‘Patient speaks Somali so we cannot treat him’ Access to mental healthcare for non- Dutch speakers in the Netherlands Hanneke Bot Glasgow, 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 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 includes working with interpreters psychology of migration contextual mental health (person in context)

Thank you