Recovery, stigma and diagnostic overshadowing

The federal Substance Abuse and Mental Health Services Administration describes recovery as a process of change through which people improve their health and wellness, live self-directed lives and strive to reach their full potential. Recovery does not mean the absence of symptoms. It means a person has a life they value and a real say in how it goes. For disability services, a recovery orientation fits naturally with person-centered planning: start with what matters to the person, build on strengths, and expect growth rather than decline.

Stigma works against recovery in small, repeated ways. A case note that says a person is noncompliant, manipulative or attention seeking travels from file to file and shapes how new staff and providers see them. Labels like these describe an interpretation, not a behavior. A more useful note records what happened, what the person said they needed and what was tried. Neutral language protects the person's dignity, and it also makes the record more accurate for everyone who relies on it later, including reviewers and the person themselves, who has a right to see much of what is written about them.

Diagnostic overshadowing is a specific kind of stigma. It happens when a new sign of distress is assumed to be part of an existing disability instead of being checked as a separate health or mental health concern. For people with intellectual or developmental disabilities, a change in sleep, appetite, mood or behavior may be written off as the disability when it could signal depression, anxiety, trauma, pain or a medical problem. A recent umbrella review of research found that some mental health conditions, including psychotic disorders, appear more common among people with intellectual disabilities than in the general population, and that under-diagnosis is a real concern. The same review rated most of the underlying studies as low quality, so the exact numbers should be treated with caution.

You are not the person who makes a diagnosis. You are often the person who notices a change first, or who reads a provider report and asks whether anyone has looked into it. The practical skill is simple: when behavior changes, ask what else might be going on, and make sure the right professional is involved.

Jonah reviews incident reports for 245D providers. A report about Adaeze, who has an intellectual disability, says she has become aggressive and has stopped eating with housemates, and that this is typical for her diagnosis. Jonah checks earlier reports and sees no similar incidents in the past year. The provider's plan proposes more structure and fewer outings. Nothing in the file shows that anyone has asked Adaeze what has changed or arranged a health or mental health check.

Pick three recent notes you wrote and rewrite any labeling phrase as a description of what happened, what the person said and what was tried.

Recall a phrase you have seen in case files that labels a person rather than describing what happened. How might it have shaped the next reader's view?