essay about mental health stigma

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What is mental health stigma?

With a growing number of people experiencing a decline in their mental health, society is becoming better equipped to respond to our needs. However, the stigma around mental illness and seeking help remains.

According to the Centers for Disease Control and Prevention (CDC) , mental illness is among the most common health conditions in the United States.

More than 50% of U.S. adults will need mental health treatment at some point during their lifetime. In addition, 1 in 25 are currently living with a serious mental illness, such as an eating disorder, bipolar disorder, post-traumatic stress disorder (PTSD), or major depression.

A national survey estimates that 11.2% of all U.S. adults report regularly feeling some form of worry, nervousness, or anxiety, while 4.7% report frequently experiencing sadness or symptoms of depression.

Given how common it is for people to experience a decline in mental health, the level of stigma that exists in society is surprising and often contradictory.

For example, one survey concluded that the majority of people in the U.S. believe in supporting those living with mental illness, so they can live normal lives with others who could help them recover.

The respondents stated they do not support the idea of keeping those with a mental health condition out of society. The survey also suggests that generally, people do not believe that those living with mental illness are excessively dangerous or prone to violence.

However, two-thirds of the survey respondents believed there was still a lot of stigma attached to mental illness, while almost half said they would not welcome a mental health facility into their neighborhood.

Keep reading to explore mental health stigma, its effects, and what people can do to overcome them.

What is a stigma?

Stigmas in society are commonplace. They can be difficult to dismantle and overcome once they become established over many years.

A stigma is a negative and often unfair social attitude attached to a person or group, often placing shame on them for a perceived deficiency or difference to their existence.

Individuals or groups can apply stigma to those who live a certain way, have certain cultural beliefs or make lifestyle choices, or to people living with health conditions, such as mental illnesses.

Mental health stigma

Mental health stigma refers to societal disapproval, or when society places shame on people who live with a mental illness or seek help for emotional distress, such as anxiety, depression, bipolar disorder, or PTSD.

The pressure of mental health stigma can come from family, friends, coworkers, and society on a broader level. Groups can also politicize stigma. It can prevent people living with mental illness from getting help, fitting into society, and leading happy and comfortable lives.

Mental health stigma can come from stereotypes , which are simplified or generalized beliefs or representations of entire groups of people that are often inaccurate, negative, and offensive. They allow a person to make quick judgments about others based on a few defining characteristics, which they then apply to anyone in that group.

For instance, people living with depression are often stereotyped as lazy, while some judge those with anxiety as cowardly.

Many people fear being labeled “crazy” for simply seeking support from a therapist. None of these characterizations are valid, and all of them are misinformed, cause pain, and prevent people from getting the help they need.

An often politicized stereotype about people with mental illness is that they are violent or dangerous. However, a small minority of people living with mental illness commit violent acts. They are actually 10 times more likely to be victims of a crime , making them a vulnerable population we should be protecting instead of fearing.

Why is mental health stigmatized?

Stigma against mental illness can come from several sources, such as personal, social, and family beliefs, and from the mental health condition itself, which may cause a person to act outside what is considered the social or cultural norm.

A lack of awareness, education, perception, and a fear of people with mental illness can all lead to increased stigma.

Effects of mental health stigma

According to the Mental Health Foundation, nearly 9 out of 10 people with a mental illness feel stigma and discrimination negatively impact their lives. They also state that those with a mental health issue are among the least likely of any group with a long-term health condition or disability to find work, be in long-term relationships, live in good housing, and be socially included in mainstream society.

Stigma against a person living with a mental health condition can make their symptoms worse and make it hard to recover. A person may also be less likely to seek help if they live with stigma.

Stigma may not be obvious or be expressed in large gestures. It can come in the words people use to describe a mental health condition or people living with mental illness. This can involve hurtful, offensive, or dismissive language, which can be upsetting for people to hear. This can cause them to feel alone and that no-one understands what they are going through.

The effects of stigma can include:

• internalization of negative beliefs
• social isolation
• low self-esteem
• hopelessness
• avoiding treatment
• worsening symptoms
• lack of criminal justice
• discrimination at work
• unemployment

How to overcome mental health stigma

Public education to increase knowledge around mental illness is paramount, since the majority of stigma comes from a lack of understanding and misplaced fear.

It is important to review reliable sources of information on mental health conditions and become better informed when learning that a friend, family member, or coworker is living with a mental illness.

At the individual level, a person with a mental health illness can get actively involved in their treatment. They could also consider getting an advocate if they feel that stigma impacts their ability to navigate day-to-day circumstances, such as employment, housing, or healthcare.

An advocate is a trained professional who helps people work through employment disputes, medical appointments, financial claims and appointments, and housing problems. They support the rights of others who may not have the strength or knowledge to do so on their own.

Stigma is a complex issue that is well-documented but challenging to overcome.

However, there are steps that a person facing mental health stigma can take, such as finding an advocate who can support them with work issues and financial matters. They can also educate others by sharing their stories to promote a wider understanding of mental health conditions.

Importantly, everyone has a role in diffusing mental health stigma. People should educate themselves about mental health issues, and better comprehend what life is like for those living with these conditions. By doing so, they can help dispel commonly held myths and stereotypes both in themselves and others.

Through education and understanding, we can eliminate the stigma around mental illness, and there is support available to people who are currently experiencing stigma.

