Dr Graham Hieke

Background: Language barriers in primary care contribute to health inequalities, limiting access to services and affecting patient outcomes. Professional interpreting services are emphasised in UK guidance, but evidence on how policymakers and commissioners deliver these services is lacking. This study aimed to explore the commissioning and implementation of interpreting services in UK primary care from the perspectives of commissioners, policymakers, interpreters and interpreting service providers. Methods: Semi-structured interviews were conducted with 31 participants (12 national policymakers, 6 commissioners, 7 interpreters and 6 interpreting service providers). Thematic analysis was conducted to explore delivery and identify best practices and key challenges in delivery. Results: The study found variation in commissioning models, with some areas favouring large national providers for widened scope and cost efficiency, while others prioritised local interpreting services for higher quality. The UK was seen as world-leading in interpreting provision, however fragmentation, lack of standardisation, accountability gaps, funding constraints within a publicly-funded healthcare system, and varied interpreter competencies and renumeration led to inconsistency in delivery. The healthcare sector was reported as having lower interpreting standards compared with other UK public sectors. Technological solutions were used in delivery and offered key advantages but sometimes failed to meet patient and provider needs. Conclusion: Strengthening national regulation, funding allocation, and service integration is essential to addressing systemic issues and improving interpreting service delivery in UK primary care. Policy recommendations include promoting ‘what good looks like’, standardising interpreter qualifications and adopting approaches tailored to local population needs.

BackgroundGlobally, one billion people suffer from mental health disorders. Migrant populations face high prevalence rates of some disorders and significant barriers in accessing mental healthcare, including language-related barriers. However, knowledge about specific communication difficulties arising from language barriers and mitigation strategies is limited, as is knowledge about country-specific differences.ObjectiveThis study explores health and social care providers’ (HSCPs’) perceptions of mental health service accessibility for migrants, language-related communication difficulties, mitigation strategies and their perceived effectiveness, and the effectiveness of HSCP training in working with migrants.MethodsWe conducted a cross-sectional survey of HSCPs in nine European countries (n = 629).ResultsHSCPs perceive mental health services as largely inaccessible for migrants facing language barriers. Cross-regional comparative analysis identified differences in the frequency of HSCPs’ interactions with migrants seeking support for their mental health where language barriers are present and in how often HSCPs’ reported experiencing communication difficulties when doing so. HSCPs report a lack of training in communicating with migrants across language barriers, with recent training associated with more positive perceptions of its usefulness. Communication difficulties were encountered throughout the care journey. Informal strategies, such as assistance from family and friends, and machine translation, are commonly used but seen as ineffective. Onsite professional/trained interpreters are deemed most effective, yet their availability is limited.ConclusionsFindings highlight the urgent need for better communication strategies and awareness of the benefits and drawbacks of different strategies to enhance mental health service accessibility for migrants.

This study addresses the mental health needs of refugees and migrants in the Netherlands, highlighting the urgent public health challenges they face. Unique psychosocial hurdles, exacerbated by cultural dislocation, language barriers and systemic inequalities, hinder their access to quality mental healthcare. This study explores how coloniality intersects with mental healthcare access, using a decolonial framework to challenge stereotypes and assumptions that marginalize migrant voices. Through semi-structured interviews with migrants and language service providers, this research reveals the complexities of navigating the mental healthcare system. Findings reveal that temporality, professionalism and language barriers are key issues in migrants’ mental healthcare journeys. We advocate for systemic changes that prioritize migrant perspectives. Ultimately, this study aims to inform policy and practice to enhance mental health services for migrant populations in the Netherlands and contribute to the broader dialogue on decolonization in mental health.

Background Communication difficulties due to unmet language needs are a driver of inequality in healthcare access. The provision of professional interpreting services should mitigate these, and their use is associated with improved patient outcomes. However, interpreting uptake in England is suboptimal and there has been limited research focused on understanding patient experiences and the potential impact on uptake. This multilingual study explored patient perspectives of access to and experience of language support in general practice (primary care) in England, including the use of professional interpreting services and informal language support (i.e. family/friends). Method This is a qualitative study based on face-to-face semi-structured interviews with 30 participants from South Asian backgrounds (Pakistani, Indian, Bangladeshi), with no/limited proficiency, living in England. Interviews were analysed with inductive thematic analysis. Patient advisors were involved in all aspects of the research and interpretation of the findings was supported by public engagement focus groups. Results Three main themes described participants challenges related to uptake of professional interpreting services including 1) the burden of articulating need, 2) prioritisation of different types of language support (professional/informal), and 3) perceptions of professional interpreting services. Participants described an onus on them to arrange interpreting themselves, whilst regular use of informal language support could inhibit offers of professional language support. Online/digital booking systems perpetuated these challenges. Patient illness appraisal impacted decision making, with informal language support prioritised for less serious matters. Patients highlighted the importance of having confidence in these services, and face-to-face interpreting was preferred to remote interpreting. Conclusions No/low English proficiency patients need additional support when booking interpreted-assisted appointments. Increasing patient awareness of and confidence in professional language support is vital to uptake of services. Emphasising the benefits of professional support over informal options is important, with links to patient safety. We provide recommendations for general practice in how to support the uptake of professional interpreting services.

