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.
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.
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.