Written: March 16, 2022
It is so important to take a person-centred approach which focuses on individual needs and uses language which feels helpful and validating to the individual.
A decade ago this month I had my first encounter with the psychiatric crisis team. A traumatic experience a few days earlier had triggered a psychotic episode, as well as post-traumatic symptoms.
When I called the crisis team for support, I was surprised that they immediately asked: “What are you going to do to distract yourself?”
I had personal strategies that I would instinctively use during this period of crisis, which were helpful. Diverting your thoughts can be helpful and effective. But I struggled with the phrase that clinicians used to describe the kind of strategies that we can use in a period of crisis. And if I called the crisis team, it was because I had already used and exhausted my own strategies and inner resources.
I might refer to “distracting” someone if I wanted to divert their attention away from something for a short while, but I always found it surprising to hear it in the context of trying to describe diverting someone’s thoughts from ending their life.
I have sometimes wondered whether the language that is used to describe these techniques – “distraction” techniques – has encouraged some crisis team staff to veer towards suggesting simple activities (such as making a cup of tea) which are not always going to be appropriate for someone who is experiencing strong thoughts of ending their life.
It may seem hard to imagine that clinicians would suggest having a cup of tea when someone is in crisis, but many people have described it on social media. It was only suggested to me once by the crisis team – on my first night at home after being in psychiatric hospital, when I felt particularly disorientated. The days immediately after being discharged from psychiatric hospital are known to be a period of time when someone may be particularly vulnerable and at risk, of course.
Throughout my time under psychiatric services, the language used has been important to me because of what it represents. I referred to “individual strategies” which helped me during a period of mental health crisis whenever the crisis team spoke of “distraction”.
The language that feels validating and respectful to each of us is highly individual. It’s about someone pinpointing the right language that speaks to us as individuals and accurately reflects our personal experience.
I also found it most helpful when language was accurate, open and honest. I have always found it puzzling that I have never heard mental health clinicians refer to psychiatrists as “psychiatrists”. This applied under community mental health teams as well as in psychiatric hospital. Staff would tell me that I would be seeing a doctor. Every time this happened, I would ask: “Is the doctor a psychiatrist?” because it was important to me to know this. My impression was that clinicians felt that it might be alarming or unsettling for a patient if they knew they were going to see a psychiatrist. I always wanted to know, though.
I also found it unhelpful when clinicians’ views about language were imposed on me. When I was being assessed by a psychologist, I described myself as being a “patient”. The psychologist told me that he didn’t like the word “patient” being used for someone who was under a psychiatric or psychological service. But I would always much prefer to describe myself in that way, because it gives a sense of equality with patients receiving physical health care. Striving for equality between physical and mental health services is so important. The term “service user” has always seemed to depersonalise the individual and so I would never wanted to be described in that way. It seems to erase my identity and only describes me in terms of my relationship with a service.
It’s so important to respect the language that feels validating and appropriate to the individual. We are all so different. Many individuals now prefer to use the term “distress” to describe suicidal feelings. I prefer to use different phrases, but I recognise that increasingly I am in a minority. A commissioner was talking about crisis services and he referred to them as services for people who are in distress. It was admirable that he had changed the language to use “distress” because many people had told him that they find this more appropriate. However, when I started to use alternative phrases, he was mildly exasperated and commented: “It’s so hard to know what language to use!” I smiled and replied: “Yes, I understand that. I think it’s best to use the language which feels most appropriate and comfortable to the person you are speaking to.”
I think that sums up the approach I would love clinicians to take: listening and understanding what kind of language the individual uses, and what language feels helpful, validating and respectful to them. Having a person-centred approach is vital within mental health services, and being person-centred also applies to the language we use.
Joy Hibbins is the CEO of Suicide Crisis, a charity that runs an award-winning Suicide Crisis Centre. For information about the Suicide Crisis Centre: suicidecrisis.co.uk
Joy is the author of “The Suicide Prevention Pocket Guidebook” which is available from most bookshops: The Suicide Prevention Pocket Guidebook: How to Support Someone Who is Having Suicidal Feelings: Amazon.co.uk: Hibbins, Joy: 9781789562996: Books