Last medically reviewed on November 10, 2020

• Mental Health
• Anxiety / Stress
• Psychology / Psychiatry

How we reviewed this article:

• Advocacy in mental health. (2018). https://www.mind.org.uk/information-support/guides-to-support-and-services/advocacy/what-is-advocacy/
• Ahmedani, B. K., et al. (2012). Mental health stigma: Society, individuals, and the profession. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248273/
• Corrigan, P. W., et al . (2002). Understanding the impact of stigma on people with mental illness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
• Haddad, P., et al. (2015). Mental health stigma. https://www.bap.org.uk/articles/mental-health-stigma/
• McCrae, N. (n.d.). The weaponizing of mental health. https://onlinelibrary.wiley.com/doi/pdf/10.1111/jan.13878
• Men and mental health. (2019). https://www.nimh.nih.gov/health/topics/men-and-mental-health/index.shtml
• Mental health. (2020). https://www.cdc.gov/nchs/fastats/mental-health.htm
• Mental health problems – an introduction. (2017). https://www.mind.org.uk/information-support/types-of-mental-health-problems/mental-health-problems-introduction/stigma-misconceptions/
• Mental health statistics: UK and worldwide. (n.d.). https://www.mentalhealth.org.uk/statistics/mental-health-statistics-uk-and-worldwide
• Metzl, J. M., et al . (2015). Mental illness, mass shootings, and the politics of American firearms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318286/
• Shrivastava, A., et al . (2012). Stigma of mental illness-1: Clinical reflections. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353607/
• Stigma and discrimination. (2015). https://www.mentalhealth.org.uk/a-to-z/s/stigma-and-discrimination
• The many forms of mental health discrimination. (2020). https://www.nami.org/Blogs/NAMI-Blog/March-2020/The-Many-Forms-of-Mental-Illness-Discrimination

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Understanding Mental Health Stigma: 17 Ways to Reduce It

If so, you know the discomfort, shame, and dehumanization that occurs.

Labeling others separates people based on actual or perceived differences. The stigma associated with being labeled aims at one’s identity and divides us and them .

The label linked to certain assumptions lingers, impacting impressions of the individual regardless of their behavior (Yanos, 2018).

The differentiation between us and them may seem minor. However, a closer look reveals the depth it reaches to the point of eroding social capital — the strength and benefits derived through societal cohesion.

This article discusses mental health stigma, its effects, and ways to reduce it.

Before you continue, we thought you might like to download our three Positive Relationships Exercises for free . These detailed, science-based exercises will help you or your clients build healthy, life-enriching relationships.

This Article Contains

Understanding mental health stigma, 2 real-life examples and statistics, 22 effects of stigma according to research, how to reduce mental health stigma, 8 questionnaires, questions, and scales, 5 activities, worksheets, and ideas, best books to educate yourself and others, resources from positivepsychology.com, a take-home message, frequently asked questions.

The definition for the word stigma includes a brand, a mark of disgrace or infamy, and a mark of censure (Dobson & Stuart, 2021).

According to Ritzer (2021, p. 162), “stigma is a person’s characteristic that others find, define, and often label as unusual, unpleasant, or deviant.”

Labels aim to show the individual as unpredictable, unreliable, and potentially dangerous (Dobson & Stuart, 2021). A label effectively applied creates fear and distance between society and the one who is labeled.

Brief history of mental health stigma

Mental illness goes back to the earliest human writings from ancient Israel, China, and Greece, explaining it as bad luck or being cursed.

More recently, Erving Goffman’s seminal work Asylums (1961) analyzed the treatment of patients in psychiatric facilities and showed the negative impact punitive treatment had on their mental health (Dobson & Stuart, 2021).

Goffman’s work revealed that labeling and stigmatization can have enduring, if not permanent, effects on patients (Dobson & Stuart, 2021).

Mental health stigma and discrimination

According to Philip Yanos (2018, p. 10), author of Written Off: Mental Health Stigma and the Loss of Human Potential , stigmatizing labels “diminish people’s participation in community life and inhibit them from achieving their full potential as people.”

Yanos views mental health stigma as a social injustice and suggests focusing on society’s adverse reactions instead of eradicating symptoms.

Stigmatization leads to discrimination.

Discrimination became lethal in 1939 when Hitler created the heinous T-4 program to euthanize residents of private hospitals, psychiatric institutions, nursing homes, and others with psychiatric or neurological disorders (Yanos, 2018).

Sadly, discrimination toward mental illness is still in news headlines, media representations, hiring practices, and structural norms.

Approximately 43.3% of US adults with mental illness will not receive help. They may avoid seeking treatment because they fear the label, stigma, and discrimination (Evans et al., 2023).

Simone Biles

As fervor for the 2021 Tokyo Olympics grew, finalists for the various teams were announced. Simone Biles was a top US gymnast with astounding strength and skills.

Soon after the Olympics began, it became clear that Biles was struggling. Citing a case of the twisties , she pulled out of the competition to tend to her mental health.

Biles returned to competition in 2023 after a two-year hiatus to win first place in the Core Hydration Classic (Holcombe, 2023).

Aaron Hernandez

The case of Aaron Hernandez is one of tragedy and missed opportunities. Hernandez found success playing football for the New England Patriots. Unfortunately, Aaron’s behavior spiraled out of control. He was ultimately found guilty of murder in 2015.

In 2017, Aaron committed suicide in jail. Autopsy results showed he suffered from chronic traumatic encephalopathy, a neurodegenerative disease often associated with symptoms similar to dementia, violence, and depression (Gregory, 2020).

4 Mental health myths and facts

A plethora of myths abound regarding mental illness. Let’s clarify a few that were obtained from the Substance Abuse and Mental Health Services Administration (2023).

Myth – Mental health issues cannot affect me.

Fact – In the United States, 1 in 5 adults experience mental health issues in a given year.

Myth – Mental health conditions result from character flaws or personality weakness.

Fact – Various factors, including physical illness, injury, brain chemistry, trauma, abuse, and family history, contribute to mental illness.

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Yanos (2018) identifies three primary types of stigma.

Public stigma

Public stigma refers to creating intentional chasms between us and them through the labeling process.

• Patient label – Identifying the individual as a patient requiring treatment or hospitalization.
• Pejorative labels – Labels such as crazy or insane refer disparagingly to the individual.

Discriminatory public behaviors include:

• Social isolation
• Gossiping about the individual
• Being passed over for promotion
• Concerns about reliability

This YouTube video demonstrates the public’s perception of people who have mental illness.

