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Language matters, especially when it comes to uplifting others and reducing stigma around issues like mental health and substance use disorders.

That's why the American Hospital Association has developed a series of posters as reminders to use person-centered, or person-first language.

For example, instead of saying, "You look great! Did you lose weight?" the posters suggest "You seem happier and brighter." Instead of referring to someone as a "frequent flyer" in the emergency department, the suggestion is "We have treated this patient before."

Jordan Steiger, senior program manager for clinical affairs and workforce at the American Hospital Association, discussed AHA's People Matter, Words Matter public awareness campaign during a CHA-hosted webinar in May. The campaign started in 2021.

The campaign's posters outline person-centered language for several categories, including eating disorders, maternal mental health, child and adolescent behavioral health, suicide, and culturally/racially aware language. The posters are free and downloadable at aha.org/people-matter-words-matter.

Jill Fisk, director of mission services for CHA, hosted the webinar. "We are culture curators, with our language that allows us to uplift the dignity of the human person and people," she said. "We get to strengthen our ministry culture and continue to hone our translation skills as we reveal the presence of God through language."

Robin Conyers, vice president of behavioral health services at CHI Health, said in a later interview that the system has used the posters at clinics and hospitals in Iowa and Nebraska two years ago. CHI Health, which is part of CommonSpirit Health, recently made it possible for leaders to order their own posters through the system print shop and with facility or system branding. The system sends leaders reminders about posters available during designated awareness days or months.

Conyers said the campaign's concept "aligns with our mission and our vision and values."

"It works towards the common goal of the reduction of stigma and education, and any chance we can to get information in front of individuals," she said. "But also, in my mind, it goes beyond just us in the health care arena. So if I'm reading that, it has applicability to my family, to my friends, to people in my church congregation, to teachers. It's so much broader and more widespread than just the language that we can use in the hospital setting."

Steiger said her boss, Rebecca Chickey, AHA's senior director of behavioral health, thought of the idea for the campaign. "She calls the People Matter, Words Matter initiative her country music song," explained Steiger, "because she was on an airplane, and she thought of this idea and literally scribbled it on a napkin."

Given her social work and work in hospitals, Steiger said she has seen how language can affect patients and families in positive and negative ways.

She cited a 2017 article in the journal Healthcare Management Forum that noted how behavioral health patients can feel judged by the health care system, including when they are treated in a paternalistic or demeaning manner, told they will never get well, and spoken to or about using stigmatizing language.

"We know that there is a lot of data that shows that stigma in the health care setting contributes to poor physical and mental health outcomes for patients," she said. "So this isn't just something that sounds good. We should do it because not being stigmatizing is the right thing to do."

She pointed out that employees and families and friends of patients also can experience negative health outcomes because of stigma.

There are several sources of stigma in health care, Steiger said. People bring their negative attitudes and behaviors through the door, which is human nature. They might be simply unaware they are using stigmatizing language, or have "therapeutic pessimism," which means holding pessimistic views about the likelihood of recovery. They may be insufficiently trained in non-stigmatizing language, and there may be a stigma in their own workplace culture around certain issues like mental health.

The posters have become some of the AHA's most downloaded resources, Steiger said. The association has asked members which topics it should address in the campaign and consulted with clinicians, administrators and other hospital stakeholders, external advisory groups, and others to develop the posters. AHA is working on posters on language to use regarding ageism and disabilities and having patients and family members look at and give feedback on the content.

Steiger said some groups prefer "identity first" language. For example, people with autism often prefer to say, "I am an autistic person" or to hear "This is an autistic patient we have with us today." She also pointed out that language evolves and changes, and it's the job of health care workers to adapt.

Providers need to listen to their patients and learn how they like to be referred to, Steiger said.

"Using person-centered language reminds us that we're talking about a human being that's in front of us and is having this experience," she said. "This isn't about their disability. It's not about behavioral health or a chronic medical condition that they might be experiencing. Despite all of that, they are a person who is living a life full of needs, wants and joys like all of us are doing."