Sichuan University
Access to Mental Health Care Service for
China’s Minority Patients and Foreign
Patients with Limited Mandarin Proficiency
(LMP)
----Mental Health Center of West China Hospital,
Sichuan University as a case study
Wen Ren, Prof., PhD, Sichuan University, China
wenrensu@hotmail.com
April 9, 2015
I am here!
Sichuan Province
Chengdu
Sichuan University
Contents
China’s linguistic and cultural diversity
Some culture-related mental illnesses among some ethnic minorities
Improved institutional support for mental health care
Access to mental health care services for LMP Patients in China
Existing and Prospective Good Practice
I. China’s linguistic and cultural diversity
1.1 China, a multi-ethnic and multilingual country
1
Most Tibetans, Vygurs,
Mongolians, Kazakhs
and Koreans live in
mountainous areas,
border areas, and
relatively
underdeveloped areas.
56 ethnic groups & 1.4 billion people;
55 minority groups, less than 9% of the
population, but nearly 114 million in total.
http://www.gov.cn/test/2012-04/20/content_2118413.htm
Mandarin is the only
2
Tibetan, Vygur, Mongolian, Kazakh, Korean
official language; 53
minority groups have their
own languages; 60 million
use them, 60% of the total
minority population.
languages, all have high vitality value
(equivalent to 56-71% of that of mandarin),
each with over 1 million speakers
3
White Paper on China’s Ethnic
Policy and Common Prosperity of
All Ethnic Groups
CHINA
4
Dao Bu, 2005
I. China’s linguistic and cultural diversity
Tibetans
Vygurs
Kazakhs
Koreans
Mongolians
I. China’s linguistic and cultural diversity
I. China’s linguistic and cultural diversity
1.2 China, a non-immigrant country, but one of the most visited
countries in the world nowadays
China has about 26 million foreign visitor arrivals in 2013 and 2014.
REGION
TOTAL
VISITING
MEETINGS SIGHTSEEING
WORKER
(10,000
RELATIVES
OTHERS
/ BUSINESS /LEISURE
& CREW
PERSON)
& FRIENDS
TOTAL
2636.08
539.57
892.99
60.33
328.54
814.66
ASIA
1636.15
300.51
541.32
15.73
238.75
539.84
AMERICAS
310.65
55.91
113.29
25.90
18.75
96.80
EUROPE
548.41
147.70
194.79
9.07
61.80
135.06
OCEANIA
81.01
14.46
27.57
9.22
3.66
26.10
AFRICA
59.69
20.97
15.96
0.40
5.57
16.79
Reference from: http://www.cnta.gov.cn/html/2015-2/2015-2-2-10-54-94590.html
I. China’s linguistic and cultural diversity
Based on the data of the 2010 census: the number of foreign
residents in China reached about 600,000.
Sichuan University
Contents
China’s linguistic and cultural diversity
Some culture-related mental illnesses among some ethnic minorities
Improved institutional support for mental health care
Access to mental health care services for LMP Patients in China
Existing and Prospective Good Practice
2. Some culture-related mental illnesses among some ethnic
minorities
2.1 Alcohol dependence
Economic and social transformation
Traditional love of and tolerance to drinking
2. Some culture-related mental illnesses among some ethnic
minorities
2.1 Alcohol dependence
It is believed in some
minority areas that alcohol
can ease pain and fatigue,
treat insomnia, and cure
rheumatism.
Guo et al, 2003(11)
Inadequacy of medical resources &
misconception about alcohol’s medicinal value
2. Some culture-related mental illnesses among some ethnic
minorities
2.2 Depression
Tibetans as a relatively more malecentered community
Religion-related causes
Sichuan University
Contents
China’s linguistic and cultural diversity
Some culture-related mental illnesses among some ethnic minorities
Improved institutional support for mental health care
Access to mental health care services for LMP Patients in China
Existing and Prospective Good Practice
3. Improved institutional support for mental health care
Law of the People’s Republic
of China on Mental Health
adopted in 2012
covering 50-90%
3. Improved institutional support for mental health care
In theory there should be a psychiatric
department in a general hospital or a
mental health hospital at or above county
level.
In practice this is not always attainable,
especially in mountainous areas, border
areas,
and
relatively
underdeveloped
minority areas where minority people live
in mixed or compact communities.
Sichuan University
Contents
China’s linguistic and cultural diversity
Some culture-related mental illnesses among some ethnic minorities
Improved institutional support for mental health care
Access to mental health care services for LMP Patients in China
Existing and Prospective Good Practice
4. Access to mental health care services for LMP Patients
in China
4.1 General situation – resources constraint
Total health care expenditure in 2013:￥ 3.2 trillion, or $51
million, 5.57% of GDP, but very small on a per capita basis.
