Multilingualism in mental health care - a long way to professionalism.

A substantial number of people with mental disorders do not speak the language of their healthcare provider well enough to participate in a full diagnostic procedure or to conduct a cultural formulation interview. Five main strategies are used to overcome language discordance and provide multilingual mental healthcare: simplified direct communication, digital translation tools, multilingual materials, multilingual clinicians, and interpreters. Each has value, but each also has limitations. Informal interpreting by relatives, children, or untrained staff raises substantial ethical, clinical, and organizational concerns. Professional interpreting represents the preferred standard, yet access remains inconsistent in many health systems. This Perspective argues that multilingual communication should be treated as a core component of professional mental health care rather than as an exceptional or improvised accommodation. Therefore, mental health care services require multilevel action on individual, institutional and systemic levels to improve the quality of communication when patient and healthcare provider do not share the same language. The "Hamburg Declaration for Multilingual Healthcare" provides actionable guidance also for health professionals, health care management and healthcare users. Strengthening multilingual communication is not merely a technical improvement but a matter of clinical quality, patient safety, and health equity.