Student Jessica Lee (left) was mentored by BU scholar Davida Pines for her project, which utilizes unique graphics to provide medical information to non-English speakers.

Mental Health

Can Art Help Doctors Improve Mental Health Care for Non-English Speakers?

BU student researcher develops comic-style graphics for Boston Medical Center immigrant health unit

In 2022, undergraduate Jessica Lee took a leave from Boston University to care for her South Korean grandfather in Tennessee, following a stroke. In his hospital room, the doctor explained to the patient and his family that he was aspirating fluid in his lungs.

“The interpreter, after a pause, said [in Korean] that he was breathing,” recalls Lee (CGS’24, Pardee’26). “I was the only one that understood both languages fluently. So I just said, ‘Hold up. No.’ I had to take over interpreting.”

The experience gave Lee, an aspiring physician, her aha moment about the difficulties facing English as a second language (ESL) patients. She decided to research a different approach: doctors using graphics to demonstrate, visually, illness and necessary self-care.

Lee has created a website for Boston Medical Center’s Immigrant and Refugee Health Center (IRHC), featuring graphics on depression and post-traumatic stress disorder. BMC, BU’s primary teaching hospital, is a federally designated safety net hospital, which serves many ESL patients, including newcomers to the US. The immigrant center provides interpreters, in person and over the phone, for more than 250 languages.

Joelle Taknint, the IRHC’s director of behavioral health, says the clinic will share Lee’s graphics with its behavioral health clinicians. “Some clinicians may choose to use these for psychoeducational purposes with patients,” she says, as, for example, “when sharing a PTSD or major depressive disorder diagnosis and discussing treatment options. Translating the text on the graphics to additional languages may also increase the likelihood of uptake for clinicians in our clinic.”

The graphics also would “allow patients to remember what the pharmacist or doctor said to them,” Lee says. “Even I forget all the time what my medications are.” She did her research for the project with guidance from Davida Pines, a BU College of General Studies associate professor of rhetoric, and with support from CGS’ Social Impact Research Fund, funded by Gary Kraut (CGS’64, COM’66).

The term “graphic medicine” was coined in 2007 for a website that collected comics dealing with healthcare, Pines says. “It’s sort of an interdisciplinary field, where there are healthcare providers and people who are in narrative medicine; when you can tell stories in comics form, you really break down a variety of barriers.”

Lee’s website targets a neon-bright need among immigrants. “The most common presentation amongst our patients is PTSD, many times with a co-occurring diagnosis of major depressive disorder,” says Taknint, a BU Chobanian & Avedisian School of Medicine assistant professor of psychiatry. “Many of our patients have been persecuted in their country of origin, due to their political affiliation, sexual orientation, gender identity, ethnicity, religion, or membership in another social group. Other patients arrive in the US seeking safety due to political instability and widespread violence in their country of origin.”

Taknint says those traumas can be compounded by perilous travel to the US and stressors once here, such as social isolation and food and housing insecurity. In treating this trauma, she says, “visuals can be quite helpful in delivering psychoeducation—education about mental health—to patients. Our existing digital mental health interventions also often make use of imagery.”

Following instructions can be particularly tricky for older ESL patients who “don’t do Google translate,” says Pines. “There’s not that kind of facility with the tech.” Also, it can be stressful for a nonexpert to absorb medical info, no matter their age. Pictures are an important aid, given that medical directions, even when written in a patient’s native tongue, “may be really difficult to read,” Lee says.

Lee, an aerospace medical technician for the Air National Guard in her home state of Tennessee, says, “If we have patients who have sublingual medications, a lot of people don’t know what ‘sublingual’ means. But if there’s a drawing that shows to put it under your tongue, it’s just easier to understand.”

Her graphics for BMC—which she plans to offer to other medical providers—marry comics’ colorful, visually appealing images with how-to illustrations that are typical of medical directions. But whereas comics involve text, Lee limits words to make it easier for patients who aren’t fluent in English. “I plan on including a lot of different traditions or cultures into the drawings themselves,” Lee says. “I might include a hijab in some of the pictures, or I might include a traditional dress of China. With each medical condition, I plan on describing the risks of the condition, how to manage it.”

Besides Lee’s experience with her grandfather’s illness, she had another important family moment involving language barriers. Her grandmother once told her that she’d taken an extra dose of her pain medication in hopes it would help with her headaches. “I looked at the bottle—it said hydrocodone,” an opioid that shouldn’t be taken beyond the prescribed amount.

“She didn’t know,” Lee says, “because she never understood what the pharmacist was saying.”