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Reframing Mental Health Language: Moving from "Functioning" to "Support Needs"

In mental health conversations, terms like "high functioning" and "low functioning" have long been used to describe how much individuals are affected by their symptoms. However, these labels are often too general to accurately reflect someone’s unique experiences and challenges. Using “functioning” as a shorthand can unintentionally miss the nuances of what people are going through and, in some cases, lead to their support needs going unnoticed or unmet. This language can be especially problematic when discussing neurodiversity, where such labels may reinforce misunderstandings or limit access to needed support.

Recent changes in how Autism Spectrum Disorder (ASD) is diagnosed offer a better way forward. Rather than using functioning levels, the DSM now classifies ASD by levels of "support needs." This shift reflects a growing awareness that everyone has unique needs that might change over time and with life’s demands.

Let’s take a closer look at how shifting from "functioning" to "support needs" can lead to more compassionate and accurate mental health care.

The Problem with "Functioning" Labels

"Functioning" labels can be misleading. For example, a person who is employed and socially active might seem "high functioning" but could be struggling intensely in private. On the other hand, labeling someone as "low functioning" may unintentionally reinforce stigma or overlook strengths, creating an additional layer of emotional burden.

In therapy, if a person's care centers only on their level of functioning, it risks missing what they actually need. This approach can make people feel pressured to meet a standard rather than empowered to focus on what really matters in their healing. When we focus on support needs instead, mental health care becomes more flexible and tailored to each person.

How Autism Spectrum Disorder Shows a Path Forward

Autism Spectrum Disorder provides a valuable example of how language can make a difference. Until recently, those diagnosed with ASD were often labeled as "high functioning" or "low functioning." This terminology could lead to missed support needs or misunderstood abilities, depending on which label was applied. For instance, people who are seen as "high functioning" might have hidden challenges with sensory sensitivities or emotional regulation that go unaddressed. Conversely, those labeled as "low functioning" might be limited by the perception that they are unable to grow or develop self-sufficiency.

The DSM now uses "levels of support needs" for ASD, ranging from Level 1 (requiring some support) to Level 3 (requiring substantial support). This approach emphasizes that needs vary from person to person and may change over time. By focusing on "support needs," mental health professionals are encouraged to see people in a fuller context, recognizing the areas where help is needed while allowing room for personal growth and potential.

Why Support Needs Matter for Mental Health as a Whole

Moving from "functioning" labels to "support needs" language benefits all mental health conversations. Here’s why:

Personalized Care: Focusing on support needs over functioning levels allows for an individualized approach. This means care that is tailored to meet each person’s unique experience rather than expecting everyone to fit a predefined level of functioning.

Reducing Stigma: Support needs language reduces the judgment that can come with functioning labels. It reinforces a compassionate approach, where individuals aren’t measured by arbitrary standards but rather seen in the context of their lives and needs.

Acknowledging Change: Support needs are rarely fixed. By focusing on needs rather than functioning, we allow for the natural ebbs and flows of mental health, validating that people may need different support at different times in their lives.

Increasing Accessibility: Shifting to support needs can help make mental health services more accessible. For neurodiverse individuals especially, needing support should not require a label of “low functioning”; it should simply be about recognizing and meeting the needs they bring.

Embracing Support Needs in Mental Health Care

As a mental health professional, I find that using "support needs" language respects each person’s unique journey and opens the door to a more flexible, inclusive, and respectful way of working together. In practice, shifting to support needs rather than functioning levels promotes a therapeutic relationship that focuses on clients’ experiences and values what they share.

Ultimately, rethinking mental health language helps make care more compassionate and effective. By recognizing people’s unique and evolving support needs, we can build a mental health approach that is more responsive, supportive, and humane.

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