“Behavioral Health”: A Reflection of Structural Stigma?

Type of illness=hospital service: neurological=neurology, cardiac=cardiology, mental illness=behavioral health

In my local health care system in Canada, the term behavioral health isn’t used, but I’ve seen it used a fair bit in the context of other mental health systems. As far as I can tell, it’s mostly an American term. Since it’s relatively new to me, I tend to consider it from a more literal perspective rather than accepting it out of familiarity, and it actually strikes me as a potential indicator of structural stigma.

What is behavioral health?

According to the United States government agency the Substance Abuse and Mental Health Services Administration (SAMHSA) in a fact sheet that’s been taken down since this post was originally published, behavioral health is:

a state of mental/emotional being and/or choices and actions that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and mental and substance use disorders.

Behavioral health care includes health promotion, prevention, treatment, and maintenance strategies across a continuum of care. SAMHSA even has a fancy little diagram to depict this. The whole thing seems a bit absurd, though, given the lack of health care coverage in the U.S., but perhaps that’s the Canadian in me talking.

behavioral health continuum of care

It sounds like behavioral health is a sanitized, euphemistic term for mental illness and addictions. So it is simply a matter of brevity and saving printer ink? Or does it reflect fundamental attitudes towards this group of disorders?

How is a behavior the illness?

I take issue with the term behavioral health because behavior is something that’s directed outward and the implication is that it’s under voluntary control. SAMHSA’s definition refers to “choices and actions”.

 To me, it seems that the use of behavioral health implies that the health care system is passing judgment on our externally observed behavior, as though they’re deciding what actions are “healthy” and acceptable by social standards. Except what is directed outward is often a small part of what’s happening in mental illness.

The main problem is what’s going on internally. It’s not about whether we “look crazy” or “act crazy”— or is it?

Stigma and sanitized terminology

So why behavioral health in the first place? I suspect it’s to do with people making decisions from on high about what terminology is considered appropriate and socially acceptable. Addiction has fallen out of favour with many organizations, and substance use disorder has taken its place. This is consistent with the DSM-5 terminology of opioid use disorder, for example, which changed from the DSM-IV diagnoses of opioid abuse and opioid dependence. Then again, the DSM-5 categorizes substance use disorders as mental disorders right along with all the other mental illness diagnoses.

Behavioral health, though, neatly shuffles mental illness and substance use disorders into a tidy little box with a neat label slapped on. Any time people start looking for tidy bland little labels, it highlights underlying stigma. If mental health disorders, including addiction, were socially understood and accepted, would there be any reason to cook up terms like behavioral health? Or does that term exist as a protective barrier to keep thoughts of crazy people from intruding into the collective consciousness?

What message does this send?

If government agencies and organizations that provide health care can’t bring themselves to acknowledge mental illness and addictions as brain-based diseases, how can we expect Jane Doofus to accept that these conditions are legitimate health conditions? If I was Jane Doofus, behavioral health would suggest to me that people need to just get over it and behave properly. So, there’s a mass shooting on the news? Sounds pretty behavioral and unhealthy to me as Jane Doofus, so mental illness must be dangerous, right?!?

Mental illnesses are disorders of what is happening in our minds/brains. Taking the “mental” out of mental health is not helpful for those of us living with those disorders. SAMHSA can think whatever they want about my behavior; it’s really none of their business, and it’s not what my illness is about.

Book cover: A Brief History of Stigma by Ashley L. Peterson

My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.

You can find it on Amazon and Google Play.

There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.

28 thoughts on ““Behavioral Health”: A Reflection of Structural Stigma?”

  1. I completely agree with your facts about behavioral health, I think people need to very mindful and understand the true meaning behind it and slowly process what term to use and what terms not to use , mental health is very important and I believe that nobody has that right to lable anyone without knowing or listening to what they have to see or understand where they come from as an individual.

      1. After reading that, you hve me truly wondering about how my therapist/pyschiatrist actually view me as a whole. From the original diagnosis to the present moment.
        I am truly annoyed after reading that, and you’re correct… change does need to happen.

          1. Roughly 3 years ago, I sat on a panel with my mental health facilty (Richard Hall Mental Health Center) and Rutgers University, New Jersey, regarding these types of studies. I was involved with two other clients of the facility.
            We had been interviewed for such a study of this nature.
            I never did read their report thereafter, but now I feel I should look it up. I want to actually go back and see what they had to say.

  2. Never heard it in the UK. I’ll watch out for it, as the NHS likes terms like this.

    I don’t know, maybe they’re worried that the ‘mental’ in ‘mental’ health is stigmatised? That it might be easier to go to an employer with a “behavioural health” problem than a “mental health” one. At least until employers catch on to what the new term means. Similar to the way that doctors will euphemistically sign people off work with “stress” to stop employers seeing that they’re off for depression or anxiety.

    That said, it does feel a bit like the CBT approach that I’ve always struggled with, that on some level we can control our thoughts and reactions, which is not always the case.

    1. That idea of “stress leave” has always bugged me. If someone’s sick, then they’re sick, and if employers are going to judge, they’re going to judge regardless of the term used.

