Got Spanish?: Next Steps in Mental Health Reform

The Op-Ed that I wrote on mental health screening made it into the Worcester Telegram and Gazette yesterday, and I would invite feedback, both from families and caregivers. It seems to me that we are embarking on a great uncontrolled experiment, and this is an opportunity to make observations about the process before it gets too out of hand. (Maybe it already has). Got an email from a colleague the other day:

Date: Fri, 11 Jan 2008
To: David Keller MD
Subject: Therapists in spanish; patient
Hello, everyone,
I saw a new family today fresh from Puerto Rico. They have a son who is 4 yo with "behavioral problems". I would like him evaluated for ADHD. It would greatly help the family if Mom can be part of his eval-which necessitates either a Spanish-speaking therapist or access to interpreter services. Please send me your suggestions- where can I send them?
Thanks,
(snip) MD

This was hard to answer; the system currently has us send patients like this to agencies, who may or may not have Spanish speaking psychologists available. It is even worse when the family speaks Polish or Portuguese, two languages that have recently become quite popular in our neck of the woods. How do we help families like this?

We can certainly have interpretors available; the UMass Interpretor service and the CMAHEC/ Language Link do a great job. Even those folks, however, will tell you that behavioral and mental health concerns are the most diffucult to translate. Bilingual therapists are hard to come by; my colleagues at local mental health agencies tell me that they are hard to find, and in the current environment are frequently hired away once they are trained. One barrier is the difficulty in credentialing foreign-trained psychologists and social workers. Some of us on the Worcester Mental Health Network would like to see the us make it easier to get the paperwork through for the people that could do the work we need done. One thing is clear: as we start screening kids for mental health problems, we will need resources to work with the families to ensure that we are not just finding problems that we can't do anything about.