Pathogenic language in psychiatric practice and how to combat it

Consumer? Views and preferences of people receiving public mental health care in Australia on the terms used to refer to them

OBJECTIVES

To understand: a) whether adults receiving public mental health care were aware they were officially referred to as 'consumers' and, b) their views and preferences on the terms used to refer to them.

METHODS

Single-page, anonymous survey conducted across two community mental health services in Northern New South Wales (NNSW). Ethics approval obtained from the local research office.

RESULTS

108 people completed the survey with a response rate of approximately 22%. The vast majority (77%) of respondents were not aware that they were officially referred to as 'consumers'. 32% of respondents disliked the term 'consumer' and 11% found it offensive. Half preferred the term 'patient', particularly when consulting a psychiatrist (55%). A small minority (5-7%) preferred the term 'consumer' for any care interaction.

CONCLUSION

Most respondents in this survey wished to be referred to as a 'patient' and a large proportion disliked being referred to as a 'consumer' or found it offensive. Further surveys should include broader sociodemographic and diagnostic/treatment variables. Official terms used to refer to people receiving public mental health care should be person-centred and evidence based.

Measuring recovery-oriented rehabilitation language in clinical documentation to enhance recovery-oriented practice

BACKGROUND

Mental health services are encouraged to use language consistent with principles of recovery-oriented practice. This study presents a novel approach for identifying whether clinical documentation contains recovery-oriented rehabilitation language, and evaluates an intervention to improve the language used within a community-based rehabilitation team.

AIMS

This is a pilot study of training to enhance recovery-oriented rehabilitation language written in care review summaries, as measured through a text-based analysis of language used in mental health clinical documentation.

METHOD

Eleven case managers participated in a programme that included instruction in recovery-oriented rehabilitation principles. Outcomes were measured with automated textual analysis of clinical documentation, using a custom-built dictionary of rehabilitation-consistent, person-centred and pejorative terms. Automated analyses were run on Konstanz Information Miner (KNIME), an open-source data analytics platform. Differences in the frequency of term categories in 50 pre-training and 77 post-training documents were analysed with inferential statistics.

RESULTS

The average percentage of sentences with recovery-oriented rehabilitation terms increased from 37% before the intervention to 48% afterward, a relative increase of 28% (P < 0.001). There was no significant change in use of person-centred or pejorative terms, possibly because of a relatively high frequency of person-centred language (22% of sentences) and low use of pejorative language (2.3% of sentences) at baseline.

CONCLUSIONS

This computer-driven textual analysis method identified improvements in recovery-oriented rehabilitation language following training. Our study suggests that brief interventions can affect the language of clinical documentation, and that automated text-analysis may represent a promising approach for rapidly assessing recovery-oriented rehabilitation language in mental health services.