The first time Adele Routliff tried communicating with her Deaf mother in public using sign language, her mother, she says, “put her hands on mine and placed [them] back in my lap. In other words, no, we don’t sign in public.” Her mother had grown up in a residential school for the Deaf where sign language was forbidden—enforced by physical punishment—and had internalized the idea that signing was only safe in private settings. Adele didn’t understand her mother’s resistance and so continued signing, even as her mother’s eyes grew wide with fear. “I didn’t understand it then,” she says. “But I know now it was shame.”
Now a certified American Sign Language-English interpreter, Adele actively works to raise awareness of deafness by bridging the communication gap and highlighting the importance of mental health in Deaf communities. Her lived experiences have motivated her in becoming a trained mental health interpreter, in providing mental health interpreting workshops for those looking to develop their skills, and in designing and implementing a curriculum for training new interpreters through Canadian Hearing Services.
Historically, Deaf mental health has been overlooked, and it received minimal attention until the past decade. Dr. Cathy Chovaz—director of the Centre for Deaf Education and Accessibility Forum (CDEAF) and an associate professor of psychology at King’s University College (Western University)—provides mental health care to Deaf individuals. She has led research that suggests that Deaf people face heightened risks of depression and anxiety, compounded by significant barriers and poorer outcomes within the justice system, mainstream education, and healthcare settings. Dr. Chovaz’ research shows that many healthcare professionals aren’t trained to recognize mental health conditions in Deaf patients. As a result, Deaf individuals are often misdiagnosed or go undiagnosed, even though they face unique challenges that put them at higher risk, such as limited early access to sign language, communication barriers within their families, neurological conditions linked to certain causes of deafness, and experiences of trauma or abuse.
The Challenges of Mental-Health Interpreting
Considering the challenges faced by Deaf individuals, it’s not surprising that sign language interpreters working in medical and mental health settings also face heightened risks.
Sign language interpreting requires the interpreter to use their face and their body to communicate, both with the Deaf person and to the hearing person, an experience that can be emotionally and physically taxing. Sign language interpreters also have to remember that their job is to relay every word exactly as it’s signed—no matter how uncomfortable it makes them. One mental health interpreter, who wishes to remain anonymous—we’ll call her Jane—shared how challenging this can be: “There have been times I felt like I needed to wash my mouth out with soap,” referring to the language she had to interpret. “You almost want to say, ‘It’s not me, it’s them.’”
You walk into the most intimate moments in people’s lives as an interpreter. I’ve been at births, I’ve been at deaths, I’ve been at funerals. I’ve been there when families have blown up.
Jane explained that while interpreters are trained to remain impartial, it’s hard not to have a natural human reaction to some of the distressing things they hear in medical and mental health settings. “You’re told you’re just there to convey the language—to maintain professionalism, set boundaries, and be mindful of how you come across,” she said. This is especially crucial in high-stress or emotionally charged situations, which interpreters often find themselves navigating. As Adele said, “You walk into the most intimate moments in people’s lives as an interpreter. I’ve been at births, I’ve been at deaths, I’ve been at funerals. I’ve been there when families have blown up.”
The Health Risks of Helping People Be Heard
Medical interpreters who work with hearing people play a critical role in helping patients with limited English access and navigate the healthcare system, but the job can bring with it significant emotional strain. They often find themselves in high-stress situations: delivering difficult news, bridging cultural gaps, and facilitating conversations between doctors, patients, and families. Research shows that interpreters, especially those working with cancer patients and children, experience high levels of stress and struggle to manage their own mental health while supporting others.
Research shows that interpreters, especially those working with cancer patients and children, experience high levels of stress and struggle to manage their own mental health while supporting others.
And this emotional burden isn’t unique to spoken language interpreters—it also extends to sign language interpreters, who face their own distinct challenges in medical settings. Although research findings are mixed, recent studies indicate that regular exposure to emotionally charged or traumatic content significantly increases sign language interpreters’ vulnerability to vicarious trauma and secondary traumatic stress, with poor mental health outcomes reported in as many as 83% of interpreters. Jane shared with me a particularly stressful assignment: “I recognized I was no longer able to manage my emotions and it was affecting my ability to interpret in a neutral manner. So I had to take a step back.”
Mindful Skills May Help Sign Language Interpreters
Those working in emotionally charged settings, particularly medical and mental health contexts, could benefit from preventive measures. One promising approach is the use of mindfulness practices. While it is an understudied area, some research suggests that mindfulness can help interpreters manage work-related stress. A recent study adapted Mindful Practice® in Medicine (MPIM)—an evidence-based mindfulness program created by two physicians to improve coping skills and combat burnout—for medical interpreters.
The findings showed that the program effectively reduced distress in both spoken and sign language medical interpreters. The study also found that most participants valued the opportunity to share their stressors in an open and understanding environment with fellow medical interpreters. This sense of community not only helped them become more empathetic listeners but also provided a supportive space to debrief and develop mindful strategies for managing the challenges of their work.
Incorporating mindfulness-based practices into interpreter training programs and providing ongoing professional development can help interpreters better handle emotionally charged situations, enhance self-awareness and emotional regulation, build resilience to burnout, and, like Jane, recognize when an assignment exceeds their capacity. Jane, though not formally trained in mindfulness practices, shared that using mindfulness has helped her. Even something as simple as parking her car further away from her workplace, requiring a longer walk, was helpful to her in processing her day. Similarly, Adele has gained the ability to check in with herself and know what her limits are. While both have been lucky enough to find mindfulness in their own lives, the industry could benefit from offering interpreters formal mindfulness training, which could significantly reduce the stress of challenging interpretation work.
