Mental Health Became Behavioral Health: We Lost Our Mind!
Posted by Dr. Vollmer on February 23, 2015
Changing terminology with the hopes of changing expectations is an old trick. If we use the word “behavior” we think of quick fixes of change, of making new, healthier habits. If we use the word “mental” then we acknowledge the vast uncertainty and confusion involved in understanding a human being. The small name change in my field from mental health care to behavioral health care parallels the changing intervention from exploring with a deep respect for uncertainty to the more concrete, more certain intervention of behavioral training. Certainty feels better on the one hand, but on the other hand, it does not mirror the patients who are fearful, vulnerable and/or traumatized and who want to be understood, even if understanding means there is a shared confusion about their mental state. The love of certainty is a sucker’s game in that certainty implies knowledge, and since there is no way to understand the deep workings of the human brain, then the one who screams the loudest, who promotes the most certainty will have temporary appeal, until the glow of idealization wears off and the feeling change to despair and hopelessness. By contrast, beginning with humility, with a position of uncertainty, gives way to healthy exploration and thoughtfulness which downstream results in a more stable, considered, examined existence. In other words, behavioral health promises short-term gains, but it does not account for the long-term disappointment and despair which may follow from the unfulfilled expectations. Mental health, by contrast suggests that there is a vague notion of mental balance and that through much hard work and contemplation, mental health can slowly improve, to create more lasting change and maturity. As parents, we want our children to grow slowly, to have baby steps of change to cement a solid adulthood, and so too with mental health, we want our patients to slowly step up their frustration tolerance in order to build a solid foundation to weather future storms. Mental health suggests a slow and deliberate intervention, whereas behavioral health suggests short-term habit change. I do not know how this change in terminology happened, but I can’t help but wonder whether a marketing genius changed the name to create a new brand of health care. If my theory is correct, I do think it is marketing genius, but at the expense of human suffering and low professional morale.
Shirah Vollmer MD 
Eleanor said
Shirah, you previous blog post “ Mental Health is Lost” and this one, “Behavioral Health” honestly have my mind swimming in all directions. I think….why is so much change in the field happening in treatment for “psychic pain”..Is it insurance issues, the fast pace of our society and culture, electronic medical records, lack of time for both physicians/psychiatrists/psychologists, etc, along with potential patients being too rushed with other “more important” demands, patients not willing to make the necessary time and money sacrifices for longer term quality treatment at deeper fundamental levels….or speaking in generalities, folks just not really caring any more about the complexity of the human mind and thus resorting to the “quick behavioral and/or medication fix”?
My opinions and views are too one sided to make any fair determination but when I see people, including children (“the identified patient” as is often the case ) that could benefit from quality treatment given time limited behavioral approaches….ie:….”homework” behavioral suggestions for instance, for those in “counseling (the “in” acceptable term these days) …..I just want to throw my hands up and wonder….what is happening in our world of care, or lack thereof, in our mental health field!
Dr. Vollmer said
Yes, Eleanor, I share your frustration. The cause for this shift from “mental health” to “behavioral health” is in part determined by a sudden influx of patients with insurance who can now access mental health care, thereby flooding the systems with more patients than they can handle. To deal with large numbers of patients, time-limited therapies, along with group therapies, provide an efficient, although not necessarily useful, intervention to move people through the system. Otherwise, without increasing the number of providers, the health care pipes will clog and then no one will have access. Access needs to increase, but how this is done, without skyrocketing costs, is a large challenge. Since Big Data has started to rule our lives, the outcome seems to be the data, and not the patient, and as such, there is a focus on good “outcomes’ no matter how short-term that may be. In essence, band-aid treatments seem to suffice, and to my dismay, there is no, or too little, pushback from clinicians. Thanks, as always.
Shelly said
I understand the issue but to someone with real mental illness, there is no other choice but to make behavioral changes. One isn’t going to be able to modify or improve the brain, except using medications, and those are just temporary fixes, not long-term ones. If they were long-term fixes, then one wouldn’t need to take the meds two or three times a day, forever. One learns to maintain a lifestyle and recognize triggers, i.e. make behavioral changes so as to maintain a reasonably normal life (marriage, children, job, community). Those with mental illnesses will never be “mentally healthy” but rather, will have learned to act normal and hide their illnesses from the world, since there is so much stigma surrounding mental illness in today’s day and age.
Dr. Vollmer said
I think that each person is different and as such, there is a range of benefit from both understanding motivation and changing behavior. I do not think we can put all of the mentally ill in one bucket. Some people, as you say Shelly, do only respond to behavioral intervention, and for them, those tools are extremely helpful. Yet, others, while they also benefit from behavioral modifications, they can also benefit from deeper exploration of their mental state. Yes, we do not have drugs which “cure” mental illness, but rather our drugs help with the debilitating symptoms, and as such, as you say, for the severely symptomatic they must be taken every day. Thanks.
Ashana M said
It’s interesting that part of your criticism of the term stems from your belief that behavioural interventions don’t work, and yet the evidence is that they do work as well or better than other kinds of interventions.. There is very little evidence that psychoanalytic approaches help people, and yet you claim they do. On the one hand, you seem to believe that using what works is important, and yet at the same time you repeatedly oppose efforts to investigate what works–dismissing it as “big data.” Your argument seems to be that your approach works and it works because you say it does, or because someone you agree with says it does. I’m puzzled. If you believe it works, where does that belief come from and what counts as evidence for you? You dismiss systematic, rigorous studies, so that’s out. What’s in? Your personal observations? The personal observations of others you know?
Dr. Vollmer said
Perhaps I am not clear in my posts. I favor behavioral interventions as one of many tools to help people with psychic pain. I also want to be clear that I claim NO evidence that in-depth psychotherapy is helpful. I only have anecdotes. I do not say that my approach “works” but I do say that my attempt for deeper understanding is a good first step towards understanding the complexity of human behavior. My issue with big data is that although it makes sense for looking at cholesterol levels and glucose levels, as markers of health, we do not have such clear indicators in the mental health world. I am a scientist in my heart and I respect research enormously so I regret that does not come through in my posts. At the same time, when our measurement tools are flawed, we need to fall back on the science of exploration and not the science of intervention. Our field is too primitive to study rigorously, and hence we are in an exploratory phase in our attempt to understand human behavior. To say we understand human behavior or to say that we have good measurement tools is simply premature. Thanks.
Go to Therapy Now said
Reblogged this on Go To Therapy Now and commented:
I might have to stop blogging and just re-post everything this woman has written! Clearly a master clinician and eloquent writer as well.
Dr. Vollmer said
Thanks.
LCSW said
I appreciate your post. I’ve been a mental health clinician long enough to see CBT come and go more than a few times as the Treatment Flavor of the Day. “If the only tool you have is a hammer, every problem is a nail”, said Erickson. The 4-to-5-30-minute sessions-and-you’re-out approach is dismissive of human complexity and individuality. CBT is a great tool, but shouldn’t be the only one in the toolkit.
Dr. Vollmer said
Hi LCSW,
Yep! We agree! Thanks.
Advancements in Behavioral Health Techniques – People's Care said
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