Mental Health Interpreting Guidelines Fo

Mental Health Interpreting Guidelines for Interpreters
Guidelines on definitions, protocols, ethics, practices, self-care and

content knowledge for interpreters working in mental health settings
Prepared by: Dr Jim Hlavac, Translation and Interpreting Studies, Monash University (2017)
An interaction between a mental health professional and a person with a mental illness is in
many ways different from an interaction between a general healthcare professional and a
person with a physical condition. In a mental health interaction, elicitation and demonstration
of symptoms, monitored testing, initial diagnosis, therapy, recovery and/or management of
symptoms all occur via interactions where the ability to openly communicate, to build rapport
and to gain the trust and confidence are critical. Where the mental health professional and the
person with a mental illness do not have a common language, the work of the interpreter in
building this relationship is critical. The mental health interpreter’s renditions therefore play a
key role in the work of the mental health professional, as s/he is reliant on these to work
effectively with the patient.
There are guidelines that inform mental health professionals on how to work with interpreters,
eg. the VTPU’s Guidelines for working effectively with interpreters in mental health settings.
(2006), AUSIT’s Guidelines for Health Professionals Working with Interpreters (2007) with a
2-page section on mental health and the APS’s Working with Interpreters: A Practice Guide
for Psychologists (2013). From the perspective of the interpreter, guidelines exist for sign
language interpreting in ASLIA’s Guidelines for Interpreting in Mental Health Settings (2011)
which describe parameters of interpreting practice with both mental health professionals and
patients. The guidelines contained in this document build on ASLIA’s (2011) guidelines, and
encompass both spoken and sign language interpreters.
The guidelines in this document provide the following: definitions of key terms, protocols, a
discussion of ethical considerations, self-care in mental interpreting, content knowledge, and
patients’ rights and legal terms. Information on medico-legal tribunals and legislation is also
provided.These guidelines are intended to assist interpreters so that they can work optimally
in mental health interactions with both mental health professional and patient.
The development of these guidelines was funded

by Language Loop – Powering VITS – through its
Industry Innovation Grants Program (2015-2017).
These Guidelines for Mental Health Interpreting are endorsed by AUSIT (Australian Institute of
Interpreters and Translators) and ASLIA (Australian Sign Language Interpreters Association).
Table of contents
Cover page 1
Table of contents 2
I. Definitions of key terms 4

Mental health 4
Patient 4
Mental health professional 4
Mental health interpreter 5
II. Protocols 6
Pre-assignment steps 6
1. Pre-interaction information 6
Pre-interaction steps 6
2. Briefing 6
3. Outlining of interpreter’s role and
negotiation of role-relationship 7
The interpreted mental health interaction 8
4. Primary contact with patient 8
5. Discourse of the mental health interaction 8
6. Patient discourse 9
7. Mental health professional discourse 10
Post-interaction 10
8. De-briefing 10
III. Ethical considerations 13

1. Professional conduct 13
2
Mental Health Interpreting Guidelines
2. Confidentiality 13
3. Competence 15
4. Impartiality 16
5. Accuracy 17
6. Clarity of role boundaries / Professional relationships 17
7. Maintaining professional relationships 18
8. Professional development 20
9. Professional Solidarity 20
IV. Self-care in mental health interpreting 21
V. Content knowledge 23
Settings 23
Services 24
Terms and definitions used for mental health illnesses
(including the terms ‘mental conditions’ and ‘mental disorders’) 25
Treatment of mental illnesses 27
V. Patients’ rights and legal terms 30

Mention of the provision of interpreters in mental health laws 30
Key terms 31
Appendices 33
Appendix 1 – List of medico-legal tribunals relevant to mental health 33
Appendix 2 – Mental health legislation in Australian states and
territories 34
References 54
3
I. DEFINITIONS OF KEY TERMS
Mental health
Mental health encompasses a person’s psychological, emotional and social well-being. A

person’s mental health may be discernible through forms of behaviour, physical symptoms or
use of language. At the same time, it may not be readily discernible; a realisation or diagnosis
of mental health problems may sometimes come about only through an indirect event or
through testing and/or systematic observation by another.
A number of factors can contribute to mental health problems. These include: biological
features, such as brain chemistry and genes; life experiences such as abuse, violence, torture
or other forms of trauma; family history of mental health problems.
Patient
In Australia and in the context of mental health interpreting, the patient1 who has limited English
proficiency (LEP)2 and/or who is Deaf3 or hard of hearing4 is the person requiring the services
of an interpreter to communicate with a mental health professional.
Mental health professional
Similar to the patient, the mental health professional requires the services of an interpreter to
communicate with an LEP and/or Deaf or hard of hearing patient. The mental health
professional may be a psychiatrist, psychologist, counsellor, therapist, mental health nurse,
1 In these guidelines the term patient is used to refer to a consumer of mental health services, i.e. a
person with a mental illness who interacts with others in the provision of services. The term patient is
appropriate for general health or medical contexts. However, within mental health services in Australia,
there is a national framework for recovery-oriented mental health services that has begun to advocate
the term consumer of mental health services. The term patient is retained in this document, due to its
brevity compared to the term consumer of mental health settings.
2 The term limited English proficiency (LEP) is used here as the guiding characteristic of the clients with
whom interpreters work. This term is used in preference to the term language other than English (LOTE)
as it is the proficiency level in English that does not enable functional and reliable communication with
an English-speaker. The term LEP also recognises that many clients have some proficiency in English
and may often address others in English or code-switch into English. These guidelines address this in
section
3 Many Deaf people who use a sign language such as Auslan also have limited English proficiency
(LEP), i.e. they are both Deaf and LEP. This means that written materials in English are often not
appropriate ways to communicate with them, nor are other text-based means of communication such
as ‘pen and paper’. A Deaf client who requests an Auslan-English interpreter requires such an
interpreter to communicate with an English-speaker. An Auslan-English interpreter should be provided
to hearing children of Deaf parents where requested as Auslan may be their first language. These
Auslan-users may require Auslan receptively but use spoken English for expressive language.
4 People who self-define as hard of hearing may use Auslan, a spoken language of their culture or both
of these. An Auslan-English interpreter should be provided where requested to meet their

communication needs as many hard of hearing Auslan-users may use a mix of sign and spoken
language.
4
social worker, general practitioner (GP), support worker, or other healthcare worker who
interacts with a patient in a therapeutic, advisory or treatment-based capacity.
Mental health interpreter
A mental health interpreter is an interpreter working in mental health settings. These settings
include not only emergency, treatment or rehabilitation settings, but also settings in which the
client is identified as a mental health client, e.g. a National Disability Insurance Scheme (NDIS)
meeting; a housing and accommodation support meeting with representatives of a relevant
support service; a medical setting relating to physical health symptoms that are a consequence
of a mental illness or condition.
A mental health interpreter should ideally have training in both general interpreting, and in
interpreting in mental health settings. The term ‘mental health interpreter’ encompasses
interpreters for spoken languages other than English and sign language interpreters (Auslan-
English interpreters and Deaf interpreters 5). In Australia, interpreters working in the mental
health sector should possess a credential or standard of practice that certifies their level of
general interpreting ability, namely certification (from 2018 onwards) or accreditation (term
used from 1977 to 2017). The terms certification and accreditation relate to a system of formal
testing of candidates or recognition of existing skill levels so that these represent a certification
of an interpreter practitioner granted by the National Accreditation Authority of Translators and
Interpreters (NAATI).
Training is a vital and necessary attribute for interpreters to possess in order to work in mental
health settings. From 2018 onwards, NAATI will be awarding a higher credential relevant to
those wishing to become mental health interpreters or who already work as mental health
interpreters, certified interpreter – specialisation: health interpreting. This credential will
be awarded to interpreters who fulfil both of the following: undertake a course of training in
health interpreting that includes a mental health interpreting component; successfully complete
a NAATI specialist test in health interpreting that includes a demonstration of skills relevant to
mental health interactions. These skills include consecutive interpreting (both dialogue and
monologue), simultaneous interpreting (including chuchotage for spoken language interpreting)
and sight translation.
Aside from (and beyond) NAATI certification, training through training courses and completion
of relevant and appropriate PD courses are key attributes that build and extend the skill-level
of a mental health interpreter.
5 A Deaf interpreter (also known as a Deaf Relay interpreter) is an individual who is usually Deaf,
fluent in Auslan, written English and who may have additional proficiency in a foreign sign language or
pidgin.
5
II. PROTOCOLS
There a number of protocols or features that interpreters should attempt to be clear about
before the interpreted interaction commences. The following are a list of the chronological
stages relevant to the interaction, and the operational and recommended steps to take before,
during and after a mental health interaction.
Pre-assignment steps
1. Pre-interaction information.
Information about the interpreting assignment that can be gained before the interaction, e.g.
address, name of institution, name of clinic or hospital area / ward that give general information
about the site / place of the interaction. Where personal information or the identity of the client/s
is made available in advance, the interpreter notes whether s/he has worked with a client
before and where this is the case, considers whether his/her relationship with the client is still
a work-related one, and/or other features that the interpreter may recall about the client’s state
of health. Where the interpreter believes that s/he can recall information about a client’s health,
the interpreter should consider carefully how reliable and clear these recollections may be.
Interpreters frequently work with many clients and should be mindful of the fact that what they
recall from a previous interaction may not always be an accurate reflection of what happened
in that past interaction, and that their recollections are subjective.
Pre-interaction steps
2. Briefing
In order for interpreters to work effectively with mental health professionals, it is important that
they request and have a briefing with the mental health professional for both to work effectively
with each other. For the interpreter, this briefing is an opportunity to gain information on the
general purpose of the interaction, or what the mental health professional seeks to ‘achieve’,
in a general sense, in the interaction. This information allows the interpreter to be informed of
the mental health professional’s perspective and intentions towards the interaction. The
interpreter is thereupon able to anticipate the way the mental health professional will
communicate with the client and the likely type of language to be used.
There are a number of points that can be touched on in the briefing with the mental health
professional. Below is a non-exhaustive list from which the interpreter may consider which are
relevant to the interaction:
 Previous experience working with interpreters in the simultaneous and/or consecutive

mode, and whether spoken or sign language
 Role of interpreter in facilitating communication between speakers/users of different
languages
 Ethical code/s by which the interpreter works, including the principle of confidentiality
 General format or purpose of interaction
 Is this the mental health professional’s first interaction with the patient
6
 Any relevant information about the patient’s speech/signing, eg. aphasia, stroke-
related language problems.
 Safety concerns. If these exist, the possibility of using a code word (eg. “flag”) for the
interpreter to signal that s/he feels that his/her physical safety is threatened
 If the mental health professional has questions about the language itself of the patient,
whether s/he will bring this up in the interaction itself or in a de-briefing after the
interaction
 Whether introduction of the interpreter includes (self-)identification of the interpreter
with full name, first name or whether the interpreter prefers not to identify him-/herself.
 The issue of the interpreter having had previous contact with the same patient. The
interpreter should use professional judgement in carefully considering the following:
- how accurately the interpreter recalls previous interactions (it is possible that
the interpreter may confuse or mix up details of patients’ medical histories.)
- the patients’ right to privacy, including the right to choose what information
about themselves they wish to divulge
- if the interpreter believes that s/he should bring up this issue with the mental
health professional then the interpreter needs to consider why s/he would do
this
The above are only an example of the issues that may be brought up in the briefing. A
recommended practice is that at least 15 minutes should be allocated for the briefing and that
the briefing time is recognised as working time for the interpreter and is thus remunerated. For
family therapy sessions, it is recommended that a longer briefing time be planned.
3. Outlining of interpreter’s role and negotiation of role-relationship
The briefing serves the purpose of an exchange of information between the interpreter and the
mental health professional, so that both are in a position to perform their tasks in the interaction
itself and to know how to work together within the interaction. The interpreter should, in the
briefing, outline his/her formal role as interpreter for the interaction. The outlining of the
interpreter’s role is a negotiated practice: the interpreter and mental health professional
negotiate and check that they know, in general terms, how the interaction may be structured,
if the interpreter would like to introduce him-/herself or allow the mental health professional to
introduce him/her and for the interpreter to then outline his/her role to the patient.
Further, the briefing allows both interpreter and mental health professional to touch on issues
such features of the patient’s speech or signing, the patient’s possible use of spoken English
or code-switching, how the interpreter will render not only the content of a patient’s speech or
signing, but also its form, particularly where this may be incoherent, repetitive, highly figurative
or metaphoric and so on. This also provides time for the interpreter and the mental health
professional to discuss whether the mental health professional will employ diagnostic tools
orvisual resources such as use of whiteboards, pictures, therapy cards, games or aural
resources such as music, guided meditation/mindfulness recordings and so forth (Anderson,
2012). In addition, the interpreter should enquire whether it is possible or advisable to take
notes and/or which mode (consecutive/simultaneous) of interpreting can or should be used.
Where the mental health professional seeks guidance on interpreting mode, the interpreter
provides information on this.
7
The interpreted mental health interaction
4. Primary contact with patient
As stated, the interpreter should discuss in the briefing with the mental health professional,
issues to do with introduction (of both parties), use of names or forms of address, and
explanation of role to the patient. The interpreter should either be introduced, or introduce him-
/herself. This does not have to include use of full name or first name if the interpreter does not
wish to identify him-/herself. (This should is to be outlined in the briefing.) In the primary contact
with the patient at the start of the interaction, the interpreter should consider the following to
check with the patient:
- Language for which the assignment is booked, certification/accreditation level of

