Transcultural Mental Health Practice Kit

Health professionals can use these assessment guidelines and tools with culturally diverse patients.

Note: These tools should only be used by qualified and experienced mental health professionals. By choosing to access or use and apply these tools, full responsibility remains with the qualified and experienced practitioners and not with the Transcultural Mental Health Centre.

The Outline for Cultural Formation (outline) in the DSM-5-TR provides a framework for assessing:

• the cultural information of a person’s mental health problem
• how it relates to a person’s social and cultural context and history.

In the DSM-5-TR, the outline can be found in 'Section 3: Emerging Measures and Modules'. It requires a systematic assessment of the:

• cultural identity of the person
• cultural conceptualisations of distress
• psychosocial stressors and cultural features of vulnerability and resilience
• cultural features of the relationship between the individual and clinician
• overall cultural assessment.

You can buy the DSM-5-TR online on the American Psychiatric Association website. It is also available in multiple languages.

NSW Health staff

If you work within NSW Health, you can access the DSM-5-TR in full online through the Clinical Information Access Portal

You can download free DSM-5 Online Assessment Measures from the American Psychiatric Association (APA) website. We have highlighted a list of cultural formulation tools for health professionals to consider.

Our Knowledge Hub provides detailed guides and specialist resources for deeper understanding of cross-cultural mental health care.

Note: Where available, we provide links to the full text or article abstracts. If a resource is not freely available, please contact your local library or hospital or university library to get the full text.

Go to the Knowledge Hub

The MIMS Australia provides detailed information on prescription and non-prescription medications available in Australia.

As a comprehensive reference guide for health professionals, it allows health professionals to enter the list of medications that the patient is on and check for potential interactions.

Note: You will need an eMIMS subscription to access to MIMS Australia. 

Learn more on the MIMS Australia website

ClinPGx is a comprehensive clinical pharmacogenomic (PGx) resource created to support and expand PGx knowledge, implementation and education. It integrates the PharmGKB, CPIC and PharmCAT projects, with additional features and content to come. 

This online resource is for clinicians and researchers. It provides access to information about the impact of genetic variation on drug response. 

Learn more on the ClinPGx website

Further reading

Assessing, diagnosing and treating mental health often relies on the interview between the patient and clinician.  

When a patient cannot speak English well, or feels more comfortable using another language, an interpreter can help everyone communicate clearly. This can improve how the patient is assessed and treated.

It is important to use a trained and accredited interpreter, not a friend, family member, or bilingual staff member. Accredited interpreters are:

• skilled
• experienced
• and follow strict rules about privacy and ethics.

Friends or family members may:

• not understand medical terms
• leave out important details
• change what is said because they are emotionally involved; and can lead to misunderstandings, incorrect diagnoses, and poorer health outcomes.

Video resource

Risks involved when using untrained interpreters in a health consultation

This video resource is from eCALD Services. The organisation offers a range of face-to-face and online courses for both caring for culturally and linguistically diverse patients, as well as for working culturally diverse workplaces. 

View the video resource

Your decision to use an interpreter during a consultation will be influenced by a range of factors. Situations where an interpreter should be used include:

• When a patient requests an interpreter
• Where a patient cannot speak and/ or understand English
• In stressful situations or where socially or psychologically complex issues are raised (such as mental health issues)
• Where matters of patient safety are concerned (e.g. consent for interventions).

Keep in mind that although a patient may be able to communicate on a social level in English, they may not be able to understand more complex health or mental health information and may need an interpreter.  

Interpreting services for clinicians

The Translating and Interpreting Service (TIS) provides interpreters to help organisations and agencies to communicate with non-English speaking clients.

You need to register to use the TIS services. When you make a booking, provide:

• your client’s name
• country of birth
• preferred language (and dialect, if relevant)
• preferred gender of interpreter
• location and anticipated duration of booking
• your own name and contact details.

Medical Practitioner Priority Line

Eligible medical practitioners can access the Medical Practitioner Priority Line 24 hours a day, every day of the year. 

The is a free phone interpreting service that connects an interpreter to communicate with non-English speaking patients.

For more information contact the TIS National Client Engagement Team. 

Health Care Interpreter Services

NSW Health staff can access Health Care Interpreter Services (HCIS) located in Local Health Districts throughout the state. 

Find more information about the HCIS on the NSW Health website

Free translation service

The Australian Government Department of Home Affairs provides a free translating service for people settling permanently in Australia.

Its purpose is to support participation in employment, education and community engagement.

Permanent residents and some temporary or provisional visa holders can have up to 10 eligible documents translated into English, within the first 2 years of their eligible visa grant date.

Learn more about the Free Translating Service on the Australian Government Department of Home Affairs website

An interpreter helps people communicate clearly and fairly. They:

• keep information private
• must not change, add, or leave out important details
• cannot give advice or share their own opinion.

Sometimes an interpreter may not provide a word for word translation of what is being said. This is because a word or phrase may not have a direct equivalent in another language. Instead, the interpreter explains the meaning of what is being said.

Working with interpreters in mental health settings can be difficult. When working with an interpreter, keep the following in mind:

• Brief the interpreter before the session so they understand what will happen.
• Set up the room so everyone can see each other and communicate easily.
• During the session, speak directly to person experiencing a mental health issue, not the interpreter, and keep natural eye contact.
• Use short sentences and give the interpreter enough time to interpret.
• Avoid technical or complicated language where possible.
• Pay attention to both spoken and unspoken (non-verbal) communication.

