‘Behavioral Health’: using this term sends the clear message to consumers that services are about controlling them rather than supporting them.

Use of the term ‘behavioral health’ to reference mental health services seemed to arise from managed care. Outcomes had to be measurable in order to render services accountable, so they could be managed. Like most aspects of managed care that made it so unpopular at its inception, and led to a backlash for most medical services, these terms shift the priority of services from benefiting the individual service recipient to benefiting shareholders and the society at large.

Somehow the terminology remained firmly in place even after the retreat from health maintenance organizations that restricted to care to tightly managed networks for most medical services. I believe that the message embedded in these terms isn’t lost on service recipients, including people who might want services if they were convinced that they were being fashioned and delivered for their benefit. Behavior is what is apparent and observable by others. If the goal is to produce healthy behaviors, it says nothing about the individual’s feelings and experiences. The implication is that these are irrelevant. I think the implication isn’t lost on deliverers of services either, and implicitly sanctions cold and perfunctory interventions that often feel toxic to recipients.

If the goal of treatment is to change behavior, we have to ask what is desirable behavior and who makes that judgement. In psychiatric rehabilitation and some forms of psychotherapy, the individual is empowered to make those calls, but often even then it amounts to an illusion. What results is a plan with measurable goals and objectives—behaviors. If we can’t talk about feelings as important, it shouldn’t be a surprise that service recipients who have coalesced into the recovery movement so often talk about meaning, spirit and wellness. It is my fervent hope that as the movement strengthens its grip on the service system, control is returned to individuals and their feelings and thoughts once again become the focus. Perhaps then the term ‘behavioral health’ will be set aside.