The right to be heard: language, access, and justice in mental health
Imagine going to a mental health appointment carrying a silent fear, loss, or feeling you cannot yet put into words. Now imagine having to explain this through an interpreter, or even more isolating, not being given one at all. In these moments, the difference between what is officially offered and what people can actually use becomes clear. Even if information about rights, treatment choices, and appointments is written down, it does not mean people can really make use of it.
The gap between availability and access
The right to health, including mental health, is recognised within international human rights agreements like the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights. However, even when governments set up mental health facilities, employ staff, and open clinics, making sure people can actually use these services is still a big challenge. Working with migrant and displaced communities, I have seen the difference between what international promises say and what people really experience. This shows that having services available does not always mean they are easy to access.
For individuals who do not speak the main language of a healthcare system, this gap can reveal significant power imbalances. The distinction between those who are truly understood and those who must struggle to communicate their pain through another’s words is not a minor logistical concern. Rather, it can become a significant barrier to seeking and receiving help. Research has identified language barriers as among the major challenges refugees encounter in accessing mental health services and obtaining appropriate support [1] and can also become additional stressors that affect psychological well-being [2].
The role and reality of interpreters
This is where interpreters in healthcare play a crucial role. They are interpreters, but just as importantly, they are facilitators of individuals’ ability to be heard, a point explored in depth in the book Working with Interpreters in Mental Health [3]. Within migrant and refugee populations, the absence of appropriate interpreting can become a significant barrier to mental healthcare. Providing an interpreter, however, involves more than translating words. It also shapes the dynamics of the conversation and whose voices are understood and recognised. Language is not a neutral medium; it carries social and cultural meanings that can shape trust, identity, and access.
A shared language between interpreter and service user can ease distress and promote engagement. However, it may also create privacy concerns, particularly where mental health difficulties remain highly stigmatised within some communities. Some individuals may therefore prefer an interpreter from a different but related linguistic background. Even within a single language, regional dialects and accents can introduce subtle misunderstandings. Ultimately, language is inseparable from cultural understandings of distress: ideas about mental health, help-seeking, and emotional expression can vary widely.
Service user experiences with interpreters
Service users who have worked with interpreters often describe their experiences as grounded in trust rather than logistics. For example, chapter 5 of Working with Interpreters in Mental Health recounts how one individual, after having her words accurately conveyed to the clinician, was finally able to articulate the origins of her distress. Another service user recalled that the interpreter’s presence transformed an otherwise isolating environment into a space where she felt at home.
Trust in the mental healthcare system depends on the support interpreters themselves receive, rather than only on their skills. Consider the case of Fatma, an interpreter who was asked at short notice to attend a child-protection hearing without any briefing or preparation. When the decision was made to place children into care, the parents directed their anger at her, believing she had failed to interpret on their behalf. Fatma was left deeply distressed and lacked supervision or support to process the experience [3]. Her situation illustrates that interpreters are not neutral or invisible instruments within the system. They too can experience the emotional consequences of decisions made by others.
Meaningful access to justice
Access also means having a voice in determining how communication happens. Real access means listening to people about what helps them communicate safely and clearly, instead of deciding for them what “access” means. There is a recently produced set of guidance produced by the British Psychological Society on Working with Interpreters in Mental health which covers a range of eventualities (4).
As the book Social Justice, Social Discrimination, and Mental Health shows, giving everyone the same information and treatment might seem fair, but if some people cannot understand it, share their needs, or have their experiences noticed, treating everyone the same can actually exclude some [5]. This is the difference, in social justice terms, between treating people equally and understanding that people may begin from different levels of power and disadvantage.
Someone who does not speak the main language may need an interpreter. Someone dealing with poverty, discrimination, or social exclusion may face obstacles that no single service can fix. Social exclusion isn’t limited to a lack of resources or services; it also means losing voice, choice, and control. Justice, then, means that what is shared through translation is not only noticed or recorded but used to guide plans, support, policies, or care.
Communication and inclusion
Communication is not merely the sharing of information. It involves trust, emotional expression, cultural meaning, and building relationships where people feel safe to share their stories. This kind of communication needs more than good intentions; it also depends on who has power in the room and whether that power is used to allow or block access.
To improve fairness in mental health, we need to create places where language differences are noticed and supported, and where the voices, needs, and well-being of service users, interpreters and clinicians are respected.
References
Satinsky, E., Fuhr, D.C., Woodward, A., Sondorp, E., & Roberts, B. (2019). Mental health care utilisation and access among refugees and asylum seekers in Europe: A systematic review. Health Policy, 123, 851–863. https://doi.org/10.1016/j.healthpol.2019.02.007
Farsimadan, F. (2021). Therapy and therapeutic considerations with refugees and asylum seekers. In D. Moussaoui, D. Bhugra, R. Tribe, & A. Ventriglio (Eds.), Mental Health, Mental Illness and Migration. Mental Health and Illness Worldwide (pp. 427–441). Singapore: Springer.
Tribe, R., Thompson, K., & Raval, H. (Eds.). (2026). Working with interpreters in mental health (2nd ed.).
Tribe, R. & Thompson, K. (2026) Guidance on working with interpreters in mental health. British Psychological Society: Leicester. Working with interpreters: guidelines for psychologists | BPS
Tribe, R., & Bhugra, D. (Eds.). (2025). Social justice, social discrimination, and mental health: Theory, practice, and professional issues. Routledge.