interpreter
- Previous experience communicating via interpreters
- Ethical principles: ‘completeness’ of interpretations, i.e. the interpreter will interpret
all speech/signing from all parties; confidentiality of interaction, i.e. no content or
details of the interaction will be passed on to others
- Physical configuration of the interaction
- Use of 1st person “I” in interpretation
- Mode of interpreting (consecutive and/or simultaneous)
In addition to the patient, the interpreter may be working with family members, friends or others
associated with the patient. In multi-party group interactions, the interpreter should check the
above features with all those with whom s/he will be working. The sign language interpreter
may also like to clarify the use of any ‘name signs’, i.e. names of people who are represented
by a specific sign designated for that person. This is particularly pertinent when interpreting
signed conversations amongst family members where the mental health professional is
‘listening in’ to family discussion.
5. Discourse of the mental health interaction
A key aspect of interpreting the speech/signing of others is to focus on the overall meaning of
the speaker’s output and what is being said/signed. Interpreters align themselves to the
content of what is said/signed and render this in the other language. However, in mental health
interpreting, the form of speech or signing is usually important to the mental health
professional. Mental health professionals rely not only on the referential content of a patient’s
utterances, but on the way the patient speaks/signs with any of the following also contributing
to a diagnosis or to forms of treatment: speed, flow, intonation, cadence, repetition of particular
forms, discourse markers (you know, like), stuttering, disfluencies, incoherent speech and
articulation, body language, conspicuous avoidance of forms or constructions (e.g. 1st person
singular “I”), conspicuous over-use of constructions (e.g. passive voice) or unusual linguistic
practices (e.g. using the 3rd person singular to refer to oneself, alliteration or rhyming
sequences) (Boyles & Talbot, 2017).
8
6. Patient discourse
Interpreters need to convey the features of the form of a patient’s speech or signing to the
mental health professional so that these are apparent to him/her in diagnosing or working with
a patient in a therapeutic setting. It is often very difficult to replicate the specific features of the
linguistic forms used by a patient in the form of the interpretation. Where interpreters are
unable to do this, or where the features cannot reasonably be replicated in an interpretation
(eg. stuttering, alliteration, rhymes), the interpreter should convey to the mental health
professional what form is being employed by the patient by way of description of this form.
When working with a patient, mental health professionals rely on these features of a patient’s
behaviour, and not only the referential content of their utterance.
Interpreters need to have knowledge of how illness and pain are expressed not only
linguistically via terms and statements of well-being, but through other linguistic forms such as
euphemism, metaphor, vocalisations, facial expressions or reference to other concepts that
index health or well-being. A patient’s descriptions of his/her disposition, comfort level and
concept of self will reflect his/her personal circumstances and his/her world-view. As a result,
for some patients, reference to colours, numbers, places, foods or other symbols (real or
metaphoric), or use of analogy or figurative language, may, for example, be the way in which
they describe themselves, their symptoms and/or (those in) their environment. A patient may
report ‘hearing voices’ or ‘seeing voices’. For spoken language interpreters, this can be a
challenge to convey what the patient is saying on behalf of him-/herself, and what s/he is
recounting from voices heard. For sign language interpreters, the Deaf patients that they work
with may hear voices or may see signed voices. Sign language interpreters need to relay both
what is being signed by the patient, and relay what the patient recounts from voices heard or
seen. Using their professional judgement, sign language interpreters may need to explain to
the mental health professional that Deaf people can both hear as well as see voices.
For sign language users, their language use may be non-standard or idiosyncratic due to their
language acquisition history, e.g. that Auslan is not their first language; lack of signing in their
upbringing; living remotely and thus having little access to the Deaf community. The interpreter
must draw the attention of the mental health professional to the issue of non-standard use of
language as it may or may not be relevant to the intervention.
As stated, the form of the patient’s speech/signing is important to the mental health
professional and the interpreter’s interpretation of the patient’s speech/signing should contain
these forms (e.g. references to colour, numbers, places and so on.). The interpreter is advised
not to ‘make meaning’ out of these forms beyond the referential content that these forms relate
to. It is up to the mental health professional to ‘make meaning’ out of the spoken/signed
interpretation, and if he/she has questions about the meaning or other significance of the
patient’s speech/signing then he/she will ask these questions via the interpreter to the patient.
Where the interpreter is not able to readily interpret the patient’s speech/signing to reflect
these forms, for whatever reason, the interpreter should describe these forms and add that
this is his/her [the interpreter’s] description, and not what the patient said/signed. It is important
in these instances that the interpreter renders the referential content in the way that it is
spoken/signed to him/her, but that he/she does not take on the role of ‘meaning maker’
(Pollard, 1998).
A patient’s language may be affected by his/her mental and/or physical condition (e.g. a person
living with dementia may have difficulty speaking because of the physical changes that occur
9
in the brain). A bi- or multilingual patient (of any degree of language mastery) may use one or
more languages to express him-/herself, or a mix of languages and/or dialects. The linguistic,
prosodic and paralinguistic features of a patient’s communicative repertoire may be
symptomatically remarkable or not. A trained interpreter is ideally placed to recognise
significant variation from what might fall within culturally acceptable linguistic (including
prosodic and paralinguistic) parameters.
7. Mental health professional discourse
A mental health professional may use different registers in his/her communication with
different interlocutors. In general, healthcare staff are trained to use everyday English and
avoid technical language when communicating with patients. As part of a multidisciplinary
team, however, an interpreter may be exposed to a wide variety of registers, including
specialist and technical ones. The same applies to the communicative repertoires of patients,
which may show wide variation across register and formality, as well as cohesion and
coherence. A mental health professional’s language may also be guided by the interpreter’s
linguistic choices in the rendition, as he/she may reasonably expect this to be a mirror of the
LEP and/or Deaf or hard or hearing patient’s language.
Interpreters are required to learn the most common terms, such as anxiety, Alzheimer's
disease, anorexia, Asperger's syndrome, attention deficit hyperactivity disorder (ADHD),
autism, bipolar disorder, bulimia, dementia, depression (including major depression), neurosis,
obsessive compulsive disorder (OCD), panic attack, paranoia, phobia (agoraphobia,
claustrophobia), post-traumatic stress disorder (PTSD), psychosis, and schizophrenia.
Each term has its definition, symptoms and suggested treatments. Terminology is a part of an
interpreter skill repertoire, and interpreters are encouraged not only to know the translation of
the various terms, but also learn about the various conditions and the types of medication
most commonly used to treat them (Crezee, 2013). Understanding how a condition, disorder
or illness presents is important for knowing how an interpreter can recognise signs of
potentially dangerous behaviour. This recommendation includes symptoms that are not only
mental ones, but physical ones as well.
The physical behaviour of a patient, which includes verbal/signing as well as non-verbal/non-

manual behaviour, are very often reflective of the mental health condition that a patient has. It
is recommended that interpreters learn about the typical physical symptoms that patients with
common mental health conditions often display (Tribe & Raval, 2003). This knowledge serves
the purpose of allowing the interpreter to focus more on the verbal/signed behaviour and not
to be needlessly distracted by behaviour that may be unusual but nonetheless common
amongst patients with particular conditions (Leanza et al., 2014). Nonetheless, the
significance of body language and other paralinguistic or prosodic features are as important
as words or signs (Anderson, 2012).
Post-interaction
8. De-briefing
The de-briefing enables both interpreter and mental health professional to touch base about
language, language-transfer or extra-linguistic features that are relevant to the way all parties
10
communicated with each other. For the mental health professional, this step is important if
there are residual questions about the patient’s speech/signing or the content or manner in
which the interpreter interpreted. For the interpreter, this step allows him/her to relate any
features about the patient’s or mental health professional’s speech/signing that were
meaningful to the interaction that may have been only partially or not fully conveyed in the
interpreter’s interpretations. It can be that the pace, turn-taking habits, speech/signing style of
the patient, discourse used by the mental health professional or other linguistic or
environmental features may have affected the interpreter’s ability to fully interpret everything
said/signed during the interaction. Where this occurs, the interpreter should use the de-briefing
to inform the mental health professional of what was not fully transferred in his/her
interpretations, especially if this relates to features of the patient’s speech/signing.
Where distress, confrontation or (potential) aggression occurred in the interaction, the

interpreter should consider speaking to the mental health professional about this. The
perspective of the mental health professional in regard to a distressing situation can inform
and further the interpreter’s general understanding of mental health interactions. This, in turn,
can be of benefit in preparing for and managing future interactions.
Further to this, recognition and acknowledgement of a distressing situation can be an important

