Should it be consumer, client, survivor, person-in-recovery, person-with-lived-experience, service user, consumer or user or...? What is it in languages other than English?
I rather prefer do not use adjectives such as "psychiatric", "cardiac", "diabetic" since there is no evidence about such categories of individuals. Instead I would prefer to use participants/individuals with psychiatric disorders, with diabetes and so on... This approach is more accurate because a person should HAVE some illness rather then BE the disorder.
In general, clinical psychologists and psychiatrists call their customers, "patients" while counselling psychologists and psychotherapists call them "clients". The distinction may also be because some clinical psychologists and most psychiatrists operate in a hospital and formal medical centre, where the norm is to call your customers, patients.
A destigmatizing name is just "A patient". We do not call a patient with cardiac problems "a cardiology patient" or with cancer "an oncology patient"
You could go for "a patient with psychiatric problems" just like "a patient with lung cancer".
A patient is someone who has health issues. A client is a customer who makes use of a service (like psychotherapy can be in some forms).
Doctors call cancer etc. patients 'patient' but the person with cancer doesn't necessarily identify himself as a 'patient' - he/she might use the term 'cancer victim' or 'cancer survivor'. The 'patient" with diabetes would say "I'm a diabetic". The 'patient' with arthritis would say, "I have arthritis". I guess it depends who's doing the defining and between whom the conversation is taking place. It also depends how significant that particular identity is and to whom.
The care provider will say "my" patient and "my" client but not "my" consumer so the term used also reflects aspects of the relationship. The patient will introduce himself as "your" patient or "your" client but not "your" service user.
The objection to "patient" is that it implies passivity. "Clients" sound as if they had more agency.
Service user.
"Customer" or "client" i think it´s more for financial, private and material relationships.
"Patient" is a passive term.
"A patient with psychiatric problems" it´s not like "a patient with any organic problem", "psychiatric problems" are never just (or only) psychiatric problems.
I prefer, till we find a better one (i don't like too much) "service user".
I answered before that i can see the other answer (sorry because of my english).
I agree that depends on the relationship and who's talking, and also the difference with the "i'm illnesses". Service user i think had more agency, and it's more active than patient. It´s true no one says "your service user", but it´s pretty common (i experienced that in Brasil) for those who are envolved and empowered for defending their rights, organized and associated with others, to present thereselves "I'm user of that service" or "i'm user of the mental health net services".
It´s a wonderful debate, phenomenology brings us lot of debate with this, and in Canadá there great experiences of that (I readed, i wasn't there)
Regards
Mary, that's a really interesting and highly contested issue (political correctness around the corner...). While conducting a delphi-study on a related topic, we've recently asked users, nurses and relatives about the most appropriate term (in German, respondents were from Switzerland). Users were completely devided between 'human being with a psychiatric disorder', 'person affected with a psychiatric disorder' and 'patient'. The term user was the second least, survivor is not used at all in the German speaking region. Nurses voted overwhelmingly for 'patient'. I'm still not sure what to conclude from that...
The problem with any nomenclature is it immediately adopts the stigma of patient. Service user, customer, client all have ring of the ridiculous about them. How many customers are forced to enter a department store and obliged by the use of an Act of Parliament to purchase a particular pair of shoes? This is a product of the PC age and the fact that people think we should not use the word patient is itself a manifestation of stigma. Do we refer to people on cardiac wards as 'service users' or is an accident victim the client of the emergency room or A&E?
We should not need to invent descriptions of patients in order to empower them. It would be a far better idea just to empower them.
Weh I was in Higher er the argument was always are we students or "service users. AS a mental health user we were "clients" or "patients" (Sorry folks this is an unveiling of my experience). neither "client" nor "patient" was very appealing in the lived experience--But as a "service user" I would then be considered "buying the services of my providers. Yes, my insurance paid for the services, but I did not by anyone off. I do not like the term "service user" It makes me think of my being a "service user" from my electric company, or "service user "of my phone service. When receiving Mental Health services, I receive something back from a therapist or a psychologist, etc. The patient in this experience gives back with a rich accounting of their lived experience that describes who they are and what their struggles are. Does this fit the criteria for "service user" I think not. Just as receive an education we are called student. I think the term "human being" is more preferable than any of the terms. Until someone comes up with a term equivalent to that, I do not like any of the terms suggested. Unfortunately the system finds it convient to use a term that stigmatizes the person. Just as the therapist, doctor. etc. are helpers, are we then Helper, yes indeed. But is that a term one could use can also be debated.
We need a term that puts the two people involved on an equal footing - sparring partner? participant? combatant? colleague? co-warrior? co-therapist?
I would like to suggest that there is no single term that is appropriate because the best term depends on context. The same person may be a participant in research, a group member in therapy, a parent at home, and voter on election day. Using any one label across contexts leads almost inevitably to stereotyping.and the making one aspect or role of the individual a master status that overwhelms other images. In my view, terms like service consumer are particularly unfortunate when used outside a very limited context, because they encourage us to see the individual as one who only receives but has nothing to give. It harkens back to the Third Reich label of "useless eaters" who needed to be eliminated because they were sopping up too many resources. Co-therapist is a great term to use when the it really reflects a process in which they play that role.
