Person-centered mental health care terminology: reforming psychiatry’s language
- Posted by Editor JPR
- Posted in Editorials & Commentary
Journal of Psychiatry Reform vol 12, #3, February 4, 2025
Author
Abraham Rudnick, MD, PhD, FRCPC, CCPE, CPPRP, MCIL, DFCPA, mMBA, Professor, Departments of Psychiatry and Bioethics and School of Occupational Therapy, Faculties of Medicine and Health, Dalhousie University, and Clinical Director, Nova Scotia Operational Stress Injury Clinic, Nova Scotia Health Authority, 210-100 Eileen Stubbs Avenue, Dartmouth, Nova Scotia B3B1Y6, Canada. Email: [email protected]
Abstract:
Mental health care, including psychiatry, continues to make progress. Yet its terminology is still often not person-centered. As language influences culture (professional and other), forming psychiatry to use more person-centered language may help transform its services to more person-centered care. This article uses a published multi-dimensional approach to person-centered mental health care in order to highlight and illustrate the need to reform psychiatry’s language (and hence assist in transforming psychiatry’s practice and policy) to be more person-centered.
Keywords: Care, health, language, mental, person-centered
Health care – and mental health care as part of that – has been making considerable progress in the last few decades in various respects, e.g., scientific, technological, ethical and more. An important aspect of such health care progress is considered to be the move to more person-centered care. This is manifest in policy and practice such as endorsement and use of shared decision making (with services users – patients and their families) in relation to treatment, resource allocation and more. A necessary although not sufficient part of such progress is the use of person-centered terminology, as language influences professional (and other) culture1. Unfortunately, medicine is lagging on use of person-centered language2. Psychiatry, in particular, needs much more person-centered language3. The current article addresses this need by describing principles of person-centered mental health care and related services, with aligned examples of associated terminology.
Person-centered mental health care, and Psychiatry (which includes, psychopharmacology and neuromodulation but also addresses, intra- and inter-professional, psychosocial mental health care such as psychotherapy and psychosocial rehabilitation), involves a comprehensive biopsychosocial approach using a variety of constructs4. In the current article, a published approach will be used to highlight pertinent examples of person-centered mental health care language replacing less/not person-centered mental health care language. This approach includes four foundations of person-centered mental health care5: 1. Person-focused care, which refers to the person with mental health challenge(s) as the (intended) beneficiary of care; 2. Person-driven care, which refers to the person with mental health challenge(s) as the decision-maker about their own care (preferably with shared decision making) ; 3. Person-sensitive care, which refers to care as addressing particular needs of the person with mental health challenge(s); 4. Person-contextualized care, which refers to care as addressing past and present circumstances of the person with mental health challenge(s).
Person-focused language: An example of non-person-centered wording that is still often used to refer to people with (severe) mental illness is “schizophrenic”. This word is de-personalizing (as it identifies that person with their disease and hence reduces them to a medical entity, which is especially harmful in relation to severe mental disorders such as schizophrenia). An alternative that is more person-centered is “person who has a diagnosis of schizophrenia”. Another example of psychiatric wording that is not person-centered and is very commonly used is “case” (this word is not specific to psychiatry and is often used also by other medical specialties as well as by other health care professions). This word is de-humanizing (in any context – psychiatric, other medical, and more generally). An alternative that is more person-centered is “care” (such as in care plan meeting rather than case conference).
Person-driven language: An example of psychiatric wording that is not particularly person-centered and is sometimes used inappropriately is “patient” (which is widely and perhaps appropriately endorsed for inpatients but there is disagreement about its use for others who use mental health services). This word is biased (towards hospitals rather than other mental health service systems, and it implies power over service users by service providers such as psychiatrists rather than a full partnership between them). An alternative that is more person-centered is “service user” (or “person who has a mental health challenge” if the person is not receiving mental health services at that time). Another example of psychiatric wording that is not person-centered and is still often used is “dysfunctional” (referring to being fairly dependent on others such as for activities of daily living). This word is over-inclusive (as most people, even if fairly impaired, are more or less functional depending on what area of functioning is addressed, which should be based on the person’s choice rather than imposed by others, with the exception of people who pose a danger to others due to their mental disorder). An alternative that is more person-centered is “not sufficiently independent in relation to…” (recognizing that no person or any other living being can be fully independent as all humans as well as all other living creatures are somewhat inter-dependent on others).
Person-sensitive language: An example of psychiatric wording that is not person-centered and is still commonly used is “chronic”. This word is stigmatizing (such as by implying no hope for clinical or personal recovery). An alternative that is more person-centered is “persistently mentally ill”. Another example of psychiatric wording that is not person-centered and is still sometimes used is “attention seeking” This word is morally distressing (as it implies that the patient is not “really” in need of mental health care). An alternative that is more person-centered is “expressing their need(s) in a maladaptive way”.
Person-contextualized language: An example of psychiatric wording that is not person-centered and is commonly used is “non-compliant”. This word is misleading (such as by suggesting that not adhering to treatment is a patient’s fault rather than considering internal and external barriers to adherence, such as past trauma from forced treatment and insufficient funding, respectively). An alternative that is more person-centered is “not adherent” (assuming that voluntary capable informed patient choice is secured). Another example of psychiatric wording that is not person-centered is “chemical imbalance”. This word too is misleading (such as by suggesting that mental illness is caused by too much or not enough neurochemicals in the brain, which at best is a gross over-simplification, and by implying that the ultimate treatment for mental disorders is biomedical although psychosocial care – including some self-help and social support as well as some psychotherapies and psychiatric/psychosocial rehabilitation – is evidence based too). An alternative that is more person-centered is “disruptive biopsychosocial variance” (that is, disruptive primarily although not exclusively to the patient).
Transforming psychiatric terminology to more person-centered language is expected to help reform psychiatry – and more generally mental health services – to a more person-centered approach. Research, education, policy development and implementation are required to facilitate this transformation and the related reform.
References
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- Akhtar N, Forchuk C, McKay K, Fisman S, Rudnick A. Handbook of person-centered mental health care. Boston: Hogrefe, 2021.
- Rudnick A, Roe D (eds). Serious mental illness: person-centered approaches. London: Radcliffe, 2011.