Mental Health and

Communications

Mental Health – A Language and Communication Primer

We have complied some useful guidelines for speaking or writing about mental illness, many of which apply equally to discussions about disability. This is aimed at staff working with carers looking after someone with mental health problems, but may be useful for others as well.

Putting the person first

Firstly, when speaking about someone who is experiencing a mental illness, ‘put the person first’. So, it’s not ‘a schizophrenic father’, it’s a father with schizophrenia. It’s a not a “depressive daughter”, it’s a daughter with depression. This emphasises that the individuals we are talking about are people in their own right. Their condition is not the sum total (or even necessarily a significant part) of their personality and experience.

Labelling

In the same way, we include the person when speaking about them. People are not to be defined solely by their conditions. For example, no one should be described as‘a schizophrenic’ in communications. This implies that schizophrenia is the main characteristic of this person, and implies that this will always be their defining feature. Instead, a person:

has schizophrenia,

is experiencing schizophrenia, or

has been diagnosed with schizophrenia

Some people argue against the use of the word 'schizophrenia' and are in favour of the more general term 'psychosis’, due to the controversy of a schizophrenia diagnosis. However, the terms above are likely to be acceptable to the vast majority of audiences.

In addition, under no circumstances should someone be termed ‘mental’, ‘schizo’, ‘mad’, ‘insane’, etc. (offensive). Instead, a person:

has mental health problems,

has a mental illness,

experiences mental ill-health,

is experiencing mental distress,

is in a state of mental distress,

is experiencing mental health problems,

has a mental health condition, or

has been diagnosed with a mental health condition/clinical depression/bipolar disorder/<insert specific condition here>, and so on.

There has been a shift in language towards talking about mental distress rather than a mental health problem, particularly as a reaction to perceived ‘medicalisation’ of mental health problems. However, any of the above terms is fine.

In some medical contexts, a distinction is drawn between 'mental illnesses' and ‘mental health conditions’. A general rule is that schizophrenia (or psychosis) and affective disorders (such as bipolar disorders) fall in the former, as there is likely to be a metabolic (chemical) disturbance or imbalance in the brain of the service user when they are unwell. Other conditions falling under the wider banner of ‘mental health disorders’ will not be deemed ‘mental illnesses’ as they do not necessarily share this chemical link to visible symptoms. Hence, under this classification, people who have been diagnosed with a personality disorder have a mental health problem but not a mental illness.

‘Service Users’

If you are speaking about a person with mental health problems in the context of mental health treatment or support, the most agreed term in the UK is ‘service user’. Some people feel that this is inappropriate, but this is generally seen as acceptable by organisations, health professionals and people with mental health problems themselves.

If someone requests to be known by another term, then that is what they should be called. Other terms used in the place of ‘service user’ include:

  • Patient
  • Client
  • Expert by experience
  • Sufferer
  • Ex-service user (if someone is no longer using mental health services)
  • Survivor
  • Consumer (Australian and US term)

‘Normal’

When describing the differences between people with mental health problems and people without, it’s important to be careful about using the word ‘normal’. Many people with mental health problems and people working in the field will find this problematic, if not necessarily offensive – what is ‘normal’? Why can’t I have a mental health problem and be normal? If 1 in 4 of all people experience mental health problems at some point in their life, why is this not normal? And so on.

However, offence will depend on context. If unsure, consider using ‘typical’ as alternative, which is much more broad and carries less negative connotations.

Mental health and mental illness

A general point is that mental health and mental illness are the opposite ends of the same spectrum. We all have a level of mental health – we are all, to varying degrees in our lives, mentally well or mentally unwell. If you are mentally well, then you could also be said to a good level of mental and emotional wellbeing.

For good communication, the key point is that if someone is ‘mentally unwell’, this is not the same as being ‘mentally ill’. The former applies to all of us at some point in our lives – having low mood, feeling down, isolated or unhappy could all be described as feeling mentally unwell. However, if someone is mentally ill, this denotes that they have a chronic mental health condition, which has significant and ongoing effects on their daily living and experience, for which it is likely they will benefit from professional help and treatment.

As a result, it is misleading to say that people with mental health problems have ‘mental health’. This is like saying that all NHS staff are humans! Instead, use the terms above– people with mental health problems, people with a mental illness, etc.

Finally, avoid using the expression ‘the mentally ill’. This can be offensive, for similar reasons to above – this presents mental illness as the only defining characteristic of the people referred to.

Mental health carers

Mental health carers is a term we use within The Princess Royal Trust for Carers, but for people unacquainted with the subject, this might suggest that the carers themselves have mental health problems. This term is fine to usewhen speaking with other people and organisations, but only after using ‘carers of people with mental health problems’ to put it in context.

Words implying criminality

A lot of older words associated with mental illness give the impression that a crime has been committed. When speaking about mental health problems, use up-to-date terms. For example:

  • People who have gone onto inpatient psychiatric wards are not then ‘released’ from hospital – in most circumstances, they have committed no crime. Instead, they are discharged from hospital[i].
  • People do not ‘commit’ suicide – this is no longer a crime. Instead, use terms such as: “a suicide, die by suicide, a suicide attempt, a completed suicide, person at risk of suicide, help prevent suicide”[ii] Some organisations are beginning to use the term ‘achieve suicide’, but The Princess Royal Trust for Carerswould not use this term, given that it runs of risk of portraying suicide as a positive achievement.

Drew Lindon

Policy and Development Officer (Mental Health and Substance Misuse)

October 2008

With thanks to Janey Antoniou (Campaigner and mental health service user) and Sarah Hamilton (Research Officer, Rethink) for their helpful and instructive feedback.

Author: Drew Lindon 10/11/2018 Page 1 of 4

[i]The Reporting of Mental Health and Suicide by the Media: A Practical Guide for Journalists”, National Union of Journalists, p.8.

[ii] Ibid., p.12