Language is how we express the ideas in our minds, and is therefore a most powerful agent that can reinforce separation, stigma and discrimination or, instead, work to overcome our differences and emphasise the things we have in common.
The Commission wants to ensure the language used reflects and respects the experience of people who live with mental illness, and includes the whole community in shared ideas of mental health and wellbeing.
But we know that some terms are contested, and may carry different meanings for different people. People who experience mental illness have different perspectives from those of their families and carers. Doctors may see things differently from nurses, social workers or health system administrators. Aboriginal people’s understandings of psychological and social wellbeing may diverge from those of other people born in NSW, or of migrant communities.
Those nuances may be contained in a single word or phrase.
This is particularly problematic when we encounter the language of the past, when people with mental illness were marginalised and not expected to be active participants in their own support. Some institutions, programs and models of care were known by names we would now consider stigmatising and undignified.
Therefore we have updated our use of language wherever practical, to emphasise a more progressive understanding of mental illness and to reassert the continuing worth and capacity of people who experience it. Occasionally, we have needed to retain historical language to allow readers to understand precisely the issues we discuss, and to seek out further references if they wish to.
Some of our considerations in making these choices are set out here:
Mental illness is the term we have typically used. Some people prefer mental ill-health because they consider it implies a less medical perspective. We have generally avoided mental health disorders or conditions, unless the instance refers to a particular report or study in which these terms were used.
Mental health consumers (or just consumers), people with lived experience of mental illness, people who experience mental illness and people who live with mental illness are used interchangeably. The term consumers may imply that people consume or use mental health services, when not everyone who struggles with their mental health does so.
Client is used only to refer to clients of particular services, such as housing. Patient is sometimes used to refer to people who are undertaking treatment, especially if this is in hospital.
Mental health support is our preferred term both for clinical and medical intervention and for social support offered to people with mental illness. It carries the notion that a person is still responsible for their own life and choices.
Care is used sometimes, and refers to people who are currently unwell. We have tried to avoid treatment because it may imply a paternalistic relationship, usually with a doctor, in which the person is a passive recipient.
We refer to drug and alcohol use, drug and alcohol misuse and drug and alcohol problems, depending on the circumstances. We avoid the terms abuse or addiction, which are imprecise and stigmatise people.
We have moved away from the term non-government organisation (NGO) in favour of community-managed organisation (CMO) though both appear in the Report.
In developing directions for change the Commission has been guided by a set of core principles. These apply at all stages of life, across all cultures, and for all communities in NSW.
Respect: Acknowledging the equal value of every human life should underpin everything we do to support and promote mental health and wellbeing. In particular, we must ensure that government, community-managed and private services always assure the autonomy, dignity and individuality of people who experience mental illness.
Recovery: Those of us who live with mental illness have the right to expect to lead fulfilling lives, and to pursue our own choices about how we live and about the support we accept, regardless of whether are experiencing symptoms. This should also be so for our families and carers.
Community: Strong connections among people are the foundation of mental health and wellbeing and resilience for individuals, families and our wider society. These connections nurture social inclusion and respect for diversity and are particularly important for people who experience mental illness and for their families and carers.
Quality: In partnership with consumers, mental health professionals, service planners and policy makers must ensure supports and services meet contemporary standards and are effective.
Equity: People who live with mental illness should expect to be supported equally in their recovery, regardless of their age, gender, culture, their sexual or gender identity, where they live or any other health problems they have.
Citizenship: Responsibility for individual and community mental health and wellbeing is shared across our society. All of us, whether or not we experience mental illness, should expect to contribute to that shared mental health and wellbeing, and to be able get support when we need it.
Hope: We should create an environment where people whose lives are affected by mental illness can experience the benefits of positive change and be optimistic for a better future.