Self-stigma

Self-stigma happens when the labeled individual will self-handicap , self-label, and use their label as an excuse for failure, limiting their development.

The effects of self-stigma can include:

• Feeling damaged
• Feeling weak
• Feeling vulnerable
• Dressing inconspicuously to be less visible in public
• Not speaking up for themself
• Holding back from seeking positions or promotions
• Feelings of embarrassment, diminishment, and self-hatred

Discriminatory behaviors include:

• Limiting self to avoid stigma

Structural stigma

Yanos (2018, p. 3) states, “Structural stigma is again a sociological concept that identifies the inherent and intentional effects that derive from social power dynamics and the policies and practices of institutions to restrict the autonomy of people with a mental illness.”

Scenarios where this may apply include:

• Involuntary hospitalization
• Denial of insurance payments in cases of suicide
• Restriction of individuals with a history of mental illness in specific career fields
• Enacting policies that prohibit insurance claims
• Mental health screenings for specific social roles
• Restricted health care for people with mental illness

When Simone Biles withdrew from the competition, she highlighted mental health (Holcombe, 2023).

Conversation about mental illness should be omnipresent. Often, we avoid it to spare discomfort. Meanwhile, the discomfort for those suffering hits a fever pitch.

How to reduce stigma in the workplace

Harvard Business Review discusses ways managers can help create an empathetic workplace culture (O’Brien & Fisher, 2019). These can also be generalized for other uses.

1. Focus on language

Terms used in gest or casual conversion can create or add to stigmatization. Using derogatory terms such as “Mr. OCD” or “schizo” can sound like an attack to those struggling.

2. Rethink sick days

Normalizing the idea of tending to mental health using sick days can contribute toward an environment of mental and physical health.

3. Open and honest conversation

Creating a space where people can talk openly about mental health issues without fear of rejection or judgment creates psychological safety .

4. Response training

Train employees in Mental Health First Aid , a national program that helps recognize those struggling and connects them to resources that will help.

Developing lesson plans for schools

Another way to promote positive mental health is through social emotional learning (SEL) curricula. Social emotional learning enhances strategic protective factors that buffer against the risks of mental health through responsive relationships, skill development, and emotionally safe environments (Collaborative for Academic, Social, and Emotional Learning, n.d.).

In addition to bolstering mental health and wellness, SEL exercises and activities help improve attitudes about self and others and decrease risky behaviors and emotional distress.

This short TED talk explains the benefits of SEL and how to change perspectives.

Yanos (2018, p. 41) describes microaggressions as “subtle communications of prejudice toward individuals based upon memberships in marginalized social groups.”

Microaggressions include comments that are rude and insensitive. The comments may exclude or nullify one’s experiences.

Yanos and his colleague Lauren Gonzales (as cited in Yanos, 2018) used the Mental Illness Microaggression Scale-Perpetrator version to measure microaggressions. They found that 62% of respondents endorsed patronizing behavior with mentally ill individuals by talking to them more slowly. Furthermore, 81% of respondents reported frequently reminding them to take their medication.

Mental health quiz

Prejudice comprises preconceived negative attitudes, feelings, and beliefs toward members of a marginalized group. These notions come from unsubstantiated opinions or stereotypes (Ritzer, 2021).

One way to combat prejudice and subsequent stigma is to learn more about the targeted group.

The following 10-question quiz will help dispel harmful attitudes and misunderstandings regarding mental illness. Dispelling myths can help reduce stigma, creating an environment of inclusiveness.

Take this mental health quiz from the Centers for Disease Control and Prevention.

Questions to ponder

• How does segregating groups of people in society impact your values?
• What do you stand to lose if you stand up for someone with mental illness? What would you gain?
• How does it make you feel when you hear about an individual with mental illness being stigmatized?
• What is the underlying fear surrounding mental illness stigma?
• What resources do you need to make a change?
• What is mental health stigma costing society?

While on the subject of interesting questions to ponder, you may find this article helpful as well: 72 Mental Health Questions for Counselors and Patients .

Many people are uncertain about starting a conversation on mental illness and stigma. Below are ideas for getting started.

1. SAFE: Mental health facts for families

Because many veterans struggle with mental illness, Michelle Sherman and the Oklahoma Veterans Affairs Medical Center created the SAFE Program : Mental health facts for families.

The acronym SAFE stands for Support and Family Education. Each session provides questions and materials for a class or group.

In particular, session 18 helps families understand the stigma around mental illness (Sherman, 2008). The program includes facts about the impact of stigma on the family’s experience of mental illness and prompts compelling questions, such as:

• What has been the most significant consequence of your loved one’s mental illness?
• What kept them from seeking treatment?

This invaluable program and others like it help families and the diagnosed realize they are not alone, provide insightful information, and build empathy and compassion for their loved ones.

2. Discussion starter

This simple handout, Stigma Discussion Starters , analyzes what stigma looks like and means and asks questions about what it would feel like to have mental illness and experience stigma.

This handout can be used as a template for discussions in college classrooms, in the workplace, and in medical settings to create a deeper understanding of what mental health stigma looks and feels like.

3. Interactive website

The wonderfully interactive website Make It OK provides resources to help educate people about mental illness and videos on language to avoid. It provides various podcasts, questions, and interactions. For example, you can scroll down to take a quiz and also sign a pledge to do your part to erase stigma.

The site is also aimed at helping those struggling with mental illness, as it provides relatable stories and resources.

4. Helpful group activities

Mental health stigma has wide-ranging effects on those labeled and society. Dialogue is essential to effect change.

Talking circles

Talking circles are integral to restorative justice and help people connect with each other and themselves.

In Heart of Hope , Carolyn Boyes-Watson and Kay Pranis state (2010, p. 170), “Chronic conditions of unmet needs for dignity, respect, and basic necessities can induce the trauma response.” Unmet needs can lead to acting-out behaviors that can disconnect individuals from their true selves.