Background: Interpreting services bridge language barriers that may prevent patients and clinicians from understanding each other, impacting quality of care and health outcomes. Despite this, there is limited up-to-date evidence regarding the barriers to and facilitators of uptake in primary care. The aim of this study was to ascertain current national uptake and experience of interpreting services in primary care (general practice) by South Asian communities in England. Methods: We conducted a national cross-sectional survey in 2023 with people with limited or no English language proficiency (n=609). Multilingual researchers interviewed people from Bangladeshi (n=213), Indian (n=200), and Pakistani (n=196) backgrounds from four regions in England (Greater London, Midlands, Yorkshire and the Humber, North West). Results: Sixty-three percent of participants reported using professional interpreting services in primary care. The most common modality was face-to-face interpreting (55%), followed by telephone (17%) and video (8%). Multivariable analysis identified several correlates of lower uptake: participants from Indian backgrounds, those living in the Midlands, and those whose family member/friend interpreted for them within the past year were less likely to have used a professional interpreter provided by their general/family practice. Participants who had visited primary care within the last 12 months, had requested an interpreter but were told they could not have one, were informed about professional interpreting services, and were given choice in their language support were more likely to have used a professional interpreter. Conclusions: Our approach provides novel data on professional interpreting service use and evidence about the factors that may play a role in patient uptake and experience

Video mediated interpreting (VMI) remains perhaps one of the most controversial topics in interpreting studies. The practice of VMI has, however, grown rapidly during the Covid-19 pandemic, and the global shift towards working online for prolonged periods has also shifted the focus of research on VMI from investigating the feasibility of VMI to developing a better understanding of the factors that can contribute to sustaining it. Pre-pandemic research on VMI has spanned all fields of interpreting: conference (e.g., Moser-Mercer, 2003; Mouzourakis, 2006; Roziner and Shlesinger, 2010), legal (e.g., Braun and Taylor, 2012a; Braun, Davitti and Dicerto, 2018; Fowler, 2018) and medical (e.g., Locatis et al., 2010; De Boe, 2020; Hansen and Svennevig, 2021). This research has generated mixed, sometimes contradictory results. In relation to legal settings, the main lines of enquiry revolve around the classical aspects of interpreting quality (Balogh and Hertog, 2011; Braun, 2013, 2014; Braun and Taylor, 2012b; Miler-Cassino and Rybinska, 2012), interpreters’ working conditions (Fowler, 2018), the interpreter’s role (Devaux, 2016) as well as participants’ behaviour (Fowler, 2016), the communicative ecology of VMI (Licoppe and Verdier, 2013; Licoppe, 2015; Licoppe and Veyrier, 2017) and the impact of VMI training on interpreting performance and stakeholders’ perceptions of VMI (e.g. Braun et al., 2012; Braun, 2014).The existing research conducted within legal settings indicates that VMI creates a range of challenges, but also that some of them are specific to the actual configuration of VMI that is used, especially the distribution of participants. For court hearings in which the interpreter is not co-located with the participant requiring the interpretation, two of the main challenges identified in previous research are a lack of rapport between the interpreter and the remote end user (Fowler, 2016) and limitations regarding the mode of interpreting. Licoppe and Verdier (2013), for example, found that interpreters could only work in consecutive mode in this setting and were thus reliant on the other participants’ awareness or willingness to pause for the interpretation. However, further studies of authentic legal proceedings are needed to confirm the identified challenges and to establish best practices for each configuration. There also seems to be a lack of consensus among interpreters regarding their perceptions of VMI, with some interpreters expressing a more positive attitude towards it and others struggling to see beyond the ‘cost-cutting’ implications (Devaux, 2016; Braun, Davitti and Dicerto, 2018). This poses the question whether there are also individual differences at play influencing how interpreters renegotiate the video-mediated modality with its added layers of complexity (Braun, 2018).In this chapter we examine one particular configuration of VMI in which a defendant takes part in the proceedings via video link from prison whilst all other participants including the interpreter are physically present in the courtroom. Drawing on observation and interview data collected between March 2019 and March 2020 in magistrates’ courts in the London area, with a focus on extradition hearings, we examine the complexities of VMI in this configuration, and the associated strategies employed by the interpreters who participated in this study. We focus on three aspects, namely a) challenges encountered by interpreters when working in the described VMI configuration, i.e. factors that have a negative impact on the interpreting process or outcome and/or on the proceedings in this configuration, and interpreters’ responses (strategies); b) aspects that compensate for the challenges; and c) positive aspects of VMI. This is a first step towards answering our central question in this study, namely to what extent the selection of interpreting strategies is related to individual differences between interpreters.

