needs

TRAUMA-INFORMED
RESPECT
CONTROL person-centred
strength

DIVERSITY choice
listen Recovery support LANGUAGE
recovery Oriented RESPECT
Language
TREATMENT experience
strength choice
Guide DIVERSITY
person-centred
CONTROL
support needs
DIGNITY hope
LANGUAGE
CONTROL listen
DIGNITY

choice DIVERSITY
support
positive TREATMENT
TRAUMA-INFORMED
RESPECT recovery
person-centred hope
TREATMENT experience
TRAUMA-INFORMED positive
DIVERSITY support
2ND EDITION
MHCC Recovery Oriented Language Guide ©MHCC 2018 1
Contents
3 Introduction
4 Recovery perspectives throughout life
5 Guidelines for recovery oriented language
6 Some general guidelines for language and communication
8 Out-dated and worn out words
11 Key Terms
12 Talking to people at both ends of the age spectrum
12 Young people
13 Older people
14 A trauma-informed recovery oriented approach
14 Overarching guidelines
15 Cultural diversity
15 Talking about suicide
16 Bibliography and references

Recovery Oriented Language Guide - Second Edition Revised

© Mental Health Coordinating Council 2018
PO Box 668 Rozelle NSW 2039
T 02 9555 8388
E [email protected]
W www.mhcc.org.au

2 MHCC Recovery Oriented Language Guide ©MHCC 2018

Words are important. The language we use
and the stories we tell have great significance
to all involved. They carry a sense of hope and
possibility or can be associated with a sense
of pessimism and low expectations, both of
which can influence personal outcomes.1

The Mental Health Coordinating Council (MHCC) developed the Recovery Oriented Language Guide
in 2013 because language matters in all aspects of life. It continues to be particularly important in the
context of mental health and recovery. It is vital that words are used that convey hope and optimism, and
support and promote a culture that fosters recovery.2

People living with mental health conditions are amongst some of the most disadvantaged people in
the Australian community, and many live with psychosocial difficulties exacerbated by historical and
current trauma, poverty, poor physical health and stigma and discrimination which often feature as part
of everyday experiences.3 The words that we use may effect a person’s sense of self and lead to more
disadvantage and social exclusion.

The mental health and human service sectors acknowledge MHCC’s Recovery Oriented Language Guide 4
(the Guide) as an extremely useful resource. We have developed this second edition primarily to align
with trauma-informed care and practice language approaches, introduce age-related language use and
promote the use of supported decision-making language.

Development of the Guide has been informed by a number of sources including: International and
Australian literature on trauma-informed and recovery oriented practice; conversations with the mental
health practitioners across service sectors; and, most importantly, through listening to the voices of
people with lived experience of mental health conditions concerning their recovery journeys.

The Recovery Oriented Language Guide underpins and informs all the work MHCC undertakes in
both the policy reform space and in its sector development activities.

You can access this resource from the website at www.mhcc.org.au/our-work/resources

MHCC Recovery Oriented Language Guide ©MHCC 2018 3

Recovery perspectives throughout life
Since ‘recovery’ was originally defined from the Every day we make a countless number of
perspectives of adult mental health consumers, decisions. They are an expression of who we are -
MHCC has sought to identify whether these our uniqueness, our relationships with others, our
standpoints also apply to people at different achievements and hopes for the future. Sharing
developmental stages of life. power is a key element in promoting recovery.

