Legislation Committee No 5

The Proposed National Assembly for Wales (Legislative Competence) (Welsh Language) Order 2009

Consultation Response

IG60(i) Dilys R Davies

Dear Sir,

I would like to submit the following testimony based on my experience as a consultant clinical psychologist as evidence of the inadequate services provided for patients in the mental health services in Wales. Specifically this refers to Welsh speakers in the psychology, psychotherapy and psychiatric services.

Whilst I was employed as a consultant clinical psychologist and clinical psychotherapy supervisor at Guy's Hospital, London, my department had a request from a West Wales hospital for clinical supervision for their psychotherapy staff. As I am a Welsh speaker whose family originates from West Wales I eagerly accepted this invitation.

The situation that I found was a shock. Even though the area is one where the majority of the population are Welsh speaking, none of the psychotherapy staff were Welsh speaking or had bothered to learn the language.

Most had moved to the area from England Patients during my supervision session were at times referred to as 'Very Welsh' by therapists when outlining a patient's presenting problem- I expect this referred to their being Welsh speaking. After the first supervision session I drove back to Guy's and shared my experience of this session. In all my years of practicing in England I had never heard of a patient being referred to as 'Very English' and as a colleague that day at Guy's pointed out, if anyone there had referred to a patient in their catchment area as 'very Afro-Caribbean' the consequences would have been challenging. An Indian colleague offered me some helpful advise in that he had come across a similar situation to that which I had experienced, and as he said; 'Its called The Raj'. Subsequently I have researched and written about this unacceptable situation that exists for Welsh speakers accessing mental health services in Wales. As well as speaking at conferences I have published 2 papers. These detail the unacceptable nature of a patient in their own country not being able to receive a service in their own language.

Language is not just words. Theorist from different disciplines - psycholinguistics, psychology, neurology and throughout the world point to the fact that language is culturally transmitted and the attitudes, values, meanings and way of seeing the world are embedded in language and in the individual psyche. If a therapist and client are not speaking the same language there is a cultural gap and this is always to the detriment of the patient's therapy.

1. The papers refer to research that show that therapy is more effective when the person is treated in their preferred language.

2. The historical and psychological issues that deter Welsh speakers from demanding the right to treatment in Welsh.

3. The general issue that patients are by definition vulnerable and may well feel that to ask for the right for treatment in Welsh would be a detriment to their own or relatives treatment. It is wrong to expect patients to anticipate the difficulty- especially that of detailed research evidence indicating less adequate treatment if not in your chosen language - as they are not in a position to have that knowledge. The onus is always on the service providers to anticipate the problem.

4. Why do not service providers anticipate the problem? It has not been a priority for professional managers, whose job it is to put into place the policies that are directed to them. It would meant an examination of the issues revolved around the provision of an adequate service. In England there is ethnic monitoring of staff to ensure that the ethnic mix of the staff reflect that of the population they serve. This is not done in Wales.

Often this is because it is not in their own professional or personal interests.For individual psychotherapists and psychologists, it is often not in their personal or professional interest to address the issue. it would mean for example bothering to examine the issues revolving around the provision of an adequate service, and exerting time and effort to learn the language of their patients.

I found that my experience at that particular hospital was common throughout Wales. Very few of the service providers speak Welsh in the mental health services and the issue is ignored. The papers that I have written are:

Dilys R. Davies (1999) Welsh psyche: implications for psychological services. International Review of Psychiatry, 11, 199-213

Dilys R. Davies (2001) Within and Without (The Story of the Welsh) The Impact of Cultural Factors on Mental Health in the Present Day in Wales. In Dinesh Bhugra and Roland Littlewood (eds) Colonialism and Psychiatry. Oxford University Press 2001.

I have also referred to the situation for Welsh speakers in Wales in other writings as an example of inadequate service provision when a dominant linguistic group dictates the provision of service and a linguistic group is ignored, for example Dilys R Davies 'Models of Psychopathology' McGraw Hill(2006).  When this happens, the themes are those of silence and invisibility.

Yours sincerely,

Dilys R Davies, Ph.D. (Psychol).,MSc (Econ)., MSc. (Psychol)., Dip. Clin. Psych. MBPS.

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