I prefer to call the patients because that´s the relationship between us. In Sweden many use the term service-users. customers and clients, but for me it´s just like someone said earlier in this conversation to give rose another name.
One thing in particular needs addressing before we worry too much about the 'status' we give someone with mental illness. The stigma comes from the absurd use of labels such as schizophrenia and borderline personality disorder. These frequently arise out faulty diagnoses or misdiagnosis based on a cursory observation of a patient often in a highly distressed state. Narrative diagnoses taking into account all patient's life experiences and not just the manifestation of often transients symptoms would treat patients more as people and less as categories of 'abnormality'.
And what about 'patient': that is, a person who suffers. User, client... have a meaning more close to the relation of the person with the health system, but 'patient' have a meaning more appropiate to describe the relation between the person with the physician.
However, I agree with Sobsey that this person is more than a patient (or a patient with a mental health problem): he is a farmer, a son, a communist...
I rather prefer do not use adjectives such as "psychiatric", "cardiac", "diabetic" since there is no evidence about such categories of individuals. Instead I would prefer to use participants/individuals with psychiatric disorders, with diabetes and so on... This approach is more accurate because a person should HAVE some illness rather then BE the disorder.
The term "behavioral health" doesn't seem to carry such a harsh stigma. While working for my state's Medicaid behavioral health program, "psych patients" were referred to as "recipients".
These Australian Guidelines to Recovery-Oriented Language (2013, p. 3) recommend asking the person what they would prefer to called: http://mob.mhcc.org.au/media/5902/mhcc-recovery-oriented-language-guide-final-web.pdf
This National Framework for Recovery-oriented Mental Health Services (2013, p. 8) addresses the issue of language in a thoughtful way: http://www.health.gov.au/internet/main/publishing.nsf/Content/67D17065514CF8E8CA257C1D00017A90/$File/recovgde.pdf
I think the best term especially if you are working with the person on a one-to-one basis is 'fellow traveller'. I think it was Yallom who came up with this interesting term. However, it does have political connotations...
Psychiatric patient is the best.
Patients hate being called users, clients and all other euphemisms. All these terms add to stigma.
Thank you, Mary, for sparking such an interesting discussion.
In Australia the term 'service user' has for some time been rejected by people who experience mental health challenges and workers alike, due in part to the perceived association with 'drug users' and 'drug using'.
Though there is considerable co-morbidity that some people do experience, it is considered to be doubly stigmatising to have others perhaps assume you use (illicit) drugs as well as experience mental ill health at times.
Patient is from the Latin patiens, to suffer. Client is from the Latin cliens, to follow. Client fits better with legal usage; attorneys don't use the term patient to describe their followers.
As a psychiatrist over the past 40 years I have taken the encroachment of the term client to suggest new stereotypes applied to psychiatric patients. Patients living in mental hospitals were not clients; since deinstitutionalization patients living in group homes, etc., have become clients.
However, seeing the homeless schizophrenic patient asleep on the floors of train (Penn Station in NYC) or bus depots or sidewalks, one cannot but observe the suffering individual.
Regarding the use of the above terminology (which often is more a type of labelling than anything else) has for a long time concerned me. I still find my self reluctant to use the terms patients, service users, clients etc. as it immediately puts them into a category, a box, a stereotype. I have often come across persons with special needs being referred to as a 'disabled person'. What does this say about how we view and interact with people. In the first instance every human being is a person and we should not have to differentiate them on the basis on their need for a health, social, physical or psychological service. In the absence of any non-judgemental terminology at this stage would the term 'consumer' not be an all encompassing word without the stigma attached. This could be further differentiated by perhaps a consumer of health services or a consumer of social services? Or are we just caught in a web of labels and stereotypes and have no options but to use jargon that has been used over the decades without question?
A systematic review of the terms used to refer to people who use mental health services: User perspectives
Geoff Dickens and Marco Picchioni
Int J Soc Psychiatry published online 21 February 2011
DOI: 10.1177/0020764010392066
It is necessary in our perception to help in the search for the analysis of the approach in which the user is subjected, in this case we can arrive at the analysis that the user is facing a "social delirium" and in this way it is also allowed Analyze the treatment of the patient from a more precise diagnosis through the recognition of these linguistic forms and the discovery of possible divisions discernible at the level of the discourse that presents itself as important places of work between doctor and patient, thus fostering the proper interaction between Both, and reach a final goal. If we treat the patient in the first instance as a non-coherent person, it can provoke a rejection of the patient towards the patient.
On the one hand by Patient is understood, in Medicine and in the Sciences of the Health in general: Person who suffers pain or discomfort and receives the services of a doctor or another professional of the health, and is put under an examination, treatment or intervention.
On the other hand customer, from the Latin cliens, is defined as: Person who accesses a product or service from a payment. You can do it regularly, or occasionally, if you access at a given time by a specific need.
In conclusion: the best term is customer.
Hi Samuel,
In Australia we have often used the term 'client' because, as you note, patients are accessing the services and there is a fee for service arrangement in that the client in the private system or the government/taxpayers in the public are paying for the regular or occasional services.
People who access services do not typically like the word client because they do not choose to be unwell, nor do they choose whether to access services. They have advocated instead for the term 'consumer'.
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