(Health Care Statistics Yearbook 2014)
Resources unevenly distributed, highly concentrated and
overused in large hospitals in big cities.
(http://health.sohu.com/20140414/n398180766.shtml )
4. Access to mental health care services for LMP Patients
in China
4.1 General situation – insufficient language services
offered by hospitals for LMP patients
Major public hospitals in mega cities have Mandarin and
English websites, but no information indicating provision of
interpretation service;
Some of them organize English training classes for staff, or
invite speakers to lecture on interpretation-related knowledge
and skills;
The major hospitals in Xinjiang and Inner Mongolia have
Vygur and Mongolian languages respectively in addition to
Mandarin for their official websites. But no Tibetan languages
are found on the official websites of major hospitals in Tibet.
4. Access to mental health care services for LMP Patients
in China
4.1 General situation – insufficient language services
offered by hospitals for LMP patients
A few private expensive hospitals in some mega cities may
have full time or part time medical interpreters, but these are
only exceptional cases.
Clifford Hospital in Guangzhou, 11 full time
professional medical interpreters,
4 language combinations .
(Zhan, 2013)
4. Access to mental health care services for LMP Patients
in China
4.2 Mental Health Center of West China Hospital, SCU
West China Hospital, SCU
• The largest comprehensive hospital in China (with 10,000 staff members
and 4,300 beds);
• Received about 5 million outpatients, inpatients and patients for emergency
treatment in 2014.
http://www.cd120.com
4. Access to mental health care services for LMP Patient
in China
4.2 Mental Health Center of West China Hospital, SCU
Mental Health Center of West China Hospital, SCU
• It houses an outpatient section (including a rehabilitation
center) and several inpatient wards with 200 beds.
• It has about 60 physicians that receive over 200,000
outpatients and over 6,000 inpatients, and provide
psychological counseling to about 10,000 persons per year.
• http://www.cdxinli.com/
4. Access to mental health care services for LMP Patients
in China
• “In modern hospitals practice, especially in public medical
institutions, physicians are under enormous economic
pressure to see as many patients as possible in as short a
time as possible.”
Davidson, 2001
4. Access to mental health care services for LMP Patients
in China
4.3 Access to mental health care services for China’s LMP minority
patients (with Tibetans as an example) and foreign patients at
MHCWCH
Patients’ own
(mis)understanding of mental
illnesses
Hospital registration and visits
4. Access to mental health care services for LMP Patients
in China
4.3 Access to mental health care services for LMP patients in China
Mental Health Center of West China Hospital, SCU
6450 discharged patients in 2014
Yis, 61
Tibetans, 415
Other minority groups,…
Han people,
5674
Data from interviews at
MHCWCH, SCU
4. Access to mental health care services for LMP Patients
in China
4.3 Access to mental health care services for LMP patients in China
Mental Health Center of West China Hospital, SCU
Foreign
countries,
49
Not specify either their ethnic
affiliation or nationalities, 208
Chinese
citizens,
6193
Data from interviews at
MHCWCH, SCU
4. Access to mental health care services for LMP Patients
in China
Language mediation in doctor-patient communication:
professional medical interpreter vs. ad hoc interpreter
 Profession (medical) interpreter: any individual paid
and provided by the hospital or health system to
interpret; training ranged from on-the-job training to
formal 40-hour training in medical terminology and
skills specific to interpreting in the medical setting.
 Ad hoc interpreter: an untrained person who is called
upon to interpret, such as a family member interpreting
for her parents, a bilingual staff member pulled away
from other duties to interpret, or a self-declared
bilingual in a hospital waiting-room who volunteers to
interpret.
(Karliner et al, 2007)
4. Access to mental health care services for LMP Patients
in China
Language mediation in doctor-patient communication:
professional interpreter
 Profession medical interpreters:
so far not provided at MHCWCH, SCU
 Professional interpreters :
if any, hired by patients (mostly Chinese/English)
4. Access to mental health care services for LMP Patients
in China
Language mediation in doctor-patient communication:
Ad hoc interpreters and other forms of mediation
 Patients’ bilingual family members, relatives, friends, colleagues, etc.
 Bilingual hospital staff members (either called upon to do direct
consultation or help with interpreting)
 Volunteers : A. self-declared bilinguals in a hospital who volunteer to
interpret; B. chance helpers; C. trade-off helpers.
