INterpreter-mediated Mental Health Act Assessments (INForMHAA)

Project update

Celia Hulme & Jemina Napier

Click here for the blog post in BSL


I am Jemina Napier, from Heriot-Watt University, and I am Celia Hulme, from the University of Manchester, and here we provide an overview of a project that we are both involved in as part of a research team.

The aim of the project is to explore mental health and interpreting but very specifically how AMHPs (Approved Mental Health Professionals) work alongside spoken language interpreters or sign language interpreters, particularly if an individual needs assessing under the Mental Health Act (in England). The person may be unable to access English written or spoken, for whatever reason, so the interpreter and the professional need to work together. Very little research has been done in this area, so it’s a very important and novel project.

The INForMHAA project has been funded by the National Institute for Health Research (NIHR), under the School of Social Care Research and it is funded for 18-months. It is an interdisciplinary project bringing together professionals from various backgrounds. 

We have a team of six people on the core research team, all from different backgrounds bringing different expertise and experiences. Firstly, we have Alys Young, Principal Investigator on the project. She is at the University of Manchester, a Professor of Social Work and brings a social work perspective, and also a Deaf Studies perspective. Then, we have, Jemina Napier, Co-investigator on the project, who is from Heriot-Watt University, a Professor and Chair of Intercultural Communication and the Director of Research for the School of Social Sciences, bringing perspective as a sign language interpreter and someone that trains interpreters and also uses BSL. Next, we have Dr Rebecca Tipton, another Co-investigator on the project. She is also from the University of Manchester and she lectures in Translation and Interpreting Studies, and speaks French. Next, we have Dr Sarah Vicary, who is also a Co-investigator on the project. She is from the Open University and is the Associate Head of School of Nations. She is also a registered qualified social worker and has been for 30 years, and she brings a social work perspective. We also have Dr Natalia Rodriguez Vicente from the University of Essex. She lectures in Modern Languages, Interpreting and Translation, and she is also a Spanish speaker and works as a postdoctoral research associate on the project. And Celia Hulme who is from the University of Manchester and is a final year PhD student in health research and I am involved in the INForMHAA project as a research assistant bringing a deaf perspective, but also a PPIE perspective. Jackie Wan Brown has recently joined the project as an intern as part of her NIHR funded pre-doctoral programme.

Project Advisory Group

With respect to the Project Advisory Group, it’s really important as a research team to have an advisory group as we have knowledge about the research process but we also need people to advise whether they are AMHPs, social workers and also interpreters; they are experts in their field. We set up an advisory group so that throughout the process of doing the research, we make sure that their personal and professional experiences are included. We also want to include key stakeholders, interpreters, both for spoken and sign languages, but also people that work as AMHPs and even teach AMHPs and go through that process.

The aim of the advisory group is to meet once every three months. So, we get together on a regular basis to talk about the research, we update them as to what we’ve been doing and how things are going. We ask them to contribute any ideas, resources that we could use such as academic literature, policies, and legislation. Also, anything that they would like to recommend that they know about, for example key contacts if we are trying to recruit people, so we also use their network alongside ours. When we produce our preliminary results, we will ask them for feedback in the results and methods. We will work alongside them to promote the research through their networks and contacts; hopefully recruit people and make sure that this research has a real strong impact. It is a really important group to have involved in the project. Hopefully at the end of the research when it’s all been completed, they will help with dissemination as well through their networks. It is an ongoing process, not only for a limited time. We are hoping that they will support in the long term as well.

Patient and Public involvement and Engagement (PPIE) group

The PPIE group is for people that are not on the Advisory Group. These are a different group; they may be service users themselves or have direct experience of being assessed under the Mental Health Act. Their inclusion in the project is of real importance so

that is why we have a PPIE group. Our aim is to recruit eight members, all from different backgrounds, because the project is focused on Interpreter-Mediated Mental Health Act Assessments, we need to get people who have direct experience of working with interpreters and being assessed by an AHMP. So, we need to reflect their background.

We are trying to make sure we have diverse representation, so, we may have different language speakers on the panel, but also people with different skills and experiences.

When we recruit individuals, we don’t get going straight away, we will train the panel members to enable them to be effective panel members.  We give them information as to

what PPIE means, the research process, and then we will get them involved in the research project. They are involved in different tasks such as project design, where we will ask their opinions. They can get involved in data collection also in dissemination of the research, be potential authors, attend conferences, present findings from the study to difference audiences and pass on information on our behalf. So, they are going to be very busy in the project.