Boyes-Watson and Pranis (2010, p. 170) go on to say, “Acknowledging the harm of these structures and having an opportunity to tell the story of the harms in one’s life are essential in promoting resilience in the face of the harmful impacts.”

Talking circles are one way to listen and speak about societal injustices like mental illness stigma. Circles are used within the justice system, schools, and other contexts.

The process includes inviting members of the community and those harmed to sit together while they share personal stories and listen to the stories of others.

In order to address mental health stigma, the circle keeper could approach various topics such as respect, dimensions of identity, or empathy.

In this YouTube video, Kay Pranis captures the essence of talking circles and outlines the origins, objectives, and process.

Empathy Bingo

The Empathy Bingo worksheet provides an opportunity to demonstrate the difference between showing empathy and other responses. This activity works great in a therapeutic setting and other settings such as a classroom or the workplace.

The facilitator reads one of the 12 prepared scenarios and corresponding responses. Participants decide if the response exemplifies empathy or other choices provided, such as one-upping, correcting, or fixing it.

This exercise is a creative way to become aware of how our responses can be interpreted and how to build empathy, which is vital for reducing stigma.

The following books provide resources to understand mental illness and its stigma.

1. Written Off: Mental Health Stigma and the Loss of Human Potential – Philip T. Yanos

Written by Philip T. Yanos, the book conveys how the pervasive nature of stigma impacts those with mental illness, profoundly affecting their lives.

Yanos approaches the topic of stigma from the standpoint of social injustice, believing that when stigma prohibits mentally ill individuals from participating in society, it is not just a personal loss, but a communal one.

Yanos discusses negative attitudes and behaviors toward mental illness, community participation of those diagnosed, and ideas for changing perceptions.

Find the book on Amazon .

2. Another Kind of Madness: A Journey Through the Stigma and Hope of Mental Illness – Stephen P. Hinshaw

Written by Stephen P. Hinshaw, it is a biographical depiction of his journey through his father’s mental illness.

After 18 years of silence, the life-changing revelation of his father’s mental illness came during a spring break from college.

Jolting as it was, it helped explain his father’s ups and downs and extended absences. It also awakened his journey to becoming a clinical and developmental psychologist and professor.

One way to internalize a lesson is through activities and exercises. Below are examples of both that can help formulate the building blocks of empathy and healing.

Positive Relationships Masterclass

Healthy relationships are crucial to individual wellbeing. The Positive Relationships Masterclass© is a coaching masterclass to help others build and maintain healthy relationships.

Participants will learn why positive relationships are crucial markers of wellbeing, the types of support needed, the benefits of building social capital resulting in stronger communities, perceptions about relationships, and how to manage relationships.

Learning to create and negotiate healthy relationships provides insight into relationship dynamics and helps change how individuals see and interact with others.

Recommended reading

If you too are intrigued by mental wellness, we have a great selection of articles that you will find interesting. Here is a short list of must-read articles:

• 19 Mental Health Exercises & Interventions for Wellbeing
• The Benefits of Mental Health According to Science
• 16 Best Mental Health Books on Wellbeing + 3 Workbooks
• 28 Mental Health Games, Activities & Worksheets (& PDF)

2 Worksheets

Telling an Empathy Story is a worksheet used in dyads or groups to build empathy through storytelling. Participants can use someone else’s story or a biography. The storyteller uses art to help convey emotions and then shares it with another or a group, thus learning empathy and allowing for self-expression through art.

The Compassion Formulation exercise encourages psychological and emotional wellbeing by bolstering self-compassion and compassion for others. Participants will explore aspects of past influences, primary fears, protective behaviors, and unintended outcomes.

An activity for kids

This class exercise called Group Circle allows kids to show kindness and enjoy its benefits through talking circles. Participants can experience empathy by talking about a time they felt different.

Positive relationship tools

If you’re looking for more science-based ways to help others build healthy relationships, check out this collection of 17 validated positive relationship tools for practitioners. Use them to help others form healthier, more nurturing, and life-enriching relationships.

17 Exercises for Positive, Fulfilling Relationships

Empower others with the skills to cultivate fulfilling, rewarding relationships and enhance their social wellbeing with these 17 Positive Relationships Exercises [PDF].

Created by experts. 100% Science-based.

The butterfly effect posits that positive shifts could ultimately create global waves of change.

This blog post presents a challenge and an opportunity. It contains questions, books, resources, and ideas to change perspectives on mental illness.

We can create a space for those struggling with mental illness to feel accepted, understood, and validated.

This change also transforms us by opening our minds and hearts and building empathy muscles. In addition, it builds social capital through communities where empathy trumps fear.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free .

Stigma affects those struggling with mental health, as it

• Limits participation in society
• Creates obstacles to seeking treatment
• Inhibits the ability to be authentic

Stigma is most often caused by:

• Lack of knowledge and understanding
• Lack of empathy
• Negative media portrayals
• Pejorative terms

If faced with stigma, the best way to cope is to:

• Seek professional help
• Find a supportive community
• Use coping mechanisms to reduce stress and anxiety
• Public stigma: “Patient” labeling and pejorative labeling
• Self-stigma: Feeling damaged, weak, or vulnerable; holding back from sticking up for yourself
• Structural stigma: Built into societal institutions
• Boyes-Watson, C., & Pranis, K. (2010). Heart of hope resource guide: Using peacemaking circles to develop emotional literacy, promote healing and build healthy relationships . Center for Restorative Justice at Suffolk University.
• Collaborative for Academic, Social, and Emotional Learning. (n.d.). SEL and mental health. Retrieved September 17, 2023, from https://casel.org/fundamentals-of-sel/how-does-sel-support-your-priorities/sel-and-mental-health/.
• Dobson, K., & Stuart, H. L. (Eds.). (2021). The stigma of mental illness: Models and methods of stigma reduction . Oxford University Press.
• Evans, L., Chang, A., Dehon, J., Streb, M., Bruce, M., Clark, E., & Handal, P. (2023). The relationships between perceived mental illness prevalence, mental illness stigma, and attitudes toward help-seeking. Current Psychology , 1–10.
• Goffman, E. (1961). Asylums . Doubleday & Company.
• Gregory, H. (2020). Making a murderer: Media renderings of brain injury and Aaron Hernandez as a medical and sporting subject. Social Sciences & Medicine , 244 .
• Holcombe, M. (2023, August 9). What we can learn from Simone Biles’ mental health break . CNN. Retrieved September 8, 2023, from https://www.cnn.com/2023/08/09/health/biles-mental-health-break-wellness/index.html.
• Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R., Demyttenaere, K., Gasquet, I., De Girolamo, G., Gluzman, S., Gureje, O., Haro, J. M., Kawakami, M., Karam, A., Levinson, D., Medina Mora, M. E., Oakley Browne, M. A., Posada-Villa, J., Stein, D. J., Adley Tsang, C. H., Aguilar-Gaxiola, S., … Bedirhan Ustun, T. (2007). Life-time prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s Mental Health Survey Initiative. World Psychiatry, 6 (3), 168–176.
• O’Brien, D., & Fisher, J. (2019, February 19). 5 ways bosses can reduce the stigma of mental health at work . Harvard Business Review. Retrieved September 12, 2023, from https://hbr.org/2019/02/5-ways-bosses-can-reduce-the-stigma-of-mental-health-at-work.
• Ritzer, G. (2021). Essentials of sociology (4th ed.). SAGE.
• Sherman, M. D. (2008, April). Support and family education: Mental health facts for families . University of Oklahoma Health Sciences Center. Retrieved September 17, 2023, from https://www.ouhsc.edu/safeprogram/index.html.
• Substance Abuse and Mental Health Services Administration. (2023, April 24). Mental health myths and facts. Retrieved September 8, 2023, from https://www.samhsa.gov/mental-health/myths-and-facts.
• Yanos, P. T. (2018). Written off: Mental health stigma and the loss of human potential . Cambridge University Press.

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• Introduction
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Changes shown on attributions (A), preferences for social distance (B), and perceptions of dangerousness (C), by condition. Significant changes ( P  < .05) from one wave to the next (eg, 1996 to 2006) are indicated with heavy lines. Changes that were significant across the full time period (ie, 1996-2018), but not across successive waves, are indicated with a dashed line. All estimates are weighted. Data collected from the US National Stigma Studies. 12

The solid line provides the estimated trend across age groups (A), over time (B), and across cohorts (C). The shaded areas around the lines represent CIs, from light (95%) to dark (75%). Estimated cohort trends, which represent cohort-specific deviations from age and period trends, were obtained by averaging over all of the age-by-period combinations for a given cohort. For convenience, cohorts are indexed according to the first birth year in the birth cohort. The 1907 and 1917 cohorts were pooled to increase cell sizes. In all cases, higher values indicate a preference for greater social distance; lower values indicate the reverse. All estimates are weighted and adjust for respondents’ educational level, sex, and race and ethnicity, as well as the education, sex, and race and ethnicity of the person described in the vignette. Data collected from the US National Stigma Studies.

eMethods. Materials and Methods

eTable 1. Unadjusted Survey Year Differences

eTable 2. Adjusted Survey Year Differences

eTable 3. Model Fit of Candidate Models in APC Analyses

eTable 4. Deviation Magnitude Tests

eTable 5. Average Cohort Deviation Across Periods

eTable 6. Age and Period Main Effects

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Pescosolido BA , Halpern-Manners A , Luo L , Perry B. Trends in Public Stigma of Mental Illness in the US, 1996-2018. JAMA Netw Open. 2021;4(12):e2140202. doi:10.1001/jamanetworkopen.2021.40202

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Trends in Public Stigma of Mental Illness in the US, 1996-2018

• 1 Department of Sociology, Indiana University, Bloomington
• 2 Department of Sociology, Pennsylvania State University, University Park

Question   What changes in the prejudice and discrimination attached to mental illness have occurred in the past 2 decades?

Findings   In this survey study of 4129 adults in the US, survey data from 1996 to 2006 showed improvements in public beliefs about the causes of schizophrenia and alcohol dependence, and data from a 2018 survey noted decreased rejection for depression. Changes in mental illness stigma appeared to be largely associated with age and generational shifts.

Meaning   Results of this study suggest a decrease in the stigma regarding depression; however, increases and stabilized attributions regarding the other disorders may need to be addressed.

Importance   Stigma, the prejudice and discrimination attached to mental illness, has been persistent, interfering with help-seeking, recovery, treatment resources, workforce development, and societal productivity in individuals with mental illness. However, studies assessing changes in public perceptions of mental illness have been limited.

Objective   To evaluate the nature, direction, and magnitude of population-based changes in US mental illness stigma over 22 years.

Design, Setting, and Participants   This survey study used data collected from the US National Stigma Studies, face-to-face interviews conducted as 1996, 2006, and 2018 General Social Survey modules of community-dwelling adults, based on nationally representative, multistage sampling techniques. Individuals aged 18 years or older, including Spanish-speaking respondents, living in noninstitutionalized settings were interviewed in 1996 (n = 1438), 2006 (n = 1520), and 2018 (n = 1171). The present study was conducted from July 2019 to January 2021.

Main Outcomes and Measures   Respondents reacted to 1 of 3 vignettes (schizophrenia, depression, alcohol dependence) meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , criteria or a control case (daily troubles). Measures included beliefs about underlying causes (attributions), perceptions of likely violence (danger to others), and rejection (desire for social distance).