The literature suggests that whilst the recovery „„ Access to supported decision-making can assist
oriented approach applies to everyone, the a person of any age develop a sense of control
language and ways of communicating that over their lives and their recovery. Through
approach need to be relevant to particular age decision-making we exercise control over our
groups. MHCC has expanded this edition of the lives, experience new things and learn about
Recovery Oriented Language Guide to include ourselves. Decision-making is so important that
some material concerning the perspectives of it is recognised as a human right
young and older people at different stages of „„ Decision-making is a skill that can be developed
their recovery journey. It provides an opportunity and practised with support.
for reflection on diversity, which includes young
people coming to terms with the new experience „„ Supported decision-making can assist a person
of mental health and older people possibly coming to live with meaning, dignity and greater
to terms with this identity and other associated independence.
trauma, grief and loss experiences. Appropriate language is a vital component in
communicating a sense of self-determination,
Whatever a person’s stage of life, mental health
because feeling powerlessness can be
and human services should be familiar with
overwhelming, especially when decisions seem to
language that reflects a recovery oriented
be or are in the hands of others.
approach to practice, and have an awareness and
understanding of the prevalence and impact of Research has shown that communication is only
trauma, which may have resulted in a range of 7 % verbal and 93 % non-verbal. The non-verbal
psychosocial difficulties, and have awareness of the component is made up of body language (55 %)
ways in which this may present. and tone of voice (38 %)5 so when communicating
with someone it is also important to consider:
Cultural diversity considerations should Being mindful of the non-verbal aspects of
always guide a worker in their communications. communication, as well as boundaries maintained,
appropriate eye contact and using body posture
When a worker is unsure of what is that is non-threatening nor disinterested.
appropriate, they should ask the person
what they would like in terms of language Always try to accommodate a person’s
interpretation, disability aids, environmental developmental age, hearing, cognitive or language
difficulties, the time and space to think, question
accommodation or supports.
and express their point of view.
Whatever a person’s background, It is important to be authentic, transparent and
developmental age or impairment experienced, sincere.
workers should adopt strength-based language
to encourage choice and control and support Use plain English language where possible.
self-directed decision-making. Using everyday language can help anyone better
understand what is happening to them, their
Just ask a person what they think would assist condition, care and treatment or circumstantial
change.
them achieve their aims and objectives, what
they need now and in the future and how they Collaboration and openness are largely
can be supported to communicate and achieve achieved through developing rapport, through
their aims. connectedness, and a sense of feeling respected
and heard.

4 MHCC Recovery Oriented Language Guide ©MHCC 2018

Guidelines for Recovery Oriented Language6
General Principles
The language we use:
„„ Represents the meanings we have constructed from experience
„„ Prompts attitudes, expectations and actions
„„ Should always reflect ‘unconditional positive regard’ 7 for people.

We may be unaware of how the words we use reflect our attitudes and the impact they have upon those
around us.

The words we choose reflect our attitudes - that we do (or do not) truly value people, believe in and
genuinely respect them.

None of us should be defined by the mental health conditions or psychosocial difficulties that we
experience, or by any single aspect of who we are; we should be respected as individuals first and
foremost.

Our language needs to be:

„„ Respectful
„„ Non-judgemental
„„ Clear and understandable
„„ Free of jargon, confusing data, and speculative comment
„„ Consistent with our body language
„„ Sincere in carrying a sense of commitment, hope and presenting the potential for opportunity
„„ Strengths-based

We need to give thought to:

„„ How the language we use, is read and heard by the person to which we are communicating, and how
it may positively or negatively contribute to their health and wellbeing
„„ What meanings we present to people to live by

Our language conveys our thoughts, feelings, facts and information, but beyond that,
we need to be reflective in our practice and ask ourselves questions like:
„„ What else am I saying?
„„ How will someone else read or hear this?
„„ Do I give a sense of commitment, hope and present opportunity or a sense of pessimism?
„„ Do I convey an awareness and expectation of recovery?

The approach to language when talking to people needs to take into consideration where they are in
their recovery journey. This may fluctuate in relation to their physical and mental health, and social and
emotional wellbeing.

MHCC Recovery Oriented Language Guide ©MHCC 2018 5

Some general guidelines for language and communications8

DO DON’T

DO put people first: DON’T label people:

DO say “person with mental health condition” DON’T say “he is mentally ill”, “she is mentally ill”
DO say “a person who has been diagnosed DON’T define the person by their struggle or
with…” distress

DON’T equate identity with a person’s diagnosis

Very often there is no need to mention a diagnosis
at all. It is sometimes helpful to use the term “a
person diagnosed with”, because it shifts the
responsibility for the diagnosis to the person
making it, leaving the individual the freedom to
accept it or not.