first step in managing work-related stress. Acknowledgement of a distressing situation from a
mental health professional may also be an important step in seeking services to deal with work-
related stress, including that related to secondary traumatic stress (STS), vicarious trauma (VT)
and burnout. (See section IV. Self-care in mental health interpreting below).
If the mental health professional questions the interpreter about features of the interaction
beyond inter-lingual transfer, the interpreter should reiterate in the de-briefing that s/he
conveyed via interpretation all things said/signed by others in the interaction. Where
appropriate, the interpreter should also re-explain his/her role to the mental health professional.
The AUSIT Guidelines for Health Professionals Working with Interpreters state the following:
Under the normal circumstances of general health interpreting, you [the mental health
professional] should not be asking interpreters to give information about the patient's
culture, unless communication has broken down. The importance of culture can be
over-emphasised. All patients have different personalities, temperaments and life
experience, and may vary considerably in the way they manifest their cultural
background. However, professional interpreters know that language expression does
not happen in isolation from customs and beliefs, especially in the health area.
Interpreters are not producing word-by-word renditions of the patients’ messages, but
are passing on information across cultures to each party. They provide the full
meaning of what is said by all parties in the languages spoken and understood by
them.
There may be rare occasions when you need to request essential cultural information
from the interpreter, or the interpreter may consider that without certain information the
message (from either party) may be distorted or there may be a total breakdown in
communication. Under these circumstances, the information given by the interpreter
should be factual (i.e. verifiable) and generally applicable to the patient's cultural
background. Where possible, the patient should be involved in the discussion via the
interpreter. Sensitive issues can also be discussed with the appropriate multicultural
11
health unit (e.g. Queensland Transcultural Mental Health Centre, Multicultural Access
units, Transcultural Psychiatric or mental health units).
(AUSIT – GHPWI, 2007. Original emphasis, square brackets added.)
Interpreters are not mental health but linguistic experts. As the AUSIT GHPWI (2007) source
recommends, interpreters should refrain from providing or suggesting an opinion on a client’s
mental health. The ethical principles of impartiality, clarity of role boundaries, and integrity of
professional relationships recommend against a mental health interpreter offering his/her
opinion on areas outside those of linguistic mediation.
However, along with their linguistic expertise, interpreters usually possess knowledge of the
culture or cultures that may strongly shape clients’ lives. In the Deaf community, there can be
conventions about accessing or working with other support services that may be not be
apparent to those who are not Deaf and that are relevant to the mental health interaction.
Similarly, there can be conventions or attitudes shared by other LOTE communities about
mental health diagnosis, treatment and health management that are not widely known
amongst others outside the LOTE communities. Where an interpreter responds to these
questions and provides a response based on his/her knowledge, the interpreter should firstly
declare to the mental health professional that s/he is stepping outside his/her role of interpreter,
and offering a response that is reflective of his/her personal knowledge only, and not
representative of interpreters or the interpreting profession (Tribe & Lane, 2009).
12
III. ETHICAL CONSIDERATIONS
In an overall sense, spoken language Interpreters are guided by the AUSIT Code of Ethics and
Code of Conduct (2012) and sign language interpreters are guided by the ASLIA Code of
Ethics and Guidelines for Professional Conduct (2007). Sign language interpreters are also
advised to be familiar with the ASLIA (2011) Guidelines for Interpreting in Mental Health
Settings. The principles from these codes, especially confidentiality, competence, professional
conduct, non-discrimination and professional accountability, are important notions that should
be followed in mental health interactions. At the same time, these guidelines recognise also
that interpreters may sometimes need to work in ways that differ from the specific intentions of
the principles, as there can be features of mental health settings that may make it difficult for
interpreters to always follow these principles.
The following are a listing of the principles from the AUSIT Code of Ethics and Code of Conduct,
the ASLIA Code of Ethics and Guidelines for Professional Conduct. Excerpts are provided from
the ASLIA Guidelines for Interpreting in Mental Health Settings (here abbreviated as ‘ASLIA-
GIMHS’), in relation to mental health interpreting performed by sign language interpreters and
by spoken language interpreters.
1. Professional Conduct
Mental health interpreters work with mental health professionals and patients in a respectful
and sensitive manner. This includes working towards the general aims of the performance of
a mental health interaction and the work of others involved in this. In regard to contact with a
patient before an interaction:
It is not recommended that a MH [mental health] interpreter meet with the patient prior
to meeting with the MH practitioner. Whilst this is [or may be] generally considered
good work practice in other interpreted settings, in a mental health setting, it creates
several risks including, but not limited to:
 the possibility of the patient “bonding” with the interpreter rather than the
clinician,
 the patient disclosing information to the interpreter that would be best
disclosed to the clinician,
 the possibility of the interpreter unknowingly undermining work done by the
clinician, and
 the blurring of professional boundaries with a patient who is, by definition of
the setting, in a heightened state of vulnerability. (ASLIA-GIMHS, 2011:4)
2. Confidentiality
The principle of confidentiality requires that mental health interpreters do not relate information
or details from mental health interactions to others outside this interaction. Confidentiality also
extends to the protection of information whether an interpreter has worked with a particular
patient (client) or mental health professional before. If a patient or mental health professional
13
asks the mental health interpreter if s/he has worked with the other party before, the mental
health interpreter should consider not responding to this question. Further, the mental health
interpreter should consider relaying this question to the other party to convey that this question
has been asked in the first place, and it is up to them as to how they answer this question,
which is then interpreted by the interpreter.
In relation to confidentiality, knowledge of a patient’s medical history and privacy, the ASLIA-
GIMHS (2011: 3) state the following:
… sharing of information needs to be counterbalanced with the need to protect the

patient’s privacy. For example, for whatever reason, a patient may talk about certain
events with his or her clinician only when using a specific interpreter. This patient
choice – whether it is conscious or unconscious – needs to be respected and managed
carefully between the MH interpreters who are sharing the interpreting work with the
patient. The guiding principle about the sharing of information needs to be how doing
so will enhance the interpreting process and, thus, the patient’s care.
At times, mental health interpreters may be privy to background information about the patient.
Mental health professionals may ask questions to an interpreter in a briefing or de-briefing
about the features that distinguish the patient’s cultural-linguistic heritage from other groups.
In regard to sign language interpreting, if a mental health professional asks questions about
the impact of deafness and how a Deaf person’s life experiences may vary from those from
the wider community, the sign language interpreter may respond to these questions. Care
should be taken to ensure that the clinician’s view of the patient is not skewed by knowledge
that is too general and which may not be applicable to that particular patient. Similarly, in regard
to spoken language interpreting, the interpreter uses his/her professional judgement whether
to respond to questions about the patient’s cultural-linguistic heritage, and should signal that
this information is being given in a general sense, and may not be applicable to the particular
patient. (See Section 8. De-briefing above.)
Knowledge of the cultural-linguistic background of a patient is to be distinguished from

knowledge about the patient’s medical history. Where an interpreter recalls details of a
patient’s medical history, the interpreter should consider how accurately s/he can remember
details, and secondly how relevant these may be to a situation. In most cases, the medical
history of a patient is accessible to the mental health professional, and the interpreter is not
the only person other than the patient with access to this.
Where the interpreter believes that the withholding of information could have a serious and
negative effect on the accuracy of a diagnosis or effectiveness of a treatment, the interpreter
should consider whether and how this information can be conveyed to the mental health
professional. It should be emphasised that the interpreter should be sure that s/he can recall
information about the patient that is relevant to the current interaction and that the withholding
of this information could result in serious harm to the patient or others. The interpreter then
may outline these concerns after the interaction, in a de-briefing with the mental health
professional.
In the de-briefing, the interpreter outlines his/her duty of maintaining confidentiality of

information, and the need to respect a patient’s right to privacy. The interpreter uses his/her
professional judgement in deciding whether these should be overridden by his/her strong belief
14
that a non-disclosure of this information could result in serious health consequences for the
patient or for others. (See Section 8. De-briefing above.)
In situations where the withholding of information (such as allergic reactions, history of self-
harm or harm to others) could be life-threatening to the patient or to others, the interpreter is
not bound by the principle of confidentiality and must convey this to the most appropriate
person, usually the mental health professional. In instances where the information may not
have a life-threatening, but serious effect, the interpreter should use his/her professional
judgement. Legally, it is not clear whether the defence of acting in the best of interests of the
patient (his/her health and/or the health of others) would protect an interpreter from an
accusation or charge of breaching the patient’s privacy. The ASLIA-GIMHS (2011: 3) state:
In the case of duty of care in relation to risk of harm to either self or others, it is important
for the MH interpreter to know that should they become aware of such risk concerns
outside the presence of the MH practitioner, that confidentiality does not bind and the
clinician involved needs to be notified of the content expressed by the patient. In part,
it is because of this possibility of patient disclosure to a MH interpreter that it is strongly
recommended that the MH interpreter does not spend time with the patient outside the
presence of the clinician. Interpreters are not trained to manage such scenarios; the
clinician is.
It should be re-stated that it is important for the interpreter to consider how clear and accurate
his/her recollection of a patient’s medical history is. Elsewhere in relation to sign language
interpreters working in a team in mental health settings, the ASLIA-GIMHS (2011: 3)
recommend the following:
A cornerstone of interpreting practice is confidentiality. The MH interpreter may find

that more than one MH interpreter – each working as a sole practitioner – shares the
responsibility for the interpreting work with a particular patient. If this is the case, a
handover of information between interpreters is essential to the interpreting process.
For example, this could include particular lexical items used in the source language by
either a clinician or a patient and the choice of lexical items used by the MH interpreter
in the target language as well as information about the type of discourse that may occur
and/or the how a patient refers to certain things, particularly if s/he is unwell and
disjointed or dysfluent in his or her communication. This information is important to
assist the MH interpreter to manage the flow of the discourse between clinician and
patient, but is not to be used to produce smooth, flowing target text from source text
that was disjointed or dysfluent.
Further information on how the interpreter works in a team with others in rendering patient
discourse can be found in Hale (2007: 37-50).
3. Competence
This principle requires that an interpreter is competent to carry out an assignment accepted in
a mental health setting. This relates to the (varied) contexts of mental health settings,
institutional structures, terminology, genres and discourse forms used by those with whom they
work. Congruent to the recommendations given in these guidelines about content knowledge
and protocols, the ASLIA-GMIHS (2011: 5) recommend that:
15
… MH interpreters undertake ongoing reading and/or professional development in
order to develop an understanding of psychopathology, the range of therapeutic
frameworks utilised in mental health settings as well as the task of language transfer in
such settings (e.g. how discourse may vary in mental health settings, the source
language terminology that may be used and its possible equivalence in the target
language, etc.).
The introduction of an advanced credential, certified interpreter – specialisation: health

interpreting by NAATI in 2018 is welcomed and this credential should become the aspirational
level of skill held by future mental health interpreters.
4. Impartiality
Interpreters remain unbiased and impartial throughout the communication exchanged between
the participants in any interpreted encounter. However, impartiality does not mean aloofness
or a prohibition to show empathy towards a patient. Where this is apparent in the discourse
and tone of the mental health professional, this should be rendered by the interpreter. Similarly,
the emotional and affective tone of the patient’s speech/signing is rendered in the same way
to the mental health professional.
In diagnostic testing, it is important that the interpreter renders only what is said/signed or
shown by the mental health professional. The interpreter does not aid (or hinder) a patient in
giving a response where this is sought by a mental health professional. It is important that the
elicited capabilities of a patient are conveyed to the mental health professional without
additional assistance from the interpreter (O’Hara & Akinsulure-Smith, 2005).
Interpreters disclose to the mental health professional any relationship that they may have with
a patient - family, friendship or other – that could be considered to be a conflict of interest for
the interpreter. Where a conflict of interest occurs, the interpreter should disclose this, and
consider his/her ability to still interpret impartially, and offer to withdraw from the assignment.
Withdrawal from an assignment is usually the optimal outcome when a conflict of interest exists
between an interpreter and a patient. The ASLIA-GIMHS (2011: 8) advocate the following:
The MH interpreter is responsible for maintaining strict professional boundaries with