Scoping review

The scoping review is an important part of the project. What we need to do is try to understand what research has been done in this area and how our research can fill a gap in knowledge. It’ really important for us to identify this gap. People talk about literature reviews, that is one way of doing it, but our project is different because its social care research. We will be doing something different and it is referred to as a scoping review. So, this helps us identify what’s been published, and what research has been done in the area, but not only academic research. It could be things that have been published such as policies, legislation, any information pertaining particularly to the Mental Health Act assessments.  We have a strict inclusion and exclusion criteria that we must follow. For example, we are interested in research to do with mental health and interpreting but would not be interested in health interpreting generally. We try to narrow it down and understand particular research about mental health. We try to identify the gaps to make sure our project aims are covering a gap and giving new knowledge. It is a long process, and we are currently in the process of filtering the research, checking, agreeing what we will and will not include. We are going through that process at the moment and that’s just one of our methods. 

Mixed-methods research

There are two phases to the project, and each phase is different. This is a mixed-methods study, so we are not only using one method but several. One method, is the scoping review, which is taking place in Phase 1. But we also want to find out the experience of the AHMPs and the interpreters, and we are getting that information through a survey questionnaire, also in Phase 1. There are two surveys because the questions are different for interpreters and AHMPs. In the survey, there is an option for them to agree to be involved in an interview so they can talk in more detail about their experiences.

Phase two involves what we call ‘simulated practice’ and what we envision will happen is

people will observe a Mental Health Act assessment taking place, so there will be

an AHMP with an interpreter, in BSL or a spoken language, doing an assessment with other

individuals (from the advisory and/or PPIE groups) observing this happening.  We will then discuss what has worked well and if there were any issues that we need to think about. This will help us develop training materials. Because of the COVID-19 pandemic, we decided that everything has to take place online.

We are lucky that Zoom has different options and a special function that we can turn on that allows you to provide different language interpretations, so different spoken languages can be used simultaneously. Our aim is to adopt a multilingual approach.  So that means AHMPs could speak English, and the individual being assessed could use BSL or a different spoken language and people can listen to different language options or watch BSL interpreters. And then after the simulation is finished we will gather their thoughts and opinions on the process and what that felt like. We want to ask them different questions using a poll. We have trialled several different options to see what works well so that people to contribute their views. We’re still in midst of that. We are currently piloting what works well. Then, we will work out the situation and what that is going to look like. We will start developing that soon, so it’s very exciting.

Data analysis

In terms of the analysis, we will use various different methods. For example, for the survey, we will be using descriptive analysis and may use statistical analysis. For the interviews, we will use something called the phenomenological approach which allows us to examine the individuals and their experiences. For the simulated practice, we will using different approaches. We will be analysing the interaction between the interpreter, the assessor, the service user, or the carer. We will be using software tools GoReact and ELAN. So, we will use both to analyse the information.

So, that’s the overall project.

Knowledge Exchange and Information Exchange (KEIE)

We also have a responsibility to share our findings. We have to make sure that research is accessible and has an impact and will benefit those people concerned. For example, service users, AMHPs and interpreters, so we do this through KEIE. We will publish papers but the main foundation and principle behind our project is accessibility, making sure information is accessible. So, we will disseminate information in English, in sign language like we’re doing today with this vlog. But also, we want to try to make it available in different spoken languages. We will have a website where these different language options are available and everything will be available in sign language. We will post regular updates as we go along that will be on the website, so that people can engage and see the information we are putting out there. We will also host workshops, deliver presentations at academic conferences and for professional organisations and communities, making sure that people are aware of what is going on with the project. For example, we delivered a workshop to NIHR SSCR, who funded the project and we talked about accessibility, what that means and how we designed our project with accessibility in mind using a multilingual approach and how we have embedded the principle of accessibility in the whole research design that will hopefully continue long after the lifespan of the project.

Website & Resources

A website is currently being developed for the project. There will be information and guidance available on the website at the end of the project. We hope to create some training materials, guidelines for interpreters working with AMHPs and guidelines for AMHPs working with interpreters plus, these resources will be free and available online, so anybody interested in the topic can download these materials, whether they teach AMHPs or are interpreters, they will have access to these materials as well.