DO emphasise abilities DON’T emphasise limitations.

Do focus on what is strong Don’t focus on what is (in your mind) wrong with
i.e., the person’s strengths, skills & passions the person

DO use language that conveys hope and DON’T use condescending, patronising, tokenistic,
optimism that supports, and promotes a culture intimidating or discriminating language
of recovery
DON’T make assumptions based on external
appearances or communication difficulties

DON’T sensationalise a mental illness

This means not using terms such as “afflicted with,”
“suffers from” or “is a victim of”

DON’T portray successful persons with mental

health conditions as superhuman. This carries the
assumption that it is rare for people with a mental
health condition to achieve great things

DO enquire as to how the person would like to be DON’T presume that a person wants to be called
addressed by a particular term (e.g., consumer or client) and
check whether the wish to be addressed by their
family or first name (e.g., Ms Smith or Kylie) or
another name which they identify

DO use language that is comfortable for you and DON’T use jargon, or unfamiliar language.
reflects your genuine, true self

DO clarify that people understand the DON’T use specialist or medical language unless
information they have been given you accompany it with plain English explanations

Make sure that whatever a person’s age, cultural

background and cognitive skills that they have
understood what has been said

6 MHCC Recovery Oriented Language Guide ©MHCC 2018

DO DON’T

DO use language that conveys optimism and DON’T use negative or judgemental language
positivity

DO ask “what is important to you?” DON’T refer negatively to aspirations identified in

the past that a person did not follow up
DO ask “what are you looking forward to doing?”

DO ask “what do you think might be steps DON’T use the concept of goals with young
forward” people or older people unless it feels appropriate.
Rather talk about aspirations, dreams and hopes

DO ask whether the person feels they have DON’T argue with a person’s perception of events
been consulted and listened to about their care,
treatment or support plans

DO validate a person’s experiences DON’T minimise a person’s experience in the

urgency of managing symptoms

DO ask whether the person has been given the DON’T argue that information was already
opportunity to ask questions, and check that they provided or known
have the information they need
DON’T assume that having said something, that it
DO check that an older person has heard and is understood
understood what has been said clearly – when
you know or sense they may have hearing and/or DON’T jump in and speak for someone
cognitive difficulties DON’T tell someone that certain information is
DO allow people the time to find the words and irrelevant
express what they need to say

DO ask people if they feel ready to make their DON’T harp on failures of the past
own decisions or would like to be supported, and
in what way

DO ask what has been helpful and unhelpful in DON’T assume that you know what is best for a
the past person

DO involve people in the development of DON’T devise treatment, care or a support plan
treatment, care and support planning without consultation with the person you are
working with
DO involve others providing care coordination
across services

DO be mindful of the importance of individual DON’T make assumptions about people based on
identity to all people, but be particularly sensitive their diagnosis
to peoples’ fears of being considered to lack
decision-making capacity DON’T make assumptions about age or disability.
Remember older people have a lifetime of
DO be mindful of older people’s fear of losing experience, and many young people have roles of
their sense of identity or a young person being responsibility despite their age
considered mature enough to make decisions

MHCC Recovery Oriented Language Guide ©MHCC 2018 7

Out-dated and worn-out words9
Language of Acceptance, Hope, Respect & Worn-out words
Uniqueness

„„ Kylie has a mental health condition or a „„ Kylie is not normal

disability

„„ Sam lives with a mental health condition „„ Sam is mentally ill

„„ Sam is a person with lived experience of …. „„ Sam is schizophrenic

„„ Sam has been told he has schizophrenia „„ Sam is a bipolar

„„ Sam has been diagnosed with ……….. „„ Sam is an anorexic

„„ Sam has experienced anorexia „„ Sam has PTSD

„„ Sam is a person with lived experience of „„ Sam is a PD

trauma
„„ Sam is a borderline
„„ Sam is a person who experiences mental
health and co-existing difficulties with „„ Sam has drug problems
substance use