any deaf person met through the context of a mental health setting. Conversely, if a
MH interpreter has a personal and/or social relationship with a deaf person, then s/he
should not knowingly accept an assignment with that deaf person in a mental health
setting. If, upon arrival at an assignment, s/he discovers that the deaf patient is
someone within that personal/social circle, the MH interpreter must inform the clinician
of this and withdraw from the assignment.
ASLIA acknowledges that this principle may be difficult to adhere to in remote and
regional settings, where availability of MH interpreters is limited. However, for the
reasons outlined, ASLIA recommends that, whenever possible, this principle is
observed and employed by the MH interpreter.
However, the withdrawal from an assignment may not be the optimal outcome if the situation
is an urgent one, or if it is not feasible to source another interpreter within a timeframe that is
critical to the patient’s condition. In such cases, the interpreter discloses the conflict of interest,
16
declares whether s/he is still able to interpret impartially, and leaves it firstly to the mental
health professional to decide whether s/he agrees for the interpreter to interpret, and secondly
to the patient that s/he agrees to the interpreter interpreting. If both parties agree, the
interpreter should add that either party may withdraw their agreement during the assignment,
if either side believes that the conflict of interest that the interpreter is compromising either the
content exchanged in the interaction or the overall purpose of the interaction.
5. Accuracy
The AUSIT Code of Ethics requires interpreters to be faithful at all times to the meaning of
texts and messages, providing optimal and complete interpretations. A faithful interpretation of
another’s speech or signing includes intonational, prosodic, para-linguistic and other features
of the source speech or signing. Interpreters are generally guided by the meaning of what is
said or signed by others and their interpreters reflect this. However, in mental health
interpreting, not only the meaning, but also the form of a patient’s speech or signing is
important. Disfluencies, repetitions, use of metaphors or imagery, use of third person about
oneself are, for example, features of a patient’s speech or signing that can be important in the
diagnosis of a mental illness or in the features of talk-therapy treatment employed by a mental
health professional. In the same way, the form of the mental health professional’s speech or
signing can be a feature of treatment that should be rendered in the interpreter’s interpretations,
e.g. unfinished questions, conspicuous use of imperatives, items used in sequences or lists.
The form of language is focussed on below in sub-sections E, F and G in the section Protocols.
The ASLIA-GIMHS (2011: 5) also describe the importance of form of language in
interpretations:
In a mental health setting – depending on the working framework and/or the intent of
the clinician in that setting – faithfulness of interpretation can mean working as a
linguistic informant to the clinician noting when language is disjointed, lacks cohesion
and/or is incoherent rather than rendering an interpretation, per se. It is important for
the MH interpreter to know that s/he is working faithfully even when what is interpreted
does not make sense – it is essential for the MH interpreter to be able to “let go” of
making sense. In this way, the MH interpreter provides the clinician with the text s/he
needs to work with the deaf patient.
It may be far more useful – depending on the clinician – to make comment about
unusual aspects of the patient’s language; for example, that a patient who is talking
about three family members has placed them all in the same signing space instead of
in three separate referential locations rather than simply rendering an interpretation of
whatever the Auslan text may be. In part, this is why it is crucial for the MH interpreter
to work closely with the clinician to become aware of the clinician’s framework and the
intent of the assignment.
An effective working rapport between the clinician and the interpreter contributes towards a
more faithful interpretation and a more seamless interaction.
17
6. Clarity of Role Boundaries / Professional Relationships
The AUSIT Code of Ethics states that interpreters should not engage in other tasks such as
advocacy, guidance or advice. The notion of clarity of role relationships overlaps with the ability
of an interpreter to be impartial. In some circumstances, previous contact with a patient (or
mental health professional) may present a complication to the mental health interaction. The
ASLIA-GIMHS (2011: 7) set out that:
Other relationships that the deaf patient may have with the MH interpreter – be they
personal, social or even at a working level – may be confused within the MH setting by
the deaf patient and, indeed, by the MH interpreter. As well, it is possible for the
integrity of the interpreting to be compromised by this confusion of relationship and
boundaries.
Therefore, it is for this reason that ASLIA strongly recommends that under no
circumstances should a MH interpreter engage in personal and/or social interaction
with a deaf patient for whom s/he interprets in a MH setting.
Even when only a professional relationship exists, a MH interpreter needs to carefully

consider undertaking other interpreting work with a deaf patient outside of the mental
health setting. This is recommended for both the patient and the MH interpreter’s well
being. For the interpreter, it may create a situation that can manifest itself with a blurring
of boundaries and/or present challenges in relation to impartiality. For the patient, it
may provoke distress or embarrassment to see the MH interpreter in another setting.
The role that the interpreter occupies can be misunderstood due to other reasons, such as
those to do with a patient’s ability to understand his/her role. For example, where the patient
directly addresses the interpreter as the mental health professional, or clearly shows that s/he
believes that the interpreter is (also) the mental health professional, the interpreter should re-
clarify this to the patient, and interpret this clarification back to the mental health professional
(Dabić, 2007). The interpreter should use his/her professional judgement in assessing whether
the patient appears to consider the interpreter to be a mental health professional. Some
interpreters report using the third person in relaying the mental health professional’s speech
or signing, as a way to clearly show that the interpreter is repeating another’s speech/signing
(Bot, 2005). However, this practice should be considered a last resort, and otherwise,
interpreters use first person in mental health interpreting interactions, as they do in other
interpreted interactions.
7. Maintaining Professional Relationships
This principle advocates that interpreters endeavour to secure satisfactory working conditions
for the performance of their duties, including physical facilities, appropriate briefing, a clear
commission, and clear conduct protocols where needed in specific institutional settings. They
ensure that they have allocated adequate time to complete their work; they foster a mutually
respectful business relationship with the people with whom they work and encourage them to
become familiar with the interpreter role.
18
The AUSIT CoE (2012: 6) states the following:
Some settings involve strict protocols where the interpreter or translator is a totally
independent party, while others are marked by cooperation and shared responsibilities.
Interpreters and translators must be familiar with these contexts, and endeavour to
have the people they work with understand their role.
In mental health research, the term ‘supervision’ is sometimes used to describe how
interpreters can work with others. This term is used in two different ways, and both ways differ
from its lay meaning that suggests a relationship in which one person occupies a superordinate
role and ‘supervises’ another person who occupies a subordinate role.
In sign language interpreting (Dean, Pollard and English, 2004), the term ‘supervision’ refers
to counselling and therapy that an interpreter has with a person outside the mental health
interaction, i.e. not with the mental health professional that s/he is working with. The purpose
of supervision used in this meaning is to provide protections for the interpreter and his/her own
mental health in relation to distressing situations and work-related stress.
In descriptions of spoken language interpreting, the term ‘supervision’ has been used to refer
to something else, namely working with the mental health professional within the mental health
interaction. A psychotherapist working with multilingual clients (mainly users of spoken
LOTEs), Beverley Costa, advocates supervision for “counsellors and interpreters who want to
work together collaboratively” (Costa, 2017: 56). Interpreters and counsellors may form a
relationship of supervision not only for the sake of the interpreted mental health interaction,
but for the well-being of the interpreter in it, and for the interpreter to work effectively with the
patient and the mental health professional. Costa (2017) advocates that supervision between
mental health professional and interpreter should contain three elements: (i) safety, trust and
confidence; (ii) triangular dynamics and emotional impact; and (iii) collaborative practice.
This form of supervision that relates to a relationship between the interpreter and the mental
health interpreters, is not binding or required of an interpreter. However, where an interpreter
works frequently with the same mental health professional, or with professionals at the same
mental healthcare facility, an interpreter may consider entering into a relationship of
collaborative supervision with others. This relationship may include: formal preparation in
regard to the purposes of an interaction, knowledge about the models of therapeutic
orientation and therapeutic interventions that will be applied in the interaction, awareness of
models of Transactional Analysis in describing human behaviour in therapy interactions
(Costa, 2016), or the dynamics that can occur “in the triangular relationship between
counsellor, client and interpreter, and… the ways in which power shifts around the triangle,
how it is negotiated and to explain the pushes and pulls experienced by all three members
involved” (Costa, 2017: 59).
It is again important to note that this embedded notion of supervision is something that
interpreters may consider in some mental health interactions where they believe that this can
assist them in the performance of their work as a mental health interpreter and address self-
care concerns that can arise from mental health interactions. It is important to note that
interpreters who engage in this form of embedded supervision still maintain an understanding
with others of their role and the boundaries of this role. Collaborative supervision should not
19
replace professional development; a mental health interpreter is required to develop his/her
professional knowledge in a general and a specific sense, drawing on training or self-
instruction resources provided from many perspectives.
8. Professional Development
Professional development, additional to training in health and mental health interpreting, is

required of interpreters today. The ASLIA-GIMHS recommends that this be a pre-requisite
before an interpreter undertakes any mental health interpreting work:
… no Auslan-English interpreter or DI [Deaf Interpreter] should work in a mental health

setting without first undergoing a minimum of 25 hours of professional development
that specifically addresses the multi-faceted nature of the mental health context. (2011:
5).
Professional development can take the form of self-directed activities, including acquisition of
content knowledge, features of discourse and so on, as recommended by the ASLIA-GIMHS:
ASLIA recommends that MH interpreters undertake ongoing reading and/or

professional development in order to develop an understanding of psychopathology,
the range of therapeutic frameworks utilised in mental health settings as well as the
task of language transfer in such settings (e.g. how discourse may vary in mental health
settings, the source language terminology that may be used and its possible
equivalence in the target language, etc. (2011: 5)
In order to move in and out of the many and varied settings that comprise “mental
health interpreting”, it is necessary to actively engage in the gaining of knowledge about
the fields of psychology and psychiatry as these disciplines include many differing
theoretical methodologies and approaches. Currency in these is essential to enabling
effective interpretation to occur. (2011: 6)
9. Professional Solidarity
This principle refers to the support that mental health interpreters, like all interpreters, extend
to each other and to further the interests of the profession. Assistance to others in the area of
mental health can be in the form of exchange of content knowledge, descriptions of practices,
exchange of information on protocols and a sharing of views on ethical perspectives. Such
exchanges do not contain information that could identify people, groups, institutions and the
principle of confidentiality is still upheld during such exchanges.
20
IV. SELF-CARE IN MENTAL HEALTH INTERPRETING
Briefings and de-briefings are necessary for the interpreter to work well in mental health
interactions. However, they are not always provided. Briefings and de-briefings should be
viewed as part of the interpreted session. De-briefings allow the interpreter to bring up issues
that relate to the interpreted interaction. These may include the speech/signing of the patient
that the interpreter may have difficulty understanding or rendering into spoken English. These
may also include re-visiting difficult situations in which the patient was distressed or appeared
to be traumatised. Discussion and reflection on these can assist an interpreter in dealing with
and managing an interaction that was upsetting or highly stressful (Diehm & Roland, 2015).
Mental health interpreters, like mental health professionals, are exposed to stressful situations
on a regular basis through the nature of their work. The cumulative effect of their work can
have a negative effect on their own mental health. Interpreters, like mental health
professionals, are exposed to the same risks of developing secondary traumatic stress (STS),
vicarious trauma (VT) and burnout. The symptoms of STS are intrusion, avoidance and hyper-
arousal. Intrusion is the inability to keep memories of an event from returning. Avoidance is
the investment of effort to escape or obviate dealing with a stressor. Hyper-arousal is an
elevated level of anxiety, animation or vigilance, whose symptoms include insomnia, irritability,
inability to concentrate and jumpiness.
There are ‘conventional’ ways to deal with work-related stress, such as engaging in activities
that are removed from work, and that distract or stimulate a person in other ways, eg. listening
to music, physical exercise, meditation. These strategies can often deal with stress
encountered and lead to a management of the stress so that the interpreter is still able to work
and not suffer an uncomfortably high level of discomfort. However, these conventional ways
of ‘winding down’ from difficult situations at work do not always alleviate, let alone resolve a
high level of work-related stress.
A high level of work-related stress, or the cumulative effect of working in distressing and
stressful situations, due to the behaviour of others or other factors, is STS, which can lead to
burnout. Burnout is associated with emotional exhaustion (e.g. low energy levels, depleted
emotional resources), depersonalisation (e.g. detachment in response to some aspects of
employment), and reduced personal accomplishment (e.g. negative self-evaluation).
Where mental health interpreters experience STS that may then develop to VT or even
burnout, they should consider professional counselling services, for example via the Employee
Assistance Program (EAP). The EAP is available in public healthcare facilities across Australia
and is available to in-house interpreters working at these. Freelance interpreters who accept
contracted assignments have, at present, variable access to EAP, depending on the Language
Services Providers with whom they are contracted. Having a self-care pathway identifying the
types of assistance available for the different issues that arise is an important feature for
interpreter self-care and well-being. The ASLIA-GIMHS guidelines are clear in multiple places
about the importance of self-care, reflection on health issues, and:
… it is strongly recommended that all MH interpreters undergo professional supervision

as a minimum standard of practice. It is further recommended that MH interpreters also
undergo regular therapeutic work of their own as this will not only enhance an
understanding of the clinical setting, it will – more importantly – provide them with a
21
vehicle for personal reflection to manage the demands of their own inner world and its
interaction with the demands of interpreting in mental health settings. (2011: 5)
22
V. CONTENT KNOWLEDGE
Interpreters need to acquire a knowledge base relevant to mental health interactions. These
include: settings, mental health personnel, mental health illnesses, mental health symptoms
and services, and treatment of mental health illnesses.
Settings
Mental health interactions can take place in a variety of settings. These include diagnostic
testing at a patient’s home or in a health care facility, counselling sessions for patients who
have experienced trauma, torture, or who have witnessed these and experienced secondary
trauma. Other settings include medication-check updates, group therapy, creative therapy
(music, art or drama therapy), family conferences, peer-support group sessions, pre-discharge
sessions.
The rehabilitation of a patient living a mental illness, such as alcoholism or drug/substance