 Patients and physicians/nurses struggling alone with gestures
4. Access to mental health care services for LMP Patients
in China
Language mediation in doctor-patient communication:
Formats of interpreting
 Live interpreting
 “Telephone interpreting”
4. Access to mental health care services for LMP Patients
in China
Cultural issues in doctor-patient communication
Stigma
Culturally sensitive topics
4. Access to mental health care services for LMP Patients
in China
Cultural issues in doctor-patient communication
It’s not about cultural differences only; it is also
about how these differences may relate to certain
mental illnesses, how these differences may
affect people’s perception of mental health
problems, and how these differences may affect
access to resources, and what can be done to
ultimately ensure equitable access.
4. Access to mental health care services for LMP Patients
in China
4.4 Drawbacks of using untrained bilinguals or ad hoc
interpreters
 Errors in comprehension and expression
 Low efficiency
 Improper involvement
 Confidentiality at risk
 Reduced patient trust and satisfaction
 Ambiguity of responsibility
(Ramirez 2003, Bloom et al 2005,
2010, Seidelman et al 2010)
Karliner et al 2006, Bauer et al
4. Access to mental health care services for LMP Patients
in China
4.5 Physician/patients response
Patients rank the need for free quality
interpreting services as top priority
Physicians echo the need for
language matching:
• Language concordance.
• Trained interpreters.
4. Access to mental health care services for LMP Patients
in China
4.6 Benefits of using professional (mental) health care interpreters
Using professional interpreters leads to better health status
assessment, improves access and quality of care, increases client trust
and rapport with service provider, enhances patients’ ability to
understand and follow doctor’s advice, raises consultation efficiency,
ensures patient satisfaction, minimize doctor-patient disputes, and
ultimately reduces cost for the medical system.
(Ramirez 2003, Bloom et al 2005, Karliner et al 2007, Tribe et al 2009, Bauer et al, 2010,
Seidelman et al 2010)
Conclusion
 In the resources constrained context, attention is often
given to the quantity of the mental health patients to be
treated rather than the quality of care they receive;
 When it comes to CALD patients with mental illnesses,
the need to address their language and cultural concerns
and the need to provide quality care should be one and
the same.
 There’s still a long way for us to go before language
provision becomes part of the mental health care
service provision, and the difficulty lies with both the
financial and the cognitional.
Sichuan University
Sichuan University
References
Bauer, A. M. & Alegria, M. (2010). The impact of patient language proficiency and interpreter service use on
the quality of psychiatric care: a systematic review. Psychiatr Serv., 61(8): 765-773.
Cheng, y. Speculation and exploration on opening the optional course of medical interpretation in medical
institutes. Researches in Medical Education, 2010(6): 836-839.
Dao, B. The language vigor, language attitude and language policy. Academic Exploration，2005（6）:95
101.
Davidson, B. (2001). Questions in cross-linguistic medical encounters: the role of the hospital interpreter.
Anthropological Quarterly. 74(4): 170-178.
Guo, W., et al. Alcohol addiction, a problem that shouldn’t be ignored in cultural transformation-a survey to
the alcohol drinking in some minority areas. Today’s Ethnic Groups. 2003(11): 40- 43.
Karliner, L.S., et al. (2007). Do professional interpreters improve clinical care for patients with limited
English proficiency: A systematic review of the literature. HSR: Health Services Research. 42(2):
727-754.
Khawaja, N. et al. (2013). Characteristics of culturally and linguistically diverse mental health clients.
Advances in Mental health. 11(2): 172-187.
Masland, M. C. , Lou, C & Snowden, L. (2010) Use of communication technologies to cost-effectively
increase the availability of interpretation services in healthcare settings. Telemedicine and e-Health, Vol.
16(6): 739-745.
Nie, W., Chen, X. & Bai, Y. On the model of training medical translators and interpreters in MTI programs,
Foreign Studies, 2013(2): 89-94.
Seidelman, R. D. & Bachner, Y. G. (2010). That I won’t Translate! Family medical interpreter in a
multicultural environment. Mount Sinai Journal of Medicine, 77:389-393.
Sichuan University
References
Tribe, R & Lane, P. (2009). Working with interpreters across language and culture in mental
health. Journal of Mental Health. 18(3): 233-242.