„„ Kylie is having a rough time „„ Kylie is decompensating

„„ Kylie is having difficulty with her „„ Kylie is treatment resistant

recommended medication
„„ Kylie is uncooperative
„„ Kylie’s medication is not helping her
„„ Kylie doesn’t accept she is mentally ill
„„ Kylie is experiencing unwanted effects of her
medication „„ Kylie has no insight

„„ Kylie disagrees with her diagnosis

„„ Kylie is experiencing …

„„ Sam is trying really hard to self-advocate and „„ Sam is manipulative, irritable

get his needs met
„„ Sam is demanding and unreasonable
„„ Sam may need to work on more effective ways
of getting his needs met „„ Sam has challenging or complex behaviours

„„ Sam is dependent

„„ Kylie is choosing not to… „„ Kylie is non-compliant

„„ Kylie would rather look for other options „„ Kylie has a history of non-compliance

„„ Sam is pleased or satisfied with the plan we’ve „„ Sam is compliant or manageable
developed together
„„ Sam has partial insight
„„ Sam and the team have developed a good
rapport „„ Sam is cooperating

„„ Sam is able to seek help and recognises when „„ Sam has acquired insight
things are not going so well „„ Sam is learning to manage his illness
„„ Sam is working hard towards achieving his „„ Sam is unmotivated
goals

„„ Sam is taking each day at a time

8 MHCC Recovery Oriented Language Guide ©MHCC 2018

Language of Acceptance, Hope, Respect & Worn-out words
Uniqueness

„„ Kylie chooses not to… „„ Kylie has no insight

„„ Kylie is concerned about the health „„ Kylie is treatment resistant

implications of her treatment plan
„„ Kylie refuses support
„„ Kylie prefers not to…
„„ Kylie won’t engage with services
„„ Kylie is very independent
„„ Kylie needs support with her ADLs
„„ Kylie seems unsure about…
„„ Kylie is low functioning
„„ Kylie might benefit from some help at home

„„ Sam is really good at… „„ Sam is high functioning

„„ Kylie has a tough time taking care of herself „„ Kylie is low functioning

„„ Kylie has a tough time learning new things

„„ Kylie is still considering her options

„„ Kylie is still working out what she needs

„„ Sam tends to (describe actions, e.g., hit „„ Sam is dangerous; abusive; angry, aggressive
people) when he is upset
„„ Sam demonstrates challenging, high risk
„„ Sam sometimes kicks people when he is behaviour/s
hearing voices
„„ Sam is high risk
„„ Sam is finding it difficult to socialise
„„ Sam is anti-social
„„ Sam likes his own company
„„ Sam is isolative

„„ Sam doesn’t want to socialise

„„ Kylie is experiencing both mental health and „„ Kylie is dually diagnosed

substance use problems
„„ Kylie has comorbidities or is comorbid
„„ Kylie tends to use non-prescribed substances
to help manage distress/cope with life „„ Kylie is MICA/MISA (mentally ill chemically
abusing, mentally ill substance abusing)

„„ Kylie is an addict

„„ Sam doesn’t seem ready to go back to work „„ Sam is unmotivated

„„ Sam is not in an environment that motivates „„ Sam is not engaged or does not want to be
him engaged

„„ Sam is working on finding his motivation „„ Sam isolates

„„ Sam has not yet found anything that sparks „„ Sam rejects help
his interests

MHCC Recovery Oriented Language Guide ©MHCC 2018 9

Language of Acceptance, Hope, Respect & Worn-out words
Uniqueness

„„ Kylie has a lot of energy right now „„ Kylie is manic

„„ Kylie hasn’t slept in three days „„ Kylie is hyper

„„ Sam is experiencing a lot of fear „„ Sam is paranoid

„„ Sam is worried that his neighbours want to „„ Sam is delusional

hurt him
„„ Sam is aggressive
„„ Sam often disagrees and gets angry with his
family, friends etc