Video resource

Working with interpreters in a healthcare setting

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Video transcript

HCIS: Working with interpreters in the healthcare setting

[Music]

[A young and older women are walking into an emergency department. Text appears on screen: Risks around using family and friends to interpret]

Young woman speaking to person off camera: Good morning, this is my mum. She's sick.

Emergency Department reception nurse: She needs to see a doctor.

Male doctor to older woman: Mrs. Nguyen, how many times have you been pregnant? Have you had any miscarriages or terminations?

Young woman: Oh really? I'm sure it's worth just five pregnancies.

Male doctor to young woman: If you don't mind, we really need to know.

Young woman to older woman in Vietnamese: He wants to know if you've had any miscarriages or terminations. I told him of course not.

Older woman to young woman (in Vietnamese): Um well, um, like you said, of course not.

Young woman to male doctor: She said no.

Female voice over: It is the doctor's duty to inform the patient of any condition they are suffering from. However, family members often do filter the information. This patient had a number of terminations but was reluctant to reveal this in the daughter's presence. The daughter was reluctant to interpret the test for cancer. In these situations, medical professionals never know what vital information they and the patient are missing out on.

Female nurse speaks to a female interpreter: We have a 37-year-old pregnant woman for a booking in. Have you interpreted for one of those before.

Female interpreter: Oh yes, many times.

Female interpreter: I think that communication flows best when doctors and the patients speak naturally talking to each other directly while being aware of the interpreter's presence.

Female nurse to female patient: Shana, I'm going to ask you some general questions. Are you married?

[Female interpreter conveys the question to Shana in Chinese. Shana answers the question in Chinese]

Female interpreter to female doctor: Yes, the grumpy man in the reception is my husband.

Female voice over: Sit facing the patient and speak directly to them. Maintain eye contact and give nonverbal reassurance.

[Male doctor answers the phone next to a female patient's hospital bed. Text appears on screen: Telephone interpreting]

Male doctor: Hello Dr Robert speaking.

Female interpreter on the phone: Hi, I'm Katicza, I will be interpreting for you today.

Dr Robert: Hello Katicza, I'd like you to interpret for Mrs Horvart here. We've performed an angiogram on her today and I'm about to give the results.

[Mrs Horvart asks Dr Roberts a question in her language]

Katicza interprets Mrs Horvart's question: Does that mean that I need surgery?

Dr Robert speaking to Mrs Horvart: Yes, I'm coming to that please be calm I'll tell you what we're proposing to do.

Katicza interprets Dr Roberts answer: Yes. We will come to that. Be calm, I will explain what we are proposing to do.

[Mrs Horvart nods and answers in her language]

Katicza interprets Mrs Horvart's answer: I will try.

Dr Robert: A clot like this could ultimately cause death so we need to perform an artery bypass.

Katicza interprets Dr Roberts answer to Mrs Horvart in her language: The clot could ultimately cause death, so to prevent this, we need to perform an artery bypass.

Mrs Horvart reacts and interrupts the interpreter: How can I calm down when you say I can die?

Female voiceover: During phone interviews healthcare providers should use a speaker telephone or a dual handset and sit close to the microphone. They should sit facing the patient and maintain eye contact. They should speak directly to the patient as you would in a face-to-face interview and pause frequently to allow information to be taken in by the interpreter and passed on to the patient.

[Two women accompany an older woman in a wheelchair to the hospital. The older woman speak to them in Spanish]

Older woman: Don't let them tale me to a nursing home.

[The two women and the older woman are now seated around a table with a female interpreter and healthcare professional. Text appears on the screen: Interpreting in family conferences]

[Female health care worker speaks to the older woman and the two women accompanying her]

Female healthcare professional: We're meeting here today to discuss the care options for Mrs Perez when she's discharged from the hospital.

Female voiceover: When patients family members or multiple healthcare professionals are present interpreting becomes more complex.

Female healthcare professional: There is a bed available in a Spanish speaking home. It is available this week and these sorts of opportunities do not come up that often.

[Female interpreter starts to interpret in Spanish but is interrupted by the women. They all speak over each other.]

Female healthcare professional: Excuse me, excuse me, excuse me! Just one at a time please can we just slow down?

Female voiceover: Typically, in these settings the English-speaking participants talk directly to each other excluding the patient from the discussion and decision making.

Women speak to the healthcare professional directly: We have a friend that went to the nursing home...

Women now speak in Spanish to the older woman: Mum, do you remember Susanna? She is very happy.

Older woman answers in Spanish: Of course I remember. How can she not be happy? She doesn't even know where she is.

[The women speaking in Spanish begin to argue among themselves. While the healthcare professional works to restore some order to the meeting]

Female voiceover: In family conferences healthcare providers need to set the rules of participation that allow the interpreter to keep up and ensure only one person speaks at a time.

[Music]

[Text appears on screen: Produced by NSW Health Care Interpreter Services; Video production by Art Resistance (www.artresistance.com.au); This project was produced with the financial assistance and/or support of: NSW Health, Multicultural Health Service - Northern Sydney LHD, Illawarra Shoalhaven LHD; NSW Multicultural Health Communication Service; Transcultural Mental Health Centre; NSW Refugee Health Service]
 

Other professional groups, ethnic community organisations, migrant resource centres, and religious organisations may also be able to help you find suitable service providers. 

For more information, refer to the lists of refugee support services providers and resources.