Why I’ve Stopped Using the Term “Behavioral Health”
by Elizabeth Bowen, Ph.D.
A big part of being a social worker is critical thinking, including reflecting on the language we use to describe the people and issues with which social workers work.
Lately I’ve been thinking a lot about the term “behavioral health.” This term has grated on me for a while. The first problem I have is that I’m never sure exactly what it’s referring to.
Often behavioral health is used as a catch-all term for substance use and mental health-related issues.
Sometimes it seems to also encompass weight management, nutrition, and other efforts to promote a “healthy lifestyle.” Then there are conditions that are clearly linked to behaviors—sexually transmitted infections, for example—but that rarely seem to be included under the behavioral health umbrella.
This ambiguity aside, my bigger concern is that I think the term can be both misleading and stigmatizing. People who study behavioral science understand that behavior is complex and is influenced by a multitude of factors, from emotions to the environment. But in everyday use, behavior sounds like something a person should be able to readily control (how many times do we hear exasperated parents admonish their children to “just behave!”?).
My fear is that when we refer to mental health and substance use problems as behavioral health conditions, we may be implying that they are essentially voluntary, a matter primarily of will or self-control.
Separating substance and mental health-related conditions into their own category of behavioral health may perpetuate a sense of false dichotomy between these issues and other chronic health problems.
In the class that I’m teaching this semester on alcohol and other drug problems, we recently read McLellan and colleagues’ (2000) widely cited article conceptualizing drug dependence as a chronic medical condition. The authors point out that addiction has much in common with chronic conditions such as diabetes and hypertension, in that all are influenced by a range of genetic and environmental factors as well as by personal choice.
Treatment adherence rates are also similar across these conditions and relapse is more the rule than the exception—yet only with addictions (and I believe often with many mental health conditions as well) is relapse seen broadly as a personal failure, instead of a testament to the need for long-term support and care.
My final concern is that the term “behavioral health” implies a focus on behavioral interventions, typically meaning some type of individual or group counseling, often along with medication. These interventions are important in treating many conditions, but I think we need to also think bigger.
Let’s talk about strengthening families to prevent abuse, neglect, and other types of trauma that can contribute to developing a variety of problems and conditions later in life, as the ACES research shows us.
Let’s work on revitalizing neighborhoods to promote health and well-being at the community level, including creating opportunities for people to build relationships that foster social capital and recovery capital (those personal, social and community resources used to sustain recovery from addictions) .
And let’s take a critical look at transforming policies that currently stand as barriers to health and recovery—particularly the many laws that frame substance use and addiction as a criminal issue rather than a public health one and have been discriminately applied to communities of color, to devastating effect.
So if behavioral health is out, what new term is in? In this case I’m not sure we need a new pseudo-category. If we want to talk about mental health and substance use problems, we should just say exactly that. And if we want to refer to all conditions for which behavior is relevant, in terms of cause, progression, treatment, or management…well, I think that could include almost every known health condition.
I would rather see social work and our peers in other fields think about and promote health more holistically, recognizing the many factors—genetic, cognitive, behavioral, family, neighborhood, and policy-level—that contribute to our well-being.
Do we still need a term for behavioral health? If so, what might some alternatives be?
Send us your ideas!
Elizabeth Bowen is an Assistant Professor in the University at Buffalo School of Social Work.
Her research interests include homelessness, HIV/AIDS and addiction as intersecting epidemics; place-based health disparities; and social determinants of health and risk behaviors.
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Bowen, E. A., & Walton, Q. (in press). Disparities and the social determinants of mental health and addictions: Opportunities for a multifaceted social work response. Health & Social Work.
Bowen, E. A. (2013). AIDS at 30: Implications for social work education. Journal of Social Work Education, 49, 265-276.
Bowen, E. A., Mattaini, M. A., & De Groote, S. (2013). Open access for social work research and practice. Journal of the Society for Social Work and Research, 4(1), 31-46.
Drug Policy Alliance. (2014). Race and the drug war. Retrieved from http://www.drugpolicy.org/race-and-drug-war
McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness. Journal of the American Medical Association, 284(13), 1689-1695.
White, W. L., & Cloud. W. (2008). Recovery capital: A primer for addictions professionals. Counselor, 9(5), 22-27. (pdf download)