„„ Kylie has been working towards recovery for a „„ Kylie has a chronic mental illness
long time
„„ Kylie is severely mentally ill
„„ Kylie has experienced serious depression for
many years „„ Kylie will never recover - she rejects help

„„ So far, Kylie has not accessed support that has

been helpful to her

„„ Sam and I aren’t quite on the same page „„ Sam is very difficult

„„ It is sometimes challenging for me to work „„ Sam has challenging behaviour

with Sam
„„ Sam won’t engage with services
„„ Sam has not had good experience with
services in the past „„ Sam doesn’t accept what he has been told by
the treating team
„„ Sam is a young person who has recently been
given a diagnosis and is a having difficulty to
come to terms with this news

If worn out words are used to describe people’s „„ Manipulative

attempts to reclaim some shred of power while
receiving services in a system that may try to „„ Grandiose
control them, then important opportunities to „„ In denial
support a person’s recovery will be lost.
„„ Passive aggressive
A person trying to get their needs met – may have
a perception or opinion different from, or not „„ Self-defeating
shared by, others - and their actions may not be
effectively bringing them to the results they want. „„ Oppositional

„„ Personality disordered

„„ Charles is an older person who displays „„ Charles is a challenging, difficult, grumpy man
frustration at times
„„ easily angered, irrational and short tempered
„„ Charles is someone used to being independent
who is finding it difficult accepting support „„ Charles rejects help and advice

„„ Charles may need some support to help him „„ Charles isn’t capable of deciding for himself
make decisions what’s best

„„ Charles may need support in some areas of his „„ Charles has complex needs
life „„ Charles has poor ADLS
„„ We need to find out what we can do to „„ Charles is uncooperative
support Charles that best suits him

10 MHCC Recovery Oriented Language Guide ©MHCC 2018

Key Terms
A Consumer is a person with lived experience of a mental health condition who is accessing or has
previously accessed a mental health service.10 Within a child and youth mental health context, both the
parents and the child or young person may sometimes also be described as consumers.

Capacity refers to a person’s ability to make his/her own decisions. These may be small decisions, such as
what to do each day, or bigger decisions such as where to live or whether to have an operation. A person
may lack capacity in some areas, but still be able to make other decisions.

Cognitive functioning refers to the underlying cognitive processes that allow for effective information
processing that assist decision-making, planning and completing actions.

Complex need is commonly used to refer to individuals who present with an inter-related mix of diverse
mental health and physical health issues, developmental and psychosocial problems.

Dignity of Risk refers to the individual’s right to make informed choices in relation to a variety of
life experiences and take advantage of opportunities for learning, developing competencies and
independence and, in doing so, takes a calculated risk.

Diversity is inclusive of but not limited to the diversity among people with respect to culture, religion,
spirituality, disability, power, status, gender and sexual identity and socioeconomic status.11

Peer Work is a fast growing occupational group in the mental health workforce. Peer services are a core
component of a genuinely recovery based service. Peer work, peer workers and peer workforce includes
all workers in mainstream or alternative mental health services or initiatives who are employed to openly
identify and use their lived experience of mental illness and recovery as part of their work. Peer support
workers provide support for personal and social recovery to other people with mental health conditions,
including in acute mental health settings housing, supported employment, community-based support and
so on.12

Psychosocial disability is an internationally recognised term under the United Nations Convention on
the Rights of Persons with Disabilities. It is characteristically used to describe many negative outcomes
for a person living with a mental health condition attempting to interact with a social environment that
presents barriers to their equality with others. Psychosocial disability may also describe the experience
of people regarding participation restrictions related to their mental health conditions as the loss of or
reduced abilities to function, think clearly, experience full physical health and manage the social and
emotional aspects of their lives.

