On more than one occasion while doing trainings on assisting people in recovery with returning to work, I’ve heard participants refer to the people they work with as “low functioning.” I always ask what that means, as we all “function” at different levels at different activities. Some people are better at math than others, so does that mean poor math students are “low functioning?” After processing with the group on what they meant by “low functioning,” the reply is that it is a way to refer to program participants whose impairment from their psychiatric symptoms tend to be more severe than other participants. However, I point out that mental illness tends to cyclical, and often there is great variation in level of symptoms and impairment. Also, the recovery process has been defined as a dynamic, non-linear process. So ultimately, the term “low functioning” is a meaningless, damaging label.
Aside from being meaningless, there are other problems with the term. First of all, it is highly disrespectful to label someone as “low functioning.” Also, it denotes low expectations that recovery is possible, thus negatively impacting the quality of services the person is likely to receive. At the typical training, after addressing these concerns with the group, I suggest they bring these concerns back to their programs to change the use of this language. Inevitably, I hear, “then what do we call the low functioning group?” After some reflective listening and responding, the participants are confronted with the fact that they don’t need to label anyone, and their job is to facilitate the recovery process.
Another way to look at their concern is that different individuals may have different support needs among their program participants. However, if someone has more support needs at a certain stage of their recovery, there is no reason to suspect that they will always have higher support needs, because as mentioned above, the recovery process is a dynamic process. Therefore, the consensus is that using language such as low functioning doesn’t ease the recovery process. USPRA has language guidelines which could be a useful resource to bring back to programs https://uspra.ipower.com/Certification/2003_Language_Guidelines.pdf,
The point is to always be respectful and assume that recovery is both possible, and the expectation of all service delivery in the mental health field. I am interested in hearing from the blogosphere on the prevalence of the use of the term “low functioning”, and to hear some ideas on how people address the use of this term in order to help the mental health field become more recovery-oriented.