Veryan RichardsRespect and dignity through the use of language – do I have a problem or an illness, asks Veryan Richards.

Everyone involved in mental health services needs to think carefully about the language and terminology they use to describe people who have a mental illness or are experiencing mental health issues. This has been the subject of some debate already but I want to share my own experience, having lived with a chronic depressive illness for 40 years.

Three phrases in particular have been used with reference to me, both on paper and in conversation: a service user, an individual and a mental health problem.

There are occasions when these phrases are appropriate, but often they are not the best choice of words. I can find them offensive and I believe that a considerable number of other people who are living with the challenges of mental illness do so as well.

Words can convey negative or positive values. In the context of mental illness, mental health and wellbeing, negative words can be experienced as patronising, derogatory, isolating, embarrassing, categorising, demeaning, inferior, insulting, demoralising, excluding and stigmatising. Positive words, on the other hand, can convey dignity, normalisation, empathy, respect, empowerment, belonging, equality, affirmation, trust, hope, recovery and worth.

A service user: Recently on Radio 5Live, Professor Nick Craddock, professor of psychiatry at Cardiff University, quoted from a survey that said that only 10% of people who receive mental health care were comfortable with the term ‘service user’.

The NHS National Treatment Agency for Substance Misuse uses the description of substance user and service user interchangeably.

The term ‘service user’ does not imply recovery. More acceptable terminology could be selected and provide balance, for example – a recipient, a patient, a service representative, a person, a member, a client, a survivor, a stakeholder, a partner.

An individual: Often in written papers a person who is dealing with a mental illness and/or condition is referred to, in a slightly condescending tone, as ‘an individual’. On reading journals and other documents discussing physical illness and/or conditions, the phrase ‘a person’ or ‘patient’ is more commonly used.

I am a person who is individual, not ‘an individual’ who has experience of living with a mental illness.

A mental health problem: Why is the phrase ‘a mental health problem’ the one most frequently chosen when referring to mental illness and mental health issues? We do not refer to physical illnesses and conditions in this way. People say “I have Crohn’s disease” not “I have a Crohn’s problem”; “I have ovarian cancer” not “I have a cancer problem”. In mental illness, people suffer with a specific illness; they have lived experience of mental and emotional distress. They have mental health issues; they deal with mental health conditions, disabilities and disorders.

We are not people or patients with ‘a mental health problem.’ But this phrase is still used regularly. For example:

• In the 2012 -2016 strategy of a leading mental health charity, the phrase ‘a mental health problem’ is used in four out of the five goals
• In the Welsh Government 2012 Strategy for Mental Health and Wellbeing in Wales, Together for Mental Health, there is repeated use of the phrases ‘a service user’ and ‘mental health problems’
• Recently, Katharine Welby, daughter of the Archbishop of Canterbury, spoke powerfully about the depressive illness that she is living with. Sue Baker, director of Time to Change, was asked to comment on television and radio and within a two-minute slot she referred to ‘mental health problems’ three times
• The Winter 2010/11 edition of The Mood Disorders Research Newsletter said: “The Mental Health Research Network also supports individuals with a personal experience of mental health problems to become involved in research.”

In Achieving Excellence, the Welsh Government’s Quality Delivery Plan for the NHS in Wales 2012 – 2016, this paragraph appears: “those who receive care deserve decent care that offers respect as well as a solution to their problems.”

The current ethos in healthcare aspires to the principles of co-production (the term used in Wales) and collective involvement (the term used in England). A move from paternalism to partnership and person-centeredness is the model proposed.

I would like to suggest that one of the aspects of this cultural shift involves the appropriate and respectful use of language. This will require consideration and a response from all the different sectors engaged in the policy and delivery of mental health care.

Language and communication are at the heart of the human experience – in oral and written form.

Do I have a problem or an illness?

Language is a powerful tool. It is used to convey a message. I hope that the message will be communicated with respect and dignity.


Veryan Richards is a person with experience of mental illness


This article first appeared in the July/August issue of Mental Health Today. For more information on Mental Health Today magazine and how to subscribe, click here.