abuse may involve treatment inside and outside healthcare facilities, and on-going monitoring.
Aged-related mental health illnesses such as dementia and Alzheimer’s Disease are
increasing in frequency due to higher rates of self-reporting or detection and an ageing society.
Settings associated with aged-related mental health interpreting include diagnosis, capacity-
ascertainment, assessment of lifestyle features, support and management services. In relation
to diagnosis, this may determine the content and purpose of a mental health interpreting
setting, such as the administration of the mini-mental status examination (MMSE), application
of the Rowland Universal Dementia Assessment Scale (RUDAS), Alzheimer’s Disease
Assessment Scale – Cognitive (ADAS-Cog) or even the administration of neuropsychological
tests.
The practice of pharmacotherapy (therapy using pharmaceutical drugs) is common in many

mental health settings, and in psychiatry, the use of psychoactive (chemical substance) drugs
such as anti-anxiety drugs, anti-depressant drugs, anti-psychotic drugs or mood stabilisers is
common. In psychiatric settings, communication between a mental health professional and a
patient may be focussed on dosage, desired effect, reactions and side effects of chemical
drugs taken by the patient.
Less commonly, the setting may include physical interventions such as electro-convulsive
therapy, or instances of psychosurgery (bilaterial cingulotomy or deep brain stimulation).
In some instances, the setting may be focussed on the elicitation of a patient’s capacities for
the completion of a neuropsychological or psychiatric report. The purpose of this report may
be for an application of guardianship for a patient, or it may be instigated by a work place to
determine work suitability or capacity. It is important to distinguish the other participants in a
setting and the role that they perform. A setting in which neuropsychological testing takes
place, administered by a neuropsychologist is a mental health interpreting setting. However,
at a tribunal where a tribunal member (presiding officer) requests the submission of a
neuropsychological report and interacts with a person with a mental health illness for the
purposes of establishing the need for a power of attorney or a guardian, such a setting is not
primarily a mental health setting, but a court setting.
23
In other cases, particularly where intervention is requested by others, a mental health
interpreter may be working with a Crisis Assessment and Treatment Team (CATT) who assess
the likelihood or self-harm, harm to others, and the need for possible involuntary treatment. A
decision on involuntary treatment may lead to the need for a patient’s circumstances to be
decided by a mental health review board or mental health tribunal. The Mental Health Tribunal
(formerly Mental Health Review Board) is made up of (in Victoria) a legal member (lawyer), a
community member (member of the public) and medical or psychiatrist member (doctor). (The
designations and website addresses of the equivalent authorities for each of the states and
territories in Australia are given in the Appendix 1.) The medico-legal features of the Mental
Health Tribunal distinguish it as a mental health interpreting setting. (Further information on
the contents of legislation relevant to mental health patients in all Australian states and
territories is contained in Appendix 2.)
In other instances, a legal interaction may be the precursor to what turns out to be a mental
health interaction. For instance, a person may appeal against a decision for him/her to not be
awarded workers compensation for (physical or mental) injuries suffered at the workplace.
Such an appeal may need to go before a Medical Panel (in Victoria) that consists only of
doctors. Where an appellant has mental health problems and these are the subject of the
appeal, this distinguishes such a setting as a mental health interpreting setting.
Lastly, the setting may be strongly shaped by its urgency, such as working with emergency
services: ambulance, police, fire brigade. In emergency situations, triage is the process by
which emergency services staff, either remotely (by telephone or video link) or in person
determine the priority of a patient’s treatment based on the severity of the condition.
Services
Services in mental health care in Australia encompass, in broad terms, the following:
- emergency services (acute mental health initial assessment and screening);
- inpatient and ambulatory services;
- outpatient services;
- clinical health services;
- disability rehabilitation and support services; and
- medico-legal services.
Health professionals attempt to achieve a variety of objectives through the provision of a range
of mental health services. These services are usually divided into child & adolescent services,
adult services, aged person services, and specialist services. Support and specialist services
include disability services, drug and alcohol services, housing and accommodation services,
income support services, recreation, and carer programs.
In Australia, there are a number of public organisations or services that provide information to
a general, non-specific audience about mental health conditions. These include the following:
- Anxiety conditions: anxiety; generalised anxiety disorder; social anxiety; agoraphobia;

obsessive compulsive disorder; post-traumatic stress disorder; panic disorder
24
(mindhealthconnect - http://www.mindhealthconnect.org.au/) (beyondblue -
https://www.beyondblue.org.au/)
- Personality disorders: personality disorder; borderline personality disorder; narcissistic

personality disorder (mindhealthconnect - http://www.mindhealthconnect.org.au/)
- Mood disorders: depression; bi-polar (mindhealthconnect -

http://www.mindhealthconnect.org.au/)
- Psychotic disorders: schizophrenia; psychosis; paranoia (mindhealthconnect -

- Eating disorders: bulimia; anorexia nervosa; disordered eating (mindhealthconnect -

- Depression; suicide prevention; supporting others; self-harm and self-injury;

pregnancy and early parenthood; grief and loss; drugs, alcohol and mental health.
(beyondblue - https://www.beyondblue.org.au/)
- Dementia, memory loss and Alzheimer’s disease (Alzheimer’s Australia -

(https://www.fightdementia.org.au/)
In addition, there are other services that are intended for age-specific groups, eg. KidsMatter
(http://www.kidsmatter.edu.au/) for children of primary school age, and headspace
(https://www.eheadspace.org.au/) for young people aged 12-25 or for their family for them to
contact a qualified youth mental health professional.
Terms and definitions used for mental health illnesses (including the terms ‘mental
conditions’ and ‘mental disorders’)
In hospital and clinical mental health settings in Australia, there are two diagnostic manuals
that are currently in use. The first is published by the American Psychiatric Association, the
Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). The second is
published by the World Health Organization (WHO), the International Classification of
Diseases: Classification and Mental and Behavioural Disorders 10th Revision (ICD-10). The
following information is taken from the WHO (2010) website on “Mental and Behavioural
Disorders”. The ICD-10 groups mental and behavioural disorders into ten categories, cited
here from WHO (2010):
1. Organic, including symptomatic, mental disorders
Mental disorders grouped together on the basis of their having in common a

demonstrable aetiology in cerebral disease, brain injury, or other insult leading to
cerebral dysfunction. The dysfunction may be primary, as in diseases or injuries.
Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive

nature, in which there is disturbance of functions, including memory, thinking,
orientation, comprehension, calculation, learning capacity, language, and judgement.
25
This syndrome occurs in Alzheimer's disease, in cerebrovascular disease, and in other
conditions primarily or secondarily affecting the brain.
2. Mental and behavioural disorders due to psychoactive substance use
Disorders that differ in severity and clinical form but that are all attributable to the use
of one or more psychoactive substances, which may or may not have been medically
prescribed.
Identification should be based on as many sources of information as possible. These

include self-report data, analysis of blood and other body fluids, characteristic physical
and psychological symptoms, clinical signs and behaviour, and other evidence such
as drugs being in the patient's possession or reports from informed third parties. Many
drug users take more than one type of psychoactive substance.
3. Schizophrenia, schizotypal and delusional disorders
This includes schizophrenia, as the most important member of the group, persistent
delusional disorders, and a larger group of acute and transient psychotic disorders.
Schizoaffective disorders have been retained in spite of their controversial nature.
4. Mood [affective] disorders
This block contains disorders in which the fundamental disturbance is a change in

affect or mood to depression (with or without associated anxiety) or to elation. Most of
these disorders tend to be recurrent and the onset of individual episodes can often be
related to stressful events or situations.
5. Neurotic, stress-related and somatoform disorders
A group of disorders in which anxiety is evoked only, or predominantly, in certain well-

defined situations that are not currently dangerous. The patient's concern may be
focused on individual symptoms like palpitations or feeling faint and is often associated
with secondary fears of dying, losing control, or going mad. Contemplating entry to the
phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression
often coexist.
6. Behavioural syndromes associated with physiological disturbances and physical

factors
The behavioural syndromes and mental disorders included in this classification are
associated with physiological dysfunction and hormonal changes in the body. They
include eating disorders and non-organic sleep disorders.
7. Disorders of adult personality and behaviour
This block includes a variety of conditions and behaviour patterns of clinical

significance which tend to be persistent and appear to be the expression of the
individual's characteristic lifestyle and mode of relating to himself or herself and others.
Specific personality disorders, mixed and other personality disorders, and enduring
26
personality changes are deeply ingrained and enduring behaviour patterns,
manifesting as inflexible responses to a broad range of personal and social situations.
They represent extreme or significant deviations from the way in which the average
individual in a given culture perceives, thinks, feels and, particularly, relates to others.
8. Mental retardation
A condition of arrested or incomplete development of the mind, which is especially

characterized by impairment of skills manifested during the developmental period,
skills which contribute to the overall level of intelligence, i.e. cognitive, language, motor,
and social abilities. Retardation can occur with or without any other mental or physical
condition.
9. Disorders of psychological development
The disorders included in this block have in common: (a) onset invariably during
infancy or childhood; (b) impairment or delay in development of functions that are
strongly related to biological maturation of the central nervous system; and (c) a steady
course without remissions and relapses. In most cases, the functions affected include
language, visual-spatial skills, and motor coordination.
10. Behavioural and emotional disorders with onset usually occurring in childhood and
adolescence
A group of disorders characterized by an early onset (usually in the first five years of
life), lack of persistence in activities that require cognitive involvement, and a tendency
to move from one activity to another without completing any one, together with
disorganized, ill-regulated, and excessive activity. Hyperkinetic children are often
reckless and impulsive, prone to accidents, and find themselves in disciplinary trouble
because of unthinking breaches of rules rather than deliberate defiance. Their
relationships with adults are often socially disinhibited, with a lack of normal caution
and reserve. They are unpopular with other children and may become isolated.
(Source: WHO, 2010)
Treatment of mental illnesses
Section I above identifies and describes mental health professionals (psychologists, mental
health nurses, counsellors etc.) performing different roles and working in a variety of settings.
Below are scenarios of practices followed by mental health professionals that shape the work
that mental health interpreters perform.
When interviewing for specific disorders, e.g. depression or manic behaviour, a mental health
professional will ask the patient to describe his/her mood, thoughts about the future, sleeping
and eating patterns, thoughts about self-harm or harm to others. When the focus is on
substance abuse, for example, the questions will explore the types of substances, exact
quantities and situations when the substances are used. Questions focusing on anxieties and
phobias will elicit descriptions of physical symptoms, and those relating to psychoses on
descriptions of hallucinations and delusions experienced by the patient (Pollard, 1998).
27
The initial mental health diagnostic interview provides a benchmark against which information
obtained in follow-up interviews or reviews during treatment are measured. Reviews focus on
the patient's description of changes to the mental health and/or physical symptoms,
specifically whether there has been an improvement, a deterioration or no change. The mental
health professional may also follow up on general questions regarding the patient's current life
situation, to find out if the treatment has had an impact on the patient's everyday life. Therefore,
in an interpreted mental health diagnostic interview the mental health professional relies on
the interpreter for a complete re-presentation of the patient's language and ideas to make a
correct diagnosis and to monitor the effects of the treatment plan.
A mental health treatment plan can include a combination of therapies. These will depend on
the diagnosis. As stated above, some mental illnesses require the use of medication
(pharmacotherapy). Some commonly used medications include anticonvulsants (mood
stabilisers), antidepressants, and antipsychotics. Medication may be prescribed to be taken
orally (tablets), as patches, or in the form of injections.
Another type of treatment is talk therapy. There are many types of talk therapy, and they all
focus, in different ways, on helping the patient understand how their symptoms are affecting
their everyday life and empowering them to make positive changes. Some forms of talk
therapy are conducted in one-on-one sessions, while others may be conducted in the form of
group therapy.
Some of the more common types of talk therapy are psychodynamic therapy, Cognitive
Behavioural Therapy (CBT), Dialectal Behavioural Therapy (DBT), gestalt therapy,
relationship counselling, grief counselling, and addiction counselling are described below:
- Psychodynamic therapy (also known as classic psychotherapy) focuses on the

