“Super utilizers” are people

The term “super utilizers” has recently brought attention to the plight of people whose complex health conditions — mental health and physical health — lead to extremely high levels of health care and other service use, such as jails and homeless services, which ultimately fail to improve their health.

We applaud policymakers for developing ground-breaking legislation to address these needs with evidence-based, intensive care (Senate Bill 292, filed jointly by Sens. Joan Huffman, R-Houston, Jane Nelson, R-Flower Mound, and Charles Schwertner, R-Georgetown, is one great example).

At the same time, health services researchers and the health care industry more broadly must also begin to consider the effect of the language we use on the people we are trying to help. As helpful as this research has been, we believe that language that fails to be respectful — i.e. to put the person first — is harmful.

Can anyone imagine referring to a loved one desperately seeking care for a child born prematurely, a spouse with stage four cancer or a parent in need of an organ transplant as a “super-utilizer”, even though the costs of treating these conditions are generally much higher? Of course not — and two reasons for that stand out starkly. First, premature birth, cancer, and organ failure are not as stigmatized by society — we don’t blame or shun the person seeking such care. Second, treatment systems are better organized to apply the best care available in these situations. Neither of these statements is true for people with severe mental health needs.

As busy professionals working hard to improve our mental health systems, we are often tempted to readily use any memorable catch-all term to get a key point across. But at the Hogg Foundation for Mental Health and the Meadows Mental Health Policy Institute, our core values as organizations that are trying to create meaningful change also demand our awareness of how neutral-seeming language can stigmatize the very people we are trying to help.

Mental health services are too often delivered years after symptoms emerge, and a lack of early, assertive care too often results in readily treatable disorders metastasizing into complex, chronic health conditions that mire individuals and health systems in expensive and ineffective care.

Fortunately, rigorous recent studies have identified opportunities to better serve these people by intervening earlier and more intensively with evidence-based care. However, these same studies, albeit with the best intentions, often also refer to a subset of people with complex health conditions as "utilizers" of various types—"high," "super," "frequent," etc.

Convenient as these terms are, they also have the effect of reducing human beings to their service needs. We consider this trade-off — convenience in return for further dehumanizing an already stigmatized population — unacceptable.

The Hogg Foundation for Mental Health and the Meadows Mental Health Policy Institute reject any language that refers to people by the costs or level of their service needs. This includes language that is part of important research we have relied on in the past and will need to continue to use. In making use of these findings, we should never do so without recognizing the people who that research is trying to help.

In Texas, we’ve come a long way in using respectful language and recognizing that words matter, but we must remain vigilant. It is absolutely true that individuals with complex conditions need better care, but they shouldn’t be stuck with the label of “users” of the system. We have faith in the ability of smart, caring, hard-working people to develop respectful language that describes the obstinate realities of the health care system without referring to people by their “costs to the system.”

The Hogg Foundation and the Meadows Institute have committed to avoid the use of these terms and instead refer to people more specifically, based on their complex needs. Instead of “super utilizers,” we will talk about "people with complex health needs." We encourage others to do the same. Yes, it is a few more words to type or say, but it turns the lens on what the system needs to do to help an individual work toward recovery and not what the individual “is” in the context of ineffective care.

Andy Keller, PhD, Meadows Mental Health Policy Institute

Dr. Andy Keller is President and Chief Executive Officer of the Meadows Mental Health Policy Institute

Octavio N. Martinez Jr., MD, Hogg Foundation for Mental Health

Octavio N. Martinez Jr., MD, Hogg Foundation for Mental Health

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