Using Visuals to Combat Language Barriers in Mental Health Care: Drawing on Information Graphics and Graphic Medicine to Support Mental Health of Patients with Limited English Proficiency

by Jessica Lee
May 1, 2025

Abstract

Though the United States has the largest immigrant population globally, language barriers remain a critical issue in the medical field. The language gap leads to worse clinical outcomes for this vulnerable population, particularly with behavioral health services, which immigrants and refugees often seek due to inevitable trauma and stress. However, language and cultural barriers in the mental health care field cause care and treatments to be challenging for providers, who must communicate with sensitivity, and for patients, who must understand their conditions and treatments. This study advocates for graphics–drawing from information graphics and graphic medicine–as a practical knowledge translation (KT) tool to address these challenges. Specifically, the proposed visuals aim to bridge the gap in understanding and conveying medical language and information between providers and patients. Therefore, this study demonstrates strong evidence to support using graphics to improve mental health outcomes for people with limited English proficiency (LEP).

Background Information – Statement of Problem

With an often increasing number each year, the United States recorded a foreign-born population of 47.8 million people, accounting for 14.3% of the total population (Moslimani and Passel). Among all U.S. immigrants, about 46% are not proficient in English (Moslimani and Passel), leaving only about half able to navigate life without a language barrier. Although millions of immigrants live and work in the United States while facing daily obstacles, they deal with yet another challenge of receiving mental health care.

As a study in Italy found immigrants to be at higher risk of psychotic disorders when compared to the native-born population (Alegría et al.), mental health care is an essential support system for immigrants, who usually deal with many stressors due to family, social life, and language barriers. For example, family separation is a common risk factor for foreigners, but feeling obligated to care more for family members responsibly and financially poses another stressor (Alegría et al.). Additionally, immigrants living in less-populated areas often find creating a sense of community and belonging challenging due to more discrimination and fewer people to connect with (Alegría et al.). Therefore, the nature of being a foreigner comes with more vulnerability regarding mental health.

A literature review and qualitative study in Canada prove that limited English proficiency (LEP) negatively impacts immigrants’ access to and support of health care, including mental health, causing worse clinical outcomes for the vulnerable population. For example, securing appointments starts an arduous journey to seeking care, in addition to the confusion surrounding various healthcare organizations and systems in each country (Pandey et al.). Another review of Hispanic and Asian populations’ health care indicates that the two populations were found to be “less likely to access mental health services over their lifetimes and spent more time living with untreated mental illness compared to the English proficient population” (Twersky et al.). Also, many with LEP have concerns about the “fear of being misunderstood, experiencing emotional distress prior to the visit, feeling unsatisfied with the care received, delaying seeking care, and the potential for harm or medical errors” (Alegría et al.). Therefore, seeking care presents a challenge emotionally and mentally to many.

Once an appointment is confirmed, developing a therapeutic relationship with healthcare providers poses another worry for people with LEP. For the patients, explaining their health concerns while trying to understand the healthcare professional’s examinations and instructions often causes miscommunication and embarrassment (Pandey et al.). On the other hand, providers tend to experience frustrations and further concerns due to misunderstandings, leading to incorrectly executed treatment plans and prolonged health issues (Pandey et al.). As a result, the inability of providers to develop comfortable, reliable relationships with patients highly impacts patient care.

The general population may assume that the language barrier is not a prominent issue since interpreter services are likely available at most clinics and hospitals. However, this proves false–especially because many interpreters, some brought by immigrant patients, are not adequately trained or skilled to interpret medical language (Pandey et al.). This issue causes the linked communication to be more prone to human error and inadequacy, potentially leading to harmful medical consequences. Particularly for mental illnesses, interpreters must receive adequate training “to create culturally safe interactions, lest the interaction become more injurious to the clients than the illness itself” (Pandey et al.). Additionally, the presence of another person in a private space may cause confidentiality issues and discomfort in disclosing medical information, while the interpreter’s time assisting may vary depending on the services available (Pandey et al.). Consequently, interpreting requires a certain level of training to provide accurately nuanced language for patients and providers.

The various issues surrounding receiving health care for people with LEP pose a high risk of untreated illnesses–primarily mental. As a result, immigrants are often more vulnerable to mental health conditions due to personal and social factors but are nonetheless hesitant in seeking and receiving necessary care. Effective strategies must address this critical issue, notably because the United States has one of the largest immigrant populations globally.

Background Information – Visuals

Two main interdisciplinary fields of medicine and visual arts include medical information graphics (infographics) and graphic medicine. Both serve as visual resources that compellingly communicate information, as humans are better at processing visual information than auditory (Barlow et al.). Infographics, in particular, serve as a knowledge translation (KT) intervention tool, meaning aim to improve health knowledge by sharing evidence (McSween-Cadieux et al.). For effective presentation, infographics enhance understanding by captivating viewers with engaging, concise representative communication (McCrorie et al.), supporting understanding of presented information that is difficult to comprehend only with words, and proving to overcome language barriers. Additionally, this KT tool’s appealing and simplified designs with pictures or drawings assist patients in bridging gaps in their comprehension while retaining the information better (Barlow et al.). The patients are more empowered to be involved in their care by receiving this infographic and reviewing it with their healthcare providers (Barlow et al.). Consequently, knowledge is being passed along through an engaging mode of communication when a patient receives an infographic concerning their health condition.

