‘Patient speaks Somali so we cannot treat him’

Access to mental healthcare for non-Dutch speakers in the Netherlands

Hanneke BotGlasgow, 9th April 2015

Healthcare & diversity policies I

• Asylum seekers: Basic healthcare insurance incl interpreter services is provided by the Ministry of Justice

• All others (refugees, migrants): health care insurance is private but compulsory, interpreter services are NOT included (since January 2012)

Healthcare & diversity policies II

• Dutch Minister of Health, 2011: – it is a citizens’ own responsibility to master the

Dutch language – everyone is free to bring a family member, friend

or acquaintance who speaks Dutch – everyone is free to bring in a professional

interpreter– funding by government or insurance of

professional interpreters would give ‘the wrong signal’

Healthcare & diversity policies III

• 2009: Law certified interpreters & translators – Register; permanent education; re-registeration

after 5 yrs– Certified interpreters/translators obligatory in

judicial field • Same period: market approach to interpreting

and translation -> fees for I &T go down• 2014: 1st re-registration period: minus 30%

Healthcare & diversity policies III

• Training of medical personnel (past 30 years) – non-Dutch patients are ‘different’; emphasis on

‘differentness’ – hardly any research/interest/training /etc re the

language barrier• Limited budget for professional interpreters;

general attitude ‘they’ should speak Dutch’• Quality Norm use of interpreters in healthcare –

including use of non-professional intepreters (joint effort of professional organisations in helathcare)

Resulting in

• Care providers are scared to treat ‘foreigners’

• Policy makers are scared of the costs of interpreters

Language barrier

• usually mentioned as the first problem to treating a diverse population

Stumbling upon the language barrier

Institutions for mental healthcare have a limited budget for professionel interpreters, resulting in:

• we share a language • my colleague speaks …….• a family member does the job• the neighbour can do the job • we speak ‘Dutch’

-> ‘help!!!’ – this does not work , we cannot treat the patient

-> we need a professional interpreter but we cannot afford it OR we need specialists

Stumbling upon the language barrier

Major stumbling blocks

• political attitude re foreigners (they steal our jobs; do not share our norms and values; they are different; et cetera)

• professional attitude (they are ‘strange’; cannot be treated as ‘Dutch originals’ )

• attitude towards non Dutch language /bilingualism

• lack of funding of professional interpreters/ lack of knowledge how to work with an interpeter

As it is

• Use of professional interpreters has decreased more than 50 % compared to 2011.

• Major mental healthcare instutions have limited budget and stumble on the language barrier

• Growth of ‘small’ mental healthcare providers, focussed on diversity, employing therapists speaking various languages; cooperating with professional interpreters

Or jumping over it?

what I would like

• delete the concept ‘inter/transcultural’

• funding of professional interpreters in healthcare is standard

• basic training of (mental) health professionals includesworking with interpreterspsychology of migration contextual mental health (person in context)

Thank you