Recovery is defined as being able to create and live a meaningful and contributing life in a community of
choice with or without the presence of mental health issues.13

Somatisation is a tendency to experience and communicate psychological distress in the form of

somatic symptoms and behavioural features. More commonly expressed, it is the generation of physical
symptoms of a psychiatric condition such as anxiety.

Supported decision-making is an approach designed to support people make significant decisions,

exercise their legal capacity, make day-to-day choices and draw upon their strengths and support
networks.

Trauma-informed is the re-conceptualisation of traditional approaches to health and human service

delivery whereby all aspects of services are organised acknowledging the prevalence of trauma
throughout society. `Trauma-informed’ services are aware of and sensitive to the dynamics of trauma as
distinct from directly treating trauma per se.

MHCC Recovery Oriented Language Guide ©MHCC 2018 11

Talking to people at both ends of the age spectrum
Young People
Just like with people from other groups or diverse cultures, when communicating with a young or older
person using language that they are comfortable with is important. Be guided by their style of speech.

Young people are no different to adults in expressing the importance of collaboration and openness as
worker attributes. What is particularly meaningful is displaying a genuine interest in people and their
lives. Asking “how’s everything going?” can be a good way of opening the door to a conversation about
anything that they may need or like to talk about. Young people characteristically relate more to concepts
of health and wellbeing rather than illness and recovery.

Use language that is real and familiar rather than imitate young people.

The idea of being asked to formulate recovery Workers should not feel uncomfortable or
goals, particularly for young people can lead needing to use language that they wouldn’t
them to feel judged, especially when they are normally use. However it is important to
unable to list concrete objectives. understand that swearing and ‘bad language’ is
a prominent feature in the vocabulary of many
Instilling hope is vital to everyone, but some young people - both when things are going well
young people feel overwhelmed thinking of the and when things are challenging.
future. Talk instead about hopes and dreams
that may have for themselves.

A young person may say “I feel crap” or “this is An alternative approach is to refer to ‘steps
shit”. Enabling conversation that is accepting forward’ rather than ‘goals’. For example,
of this language is important in establishing “what do you think may be some useful steps
rapport with a young person. Some of the forward?” or “what are you looking forward
expressions used by young people may offend to doing (e.g. when you are discharged from
others from different age groups and cultures, hospital, go home etc.)?” Young people are
nevertheless, it important to be accepting of often figuring out who they are and what they
contemporary vernacular. want of life and don’t want to be cornered.

Young people are increasingly comfortable using technology-based communications to discuss their
emotions and experiences.14 It would appear that the absence of social cues such as facial expressions
and gestures provides young people with an opportunity to disclose serious or sensitive information
in what they perceive as a less-judgmental environment (where they can meet and converse with like-
minded people).15 Health practitioners have noted that meeting young people in a space where they are
comfortable can help build rapport and improve communication, even when online.16 Having discarded
the formalities of meeting face-to-face, online communication can offer a vehicle for frank and sincere
discussion about a person’s mental health difficulties.

The NSW Child and Adolescent Mental Health Services Competency Framework17 identifies the
importance of mental health workers being culturally sensitive to adolescents when working with them;
for example, appropriate non-verbal communication, eye contact and body posture.

12 MHCC Recovery Oriented Language Guide ©MHCC 2018

Older persons
Using a recovery oriented approach sets out to enable a person living with a mental health condition to
create and live a meaningful and contributing life in their community of choice.18

Many older people have a clear sense of who they are and how they define themselves, and can build on
a lifetime’s experience and resilience which can buffer the impact of any illness or circumstance.

Working with older people often includes:

Supporting a person to maintain a sense of enduring self-identity. Older people living with mental
health conditions have described this as ‘continuing to be me’.19 It is important to express a genuine
interest in knowing who they are.

Understanding that for some older people’s mental health conditions may have become so
entrenched that their sense of who they are is compromised by illness and its impacts. This may
result in them appearing helpless and hopeless. The language we use should reflect the fact that
there are other perspectives without minimising what they are actually feeling.