patient's past to determine the origin of the mental health problems.
- In CBT the focus is on understanding how thought can influence behaviour, and how
changing one's thoughts can change behaviour. CBT is frequently used to treat
phobias, anxiety, depression and addictions.
- DBT teaches stress and emotion management and coping mechanisms, and
improving relationships. DBT involves skills training, acknowledging thoughts which
are usually avoided, as well as cognitive therapy and behaviour changes.
- Gestalt therapy is a humanistic and existential therapy that focuses more so on

process (what is happening) over content (what is being talked about). The main goal
of gestalt therapy is change through self-awareness, with emphasis on what is current
being experienced somatically.
- Relationship counselling is offered for problems involving families, marriages and

partnerships. Family therapy (also known as Family and Systemic Psychotherapy)
engages the whole family system as a functioning unit. Social context, communication
and relationships hare given primary importance in this therapy.
- Grief counselling is indicated following a loss, change or death.
28
- Addiction counselling addresses various types of addition, e.g. internet addition,
gambling, or substance abuse.
29
VI. PATIENTS' RIGHTS AND LEGAL TERMS
Patients have rights in relation to their power to decide on a form of treatment, information
provided to them to make this decision, to access of their medical records as well as other
rights. In regard to the rights of patients with mental health conditions, it is recommended that
an interpreter working in mental health settings familiarise him-/herself with descriptions of
patients’ rights in relevant authorative documents such as the Mental Health Act, the
Declaration of Human Rights and the Australian Health Care Charter. It is also recommended
that an interpreter be familiar with governmental, state or institution policies or guidelines in
regard to the provision of language services. Relevant sections of legislation, charters, policy
directives or guidelines are provided below together with the implications that these have on
the provision of interpreting services and how the interpreter works.
Amongst others, an important right is the right to an interpreter where one is requested or
needed. The national Australian Charter of Healthcare Rights (2008) states that patients have
“a right to be informed about services, treatment, options and costs in a clear and open way”,
with an even clearer message issued in the 2nd person: “You can use interpreters if English
is not your first language. Interpreter services are free and can be provided in person or by
phone” (Australian Commission on Safety and Quality in Healthcare, 2015: 2).
Most states and territories also have clear policies about access to an interpreter. For example,
the Australian Charter of Healthcare Rights in Victoria (Department of Health and Human
Services, 2016) is very clear in defining patients’ rights: “You have a right to an accredited
interpreter if you need one when using a publicly-funded healthcare service, such as a
hospital or community health centre” (2016: 9, original emphasis) and “Interpreters should be
provided at important points during your care, such as when discussing medical history,
treatments, test results, diagnoses, during admission and assessment and when you are
required to give informed consent” (2016: 12).
Mention of the provision of interpreters in mental health laws
Within the area of law and mental health, individual states and territories have legislation that
may or may not include mention of the provision of interpreters. In Victoria, the Mental Health
Act 2014 (Part 1, Section 8) requires an interpreter to be provided at the point of admission,
and at other points where permission for treatment is requested: “any advice, notice or
information given or provided to a patient under this Act [i.e. sanctioned actions undertaken
by mental health professionals] must be explained by the person giving the advice, notice or
information to the maximum extent possible to the patient in the language, mode of
communication and terms which the patient is most likely to understand.” The wording of this
section relates to the perceptional or cognitive capability of mental health patients. This
wording is widely understood and applied to the situation of LEP patients in a way that
interpreters are requested for such interactions. The need for interpreters is set out in Part 8,
Division 5, Section 185 of the Victorian Mental Health Act 2014. Equivalent acts exist in other
Australian states and territories, usually with congruent descriptions of the need for interpreting
services. In terms of therapeutic treatments provided for a mental health patient, the content
of legislation can have consequences on the decisions made in relation to mental health
30
patients (Kämpf, 2013). This is very often the case in relation to involuntary treatment
decisions (Kämpf, 2010).
Legal terms
The Victorian Mental Health Act 2014 has sections that define key words. These words have
specific meanings in the legislation and are used in specific contexts. Interpreters are
encouraged to become acquainted with these terms and concepts, their definitions and
LOTE equivalents through self-directed study. A selection of key legal terms are presented
below (adapted from Victorian Legal Aid, 2016).
protection of rights: for patients, e.g. statement of rights, right to communicate, advance
statements, nominated persons.
involuntary / compulsory patients: a person subject to:

a) an assessment order;
b) an court assessment order;
c) a temporary treatment order, treatment order.
involuntary treatment order (community or inpatient):

temporary treatment order (authorised psychiatrist, 28 days max – or potentially 42 if
the tribunal extends it in light of exceptional circumstances);
treatment order (Mental Health Tribunal, if <16yo, max 3 months, if 16 and over,
duration max 12 months community, 6 months inpatient)
assessment order: 24 hrs or 24 hrs after admission (and possibly up to 96 hours) for
inpatients made by doctor or mental health practitioner if person meets assessment order
criteria, allows for compulsory examination and detention (if inpatient)
Note: Criteria only requires a person to ‘appear to have mental illness’.
treatment criteria: the treatment criteria for a person to be made subject to a temporary
treatment order or treatment order are -
a) the person has mental illness; and
b) because the person has mental illness, the person needs immediate treatment to
prevent:
(i) serious deterioration in the person's mental or physical health, or
(ii) serious harm to the person or to another person; and
c) the immediate treatment will be provided to the person if the person is subject to a
temporary treatment order or treatment order; and
d) there is no less restrictive means reasonably available to enable the person to
receive the immediate treatment.
advance statement: an advance statement is a document that sets out a person's

preferences in relation to treatment in the event that the person becomes a patient.
nominated person: the role of a nominated persion in relation to a patient is to

provide the patient with support and to help represent the interests of the patient; and
31
receive information about the patient (in accordance with this Act); and be one of the
persons who must be consulted (in accordance with this Act) about the patient's treatment;
and assist the patient to exercise any right that the patient has under this Act.
presumption of capacity: a person is deemed to have capacity to give informed consent if

the person understands, is able to remember and use information relevant to the decision
and is able to communicate their decision. A person on a treatment order can still be given
treatment against his/her wishes, even if s/he has capacity, if certain criteria are met.
informed consent: a person gives this if s/he -

a) has the capacity to give informed consent to the treatment or medical treatment
proposed;
b) has been given adequate information to enable the person to make an informed
decision;
c) has been given a reasonable opportunity to make the decision;
d) has given consent freely without undue pressure or coercion by any other person;
and
e) has not withdrawn consent or indicated any intention to withdraw consent.
restrictive interventions: e.g. notification of use, seclusion, bodily restraint.
complaints (and grievances): e.g. Mental Health Complaints Commissioner, complaints

management, conciliation, investigations, compliance notices.
These and other terms are presented in the context of legislation and in greater detail in
Appendix 2. Appendix 2 contains 13 tables that set out key words and legal definitions
contained in State and Territory legislation in Australia that relate to features of mental
illnesses and mental health therapies. Included in Appendix 2 are exclusion criteria from
definitions of mental disorders or disturbances and the legal definitions for ‘involuntary
treatment orders’ that are administered without the consent of the patient.
32
APPENDICES
Appendix 1 – List of medico-legal tribunals relevant to mental health
Official judicial bodies powers of each state and territory that conduct mental health inquiries,
make and review orders, and hear appeals about the treatment and care of people with a
mental illness:
ACT – Australian Capital Territory Civil & Administrative Tribunal – Mental Health
https://www.acat.act.gov.au/application-type/mental_health
NSW – Mental Health Review Tribunal

http://www.mhrt.nsw.gov.au/the-tribunal/
NT - Mental Health Review Tribunal

https://nt.gov.au/law/courts-and-tribunals/mental-health-review-tribunal
QLD - Mental Health Review Tribunal

https://www.mhrt.qld.gov.au/
SA – South Australian Civil and Administrative Tribunal – Mental Health

http://www.sacat.sa.gov.au/types-of-cases/mental-health
TAS – Mental Health Tribunal

http://www.mentalhealthtribunal.tas.gov.au/
VIC – Mental Health Tribunal

http://www.mht.vic.gov.au/
WA – State Administrative Tribunal – Mental Health Appeals

http://www.sat.justice.wa.gov.au/M/mental_health_appeals.aspx
33
Appendix 2 – Mental health legislation in Australian states and territories
This appendix contains 13 tables.
Table 1 contains key words or definitions (purposes and objectives) found across mental
health legislation from all States and Territories. There is some variation in the key words or
definitions used from jurisdiction to jurisdiction, and in some States or Territories a more
detailed description of the purposes and objectives of mental health legislation is given, while
in others this is shorter.
Table 2 contains definitions of what a ‘mental illness’ in legal terms. These definitions come
from legislation from all States and Territories known as the Mental Health Act.
Table 3 contains a comprehensive list of diagnostic criteria of mental illness and the
representation of these criteria in each State’s or Territory’s respective legislation.
Table 4 contains regulations from ACT, NSW and NT that are supplementary to the definition
of a mental illness. In these supplementary regulations the definitions of a ‘mental disorder’
(ACT, NSW) and ‘mental disturbance’ (NT) are described.
Table 5 contains a comprehensive list of exclusion criteria by which a mental illness is not
diagnosed. Table 4 shows the representation of exclusion criteria in each State’s or Territory’s
respective legislation.
Tables 6-13 contain regulation on medical treatment that can be given to a patient without the
patient’s consent. This regulation is known as ‘treatment order’ (ACT) or ‘involuntary treatment’
(NSW, NT, QLD, SA, TAS, VIC, WA). For each State and Territory information from the
regulations is provided in relation to definition of self-harm and of harm to others.
The author would like to acknowledge the contribution of Annegret Kämpf for the collation of
mental health legislation from Australian states and rerritories.
34
Table 1: The Purpose and Objectives of the Mental Health Legislation
legislative terminology ACT NSW NT Qld
main provisions 5, 6 3 3 3
additional provisions 7, 8 68 9-13 5
provision of care and 5(c) 3(a), 68(b) 3(a) 5(l)

treatment
protection of rights 5(d) 3(d) 3(a) 3(2)(a)
rehabilitation/recovery 5(a), 6(j)(v) 3(a), 68(d) 3(2)(c), 5(k)
access to services 5(d), 5(f), 6(e) 3(d)
information about rights 8(b) 68(i) 3(j), 9(d) 5(d)
respect to will and 6(d), 6(j)(iii) 68(h) 5(b)

preferences
informed consent 6(b), 6(g), 68(h1) 3(d), 7, 9(j) implied

6(h), 6(j)(i)
promotion of capacity 5(b), 6(j)(iv)
presumption of capacity 6(i), 8(1)(b) 5(b)
decision-making capacity 7, 8 68(h1) 3(1)(a), 14
self-determination/self- 5(b), 6(c) 5(e)

reliance
own choices 5(e), 5(f), 5(g), 68(e) 9(g), 9(m) 5(b)

7(c), 7(d),
6(j)(ii)
participation 5(b),5(e), 6(g) 3(e) 9(g)
support 5(b), 5(c), 5(f), 68(e), 68(h1) 5(c), 5(d), 5(j)

5(g), 6(g),
6(h), 6(j)(ix),
8(1)(c), 8(1)(d)
support to exercise rights 6(j)(viii), 8(b) 5(c), 5(d), 5(j)
voluntary services 3(c) 3(c), 9
35
legislative terminology ACT NSW NT Qld
additional provisions 7, 8 68 9-13 5
principle of least restriction 5(c) 68(a), 68(f) 8(a)-(c) 3(2)(b), 3(3), 13
human rights 5(d) rights and 3(d) civil rights 3(a) civil rights human rights
inherent
8(b) liberty,
dignity
rights, dignity,
6(a) same privacy and
rights self-respect
6(f)(ii) rights, 8(c) autonomy
liberty, dignity,
autonomy and
self-respect
best interests 8(3) best interests
36
Table 1: The Purpose and Objectives of the Mental Health Legislation (continued)
legislative terminology SA Tas Vic WA
additional provisions Sched 1 11 Sched 1
provision of care and 12(a) 10(b) 10(1)(a)(i)

treatment
protection of rights 12(b) 10(c) Sched 1 A
rehabilitation/recovery 6(a)(i), 7(a) Sched 1(f) 10(f), 11(1)(b)
access to services
information about rights 7(i) 10(g) Sched 1 P13
respect to will and Sched 1(m) 11(1)(b) [8]

preferences
informed consent [68] [16]
promotion of capacity [68, 69] [13]
presumption of capacity [70]
decision-making capacity [68, 69]
self-determination/self- Sched 1 P3
reliance
own choices 12(e), Sched 11(1)(d) Sched 1 P12

