English

• Self-guided learning materials

 

The guidance is intended for AMHPs (Approved Mental Health Professionals) and spoken and/or signed language interpreters who are working together under the Mental Health Act 1983 (MHA).

It is useful for AMHP educators offering training leading to approval to practice as an AMHP,  subsequent reapproval ,and Continuing Professional Development (CPD), as well as for interpreting educators offering initial interpreter training and CPD.

It is relevant to others involved in Mental Health Act assessments (MHAAs) such as Section 12 doctors and police personnel, but its primary focus is on AMHPs and interpreters working together in MHAAs. 

It may be of interest to people who use services, carers, and those with lived experience of assessment via interpreters whether under the Mental Health Act or other statutory instruments.

It has some applicability to professionals working under different jurisdictions, whether in the UK or internationally, in cases where someone may undergo an assessment under the equivalents of the Mental Health Act 1983 and where spoken and/or signed language interpreters are involved.

What is the aim of this guidance? 

The self-guided learning materials, teaching resources, professional practice guidelines, tips, factsheets and practice examples, have been produced following the 3-year ‘Interpreting for Mental Health Act Assessments’ (INforMHAA) research study funded by the NIHR SSCR (National Institute of Health and Care Research – School of Social Care Research). It is, therefore, a research evidence-informed resource. 

The research approach encompassed a comprehensive scoping review, surveys, interviews and simulated practice scenarios accompanied by structured feedback. 

How to use the guidance

The guidance is presented as a series of topics and can be dipped in and out of as needed. Each resource is written to be used in a stand-alone manner, but readers are signposted to supplementary relevant resources where necessary. Some parts are specifically intended more for interpreters than AMHPs, but all is of relevance.

The guidance is divided into 13 topics beginning with overarching considerations then taking a temporal perspective of before the MHAA  (preparation), during the MHAA , and after the MHAA.  Links to other parts of the guidance and specific resources are also provided.  You do not need to review the resource from start to finish in the order the parts are presented; each part stands alone.  

Topic	What is covered
OVERARCHING CONSIDERATIONS
1. Self-guided learning materials	Background to development of the guidance and resources.
2. The context and key roles	Statutory guidance on interpreter use and legal requirements. How work in MHAAs is outside usual metal health interpreting professional practice. What does it mean to keep the assessed person at the centre? Who is responsible for what?
3. Legal decision making in practice	Clarifying the place of the interpreter within legal decision making and the role of the interpreter (not as advocate).
BEFORE THE ASSESSMENT (PREPARATION)
4. When and why interpreters	AMHP responsibilities and practicalities in ensuring an interpreter is present. When might it be acceptable not to have an interpreter? What kinds of interpreters are required with what ranges of experience?
5. Briefing between Interpreters and AMHPs	Why is briefing important? What might be negotiated? What might an AMHP want to ask? What might an interpreter want to check? What kinds of content will be included?
6. Key concepts and terms for Interpreters (and AMHPs)	Statutory nature of the language used in MHAAs means some words and intentions may not be  fully understood. Why AMHPs need to know the meanings have been ‘properly’ conveyed by the interpreter. Why interpreters can’t just translate verbatim.
DURING THE ASSESSMENT
7. Types of interpreting	What kinds of interpreting might the AMHP want to ask for and why. What interpreting approaches the interpreter may seek to offer and why.  Key considerations in the representation of the person being assessed through interpreter mediation.
8. Stopping an interpreter mediated assessment	How can AMHPs say if they are not happy with an interpreter mediated MHAA.   When should a MHAA be stopped and why. Pragmatic considerations in stopping linked to ethics, risk and harm.
9. Cultural sensitivity and cultural brokering	What role if any does an interpreter have in cultural brokering?  Interpreting and advocacy. What might be best practice in using cultural and community information and background that an interpreter may have and when this is not ok.
AFTER THE ASSESSMENT
10. The full patient journey	Why interpreters are needed for continuity immediately after the MHAA and subsequently.
11. Debriefing and care	What a good debriefing might look like.   How are interpreters looked after.
12. Issues in recording	Recording language use and interpreter booking on systems.
13. Governance, accountability and safeguarding	Important issues in safeguarding and governance when an interpreter is part of the assessment.

 

Accompanying resources

Topic	What is covered
R1  Purpose of the resource	Description of why the resource has been created, including a disclaimer.
R2  Written interpreter-mediated MHAA scenarios	Four written MHAA scenarios with background of why they have been created and possible uses for training.
R3  Web links	Links to where the resources are hosted with descriptions of languages and formats.
R4 Training ideas: How to use the video resources	Guidance on how the video scenario versions might be used for training of AMHPs and interpreters.
R5 Developing debriefing skills	Training resource that can be used to follow up on the debriefing good practice.
R6  Curated reference list	A list of useful references with pointers for why they might be useful follow-up reading
R7 Minimum best practice checklist for interpreters	Focus on specific practice in the MHAA interview.
R8 What to record	Aide memoire linked to the recording guidance section.
R9 Minimum best practice checklist for AMHPs	Focus on specific practice in the MHAA interview.
R10 Related guidance documents	Overview of related guidance documents with an introduction as to why each may be useful with live links.