Awareness that older people tend to conceptualise recovery rather differently to young people and
adults more generally. Their aim may be simply to maintain a sense of who they are despite the
disabilities they experience, and be valued and respected to know what they want and need.

Considering that a person may feel patronised and cornered when asked about goals for recovery.
Older people may prefer to have their recovery journey expressed in a way which focuses on what
will give them the best life they can live in the circumstances.

There is evidence suggesting that older people’s dignity and autonomy is being undermined in health
care settings and that a sizable cross section of healthcare professionals hold stereotypical, negative
attitudes towards older people.20 Diminishing mental health among older people is often not identified by
relatives, health care professionals and older people themselves who may attribute symptoms of to the
effects of ageing or to physical and environmental changes.

Often service providers make assumptions about older people, and what is appropriate communication.
Important to language in this context is communicating respect and supporting choice and autonomy
whatever difficulties a person may be having. Importantly, assuming capacity as a first principle.21

Three components of recovery appear to be distinct to older people: the significance of an established
and enduring sense of identity; coping strategies which provide continuity and compensation and
therefore reinforce identity, and the impact of coexisting physical illness.

It is vital that when communicating with an older person that they are supported to have their voice
heard and their choices understood. Older people should be reassured that their autonomy and ability
to self-determine life choices will not be undermined unnecessarily, especially when other disabilities
may be involved.

Avoid asking others, even those close to them about what they want, unless a person clearly wants
someone else to speak on their behalf, or are unable to communicate their preferences.

MHCC Recovery Oriented Language Guide ©MHCC 2018 13

A trauma-informed recovery-oriented approach
Recovery orientation has been adopted as an overarching philosophy to guide mental health practice and
is embedded into policy and standards nationally.22 An understanding of trauma is integral to a recovery-
oriented approach. In fact developing and implementing trauma-informed systems of care is one of the
first steps towards becoming recovery oriented. Critical to this objective is to use language that reduces
the possibilities for re-traumatisation and harm within service systems and practice. A trauma-informed
recovery-oriented approach is person centred and involves sensitivity to individuals’ particular needs,
preferences, safety, vulnerabilities and wellbeing, recognises lived experience and empowers people with
lived experience to genuinely participate in decision-making.

Overarching guidelines
„„ Speak or write about a person with a mental „„ Express ‘shortfalls’ as work or progress still to
health condition, psychosocial disability, be achieved.
cognitive impairment, problem and/or difficulty; „„ Record the person’s own hopes or ambitions
not about a disorder, diagnosis, symptom/s as well as those held by the support or treating
and/or case or bed or a derisory term such as team and what needs to happen for such hopes
‘frequent flyer’ or ‘blocked bed’. to be realised.
„„ Always include a description of a person’s „„ Seek to express issues of risk (safety appraisal)
strengths and resourcefulness alongside the in terms of planning for recovery, safety and
difficulties they experience. success; including for people who may be
„„ Where applicable, explicitly own words and required to comply with involuntary treatment.
concepts such as diagnosis or assessment as „„ Seek to ensure that issues of compromised
from a medical/service provider opinion or safety include risk of re-traumatisation as
perspective rather than as a pronouncement of a consequence of a range of involuntary
universal truth. treatment, including detention in a hospital
„„ Do not make assumptions and describe environment.
achievements, possessions or connections as „„ When actions are suggested that the person
merely grandiose delusions. disagrees with, give a clear reason why these
„„ Do not assume that disclosures of abuse are are considered necessary in terms of supporting
necessarily imaginary or represent part of the someone’s recovery, and acknowledge their
psychosis a person may be experiencing. alternate view.
„„ Do not assume that risks presented in files and „„ Ensure demonstration of respect with reference
notes that relate to the distant or very distant to people’s concerns about the physical and
past have current relevance. psychological impacts of medication/s that they
are expected to accept, and that discussions
„„ Record people’s progress and their efforts
appropriately factor in the competing risks.
towards their own recovery, the steps forward
that they have made, using the person’s own …… When there is opportunity, such as in
words and meaning. regards to Mental Health Review Tribunal
determinations, always offer a copy to the
„„ Where there are different views between the
person following the hearing decision.
person writing a letter or report and the person
it is important to: „„ In respect to reports to be presented to a
Tribunal, always offer to discuss the draft prior
…… include recognition of that awareness
to a hearing unless there is good reason, in
…… describe their viewpoint in their own words, which case:
and
…… offer to review and respond to their views
…… describe how their viewpoint contrasts with on what you have written
the author’s
…… where there are significantly different
For example, “whereas I think ... I’m aware viewpoints, consider how these can be
that Sam has a very different point of view included either by amending what you have
and considers or stated that ...” written if it is acceptable to you or otherwise
include a description of the person’s
…… Note directions for negotiating these
alternate viewpoint in the file
differences