Mass production, simple printing, or sharing a digital, downloadable version supports the efficient dissemination of information graphics (Hibberd et al.). Especially when explaining medical jargon with complex concepts, accompanying visuals with informative words provides significant support for patients to understand better and take the initiative in solving their health issues (Hibberd et al.). Hence, infographics are usually readily accessible for public use and are a more comfortable way to break down and appealingly relay medical knowledge.

Whereas infographics are more linear with factual, logistical content, graphic medicine offers multiple perspectives of medical-related experiences through a visual story. Introduced in 2007 by Dr. Ian Williams, this reasonably new medium is also called “graphic narratives” and is a comic genre about health care. They aim to tell a story through panels, drawings, and frequently words within a medically-related setting. Comic producers Anthony Farthing and Ernesto Priego recommend in their article using this medium to educate in healthcare environments and cut stereotypes. Particularly in support of mental health, comics provide a relatable community with interactions depicted through characters in panels (Farthing and Priego). Therefore, graphic medicine captivatingly highlights various experiences through a narrative with drawings, breaking stereotypes while sharing more about specific medical situations and the multiple experiences of patients, families, and healthcare workers.

In a more technological world, webcomics and e-graphic medicine provide a “unique communicative opportunity” to convey invisible mental health struggles to others (Bandyopadhyay). Opening doors for a better connection with communities, digital mediums often contain open comment sections, where people can discuss experiences with each other and alleviate some stress and isolation (Bandyopadhyay). For example, some artists–such as Gemma Correll on Instagram (@gemmacorrell)–run accounts on social media with short comic panels or graphics, which are also shareable. As a result, the public can share and connect with others, assuring each other that no one is struggling alone.

Discussion and Proposal

Language barriers in mental health care remain a critical issue in the United States, where tens of millions of people have limited English proficiency. Especially since numerous immigrants and refugees face more stressors from family and social life than the native-born population, mental health support must be available for vulnerable communities. However, limited English proficiency presents challenges for providers delivering and patients receiving adequate care with greater levels and risks of misunderstandings and discomfort.

Graphic medicine and medical infographics are resources that healthcare workers can use to discuss and educate people with LEP about medical conditions, preventing inadequate care due to language barriers. Both are usually colorful and more interactive, with graphics accompanying the words and explaining the content. Not only do these mediums inform viewers, but they also help people retain the information they receive better as knowledge translation tools. Additionally, hospitals and clinics are equipped to share and utilize these visual resources easily by printing them out or providing a free, online downloadable version. Therefore, visual tools can serve as beneficial and feasible supplements used during provider-patient interactions, even if adequately trained interpreters are available.

Though separately practical, a style of visual resources combining graphic medicine and medical infographics presents a more beneficial tool. In other words, adding comic-style graphics in an infographic template on the pages can better assist in communicating medical information while leading to more direct conversations between healthcare providers and patients without the middle-man interpreter. While infographics are more informative to help educate concepts, graphic medicine allows for more personal connections and relatability. As a result, they would present an informative and personal resource that can be accessed and shared without difficulty in person or online.

Drawing more from informational graphics, creators must craft the visuals used in mental health care more sensitively and carefully. As a study done in Spain indicates, knowing the audience and providing a compelling, concise story and image heavily contributes to creating an advantageous visual communication tool (Hernandez-Sanchez et al.). Using visuals would support a better understanding of the complex medical jargon and ideas (Hibberd et al.) while alleviating concerns of misunderstanding information. Additionally, mental health-related graphics must help break possible cultural stigmas by using illustrations to advocate and normalize mental health support. Adding a short strip of comic panels within the infographics offers encouragement to patients to receive therapies and treatments by depicting a sense of community that others struggle with the same issues.

Making the infographics available for public use and sharing may play an active role in creating a tight-knit community to socialize and develop safe relationships to discuss mental health. The illustrated art fosters an open and shared space for people to express themselves without boundaries, banding together relatable thoughts (Bandyopadhyay). Therefore, having a monitored comment section online with posted visual resources can encourage further interpersonal interactions that uplift people as social media does.

Although visuals serve as advantageous tools in healthcare, their creation, use, and dissemination include limitations and caution. For example, the resource must be developed carefully and knowledgeably and not be the only resource presented by providers due to the risk of oversimplification (Barlow et al.). Taking ample time to research the medical conditions properly, design the graphics, and set a thorough plan to share the product should help avoid risks like spreading misinformation. Additionally, successfully disseminating the graphics requires an intentional plan, such as using social networks (Hernandez-Sanchez et al.) or spreading them through direct contact. Posting creative products with backed-up research as a free resource online on websites and social media while sharing them with hospitals and clinics can support the dissemination to have them incorporated for better care of patients with LEP.

Conclusion

The influence of the rising fields of graphic medicine and medical infographics shows excellent potential in creating visual resources that are most useful for educating patients with LEP and helping them understand and accept their mental health conditions. Because the millions of immigrants in the United States are inevitably more vulnerable to psychiatric illnesses than native-born Americans, mental health support must be a comfortable option for all. Therefore, this paper proposes a graphic resource as a supplement for patients with LEP to comprehend their conditions for adequate treatment.

Future Direction

Moving forward, I will draft and share a guidelines document for people interested in joining my project to create visual resources, as my goal is to expand beyond mental health and Boston. More than five people have contacted me about contributing during the next academic year, so I am excited to work with them and share more information during the summer to prepare them for research, outreach, and creation opportunities. Therefore, I see great potential in expanding this project to impact people with limited English proficiency positively, effectively, and creatively.

Works Cited

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