The doctor doesn’t understand Xhosa and the service user doesn’t understand English - Exploring the role of security guards acting as informal interpreters in psychiatric care in South Africa

Sep 30, 2026

Uploaded by Pentious

The study examines informal interpreting practices in mental healthcare in South Africa, focusing on security guards serving as interpreters. Guided interviews were conducted with security guards and mental health care providers at a psychiatric hospital, then analyzed via thematic analysis. Findings show providers rely on security guards despite concerns about treatment quality, driven by limited interpreting services and perceived linguistic, racial, and socioeconomic similarities. Reported benefits include immediate accessibility and minimal care, while drawbacks include diverted duties, emotional distress, role conflicts, ethical risk from inaccurate interpretation, and shifting power dynamics.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Aims

Methods

Results

Conclusions

vi24 European Journal of Public Health, Vol. 35, Supplement 6, 2025 OP 4: Health Services 2, B302 (FCSH), September 3, 2025, 14:30 - 15:30 Aims: Assigning qualified interpreters is considered one of the most effective approaches to facilitate communication in language-discordant encounters in mental healthcare (MHC) . However, particularly in settings with fewer resources, they are not always available and informal practices are often used. This study aimed to investigate informal interpreting practices in MHC in South Africa, focusing on security guards (SGs) serving as interpreters. Methods: Guided interviews were conducted with SGs (n ¼ 12) and MHC providers (n ¼ 18) at a psychiatric hospital in South Africa. The interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach. Results: Despite recognizing that SGs serving as interpreters is not an ideal solution to overcome language barriers and could potentially jeopardize the quality of treatment and its outcomes, MHC providers reported relying heavily on them due to the underrepresentation of South Africa’s linguistic diversity among them. Given the lack of formal interpreting services, the perceived racial, linguistic and socioeconomic similarities between SGs and some service users, as well as their immediate accessibility, were described as beneficial to providing a minimal level of care. Drawbacks reported are SGs being pulled away from their actual duties, experiencing emotional distress, juggling multiple sometimes conflicting roles, and the risk of incorrect interpretation, which could compromise ethical standards of care. Additionally, the complexity of power became apparent: While SGs hold little institutional power within the mental healthcare system, they become powerful figures when serving as interpreters. Conclusions: It can be assumed that MHC providers will resort to informal interpreting practices as long as effective alternatives are lacking. In doing so, risks such as reduced quality of care are accepted, and the consequences and effects on those serving as interpreters are neglected, which raises concerns from an ethical point of view. Abstract citation ID: ckaf180.068 185 ‘The doctor doesn’t understand Xhosa and the service user doesn’t understand English’. Exploring the role of security guards acting as informal interpreters in psychiatric care in South Africa Saskia Hanft-Robert1, Lindokuhle Shongwe2, Qhama Cossie3,4, Philasande Sithole4, Tessa Roos3,4, Mike Mösko1,5, Leslie Swartz2 1Department of Medical Psychology, University Medical Center HamburgEppendorf, Hamburg, Germany 2Department of Psychology, Stellenbosch University, Stellenbosch, South Africa 3Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa 4Department of Health & Wellness, Valkenberg Hospital, South Africa 5Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany

FAQs

Why do providers rely on security guards as informal interpreters in South Africa?

They are often the only available option in settings with limited resources. Providers also cite underrepresentation of interpreters across linguistic diversity and perceived similarities with some service users, along with immediate accessibility.

What are the main benefits and drawbacks reported about this interpreting approach?

Benefits include providing a minimal level of care and facilitating communication through accessibility. Drawbacks include risks to ethical care from incorrect interpretation, emotional distress, having guards pulled from their duties, and juggling multiple conflicting roles.

How does the study describe power dynamics when security guards act as interpreters?

Security guards have little institutional power in the mental healthcare system, but they become powerful figures when interpreting, making power complexity more apparent.

Sep 30, 2026

Uploaded by Pentious