Results   Of the 4129 individuals interviewed in the surveys, 2255 were women (54.6%); mean (SD) age was 44.6 (16.9) years. In the earlier period (1996-2006), respondents endorsing scientific attributions (eg, genetics) for schizophrenia (11.8%), depression (13.0%), and alcohol dependence (10.9%) increased. In the later period (2006-2018), the desire for social distance decreased for depression in work (18.1%), socializing (16.7%), friendship (9.7%), family marriage (14.3%), and group home (10.4%). Inconsistent, sometimes regressive change was observed, particularly regarding dangerousness for schizophrenia (1996-2018: 15.7% increase, P  = .001) and bad character for alcohol dependence (1996-2018: 18.2% increase, P  = .001). Subgroup differences, defined by race and ethnicity, sex, and educational level, were few and inconsistent. Change appeared to be consistent with age and generational shifts among 2 birth cohorts (1937-1946 and 1987-2000).

Conclusions and Relevance   To date, this survey study found the first evidence of significant decreases in public stigma toward depression. The findings of this study suggest that individuals’ age was a conservatizing factor whereas being in the pre–World War II or millennial birth cohorts was a progressive factor. However, stagnant stigma levels for other disorders and increasing public perceptions of likely violence among persons with schizophrenia call for rethinking stigma and retooling reduction strategies to increase service use, improve treatment resources, and advance population health.

Stigma, the prejudice and discrimination attached to devalued conditions, has been consistently cited as a major obstacle to recovery and quality of life among people with psychiatric disorders. 1 - 3 Stigma has been implicated in worsening outcomes for people with serious mental illness, 4 , 5 with nearly 40% of this population reporting unmet treatment needs despite available effective treatments. 6 , 7 Although some psychiatrists claim that stigma has decreased 8 or is irrelevant, 9 stigma remains concerning to health care professionals, patients, advocacy groups, and policy makers. Research has not supported claims of a decrease in stigma. 3 Moreover, national levels of public stigma have been associated with treatment-seeking intentions and experiences of discrimination reported by people with mental illness. 10 , 11 Findings on antistigma interventions also reflect the persistence of stigma 3 , 12 , 13 ; the unclear, limited, or short-term effectiveness of both large-scale messaging and small-scale interventions 12 - 16 ; and the lack of scalability of many such programs. Herein, we examine US public stigma over a 22-year period to provide a detailed assessment of changes in the nature and magnitude of public stigma over 2 decades for major mental health disorders.

The US National Stigma Studies (US-NSSs) use the General Social Survey (GSS), a biannual, household-based, multistage, cluster-sampled interview project providing nationwide, representative data on adults (age ≥18 years) living in noninstitutionalized settings in the continental US. 12 Face-to-face interviews for the US-NSSs were conducted by trained interviewers using the pencil/paper mode in 1996 (n = 1444; response rate, 76.1%) and computer-assisted personal interview format in 2006 (n = 1522; response rate, 71.2%) and 2018 (n = 1173; response rate, 59.5%). The GSS follows the American Association for Public Opinion Research ( AAPOR ) reporting guideline, which the present study followed. Mode effects, tested between 1996 and 2006, were minimal 17 and analyses to identify potential biases resulting from changing response rates did not identify problems. 18 Weights are provided and used where appropriate. Respondents receive an information page in English/Spanish and are asked for their consent to begin the interview. Institutional review board approval for the GSS and this study is held at NORC and at Indiana University. The present study was conducted from July 2019 to January 2021.

The US-NSSs used a survey experimental design using vignettes describing a fictitious person with behaviors meeting Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition 19 criteria for schizophrenia, major depression, alcohol dependence, and a daily troubles control (eMethods in the Supplement ). 20 , 21 This vignette strategy avoids identifying the nature of the problem, allowing for data collection on knowledge, recognition, and labeling by respondents. 20 , 21 The vignette character’s psychiatric condition as well as their self-reported sex (man or woman), race (African American, Hispanic, or White), and educational level (eighth grade, high school, or college) were randomly varied and assigned as experimental characteristics in the stimulus. These data were not reported or collected in the interview. One vignette per respondent was read aloud by the interviewer and printed on a card given to the respondent who was then asked a series of questions.

Three sets of dependent variables operationalized stigma. First, attributions targeted respondents’ evaluation of likely scientific causes (chemical imbalance and genetics) as well as their recognition of the situation as a mental illness. Other potential moral/social explanations (bad character, God’s will, ups and downs of life, and way raised [all coded 1 if very/somewhat likely; 0 otherwise]) were also included. Second, dangerousness asked about the likelihood that the vignette person would do something violent toward others (coded 1 if very/somewhat likely; 0 otherwise). Third, social distance, the most common measure of stigma, measured respondents’ unwillingness to work closely with the vignette person on a job, live next door to them, spend an evening socializing with them, marry into their family, make friends with them, or live near a group home (categories collapsed into not willing/do not know [1] or willing [0]); details are reported in eTable 1 in the Supplement . Additional analyses used an overall social distance, factor-analytic scale for depression (1-factor solution, factor loadings ranging between 0.47 and 0.80, Cronbach α = .85).

Statistical analyses evaluated changes across years. Because data were weighted, a design-based F statistic that used the second-order Rao and Scott 22 correction was used to test the equality of raw percentages. To adjust for possible sociodemographic shifts between survey years and examine disparities, logistic regression models were fit. Differences in the estimated probabilities for outcomes were calculated, holding control variables at sample-specific means. The delta method was used to determined 95% CIs. To explore subgroup differences in trends, we fit a series of regression models that included interactions between time periods and respondents’ sociodemographic characteristics. Model estimates were used to calculate estimated probabilities of preferring social distance at each time point (1996, 2006, and 2018) and for each group (eg, men vs women), as well as group-specific changes over time and group differences in trends. Owing to the population representation of racial and ethnic groups in the US population, African American and Hispanic groups were collapsed into a non-White category in the subgroup analysis to avoid estimation problems within the vignette-specific analyses. Variance estimates were again obtained via the delta method. In addition, an exploratory age, period, and cohort analysis applied the age-period cohort (APC)–I method of Luo and Hodges 23 to assess the unique contribution of birth cohorts to overall trends in the preferences of US residents for social distance. Aligned with Ryder’s view that a cohort’s meaning is “implanted in the age-time specification,” 24 [p861] this approach quantifies cohort associations as the differential outcomes of time periods depending on age groups (eMethods in the Supplement ). Different from conventional APC models that assume cohort associations occur independently of period and age, the APC-I approach acknowledges the association of age, period, and cohort, as originally proposed by Ryder, which makes the approach useful for identifying factors that might be attributed to cohort membership. The total sample size of the individual-level APC analysis is 4134, with the number of participants per age-period combination ranging between 126 and 345. Hypothesis tests were all 2 sided. The APC analysis was carried out using R, version 3.6.2 (R Foundation for Statistical Analysis). The rest of the analysis—including data cleaning and variable transformations—was performed using Stata, version 16 (StataCorp LLC). Findings at P  < .05 were considered significant.

