Saturday, 29 June 2013

The language of mental health: am I a person or a service user?

I wrote a bit about the language of mental health before. Surprise, surprise, there is no getting away from its complexities as seen in recent posts. So, this spurred me to go back to basics and look specifically at the language around the person and mental health. At the end of the post I’ve added our first blog poll to find out what you think.

Step 1 of seeking help and support around mental distress usually involves going to see our GP. At that point we are clearly regarded as the doctor’s patient – the language is so engrained that we barely question it. But that doesn’t mean that a) we like it, or b) we consider ourselves at the start of a medical “journey” - whatever diagnosis that we might have left the surgery with.

Before working in the field of mental health, I didn’t consider the terminology that much. But now the language around the person and mental health is very much to the forefront of my mind. It’s there every day I’m at work (and often outside – because the language of mental health is actually everywhere). At work colleagues and I regularly engage with “people in contact with mental health services” to find out what kind of services they would like. But what do we call them? We think we need some way to distinguish these people from everyone else. And we worry that we might offend or label people unintentionally, yet at the same time we want to make sure we are understood.

Patient is one word. It’s easy and everyone recognises it. Service user – a term increasingly common in the spheres of government, health, social care and even the voluntary sector – is just two. My feeling is that it is increasingly reviled by the people it is used to describe (which is all of us in effect). It hints at other negative terms such as drug user. The words don’t refer in any way to mental distress... the user could be accessing refuse services as far as we know. Other more acceptable descriptions are longer winded. What about – a person with lived experience of mental distress for example? But in a world where language is shortened repeatedly into – OMG – acronyms, never mind just quicker and shorter words.... have we all just become too lazy?

This topic is by no means new, though it certainly has not been resolved – not in Powys or Wales anyway.
Research in England from 2010 reported on people’s preferences in The Psychiatrist, journal of the Royal College of Psychiatrists, at the time, and perhaps surprisingly “patient” was actually voted all out favourite term.

According to the Open University, “certain terminology should be avoided, such as the use of labels referring to one aspect of a person, such as calling them 'a schizophrenic', as well as the casual use of words such as mad or crazy. The way in which these terms become accepted as normal conversation is very damaging.” And yet several prominent and very successful organisations have now adopted previously stigmatizing language in their names, eg: Mad in America, and Madness Radio

Acceptance, humour and even rebellion are a large part of what has become known as the psychiatric survivor movement – originally the more radical and political side of the mental health arena but now seeping into the everyday at an ever greater pace. A forum member called Apotheosis created his/her own comic definitions, (more general than just about the person but relevant nevertheless), on – read them and make up your own mind!

So – to the poll. It’s very simple – just choose your favourite term – if you can find one in the list – and let us know. If none of these terms fits the bill as far as you are concerned – that’s fine – either post a comment or email with your suggested alternative. We really would like to know what you think and how we should be referring to ourselves.

What should we call someone who has contact with mental health services?



  1. The language of mental health is a highly debatable area. Having thought long and hard, can I suggest that 'human being' be added to that list please?

  2. I like punter.

  3. Hi both

    I really like your suggestions - many thanks! I've also received an email suggesting "person" or "people."

    Keep the ideas coming!

  4. I came across an interesting short video on the language of mental health today. It features David Crepaz-Keay, the Head of Empowerment and Social Inclusion at the Mental Health Foundation, talking about his own experience as someone who has lived with hearing voices since adolescence. Don’t call me crazy, call me mad!

    David will be at our Shaping Services event on 19 September in Llandrindod Wells. Read more about Shaping Services event here.

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  6. In Powys perhaps we (as service users) should now be referred to as 'Individual mental health condition managers'?

    1. Hi Philip

      Thanks for your suggestion - brilliant!


  7. The Scottish Recovery Network has recently carried out its own survey about the language and terminology we use around mental health, specifically "the preferred collective terms for people with experience of mental health problems". You can find out more about this and also links to blog posts by Dr David Christmas of the Royal College of Psychiatrists Scotland and SRN Director Simon Bradstreet here