Is there something wrong with “behavioral health”?

Substance Abuse and Mental Health Services Administration (SAMHSA)

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 rather offensive.

According to the United States governmental agency the Substance Abuse and Mental Health Services Administration (SAMHSA), behavioral health is:

“a state of mental/emotional being and/or choices and actions that affect wellness. Substance abuse and misuse are one set of behavioral health problems. Others include (but are not limited to) serious psychological distress, suicide, and mental illness.”

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.

SAMHSA

It sounds like behavioral health is a whitewashed, euphemistic term for mental illness and addictions. The American Hospital Association puts it pretty clearly: “Behavioral health is used to include both psychiatric and substance use disorders”. So it is simply a matter of brevity (finding a term that uses fewer words to save printer ink?), or does it reflect fundamental attitudes towards this group of disorders?

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?

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 favor 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 categorizes substances 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 little 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 sort of protective barrier to keep thoughts of crazy people from intruding into the collective consciousness?

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 behavioural 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.


Originally published at mentalhealthathome.org on January 22, 2019.