1(j)
Participation 7(a) 10(d)(i),

11(1)(b)
Support [11(1)(k), Sched 1 P4

11(1)((l)]
support to exercise rights 10(d)(ii)
voluntary services 7(b) 11(1)(a)
37
Table 2: The Definition of Mental Illness
Mental Health Act 2015 (ACT)
Mental illness means a condition that seriously impairs (either temporarily or permanently)
the mental functioning of a person in one or more areas of thought, mood, volition,
perception, orientation or memory, and is characterised by –
(a) the presence of at least one of the following symptoms:
s 10
(i) delusions;
(ii) hallucinations;
(iii) serious disorders of streams of thought;
(iv) a severe disturbance of mood;
(b) sustained or repeated irrational behaviour taken to indicate the presence of at
least 1 of the symptoms mentioned in paragraph (a).
Mental Health Act 2007 (NSW)
Mental illness means a condition that seriously impairs, either temporarily or permanently,
the mental functioning of a person and is characterised by the presence in the person of
any one or more of the following symptoms:
(a) delusions,
s4
(b) hallucinations,
(c) serious disorder of thought form,
(d) a severe disturbance of mood,
(e) sustained or repeated irrational behaviour indicating the presence of any one or
more of the symptoms referred to in paragraphs (a)–(d).
(1) A person is a mentally ill person if the person is suffering from mental illness and,
owing to that illness, there are reasonable grounds for believing that care,
treatment or control of the person is necessary:
(a) for the person’s own protection from serious harm, or
s 14
(b) for the protection of others from serious harm.

(2) In considering whether a person is a mentally ill person, the continuing condition of
the person, including any likely deterioration in the person’s condition and the
likely effects of any such deterioration, are to be taken into account.
38
Table 2: The Definition of Mental Illness (continued)
Mental Health and Related Services Act 2009 (NT)
(1) A mental illness is a condition that seriously impairs, either temporarily or

permanently, the mental functioning of a person in one or more of the areas of
thought, mood, volition, perception, orientation or memory and is characterised:
(a) by the presence of at least one of the following symptoms:
(i) delusions;
(ii) hallucinations;
s6
(iii) serious disorders of the stream of thought;

(iv) serious disorders of thought form;
(v) serious disturbances of mood; or
(b) by sustained or repeated irrational behaviour that may be taken to indicate
the presence of at least one of the symptoms referred to in paragraph (a).
(2) A determination that a person has a mental illness is only to be made in
accordance with internationally accepted clinical standards.
Mental Health Act 2016 (Qld)
(1) Mental illness is a condition characterised by a clinically significant disturbance of

s 10
thought, mood, perception or memory.

(4) On an assessment, a decision that a person has a mental illness must be made in
accordance with internationally accepted medical standards.
39
Table 2: The Definition of Mental Illness (continued)
Mental Health Act 2009 (SA)

s3
Mental illness means any illness or disorder of the mind.
Mental Health Act 2013 (Tas)
(1) For the purposes of this Act –

(a) a person is taken to have a mental illness if he or she experiences,
s4
temporarily, repeatedly or continually –

(i) serious distortion of perception or thought; or
(ii) a serious impairment of mood, volition, perception or cognition.
Mental Health Act 2014 (Vic)
(1) Mental illness is a medical condition that is characterised by a significant

disturbance of thought, mood, perception or memory.
s4
(3) Subsection (2)(l) does not prevent the serious temporary or permanent
physiological, biochemical or psychological effects of using drugs or consuming
alcohol from being regarded as an indication that a person has mental illness.
Mental Health Act 2014 (WA)
(1) A person has a mental illness if the person has a condition that –
(a) is characterised by a disturbance of thought, mood, volition, perception,
orientation or memory; and
s6
(b) significantly impairs (temporarily or permanently) the person’s judgment or

behaviour.
(4) A decision whether or not a person has a mental illness must be made in
accordance with internationally accepted standards prescribed by the regulations
for this subsection.
40
Table 3: The Diagnostic Criteria of Mental Illness
ACT NSW NT Qld
- impairment of
- thought serious serious serious significant
- mood serious serious serious significant
- volition serious serious
- perception serious serious significant
- cognition
- orientation serious serious
- memory serious serious significant
- characterised by diagnostic criteria

(symptoms)
- delusions + + +
- hallucinations + + +
- serious disorder of thought form + + +
- serious disorder of mood + + +

- characterised by sustained or repeated
irrational behaviour indicating the
+ + +
presence of at least one of the
symptoms referred to above
- impairment of judgment or behaviour
Mental Health Act, ss 10 4 6 10
41
Table 3: The Diagnostic Criteria of Mental Illness (continued)
SA Tas Vic WA
diagnostic criteria (any of these)
- disturbance of
- thought serious significant any
- mood serious significant any
- volition serious any
- perception serious significant any
- cognition serious
- orientation any
- memory significant any
- characterised by diagnostic criteria

(symptoms)
- delusions
- hallucinations
- serious disorder of thought form
- serious disorder of mood

- characterised by sustained or repeated
irrational behaviour indicating the
presence of the symptoms referred to
above
- impairment of judgment or behaviour significant
42
Table 4: The Definition of Mental Disorder or Mental Disturbance
mental disorder, s 9
"Mental disorder"
ACT
(a) means a disturbance or defect, to a substantially disabling degree, of perceptual

interpretation, comprehension, reasoning, learning, judgment, memory, motivation
or emotion; but
(b) does not include a condition that is a mental illness.
mental disorder, s 15
A person (whether or not the person is suffering from mental illness) is a mentally
disordered person if the person’s behaviour for the time being is so irrational as to justify a
NSW
conclusion on reasonable grounds that temporary care, treatment or control of the person
is necessary:
(a) for the person’s own protection from serious physical harm, or
(b) for the protection of others from serious physical harm.
mental disturbance, s 15
The person's behaviour is, or within the immediately preceding 48 hours has been, so
irrational as to lead to the conclusion that:
(i) the person is experiencing or exhibiting a severe impairment of or deviation from his
NT
or her customary or everyday ability to reason and function in a socially acceptable

and culturally appropriate manner; and
(ii) the person is behaving in an abnormally aggressive manner or is engaging in
seriously irresponsible conduct that justify a determination that the person requires
psychiatric assessment, treatment or therapeutic care that is available at an
approved treatment facility.
43
Table 5: The Exclusion Criteria
text of the legislation ACT NSW NT Qld
exclusion criteria (not only because of

any of these)
- political or religious opinion or belief + + + +

- cultural opinion or belief + +
- political or religious activity + + +
- cultural activity +
- philosophy + + + +
- sexual preference, orientation or
+ + + +
promiscuity, sexual activity
- immoral or indecent conduct + + + +
- illegal conduct + + + +
- alcohol or other drug abuse + + + +
- intoxication
- economic or social status + + +
- cultural or racial group + + +
- antisocial behaviour + + + +
- intellectual/ behavioural
+
nonconformity
- sexual disorder + +
- intellectual disability + + +
- physical disability
- personality disorder or habit or
+
impulse disorder
- developmental disability of mind
- family conflict + +
- professional conflict +
- prior mental illness +
- prior involuntary status + +
- acquired brain damage +
44
Table 5: The Exclusion Criteria (continued)
text of the legislation SA Tas Vic WA
exclusion criteria (not only because of

any of these)
- political or religious opinion or belief + + + +

- cultural opinion or belief +
- political or religious activity + + + +
- cultural activity +
- philosophy + + + +
- sexual preference, orientation or
+ + + +
promiscuity, sexual activity
- immoral or indecent conduct + + +
- illegal conduct + + + +
- alcohol or other drug abuse + + +
- intoxication +
- economic or social status + + + +
- cultural or racial group + +
- antisocial behaviour + + + +
- intellectual/ behavioural
nonconformity
- sexual disorder
- intellectual disability + + +
- physical disability +
- personality disorder or habit or
impulse disorder
- developmental disability of mind +
- family conflict +
- professional conflict +
- prior mental illness + +
- prior involuntary status +
- acquired brain damage +
Mental Health Act, ss Sched 1 4 4 6
45
Table 6: The Requirements for Treatment Order (ACT)
ACT self-harm harm to others
no capacity
The person does not have decision-making capacity to consent to the treatment, care or
if ACAT's belief on reasonable grounds

support and refuses to receive the treatment, care or support.
s 58(2)(b)
OR
capacity
The person has decision-making capacity to consent to the treatment, care or support,
but refuses to consent.
AND
OR OR
The person is doing, or is likely The person is suffering, The person is doing, or
s 58(2)(c)
to do, serious harm to themself; or is likely to suffer, is likely to do, serious

serious mental or harm to someone else.
physical deterioration
AND if capacity
if ACAT is satisfied
ACAT must be satisfied
that the harm or
s 58(2)(d)
deterioration, or likely
harm or deterioration is
of such a serious nature
that it outweighs the
person's right to refuse
to consent).
- The person has a mental illness.

- The ACT Civil and Administrative Tribunal (ACAT) is satisfied that psychiatric treatment,
care or support is likely to
o reduce the harm or deterioration, or the likelihood of harm or deterioration, or
o result in an improvement in the person’s psychiatric condition.
- The ACAT is satisfied that the treatment, care or support to be provided under the
psychiatric treatment order cannot be adequately provided in another way that would
involve less restriction of the freedom of choice and movement of the person.
46
Table7: The Requirements for Involuntary Treatment (NSW)
NSW self-harm harm to others
A person is a mentally ill person.
[A person who is suffering from mental illness
if belief on reasonable grounds

and, owing to that illness, there are reasonable
grounds for believing that care, treatment or
control of the person is necessary:[
OR
ss 29, 51, 14
[for the person’s own protection from serious [or the protection of others
harm. from serious harm.]
In considering whether a person is a mentally ill
person, the continuing condition of the person,
including any likely deterioration in the person’s
condition and the likely effects of any such
deterioration, are to be taken into account.]
- With the approval of the Mental Health Tribunal following a mental health inquiry, ss34,
35.
47
Table 8: The Requirements for Involuntary Treatment (NT)
NT self-harm harm to others
if authorised by psychiatrist and Mental Health Tribunal

As a result of mental illness the person requires treatment and without the
treatment, the person is likely to cause
OR OR
serious harm to suffer serious serious harm to someone else.
him- or herself. mental of physical
deterioration.
AND
capacity
s 14
The person is not

capable of giving
informed consent
to the treatment or
has unreasonably
refused to consent
to the treatment.

- There is no less restrictive means of ensuring that the person receives the
treatment.
- The treatment is authorised by the Mental Health Tribunal.

OR
- The treatment is authorised by a psychiatric practitioner and treatment is
necessary:
(a) to prevent the person causing serious harm to himself or herself or to
someone else; or
s 55
(b) to behaviour of the person likely to cause serious harm to the person or to
someone else; or
(c) to prevent further physical or mental deterioration of the person; or
(d) to relieve acute symptomatology.
- Every practicable effort must be made to involve the person in considering the
nature and effect of the treatment and any alternatives that are reasonably
available.
(a) the treatment is in the best interest of the person;

(b) the anticipated benefits of the treatment outweigh any risk of harm or
discomfort to the person;
s 56
(c) alternative treatments that would be likely to produce equivalent benefits

and with less risk of harm are not reasonably available; and
(d) the treatment represents the least restrictive and least intrusive treatment
option reasonably available.
48
Table 9: The Requirements for Involuntary Treatment (Qld)
Qld self-harm harm to others
if treatment authority is satisfied

capacity
The person does not have capacity to consent to be treated for the illness.
AND
Because of the person's illness, the absence of involuntary treatment, or the
absence of continued involuntary treatment, is likely to result in
ss 48, 49, 12
OR
imminent serious harm to the person; imminent serious harm to others.
OR
the person suffering serious mental or
physical deterioration.