•There is a strong need for language support in mental health services.•Migrants, refugees and healthcare professionals are not aware of language support options.•Systemic, interpersonal, and intrapersonal factors affect uptake of language support options.•Improving language support and cultural competency in mental health services is essential.•Seeking, providing and accessing mental health services is a complex system. Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present. We undertook a rapid systematic review of the literature (01/01/2011 – 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively. 58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems. Language barriers impede TCNs’ access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services.

This article focuses on the involvement and management of spontaneous volunteers (SVs). It develops a new theorywhich we call the involvement/exclusion paradoxabout a situation which is frequently manifested when SVs converge in times of disaster. After reviewing research and policy guidance relating to spontaneous volunteering, we present findings from a study of responses to winter flood episodes in England. Taking together the empirical findings and the literature, the article analyzes elements inherent in the involvement/exclusion paradox and develops a conceptual model to illustrate and explain the paradox. Implications for managers and future research are discussed.

This chapter examines the types of individuals who choose to volunteer for the Special Constabulary. After providing some historical context around the development of the Special Constabulary, including the types of individuals more likely to be selected for such work, the chapter then draws on previously published statistics to chart the overall headcount of the volunteer police service. The remainder of the chapter is devoted to considering the membership profile of the Special Constabulary, primarily using official statistics published by the Home Office. The chapter challenges the notion that the Special Constabulary is both more representative of the general population it serves and more diverse than the regular service. The final section of this chapter considers some of the possible implications of membership diversity for the Special Constabulary, such as the relationship between volunteers in policing, the local community and the wider police service. This chapter examines the types of individuals who choose to volunteer for the special constabulary. It provides brief overview of the historical context and role of the special constabulary, considering the way in which it has developed over the years and discusses previously published statistics to chart the overall headcount of the volunteer police service. Deeper analysis of the statistics concerning the gender profile and ethnic diversity of the special constabulary highlights considerable regional variations, which to some extent undermine more general claims about the representativeness of the volunteer police. The chapter considers some of the possible implications of membership diversity for the Special Constabulary, such as the relationship between volunteers in policing, the local community and the wider police service. Whilst the special constabulary may be considered as being more diverse than the regular service, it is far from being representative of the population it serves.

The advent of AI-supported, cloud-based collaborative translation platforms have enabled a new form of online collaborative translation — ‘concurrent translation’ (CT). CT refers to commercial translation performed on such platforms by multiple agents (translators, editors, subject-matter experts etc) simultaneously, via concurrent access. Although the practice has recently gained more ground, research on CT is scarce. The present article reports on selected key findings of a study that investigates translators experiences with CT via a survey of 804 professional translators working in CT mode across different commercial platforms. Despite the affordances such as peer learning, positive competition, speed, flexibility of the volume of work and working time, and reduced responsibility and reduced stress, CT workflow comes with its substantial challenges such as time pressure, negative competition, reduced selfrevision and research, all of which result in quality compromised for speed.

The experiences of police officers who have retired from the police service have rarely comprised the focus of empirical studies in England and Wales. Drawing on the findings of a survey of former police officers, this article examines the circumstances within which officers leave the service and aspects of the transition to retirement. We find that that certain individual, role, and organisational factors come together to explain how the transition to retirement is experienced by police officers. We conceptualise police retirement as a multi-dimensional process during which a number of factors may come into play and have different effects depending on the circumstances in which retirement occurs. Findings are considered in light of wider conceptualizations of the process of retirement and implications are discussed.

This article reports the findings of a large scale survey (N=10,897) which sought to reveal patterns of injury on duty (IoD) and perceptions of organisational and other support amongst serving police personnel in England and Wales. We found that IoD is a multi-faceted issue incorporating wide-ranging physical and psychological injuries and illnesses. We also found that, by their own testimony, IoD is not experienced equally amongst police personnel. Reported experiences of IoD together with satisfaction with, and priorities for, support in the aftermath of injury were shaped by injury type, the role played in the police organisation and the individual characteristics of police personnel, notably, gender. Conceptual and practical implications are discussed.

This chapter examines the reasons why individuals choose to volunteer for the Special Constabulary. It begins by considering some of the different perspectives used to understand volunteer motivation, before identifying and discussing some of the most dominant reasons given by special constables in previous research. Here findings from the literature are divided into three sections: career driven motives and an interest in police work; other self-orientated motives; and finally those which are more altruistic or other-orientated. The chapter also seeks to update existing research on Special Constabulary motivation by introducing findings from a previously unpublished online survey delivered across two forces. This chapter examines the reasons why individuals choose to volunteer for the Special Constabulary. It considers some of the different perspectives used to understand volunteer motivation, before identifying and discussing some of the most dominant reasons given by special constables in previous research. Although there are potentially numerous motivations that might initiate and sustain special constabulary volunteerism, existing research would suggest that they coalesce around three dominant themes. The dominant themes include career-driven motives and an interest in policing and police work; altruistic or other-orientated motives associated with wanting to give something back or helping the community; and more instrumental self-orientated motives concerning personal development. Findings concerning career-driven motives and both service length and time volunteered should be acknowledged by the special constabulary-and particularly by those who have recruited high numbers of volunteers at a time when recruitment opportunities into the regular service remained closed.