In the field of behavioral health, words 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 craft.
“I’ll never forget, years ago, when I was asked to give a talk about tribes and behavioral health indicators, I presented the data showing higher rates of suicide, alcohol use, earlier ages of initiating substance use, etc. I thought I had done a good job of documenting ‘need’. However, a tribal leader came up to me saying I had painted such a negative view of their community, I had said nothing about the richness and the survival strengths of their tribe.”
This quote from Larke Huang, Director of the Office of Behavioral Health Equity (OBHE), underscores how our words have the capacity to uplift communities or to marginalize them.
How often have you asked yourself, “Should I say BIPOC (Black, Indigenous, People of Color) or People of Color? Limited English Proficient (LEP) or Non-English Language Preference (NELP)? Minority or minoritized? At OBHE, we receive these questions routinely and struggle with them often. There are times when an answer is straightforward, but more often, the complexity of the issue leads to the response: “It depends.” Facing 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 are sharing a preview of the GET.
Principles of Behavioral Health Equity Terminology
Equitable terminology refers to consciously selecting words that promote inclusivity 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 attribute. This often involves using person-first language, which puts the person before their diagnosis, disability, or other characteristics. Person-centered language also means deferring to the terminology expressed by individuals with lived experience.
- Strengths-Based: Highlighting the inherent strengths and assets in all individuals, families, and communities. It seeks to depict people in terms of their strengths and assets rather than exclusively describing their vulnerabilities and weaknesses through a deficit lens. If referencing deficits is necessary in our work, then it is important to also counterbalance with 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 also can contribute to internalization of negative attitudes and beliefs, known as self-stigma or internalized stigma, which is often harmful to an individual’s mental health and well-being.
- Ever-Evolving: Adapting to changes in terminology. Language is fluid and changes with social norms. It also is context-dependent, meaning that terms deemed appropriate in one situation may not be suitable in another.
The Power of Words in Behavioral Health
Shifting Attitudes to Increase Support
Equitable terminology can shape the culture around behavioral health. The words we use can influence strategies to address challenges. For example, the term “substance abuse” implies a personal failure within an individual’s control, cultivating prejudicial beliefs and hindering public support for treating addiction as a health condition. In contrast, using the term “substance use disorder” identifies the issue as a behavioral health condition, requiring public health support. Words can be tools for advocacy that nudge societal attitudes and policies towards a more inclusive and supportive approach to behavioral health.
Creating a Culture of Acceptance and Empowerment
Equitable terminology not only reduces stigma surrounding mental health and substance use but can also promote a culture of acceptance, inclusion, and dignity, where individuals are not devalued based on their behavioral health status. This process can encourage the development of environments that foster empowerment in seeking behavioral health services and resources.
Acknowledging Historical and Systemic Influences
Equitable terminology acknowledges 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 instance, "minority" indicates a numerically smaller group compared to "majority," but the term "minoritized" implies that societal power structures actively marginalize certain groups. This nuanced shift in terminology underscores the active process of marginalization that unfairly disadvantages specific groups.
Adopting Terminology for Equity: Some Considerations
- Accept: Understand that engaging in equity-related discussions may generate discomfort, as it often calls for addressing personal biases, presumptions, and areas of privilege.
- Be Respectful: Acknowledge and respect how people choose to define and identify themselves.
- Learn and Listen: Embrace the insights from those with different life experiences, especially people with lived experience. This might mean unlearning preexisting beliefs and attitudes that no longer match today's realities.
- Be Receptive: Stay open to feedback and willing to adapt terminology with changing norms.
- Take Responsibility: If you offend someone, even unintentionally, take responsibility and apologize. Mistakes are a part of being human, and normalizing apologies fosters a safe environment for difficult conversations about equity.
- Seek Education: Find learning opportunities about equitable terminology, social determinants of health, and historical and systemic causes of behavioral health disparities. This information provides context and informs our word choice.
- Engage: Stay in the conversation, even when unsure about the correct terms to use. Ask questions in good faith.
Guide to Equity Terminology (GET): The Next Steps
This blog introduces the importance of equitable language and its role in promoting behavioral health equity, setting the stage for the forthcoming Guide to Equity Terminology. This Guide will provide further insights and practical guidance in this vital area. Stay tuned for its release.
- SAMHSA: OBHE website
- SAMHSA: Language Access Plan
- Centers for Disease Control and Prevention (CDC): Inclusive Communication Principles
- CDC: Healthy People 2030 Social Determinants of Health
- National Institute on Drug Abuse (NIDA): Words Matter - Terms to Use and Avoid When Talking About Addiction
- Executive Order on Further Advancing Racial Equity and Support for Underserved Communities Through the Federal Government