2. Context and key roles 

Part 2 of the guidance provides a brief overview in lay terms of the context of the Mental Health Act (MHA) 1983, MHA assessments (MHAAs), and roles associated with Approved Mental Health Professionals (AMHPs) and interpreters in conducting a MHAA.  It is particularly intended for interpreters new to working in this context but may be helpful to AMHPs unfamiliar with working with interpreters to get a better understanding of the role of interpreters in this context.

 

3. Legal decision making in practice

In any Mental Health Act assessment (MHAA) it is the Approved Mental Health Professional (AMHP) who is ultimately responsible for making the decision about its outcome. That said, where there is a need for interpreter-mediation, interpreters contribute to the making of the most appropriate decision as it is their role to mediate communication. Part 3 explains how both parties can navigate this process successfully, and how they should be aware of their respective roles and responsibilities in this process, and that there are practice matters that need to be considered. 

4. When and why is an interpreter needed

 

Our research indicates that the current guidance for AMHPs as to when and why an interpreter may be needed tends to focus on what is recommended and not the how. It is also aspirational, lacking a true reflection of the practical complexities encountered in the professional field. Part 4 of the guidance will consider when to use an interpreter, what kind of interpreters are required, including how to ascertain their level experience, and what compromises might be involved. 

 

5. Briefing between interpreters and AMHPs

 

A briefing refers to a preparatory session that takes place between an AMHP and an interpreter before conducting a MHAA. It sets the foundation for developing shared understanding and effective collaboration between the AMHP and the interpreter during the actual assessment. Our research shows the benefits of a pre-assessment briefing between an AMHP and an interpreter in pre-empting common misunderstandings about respective professional roles and reflecting on preferred strategies to address common practice challenges. Part 5 of this guidance outlines key considerations and practices for AMHPs and interpreters to conduct effective briefings.

6. Key mental health legal terms and concepts

Part 6 of this guidance includes information about key terms and concepts in mental health legislation because our research has shown that many interpreters may not be fully aware of the meaning and implications of some key mental health legal terms and concepts that are particular to MHAAs.  This can create unnecessary difficulties in preparing for and during a MHAA when terms and concepts drawn from the law and mental health have certain meanings or implications.  Sometimes terms may seem intelligible across languages because in different contexts they can be commonly used so the highly specific meaning in the terms of the law and mental health, especially in a MHAA, is lost. Section 6 of this guidance helps navigate this challenge.

 

7. Types of Interpreting 

From an AMHP’s point of view, how an individual communicates, not just what they say, is helpful to gauging an individual’s mental state, their ability to engage in discussion about their circumstances and the potential outcomes of the assessment and what these may imply.  AMHPs also must assure themselves that key points they are required to say are conveyed by the interpreter with precision in order to fulfil the statutory duties entailed in the AMHPs’ role.  

AMHPs may not be aware that interpreters have at their disposal different approaches to interpreting that they are taught and may be deployed as appropriate to the situation; for example, ‘consecutive’ or ‘simultaneous’ interpreting.  Part 7 of this guidance draws on our research, which has shown that most AMHPs regard interpreters as neutral conduits of information exchange and do not realise that there are choices to be made about types of interpreting nor have considered the complexities of representation, to explain that Interpreters do more than ‘just translate’ words/signs between languages, they seek equivalency of meaning between languages that in some cases means they might use different words or expressions than those of a literal translation.  This can be both beneficial and a problem in statutory work. Informing AMHPs of the different types of interpreting and considering the unique aspects of each assessment, part 7 aims to help AMHPs make informed decisions about which interpreting method is best suited depending on the demands of the situation.

 

8. Deciding to stop a MHAA interview 

There are occasions when serious consideration should be given to whether an interpreter-mediated interview during a MHAA should not go ahead or be stopped. It is the responsibility of the AMHP to make such a decision. Part 8 of this guidance outlines the reasons for such a decision relating to the effectiveness of the assessment affecting the requirement to interview ‘in a suitable manner’. Our research indicates that AMHPs may be very reluctant to stop an assessment because of practicalities associated with sourcing interpreters and time required.  This guidance will help AMHPs who may not have considered fully the implications of interviewing in a suitable manner. It also discusses the possibility of discontinuing the interview if the interpreter’s communication skills or performance do not meet the required standards.  The decision to stop must be balanced against the needs of the person who may be distressed, and a delay could add to this. Part 8 aims to support AMHPs in navigating this decision-making process.

9. The role and responsibilities of interpreters: Cultural sensitivities and cultural brokering

Our research confirms previous research findings in other domains that AMHPs (alongside other professionals, in for example, healthcare and the legal system) have varied perspectives on the role of interpreters and may not be clear on how much they can ask the interpreter to do with respect to providing cultural explanation or context. Some have a very narrow focus on what an interpreter’s role should be that might exclude all culturally explanatory information. Others see the cultural insights that an interpreter might bring as part of their role in ensuring full understanding of all parties. Likewise, our data and initial training reveals that interpreters themselves are also not sure about how much cultural information they should provide in MHAAs. Part 9 of the guidance explains what is appropriate for both AMHPs and interpreters to consider in terms of cultural brokering. It provides guidance to both AMHPs and interpreters, helping them navigate the delicate balance of when and how to incorporate cultural explanations.