Table 1 provides the sociodemographic profile of US NSS respondents across the 3 survey periods: 1996 (n = 1438), 2006 (n = 1520), and 2018 (n = 1171). Representation of age, sex, race and ethnicity, and educational level were roughly in line with US Census Bureau data (1996: men, 642 [44.6%]; women, 796 [55.4%]; mean [SD] age, 44.7 [17.0] years; 2006: men, 666 [43.8%]; women, 854 [56.2%]; mean [SD] age, 46.7 [17.0] years; men, 566 [48.3%]; women, 605 [51.7%]; mean [SD] age, 49.0 [17.4] years). The slight overrepresentation of women across time has been commonly seen in interview studies. The GSS did not collect specific ethnicity data until 2000; from then, race and ethnicity categories comprised non-White (2006: 425 [28.0%]; 2018: 322 [27.5%]) and White (2006: 1095 [72.0%]; 2018: 849 [72.5%]) individuals. Overall mean (SD) age was 44.6 (16.9) years.

Figure 1 depicts unadjusted changes across survey waves. Adjusted changes reveal few differences compared with unadjusted results and are reported here (eTable 2 in the Supplement ). Scientific attributions (chemical imbalance, genetics) were high and selected by increasing percentages of US residents, with the major increase occurring in the first period (1996-2006). Overall, in the earlier period (1996-2006), scientific attributions (eg, genetics) for schizophrenia (11.8%), depression (13.0%), and alcohol dependence (10.9%) increased. The only case in which public endorsement was lower than 50%, but still substantial, was for the control situation: daily troubles ( Figure 1 A; eTable 1 in the Supplement ). These results may suggest a medicalization of life problems. However, this early significant increase in the category of chemical imbalance was followed by a decrease later.

Although problem recognition increased only for schizophrenia in the first period and for alcohol dependence only in the second period, the levels were high for all mental illnesses. No change was documented for depression, with recognition already high, or for the control, in which depression was considered not warranted, signaling a distinct difference in the public response to nonclinical problems ( Figure 1 A).

Social and moral attributions were endorsed by relatively few respondents with little change over time ( Figure 1 A). Significantly fewer respondents cited ups and downs as a cause of depression or selected God’s will. The latter choice decreased significantly in the first period for daily troubles, even as the way an individual was raised increased significantly later. Alcohol dependence, however, was increasingly stigmatized, marked by significant change in respondents simultaneously citing bad character (18.2%) and ups and downs of life (11.3%) (eTable 2 in the Supplement ). Overall, trends suggest increasing mental health literacy, including distinguishing between daily problems and mental illness.

Social distance showed little change over time, except for depression ( Figure 1 B). In the later period (2006-2018), the desire for social distance decreased for depression in work (18.1%), socializing (16.7%), friendship (9.7%), family marriage (14.3%), and group home (10.4%) (eTable 2 in the Supplement ). For depression, the decreases were statistically significant and substantial. Reductions occurred in the later period, spanning all domains except neighbor, which was already low. Other minor changes in a direction indicating a higher stigma were in evidence early. This change included an increase in social distance for schizophrenia as neighbor and having the vignette person marry into the family ( Figure 1 B; eTable 2B in the Supplement ).

Inconsistent, sometimes regressive change, was observed, particularly regarding dangerousness for schizophrenia ( Figure 1 C) (1996-2018: 15.7% increase, P  ≤ .001) and bad character for alcohol dependence (1996-2018: 18.2% increase, P  ≤ .001).

The similarity between unadjusted and adjusted results suggests that sociodemographic characteristics offer little power in explaining stigma. Table 2 reports the results of analyses of subgroup factors for race and ethnicity, sex, age, and educational attainment (vignette person characteristics controlled). There were no significant differences in the overall time trends for sociodemographic groups, but a few associations were observed within periods. More men endorsed stigma (ie, in the most recent period for socializing, in the middle period for neighbor, and in the earliest period for friendship and group home support) compared with women. More respondents who self-reported race as non-White desired social distance from individuals with depression as neighbors in the most recent period.

The most consistent sociodemographic association was noted with age. Older individuals in each period were significantly more unwilling to have the vignette person marry into the family. This response did not change over time. In addition, more individuals with lower levels of education endorsed stigma in the most recent period (neighbor) and the middle period (marriage into the family).

In Figure 2 , a composite social distance scale depicts possible explanations of the stigma decrease for depression (eTables 3-6 in the Supplement ). Age and social distance appeared to be conservatizing factors ( Figure 2 A). Distinct period responses were noted, especially from 2006 to 2018, when stigma toward depression decreased significantly (Figure 2B). Two cohorts were more likely than expected to report lower stigma—the Silent Generation (part of the 1937-1946 birth cohort, after the Greatest Generation but before the Baby Boomers) and Millennials (1987-2000 birth cohort) ( Figure 2 C). The average deviation for the 1937-1946 birth cohort was −0.12 (SE, 0.05) ( P  = .02), and the average deviation for the 1987-2000 birth cohort was−0.21 (SE, 0.08) ( P  = .01) (eTable 5 in the Supplement ).