  3. As an American, I’m of the opinion that “behavioral health” is simply the latest in a long line of buzz words. In the future it’ll be replaced by something else, something else probably more politically correct and absurd. See down in the lower 48 here (and our outlying ‘states’) we have become a country of namby pamby twerps in regard to calling a spade a spade. We don’t plain speak much any more, we’re too aware that somebody will probably be offended and given the ease with which it’s done, probably sued for our last dime too. Saying one is “mentally ill” – although that’s the name of the disease for many of us; makes people uncomfortable. Behavioral health is easier to accept because nobody much knows what the hell that really means, well aside from the ‘professionals’. Personally I’ve never had anyone – therapist or doctor, say to me “Your behavioral health is of concern. Go to a behavioral health clinic or a behavioral health therapist.” It’s still ‘mental health.’ So context is also a big part of that whole ‘behavioral health’ idea. The patients know what they are or have to deal with. And the more sensible patients (like me if I do say so), don’t pay any mind to the LABEL, we are happy enough if we can just get proper care whatever name they call it by.

  4. I got curious, after reading your post, to see what others might say about the term, which I mostly associate with large, kind of bureaucratic health care organizations. I found this, which I found kind of interesting (insighttlelpsychiatry.com)

    The Difference Between Behavioral Health and Mental Health
    Many people are more familiar with the term, “mental health.” Mental health covers many of the same issues as behavioral health, but this term only encompasses the biological component of this aspect of wellness. The term, “behavioral health” encompasses all contributions to mental wellness including substances and their abuse, behavior, habits, and other external forces.

    So I can see where the person is coming from, but it still seems entirely unnecessary to me to add a new term. I don’t think anyone working in mental health only thinks about what is going on biologically in the brain and wouldn’t take into consideration people’s use of alcohol or drugs, or the way they live their lives.

    I can’t help but wonder if it developed out of CBT–also an approach well-loved by large, bureaucratic health care organizations, because it promises to “fix” things in a limited number of sessions, thereby saving insurance companies a lot of money.

  5. I guess I never thought of it that way. I’ve never heard the term outside of CBT & DBT. My therapist doesn’t use the term but she’s my first therapist so I couldn’t tell ya with much experience. We’re going to start EMDR, a type of DBT. But it’s for my PTSD to help with my triggers that lead to freak outs, not my bipolar.

  6. I agree with what you’ve said. The language which is used to describe things has a major impact on how we perceive them because of the other context and association of the words. It’s often part of a pretty unsubtle attempt to exert control over groups of people by manipulating others’ perception of them.

  7. I don’t even know what to begin to write; in my country some are saying the term mental health should be replaced with ’emotional health’ because mental is stigmatizing and they think all those so called mental illnesses are a dysregulation of emotional wellbeing – whatever crap that is. As a CBT Therapist, I know behaviour patterns are important, but simply can’t be it, attribute/substitute enough for mental health. We can only keep advocating like this while taking care so jealously of our own mental health. Thanks for all you do Ashley

    1. Emotional health sounds rather silly, since it also captures just one piece of the puzzle. I don’t know why people feel the need to avoid talking about mental health and mental illness…

      1. I don’t know too. It is silly not only in sound for real. I mean, is emotions all there is to mental? Or do they mean mental doesn’t exist and so the mind is equally an illusionary creation of behaviour? So sad to see what time and money are wasted on figuring out while many are messed up to their graves without any significant care to help them cope and recover.

  8. I’ve sort of started just leaning towards “chronic mental and physical illnesses” as a label to indicate that spooniedom applies equally to someone with depression or lupus. Not sure if I totally like it, but at least trying to make the umbrella term just be “illness” with subcategories of “in the peripheral body” vs. the brain might be less stigmatizing? Though, under that definition migraine, epilepsy and brain cancer really should be “mental illness.” Maybe the only real answer is just accept they are all “chronic illness” – and the only further qualifications needed might be which specialist to refer to after diagnosis. But, that’s a pipe dream, I know. I totally agree, though, on how squicky behavioral health feels as a term…

  9. Behavioral issues are linked to both physiological and psychological issues.

    This is the theory advocated by the 3000 years ancient Chinese wisdom in the book called “Yellow Emperor’s Inner Classic”.

    For those of you curious and interested, you are welcome to me Blogs and Video courses at


    In the blog there are links to the video courses.

  10. I feel we should scratch both mental and behavioral health. All of these disorders are brain disorders. Call it brain health, lol. The brain is a large, physical organ and although *some* symptoms are displayed behaviorally there are symptoms that can’t be seen or observed through our behavior. This is evident in that many of us with a mental illness aren’t obvious unless you truly know us. Everyone, sick or not, exhibits unwanted behaviors sometimes. I just feel it’s a physical illness of a large organ, our brain, so there should be no distinction. And I also feel labels have such stigma that a label alone can be damaging and traumatizing. I think they need to diagnose in terms of Clusters of symptoms. They need to change the way they classify people and maybe say you have a cluster A, B, or C brain disorder. Because some terms like Bipolar and BPD have gotten such horrible stigma attached that they are damaging.

    I don’t have the answers, but I agree things need to change! Great post! Thought provoking!

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