- There is no less restrictive way of ensuring that the person to receive care and treatment
for the person's mental illness.
49
Table 10: The Requirements for Involuntary Treatment (SA)
SA self-harm harm to others
Because of a person’s mental illness, the person requires treatment
if a psychiatrist or authorised medical practitioner is satisfied

OR
for the person’s own protection from harm for the protection of others from
(incl. harm involved in the continuation or harm.
deterioration of the person’s condition).

- The person requires treatment.
- There is no less restrictive means than detention and treatment order of ensuring
s 25
appropriate treatment of the person’s illness.

- The option of voluntary treatment or a community treatment order must be
considered.
50
Table 11: The Requirements for Involuntary Treatment (Tas)
Tas self-harm harm to others
capacity
if the Mental Health Tribunal is satisfied

The person does not have decision-making capacity
Without treatment, the mental illness will,

or is likely to, seriously harm
ss 39, 40
OR
the person's health or safety. the safety of other persons.

- The treatment will be appropriate and effective in terms of the outcomes referred to in
section 6(1).
- The treatment cannot be adequately given except under a treatment order.
51
Table 12: The Requirements for Involuntary Treatment (Vic)
Vic self-harm harm to others
Because the person has mental illness, the person needs immediate treatment to
the Mental Health Tribunal is satisfied

prevent
ss 5, 55
serious deterioration in the person's OR

mental or physical health
serious harm to another person.
OR
serious harm to the person

- The person will be provided immediate treatment.
- There is no less restrictive means reasonably available to enable the person to receive
the immediate treatment.
- The person's capacity to give informed consent must be considered in light of Part 5
Divisions 1-3.
52
Table 13: The Requirements for Involuntary Treatment (WA)
WA self-harm harm to others
capacity
The person does not demonstrate the capacity to make a treatment decision about
if a psychiatrist is satisfied
the provision of the treatment to himself or herself.
Because of the mental illness, there is –
OR
ss 24, 25
a significant risk to the health or safety of a significant risk to the safety of

the person; another person;
OR OR
a significant risk of serious harm to the a significant risk of serious harm to
person. another person.
- The person has a mental illness requiring treatment.

- The person cannot be adequately provided with treatment in a way that would involve
less restriction on the person’s freedom of choice and movement than making an
inpatient treatment order.
53
REFERENCES
Anderson, A. (2012). Interpreting Psychotherapy: Developing the Interpreter's Uncommon

Sense. Available at: http://works.bepress.com/arlynanderson/3
APS [Australian Psychology Society] (2013). Working with Interpreters: A Practice Guide for
Psychologists. Available at: https://www.psychology.org.au/practitioner/resources/
ASLIA [Australian Sign Language Interpreters Association] Code of Ethics and Guidelines
for Professional Conduct. (2007). Retrieved from https://aslia.com.au/wp-
content/uploads/2015/09/ASLIA-Code-of-Ethics.pdf
ASLIA [Australian Sign Language Interpreters Association] Guidelines for Interpreting in
Mental Health Settings. (2011). Retrieved from https://aslia.com.au/wp-
content/uploads/2015/09/ASLIA-Mental-Health-Guidelines.pdf.
AUSIT Code of Ethics and Code of Conduct. (2012). Retrieved from
http://ausit.org/ausit/documents/code_of_ethics_full.pdf
AUSIT [Australian Institute of Interpreters and Translators] Guidelines for Health
Professionals Working with Interpreters. (2006). Retrieved from
http://ausit.org/AUSIT/Documents/Guidelines_For_Health_Professionals.pdf
Australian Commission on Safety and Quality in Health Care (2015). Health literacy: A
summary for Clinicians. Retrieved from https://www.safetyandquality.gov.au/wp-
content/uploads/2015/07/Health-literacy-a-summary-for-clinicians.pdf
Bot, H. (2005). Dialogue Interpreting in Mental Health. Amsterdam/New York: Rodopi
Boyles, J. & Talbot, N. (2017). Working with interpreters in psychological therapy. Abingdon,
Oxon: Routledge.
Costa, B. (2016). The importance of training and clinical supervision of interpreters and
practitioners for best teamwork in gender violence contexts. In: M. Del Pozo Triviño, C.
Toledano Buendía, D. Casado Neira & D. Fernandes del Pozo (Eds.) Construir
puentes de comunicación en el ámbito de la violencia de genero/Building
communication bridges in gender violence. Granada: Comares. 61-71.
Costa, B. (2017). Team Effort – Training Therapists to Work with Interpreters as a
Collaborative Team. International Journal for the Advancement of Counselling. 39: 56-
69.
Crezee, I. (2013). Introduction to healthcare for interpreters and translators. Amsterdam;
Philadelphia: John Benjamins
Dabić, M. (2010). The role of the interpreter in intercultural psychotherapy. CTIS Occasional
papers. 5, 65-80.
Dean, R. K., R. Q. Pollard, and M. A. English. (2004). Observation-supervision in mental
health interpreter training. CIT: Still shining after 25: 55-75. Available at:
http://www.interpretereducation.org/wp-content/uploads/2012/10/Observation-
Supervision-in-Mental-Health-Interpreter-Training.pdf
54
Department of Health & Human Services (2016). The Australian Charter of Healthcare
Rights in Victoria. (2016). Retrieved from
https://www2.health.vic.gov.au/about/participation-and-communication/australian-
charter-healthcare-rights/working-with-consumers/in-your-language
Diehm, R., & Roland, D. (2015). The impact of secondary exposure to trauma on mental
health professionals. InPsych, 37(1). Retrieved from
https://www.psychology.org.au/inpsych/2015/february/diehm/
Hale, S.B. (2007). Community Interpreting. Houndmills, Basingstoke: Palgrave Macmillan.
Kämpf, A. (2013) Coercive Care: The Role of the Law in Treatment Decisions. In Coercive
Care: Rights, Law and Policy. McSherry, B. & Freckelton, I. (Eds), London/New York:
Routledge. 76-92.
Kämpf, A. (2010). Involuntary Treatment Decisions: Using Negotiated Silence to Facilitate
Change?’ In Rethinking Rights-Based Mental Health Laws. McSherry, B. & Weller, P.
(Eds.), London: Hart Publishing. 129-150.
Leanza, Y., Miklavcic, A., Bovin, I., & Rosenberg, E. (2014). Working with Interpreters. In
Cultural Consultation Encountering the Other in Mental Health Care. Kirmayer, L.,
Guzder, J. & Rousseau, C. (Eds.) New York: Springer. 89-114.
Mental Health Act 2014. (2014). Retrieved from
http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/f932b66
241ecf1b7ca256e92000e23be/0001F48EE2422A10CA257CB4001D32FB/$FILE/14-
026abookmarked.pdf
O’Hara, M. & Akinsulure-Smith, A. (2005). Working with interpreters: tools for clinicians
conducting psychotherapy with forced immigrants. International Journal of Migration,
Health and Social Care. 7(1), 33-43
Pollard, R.Q. (1998). Mental health interpreting: a mentored curriculum. Rochester, NY:
University of Rochester
Tribe, R., & Raval, H. (2003). Working with Interpreters in Mental Health. Hove, East
Sussex: Routledge.
Tribe, R., & Lane, P. (2009). Working with interpreters across language and culture in mental
health. Journal of Mental Health, 18(3), 19.
Victorian Legal Aid. (2016). Introduction to the Mental Health Act 2014. Retrieved from:
https://www.legalaid.vic.gov.au/information-for-lawyers/practice-resources/mental-
health-law/introduction-to-mental-health-act-2014
VTPU [Victorian Transcultural Psychiatry Unit]. (2006). Guidelines for working effectively
with interpreters in mental health settings. Retrieved from:
http://www.vtmh.org.au/docs/interpreter/VTPU_GuidelinesBooklet.pdf
WHO [World Health Organization]. (2010). Mental and behavioural disorders. Retrieved from
http://apps.who.int/classifications/icd10/browse/2010/en#/V
55

Mental Health Interpreting Guidelines Fo

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Mental Health Interpreting Guidelines Fo

Uploaded by

Copyright:

Available Formats

Mental Health Interpreting Guidelines for Interpreters

Guidelines on definitions, protocols, ethics, practices, self-care and

The development of these guidelines was funded

I. Definitions of key terms 4

III. Ethical considerations 13

IV. Self-care in mental health interpreting 21

V. Patients’ rights and legal terms 30

Appendix 2 – Mental health legislation in Australian states and

Mental health encompasses a person’s psychological, emotional and social well-being. A

Mental health professional

of these. An Auslan-English interpreter should be provided where requested to meet their

Mental health interpreter

 Previous experience working with interpreters in the simultaneous and/or consecutive

3. Outlining of interpreter’s role and negotiation of role-relationship

4. Primary contact with patient

- Language for which the assignment is booked, certification/accreditation level of

5. Discourse of the mental health interaction

7. Mental health professional discourse

The physical behaviour of a patient, which includes verbal/signing as well as non-verbal/non-

Where distress, confrontation or (potential) aggression occurred in the interaction, the

Further to this, recognition and acknowledgement of a distressing situation can be an important

… sharing of information needs to be counterbalanced with the need to protect the

Knowledge of the cultural-linguistic background of a patient is to be distinguished from

In the de-briefing, the interpreter outlines his/her duty of maintaining confidentiality of

A cornerstone of interpreting practice is confidentiality. The MH interpreter may find

The introduction of an advanced credential, certified interpreter – specialisation: health

The MH interpreter is responsible for maintaining strict professional boundaries with

Even when only a professional relationship exists, a MH interpreter needs to carefully

7. Maintaining Professional Relationships

Professional development, additional to training in health and mental health interpreting, is

… no Auslan-English interpreter or DI [Deaf Interpreter] should work in a mental health

ASLIA recommends that MH interpreters undertake ongoing reading and/or

… it is strongly recommended that all MH interpreters undergo professional supervision

The rehabilitation of a patient living a mental illness, such as alcoholism or drug/substance

The practice of pharmacotherapy (therapy using pharmaceutical drugs) is common in many

- emergency services (acute mental health initial assessment and screening);

- inpatient and ambulatory services;

- clinical health services;

- disability rehabilitation and support services; and

- Anxiety conditions: anxiety; generalised anxiety disorder; social anxiety; agoraphobia;

- Personality disorders: personality disorder; borderline personality disorder; narcissistic

- Mood disorders: depression; bi-polar (mindhealthconnect -

- Psychotic disorders: schizophrenia; psychosis; paranoia (mindhealthconnect -

- Eating disorders: bulimia; anorexia nervosa; disordered eating (mindhealthconnect -

- Depression; suicide prevention; supporting others; self-harm and self-injury;

- Dementia, memory loss and Alzheimer’s disease (Alzheimer’s Australia -

1. Organic, including symptomatic, mental disorders

Mental disorders grouped together on the basis of their having in common a

Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive

2. Mental and behavioural disorders due to psychoactive substance use

Identification should be based on as many sources of information as possible. These

3. Schizophrenia, schizotypal and delusional disorders

4. Mood [affective] disorders

This block contains disorders in which the fundamental disturbance is a change in

5. Neurotic, stress-related and somatoform disorders

A group of disorders in which anxiety is evoked only, or predominantly, in certain well-

6. Behavioural syndromes associated with physiological disturbances and physical

7. Disorders of adult personality and behaviour

This block includes a variety of conditions and behaviour patterns of clinical

A condition of arrested or incomplete development of the mind, which is especially

9. Disorders of psychological development

Treatment of mental illnesses

- Psychodynamic therapy (also known as classic psychotherapy) focuses on the