest really understanding the community you are dealing with e.g. their values, preferred way to access information (e.g. hard copies or online), perception of mental health, etc. Without an in-depth understanding as a staring point then all else might be futile.

For example, individualistic western psychology concepts applied to an individual with collectivist ideals in a therapeutic setting might be ineffective.

Pepper xo

[Donte]

Hello Pepper,

Thank you for your insight. I agree. The individual I refer to may be very different to any other person of the same cultural background faced with the universal issue of disability and mental health. Her approach to this daily challenge of caring for an adult son with disability may differ from others who speak her language or share her beliefs. And it is very difficult to know unless we get to know the particular person and look at their situation and needs. I believe that a person-centered approach is always best even in a collectivist setting.

The first thing to help us identify the needs and respond appropriately would be to engage directly with the person. If unable to do so for a variety of reasons, then try to communicate as effectively as possible with significant others in the life of that individual with the aim to understand as much as possible the issues impacting on them in order to attempt to address them as appropriate.

I like your point of individualist approach in a collectivist context. Often, in certain cultures having a power of attorney or an advanced care plan and a will is not acceptable. In situations when an individual is hospitalized and/or unable to talk/express their needs, the family and relatives step in and speak on their behalf. However, not only they may not express the person's views but also they (relatives) may fight amongst them and want different things. One of the complexities doctors, aged care and palliative care staff and other medical professionals face is the often conflicting views of the various family members. Trying to decide who is the decision maker in the group is a nightmare.

Often, in certain groups, if someone has been diagnosed with a terminal illness for example, the family may choose not to disclose that diagnosis to the patient and argue with staff and/or among themselves about this issue. On the other hand the patient may desperately want to know the prognosis. Or they may be aware that they’re dying but playing along not to upset the rest of the group. Imagine the frustration of the staff in a situation like this. That is why it’s imperative to address the individual who is your actual client despite what the family says, but simultaneously consult and engage and involve the family in the care plan of the individual. It is a very sensitive, fine line to thread but unless it’s done issues will linger. Ultimately, I don’t want to be treated as a Greek or as a gay but as a person.

[Peppermintbach]

Hi Donte’ and all readers,

Thank you. Always appreciate your insight too:)

I particularly liked the following point that you raised:

I believe that a person-centered approach is always best even in a collectivist setting.

I think you made a valid point about how it’s so important to recognise that even in families (or individuals) with a collectivist mindset, there will still be conflicting viewpoints.

Perhaps one approach is for health professionals to ask their patient about his/her/other disclosure preferences (e.g. no disclosure to any third parties, disclosure to only immediate family members, etc) and to sign a legally binding disclosure statement. That way, the patient’s rights (in terms of disclosure) are respected and health professionals are protected too.

Mind you, this would probably be a lot more complex in practice because there are also issues of creating unnecessary red tape, time constraints, families pressuring their unwell relative to sign in favour of disclosure to third parties, finding translators, etc.

Kind thoughts,

Pepper xo

[Donte]

Hi Pepper,

Indeed, very complicated situations in highly stressed environments where emotions run high.

[Peppermintbach]

Hi Donte’ and all,

True, true...just as well we are having this conversation. Hopefully with more discussion (in general), there will be action and progress...

A great thread 🙂

Pepper xo

[Donte]

I guess people from culturally and linguistically diverse backgrounds don’t have an issue communicating. They’ve been doing it all their lives! And very well! This is an issue for organizations and professionals. They need to learn to engage the 46% of the population which is of a diverse background. Agencies need to ensure they use translated resources, bilingual workers, interpreters etc.

[Donte]

It is incumbent on health and aged service providers to ensure that they remove any language barriers which may preclude non-English speaking people getting full access to services and to making informed choices with respect to these services.

The engagement of an interpreter service is necessary when a person is unable, or
has a limited capacity, to communicate in English or indicates that they would be more comfortable
communicating in their preferred language.

It should be explained to people by the service provider that the interpreter is important to make sure the professional understands what they are saying. People need to be reassured about the role of an interpreter and confidentiality of the service. Some people will try and use family members, who may discourage the use of professional interpreters.

Professionals need to let non-English speakers know that they are entitled to the service and that the service is free in aged care and health services. If they are worried about knowing the interpreter (especially if they come from a small community) support services need to offer to arrange a phone interpreter from another state if allowed by their organisation.

The interpreter’s role is to provide accurate communication between you and your consumer whilst
maintaining integrity, impartiality and confidentiality. It is not the role of interpreters to give advice, complete forms or impart unrelated information.

Accessing interpreters is particularly important when conducting clinical and other needs assessments, collecting detailed personal information, explaining admission to/provision of a service, developing and reviewing care plans/treatments, explaining person's rights and responsibilities and gaining informed consent.