In the field of behavioral health, words they are often our primary tools. We don’t have hammers and saws, thermometers and stethoscopes, or brushes and palettes. Words are powerful tools and using them with intention is central to our art.
“I’ll never forget, years ago, when I was asked to talk about race and behavioral health indicators, I presented the data that showed higher suicide rates, alcohol use, earlier ages of onset of substance use, etc. he had done a good job of documenting the “need”. However, a tribal leader came to me saying that I had painted such a negative view of their community, I had not said anything about the wealth and survival strengths of their tribe.”
This quote from Larke Huang, Director of the Office of Behavioral Health Equity (OBHE), highlights how our words have the ability to elevate communities or marginalize them.
How often have you asked yourself, “Should I say BIPOC (Black, Indigenous, Colored) or Colored? Limited English Language Preference (LEP) or Non-English Language Preference (NELP)? Minority or minority? At OBHE, we get these questions regularly and wrestle with them often. There are times when an answer is simple, but more often, the complexity of the issue leads to the answer: “It depends.” Addressing this ambiguity, we decided to develop a Guide to Equity Terminology (GET) as a decision support tool. And, in recognition of July as Minority Mental Health Month, we’re sharing a preview of GET.
Principles of Health Equity Behavioral Terminology
Fair terminology refers to the conscious choice of words that promote inclusion and respect, while also considering who is represented and who is absent from the conversation. It is built on the following guiding principles:
- Person-centered: Prioritizing the whole person by considering their multiple intersecting identities and qualities, rather than reducing them to a single characteristic. This often involves the use of first-person language, which puts the person before their diagnosis, disability or other characteristics. Person-centered language also means deferring to terminology expressed by people with lived experience.
- Based on strengths: Highlighting the inherent potential and strengths in all individuals, families and communities. It seeks to portray people based on their strengths and advantages rather than solely describing their vulnerabilities and weaknesses through a deficit. If reporting deficits is essential to our work, then it is important to also balance strengths and assets.
- Non-stigmatizing: Avoiding discriminatory, prejudicial, offensive and stigmatizing words. Stigmatizing language creates negative associations and devalues individuals, families and their communities. It can also contribute to the internalization of negative attitudes and beliefs, known as self-stigma or internalized stigma, which is often harmful to a person’s mental health and well-being.
- Constantly evolving: Adapt to terminology changes. Language is fluid and changes with social norms. It is also context-dependent, meaning that terms that are appropriate in one situation may not be appropriate in another.
The power of words in behavioral health
Changing attitudes to increase support
Fair terminology can shape the culture around behavioral health. The words we use can influence strategies for dealing with challenges. For example, the term “substance abuse” suggests a personal failure under one’s control, fostering biased beliefs, and hindering public support for treating addiction as a health condition. In contrast, the use of the term “substance use disorder” identifies the issue as a behavioral health condition, requiring public health support. Words can be advocacy tools that move societal attitudes and policies toward a more inclusive and supportive approach to behavioral health.
Creating a Culture of Acceptance and Empowerment
Fair terminology not only reduces the stigma around mental health and substance use, but can also promote a culture of acceptance, inclusion and dignity where people are not devalued based on their behavioral status. This process can foster the development of environments that foster empowerment in seeking behavioral health services and resources.
Recognition of historical and systemic influences
Equity terminology recognizes the historical and systemic factors that contribute to behavioral health disparities, including the impact of social determinants of health influenced by racism, colonization, ableism, and other forms of oppression. For example, “minority” denotes a numerically smaller group compared to “majority,” but the term “minority” implies that social power structures actively marginalize certain groups. This nuanced change in terminology highlights the active process of marginalization that unfairly disadvantages specific groups.
Adopting Equity Terminology: Some Considerations
- Accept: Understand that engaging in justice-related discussions can be uncomfortable, as it often requires confronting personal biases, assumptions, and areas of privilege.
- Be respectful: Recognize and respect how people choose to define and define themselves.
- Learn and Listen: Embrace ideas from people with different life experiences, especially people with lived experience. This may mean unlearning preexisting beliefs and attitudes that no longer fit today’s reality.
- Be receptive: Be open to feedback and willing to adjust terminology to changing norms.
- I’m taking the responsibility: If you offend someone, even unintentionally, take responsibility and apologize. Mistakes are part of being human, and normalizing apologies creates a safe environment for difficult conversations about equality.
- Search for Education: Find learning opportunities about equity terminology, social determinants of health, and historical and systemic causes of health behavior disparities. This information provides context and informs our word choice.
- Engage: Stay in the conversation, even when you’re not sure about the correct terms of use. Ask questions in good faith.
Guide to Equity Terminology (GET): The next steps
This blog introduces the importance of equity language and its role in promoting behavioral health equity, setting the stage for the upcoming Equity Terminology Guide. This Guide will provide further information and practical guidance in this vital area. Stay tuned for its release.