14 MHCC Recovery Oriented Language Guide ©MHCC 2018

„„ Be aware that letters and reports are of the conversation and a reminder of decisions
constructions rather than objective descriptions: - and copied to the other relevant parties
(e.g., peer workers, support workers, general
…… where possible, write reports with the
practitioners).
person they are about, while at the
same time preserving the integrity and „„ Set up recovery-oriented language prompts in
authenticity of your own viewpoint organisational documents and data templates,
and include in continuous improvement audit
…… Where not possible, write them knowing that
processes.
the person may read them
„„ Ensure that in talking to anyone, that
„„ Where there is a practice of offering people
environmental safety has been established
copies of letters written about a person,
before discussing anything that may represent a
consider if the letter could instead be written
directly to the person it is about - as a record trauma trigger for a person you are supporting.

Cultural Diversity
People from different cultures may express their distress in physical or somatic symptoms, or
in descriptive terms unusual to you. It is important that workers pay attention to the person’s
description of their lived experience.

Living with a mental health condition may be considered a weakness in some cultures, and some
people may find a diagnosis shaming or guilt provoking, whilst others may consider it a relief to put
a name to their difficulties. Try and find out how a person’s culture affects the way they perceive
their condition and use language that most appropriately relates to their experience.

Talking About Suicide23

One impetus to change the language of suicide began in the bereavement community. In addition to the
insensitive language often used to describe suicide, and the silence and denial - the absence of suicide
language and conversation is a major contributor to the stigma people face in the community.24

Suicide often leaves the bereaved with especially acute feelings of self-recrimination. Those who are left
behind may feel the full burden of suicide’s stigma, and can feel abandoned and ashamed. Added to this
injury is the mention of suicide in euphemistic language that goes to great lengths to neutralise the real
meaning that exists concerning death as a consequence of suicide and the loss attached to it. Because
this silence can be debilitating, the need for language that addresses the act of suicide in a direct but
respectful way was identified and has, in recent years, gathered momentum.25

Suicide is no longer a crime, and so we should stop saying that people commit suicide. We now live in a
world where we seek to understand people who experience suicidal thoughts, behaviours and attempts,
and then to treat them with compassion rather than condemn them.26 Part of this is to use appropriate,
non-stigmatising language when referring to suicide.

Often people seek attention from others for comfort and reassurance when they are distressed. In the
context of a suicide attempt or suicidal ideation people are often described as ‘attention seeking’. This
is unhelpful language suggesting that a person is repeatedly displaying negative behaviours to gain
attention. It is important to acknowledge the sequence of events leading to the situation arising and then
state the actual behaviour of concern.

Appropriate Words Worn-out words

„„ Died by suicide „„ Committed suicide
„„ Took his or her life „„ Successful suicide
„„ Ended his or her life „„ Completed suicide
„„ Non-fatal attempt at suicide „„ Failed attempt at suicide
„„ Attempt to end his of her own life „„ Unsuccessful suicide

MHCC Recovery Oriented Language Guide ©MHCC 2018 15

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16 MHCC Recovery Oriented Language Guide ©MHCC 2018