Language mediation in psychotherapeutic healthcare for refugees in Germany – shunting responsibility between levels and actors

• DOI: https://doi.org/10.1108/IJMHSC-05-2022-0053
• Published date: 19 December 2022
• Date: 19 December 2022
• Pages: 28-41
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations,Labour movements
• Author: Renate Reiter,Lisa Walter

Language mediation in psychotherapeutic

healthcare for refugees in Germany –

shunting responsibility between

levels and actors

Renate Reiter and Lisa Walter

Abstract

Purpose –Refugees’ access to psychotherapeutic care is insufficient in Germany. One factor

particularly contributingto hindering their access to adequate therapeutic care is a lack of provision of

language mediation. This paper aims to explore the institutional system in which the financing of

language mediation in the contextof the medical treatment of asylum seekersin Germany is located. It

examines why the languagebarrier problem resulting from a lack of financing is not being solved,even

though ithas been well known for years as a structuralproblem of day-patient health careto refugees and

migrantsin Germany.

Design/methodology/approach –The financing of language mediation is analysed against the

background of theories of the so-called ‘‘shunting yard’’, in which public responsibilities for the

assumption of costs are shifted from one level and actor to the other, thus preventing sustainable

solutions being achieved. A mix of qualitative methods including the evaluation of official documents,

reportsand secondary literature, and of 23 expertinterviews was used.

Findings –The financing of language mediation is a perfect example of the ‘‘shunting yard’’

phenomenon, with responsibilities being shifted between federalgovernment, health insurance bodies

and the municipalitiesin Germany. This paper argues that the specific financingstructure in the German

federal system can be viewed as a reason for the non-solution of the language barrier that hinders

refugees’access to health care.

Originality/value –The problem of thefinancing of language mediation in thecontext of health care has

been rarelytreated from a social sciences perspective.This paper contributes to addressingthis gap.

Keywords Asylum seekers, Health care, Language mediation, Psychotherapy, Shunting yard,

Germany

Paper type Research paper

1. Introduction

Refugees bear an increased risk of developing mental illnesses compared to people who

have not had to flee their homeland [Reiter et al. 2019a:13;Deutsche Gesellschaft fu

¨r

Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), 2016;

Trilesnik et al., 2019;Liedl et al.,2017, p. 1]. Especially when measured against their above-

average need for psychiatric and psychotherapeutic care, in Germany refugees have very

limited access to care (To

¨ller et al.2020;Bo

¨ttche et al.,2016;Altunoz et al.,2016;Giacco

et al., 2017;Schro

¨der et al., 2018;Schreiter et al.,2016). One obstacle that regularly

prevents refugees and asylum seekers from engaging in psychotherapy is the language

barrier between patients who may not speak German proficiently and therapists who only

speak German (To

¨ller et al. 2020; Reiter et al. 2019a; Trilesnik et al.,2019). Theoretically,

Renate Reiter is based at

the Department of Political

Sciences, Faculty of

Cultural and Social

Sciences, FernUniversitat in

Hagen, Hagen, Germany.

Lisa Walter is based at the

Deutsches Zentrum fu

¨r

Integrations- und

Migrationsforschung,

Berlin, Germany.

Received 24 May 2022

Revised 10 October 2022

Accepted 17 November 2022

This study was supported by

Federal Ministry of Education

and Research (BMBF)

Germany (01UM1815BY).

PAGE 28 jINTERNATIONAL JOURNAL OFM IGRATION,HEALTH AND SOCIAL CARE jVOL. 19 NO. 1 2023, pp. 28-41, ©Emerald Publishing Limited, ISSN 1747-9894 DOI 10.1108/IJMHSC-05-2022-0053