Zhan, C. & Yan, M. Status Quo, Problems and Future development of Medical Interpreting in
China: A Study of Medical Interpreting Activities in Guangzhou Area, Journal of
Guangdong University of Foreign Studies, 2013(3): 47-50)
http://www.cd120.com
http://www.cnta.gov.cn/html/2015-2/2015-2-2-10-54-94590.html
http://www.cdxinli.com/
http://www.clifford-hospital.org.cn/
http://www.gov.cn/jrzg/2012-10/26/content_2252122.htm
http://www.mzb.com.cn/html/Home/report/105836-1.htm
http://www.pumch.cn/
Sichuan University
Sichuan University
Contents
China’s linguistic and cultural diversity
Some culture-related mental illnesses among some ethnic minorities
Improved institutional support for mental health care
Access to mental health care services for LMP Patients in China
Existing and Prospective Good Practice
5. Existing and Prospective Good Practice
Existing and Prospective Good Practice of Mental Health Care Provision to
LMP Patients in China in Resource Constrained Contexts
Existing good practice
 Help train Tibetan physicians;
 Use physicians/nurses who can speak the patient’s language (now mostly
English);
 Set up a special liaison office (with the help of the Chengdu Office of TAR
government) for coordination work;
 Encourage mutual help among patients and their relatives/friends;
 Use “telephone interpreting”
5. Existing and Prospective Good Practice
Existing and Prospective Good Practice of Mental Health Care Provision to
LMP Patients in China in Resource Constrained Contexts
Prospective good practice
 Educate minority people with basic mental health related knowledge;
 Enroll ethnic minority students to study at medical schools who are willing to
go back to their hometown upon graduation;
 Recruit physicians/nurses who can speak a minority language or a foreign
language;
 Set up medical/health care interpreting programs in universities;
 Include interpreting courses in the curriculum for medical/psychiatry students
5. Existing and Prospective Good Practice
Existing and Prospective Good Practice of Mental Health Care Provision to
LMP Patients in China in Resource Constrained Contexts
Prospective good practice
 Work with T/I service providers
 Use communication technologies
Sichuan University
References
Bauer, A. M. & Alegria, M. (2010). The impact of patient language proficiency and interpreter service use on
the quality of psychiatric care: a systematic review. Psychiatr Serv., 61(8): 765-773.
Cheng, y. Speculation and exploration on opening the optional course of medical interpretation in medical
institutes. Researches in Medical Education, 2010(6): 836-839.
Dao, B. The language vigor, language attitude and language policy. Academic Exploration，2005（6）:95
101.
Davidson, B. (2001). Questions in cross-linguistic medical encounters: the role of the hospital interpreter.
Anthropological Quarterly. 74(4): 170-178.
Falkenstein, S.(2004). An evaluation of mental health services for culturally diverse. Journal of Social Work
in Disbility and Rehabilitation. 3(3): 53-74.
Guo, W., et al. Alcohol addiction, a problem that shouldn’t be ignored in cultural transformation-a survey to
the alcohol drinking in some minority areas. Today’s Ethnic Groups. 2003(11): 40- 43.
Karliner, L.S., et al. (2007). Do professional interpreters improve clinical care for patients with limited
English proficiency: A systematic review of the literature. HSR: Health Services Research. 42(2):
727-754.
Khawaja, N. et al. (2013). Characteristics of culturally and linguistically diverse mental health clients.
Advances in Mental health. 11(2): 172-187.
Masland, M. C. , Lou, C & Snowden, L. (2010) Use of communication technologies to cost-effectively
increase the availability of interpretation services in healthcare settings. Telemedicine and e-Health, Vol.
16(6): 739-745.
Nie, W., Chen, X. & Bai, Y. On the model of training medical translators and interpreters in MTI programs,
Foreign Studies, 2013(2): 89-94.
Sichuan University
References
Seidelman, R. D. & Bachner, Y. G. (2010). That I won’t Translate! Family medical interpreter
in a multicultural environment. Mount Sinai Journal of Medicine, 77:389-393.
Tribe, R & Lane, P. (2009). Working with interpreters across language and culture in mental
health. Journal of Mental Health. 18(3): 233-242.
Zhan, C. & Yan, M. Status Quo, Problems and Future development of Medical Interpreting in
China: A Study of Medical Interpreting Activities in Guangzhou Area, Journal of
Guangdong University of Foreign Studies, 2013(3): 47-50)
http://www.cd120.com
http://www.cnta.gov.cn/html/2015-2/2015-2-2-10-54-94590.html
http://www.cdxinli.com/
http://www.clifford-hospital.org.cn/
http://www.gov.cn/jrzg/2012-10/26/content_2252122.htm
http://www.mzb.com.cn/html/Home/report/105836-1.htm
http://www.pumch.cn/
Sichuan University