In this section we will consider recovery-based perspectives on diagnosis, labelling and stigma in mental healthcare.

At the end of this sub-unit, you will be able to:

  • Reflect on your knowledge of diagnosis, labelling and stigma in relation to recovery-orientated mental health practice.
  • Analyse research on the experiences of diagnosis from the perspectives of service users.
  • Critically evaluate how the use of language can impact on recovery-orientated mental health care.
  • Use best practice guidelines and research evidence to develop your clinical skills in reducing stigma.

Introduction to diagnosis, labelling and stigma

Understanding the impact of diagnosis

Read the paper by Pitt et al. (2009) ‘Impact of a diagnosis of psychosis: user-led qualitative study’, a service-user led research study.

The authors conclude that the impact of a psychosis diagnosis was contradictory in nature and that this

“broadly translates as a ‘means of access’ versus a ‘cause of disempowerment’ and as ‘naming the problem’ versus ‘labelling the person’” (pg. 422)

Language and recovery-orientated practice

The language used when working with people affected by mental health difficulties can be a powerful tool for promoting recovery-orientated practice and for reducing stigma. Recovery-orientated language should be person-centred and hope inspiring, emphasising strengths/abilities rather that focusing on limitations, diagnoses or 'problems'. Recovery-orientated language may facilitate respectful and trusting therapeutic relationships and it is important that language reflects the views of the person using the service rather than prioritising clinician's views (Harris & Felman, 2012).

  • Read the article by Ashcraft and Anthony (2006). The authors explore the importance of language in promoting recovery-orientated ways of working in clinical settings and emphasise how changes in language may be an important catalyst for service transformation.

  • Read the guidelines by Harris & Felman (2012) and the Mental Health Coordinating Council in Australia (2013). Both sets of guidelines provide useful advice for how to embed recovery-orientated language in clinical practice. A number of tips and examples are shared on how to reframe common conversational phrases to ensure they are person-centered and not problem focused.

  • Reflecting on your clinical practice, are there any changes you can make to the language either written or verbally you use with people with mental health difficulties to reduce stigma?

  • With reference to the guidelines by Harris & Felman (2012) and the Mental Health Coordinating Council (2013), review a recent care plan or case documentation you have written or a recent session where you supported someone with mental health difficulties. Answer the following questions:
    • What were the strengths of the language you used in the interaction/documentation in terms of promoting person-centered, recovery-orientated care?
    • Are there any changes you could make to the language you used which may reduce stigma and enhance the therapeutic relationship?

Case study reflection

Public stigma and self-stigma may influence a person's decision to seek help in times of mental distress and some people may feel stigmatised as a result of engagement with mental health services.

Read about some of the strategies that can be employed to reduce stigma at individual, family, workplace, national and international levels suggested by Thornicroft et al.(2008) and Vogel & Wade (2009).

Watch John’s case study and answer the following questions:

  • What benefits might there be for John with engaging with mental health services?

  • What risks do you think there may be for John in engaging with mental health services?

  • List some potential benefits for John if he was to receive a diagnosis for his mental health experiences?

  • List some potential disadvantages for John of receiving such a diagnosis?

  • Think about your clinical practice. As a mental health professional, what strategies can you use to help a service user understand and normalise a mental health diagnosis in order to reduce feelings of stigma?

In this section the relative merits and demerits of labelling and diagnosis in mental illness were examined. Labelling and diagnosis may have helpful functions for individuals with mental health problems and their families, in terms of understanding their experiences and gaining access to supportive services. However, people with mental health difficulties may feel stigmatised by their diagnosis or mental health issues which can negatively impact on their emotional health, interactions with others and engagement with mental health support services. The importance of recovery-orientated language in clinician settings was presented, as well as number of anti-stigma interventions aimed at reducing stigma at an individual, familial, therapeutic and societal levels.

Ashcraft, L. and Anthony, W.A. (no date). Tools for transforming language. Behavioral Healthcare Magazine..

Callard, F., Bracken, P., David, A.S. and Sartorius, N. (2013). Has psychiatric diagnosis labelled rather than enabled patients? BMJ 347:f3412.

Corrigan, P. (2004). How Stigma Interferes with Mental Health Care. American Psychologist 59(7): 614-625.

Goffman, E. (1968). Stigma: Notes on the Management of Spoiled Identity. Penguin, London.

Harris, J. and Felman, K. (2012). A Guide to the Use of Recovery-Oriented Language In Service Planning, Documentation, and Correspondence. Mental Health America Allegheny County: Pittsburgh.

Link, B.G. and Phelen, J.C. Conceptualising Stigma. Annual Review of Sociology 27: pp.363-385.

Pitt, L., Kilbride, M., Welford, M., Nothard, S. and Morrison, A.P. (2009). Impact of a diagnosis of psychosis: user-led qualitative study. BJPysch Bulletin 33(11): 419-423.

Mental Health Coordinating Council (2013). Recovery Oriented Language Guide. New South Wales, MHCC.

Thornicroft, G., Brohan, E., Kassam, A. and Lewis-Holmes, E. (2008). Reducing stigma and discrimination: candidate interventions. International Journal of Mental Health Systems 2(3).

Vogel, D.L. and Wade, N. (2009). Stigma and help-seeking. The Psychologist 22(3): pp.20-23.

The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.