 

10. The Full Patient Journey

The requirement for interpreter mediation may extend beyond the interview which forms part of the MHAA.  For the AMHP whose responsibilities include the provision of interpreters and for the interpreter who is booked for the interview this has implications.  The research underpinning this guidance has demonstrated that there can be constraints on the amount of time that an interpreter is booked for and/or lack of consideration of other aspects of interpreter requirements across the full journey of the person being assessed. In Part 10 of the guidance we outline some additional considerations that may not apply in all cases but at least need to be thought about.

11. Debriefing

Debriefing is a short, informal conversation between professionals and occurs after a MMHAA has taken place and the outcome has been communicated to the assessed person. 

The purpose of a debrief is to create a space for reflection on the overall MHAA process, the effectiveness of interprofessional working, the specific language and cultural challenges presented by the encounter, and any issues impacting on the well-being of the professionals involved.  

Evidence from our research suggests that interpreters very rarely have briefings with professionals including AMHPs.  Part 11 of the guidance gives insight into why even in a short debrief can offer many benefits for both professionals. AMHPs can create a safe space for interpreters to express their needs, offer them coping strategies, and address any outstanding needs to help with closure (‘containment’). At the same time, our research shows it is helpful in completing the AMHP report form if any challenges associated with the any aspect of the interpreting process are noted. Sometimes it is not feasible to address these during the assessment so they can be discussed in the debrief. This is helpful for future practice too. 

12. Issues in recording

Local recording following a MHAA(the Approved Mental Health Professional’s report form) varies regionally/nationally with no uniform template or requirements. The absence of this uniform recording makes it very difficult to identify where any disparities may exist in assessment or outcome related to language use or the conditions of interpreter-mediation during assessments.  Our research has shown that on a local level, information about preferred interpreters, difficulties that might have arisen in the assessment related to interpreting/language use, and good practice are sometimes recorded but not consistently. Part 12 of the guidance gives an overview of what information can be recorded by AMHPs on completion of a MHAA

 

13. Governance, Accountability and Safeguarding

Several issues concerning governance have arisen through our research, focusing around four key themes: regulation, confidentiality, safeguarding and remote assessment. There are good practice guidelines for each of these themes which are outlines in Part 13 of the guidance. In particular, our research has shown that ‘remote interpreting’ in its many different forms can pose difficulties in a MHAA situation and needs to be considered carefully for the potential impact of MHAA outcomes.

RESOURCE R1 

Introduction to the simulated best practice videos

As part of the project four simulations of Mental Health Act assessments (MHAAs) were filmed. These were filmed for three purposes:

1. To visually illustrate examples of good practice and not so good practice in AMHP and interpreter behaviours during an MHAA.
2. To use the simulations as part of further data collection by running online focus groups with AMHPs, interpreters and service users as a stimulant for discussion on what constitutes good and not so good practice
3. To have a freely available training resource to be used in initial and CPD training for AMHPs and interpreters.

Each video simulation was created using a scenario developed by the INforMHAA research team, drawing on our own experiences as AMHP and interpreter practitioners, as well as authentic experiences reported to us by AMHPs, interpreters and service users through our surveys and interviews.

Each video features professional actors playing the role of person or parent, and a real AMHP. Three of the scenarios include a real professional interpreter. In three of the scenarios there was also a member of the INforMHAA research team or advisory group playing the role of a medical professional.

In each video the AMHP and interpreter were both directed specifically to ask questions/ make decisions or interpret in such a way that highlights key issues that can arise in these assessments. This is not a reflection of the quality of their skills as AMHPs or interpreters in real practice and also do not necessarily offer a model to replicate. We are grateful to the AMHPs and interpreters for being prepared on occasions not to demonstrate their usual excellent practice (!)

The goal in creating the scenarios to illustrate examples of good and not so good practice was to stimulate discussion about best practices for AMHPs and interpreters in working together.

Two ways to use the simulated practice work

We are using the scenarios in two different ways. 

• In the first approach we propose, the focus is more on the practice of interpreting with close attention to the interactions between the interpreter, the AMHP and the person being assessed.  The videos we made are available to download from the INForMHAA website and details of where to find them can be found in Resource R3. Resource R4 provides guidance on how the videos might be used in interpreter training or joint interpreter/AMHP training.  

The second approach we offer uses only the written information we created that supported the improvisation of the actors in the films because in their own right these semi-scripted scenarios are useful for training purposes.  There is more detail in this version of the background and legal issues.  They are suitable for initial AMHP training as well as for joint AMHP/interpreter CPD). These can be found in Resource R2, with a background to each scenario and how they may be used in training.