Our analyses identified both stability and change in stigma over the 22-year period from 1996 to 2018. Five robust and clear patterns emerged. First, the period around the turn of the century (1996-2006) saw a substantial increase in the public acceptance of biomedical causes of mental illness. Survey participants were more likely to recognize problems as mental illness and draw a line between daily troubles and diagnosable conditions. These changes mark greater scientific beliefs and a decrease in stigmatizing attributions, but no reduction in social rejection. Overall, trends suggest increasing mental health literacy, including distinguishing between daily living problems and mental illness, aligning with earlier research. 25 , 26 Second, the more recent period (2006-2018) documented, to our knowledge, the first significant, substantial decrease in stigma, albeit for one mental illness diagnosis: major depression. Fewer survey respondents expressed a desire for social distance from people with depression across nearly all domains, including work and family. Considered in the context of previous research, these decreases are statistically significant, substantively large, and persist in the presence of controls. Other disorders did not see reductions in social distance, and public perceptions of dangerousness for schizophrenia and moral attributions for alcohol dependence increased.

Third, respondents’ sociodemographic characteristics offered little insight into stigma, generally, or into observed decreases for depression. What is unusual about these findings is the absence of subgroup differences, suggesting a broad shift in the respondents’ thinking about depression. This absence of sociodemographic differences may be unexpected, but it supports findings from earlier NSSs. 10 , 27

Fourth, change over time may be associated with age as a conservatizing factor, 28 , 29 a cohort process in which older, more conservative individuals are replaced by younger, more liberal US residents, 29 , 30 and/or a period outcome stemming from broad shifts that are uniformly seen regarding social distance discriminatory predispositions across age and cohort. Although prior research tended to assume the observed trends primarily reflect a period-based process, we used the APC-I method to explore unique cohort patterns in public stigma of mental illness. Disaggregating the effects of age, period, and cohort revealed age as a conservatizing factor also seen in a parallel German study, 12 and a liberalizing tendency among both pre-WWII birth cohorts (referred to by demographers as the Silent Generation) and the most recent birth cohorts (Millennials), and a recent period outcome.

Fifth, although findings for depression are notable, other results may raise concerns. For schizophrenia, there has been a slow shift toward greater belief of dangerousness. Although not statistically significant in either of the time periods, the increase was substantial and relatively large over the entire period (approximately 13%), a finding analyzed in detail elsewhere. 31 The results for alcohol dependence are similarly mixed. Although there was an increase in the selection of alcohol dependence as a mental illness with chemical and genetic roots, the problem was also trivialized as ups and downs. Moreover, we observed a return to a moral attribution of bad character in the first period that remain stable into the second period.

This study has limitations. Responses to survey vignettes reflect attitudes, beliefs, and predispositions—not behavior. The lack of importance of sociodemographic characteristics may signal insensitivity in a vignette approach or in stigma measurement. 32 - 34 Although subgroup differences are widely believed to exist, such research is rare and often not generalizable. Yet, although our estimates of sociodemographic outcomes are somewhat inefficient owing to sample size constraints, power analyses indicate that they are adequately powered to detect very small effects overall (Cohen h = 0.12), and small to moderate associations within vignette condition (Cohen h = 0.25) (eMethods in the Supplement ). In addition, our vignettes are designed to capture public perceptions of behavior changes that typically occur with the onset of mental illness. Public response might differ if the vignettes included information about help-seeking and eventual recovery. Research that specifically targeted this limitation revealed a small but statistically significant lowering of public stigma when vignette persons were described as being in treatment or recovery. 35

Other limitations must also be considered. Decreasing response rates present a challenge to researchers who seek to model trends over time in attitudes or behaviors. As noted, GSS response rates decreased approximately 16% over the 22-year period in question. If GSS respondents were somehow increasingly selected on tolerance for individuals with mental illness, finding stigma change would be likely even in the absence of actual change. This explanation seems unlikely given our results. We found respondents’ attitudes toward mental illness were more accepting in some cases (eg, depression), but less accepting in others (eg, schizophrenia). Even for depression, in which change was found across social venues, the degree to which that happens varied greatly. If findings were an artifact of a simple sample selection process, we would not expect to observe this level of complexity. Trends over time would be more consistent across conditions, and differences between social domains would be less pronounced.

Equally important, although it may be tempting to associate the changes in mental health literacy in the earlier period with the stigma reduction for depression in the latter period, doing so would be premature. These data cannot support claims about lag effects owing to the GSS’s cross-sectional design. In addition, previous work, which examined this issue in detail in the earlier period alone, could document neither individual nor aggregate associations between accepting scientific attributions for mental illness and stigma levels. 10

Despite limitations, these findings have important implications for research and treatment as well as antistigma program and policy efforts. First and foremost, the results of this study suggest that public stigma can change. To our knowledge, this study is one of the first indications that revise the larger cultural climate of prejudice and discrimination without the coordinated, translational, and research-monitored program of stigma reduction used in other Western nations. 3 , 12 , 13 Research and antistigma efforts require content retooling to make use of what is known and address the most problematic and unique aspects of stigma. In the US, controversial and structural aspects of mental illness stigma have rarely been addressed. Not only are perceptions of violence increasing for schizophrenia, individuals with schizophrenia likely face the greatest resistance in dismantling public, legal, policy, treatment, and resource barriers. Furthermore, calls for tailoring efforts to diverse or specialized populations may be limited by a thin, unrepresentative, and contradictory scientific base. 36 , 37 Data gaps in our analysis signal the need for novel stigma targets in research, whether new measures or populations widely believed to hold distinct ideas about mental illness and stigma. Our results also raise questions on how the progress reported herein can be accelerated and regressive shifts reversed. These results suggest that we must be realistic because societies change slowly and change efforts must be persistent and sustainable. Randomized clinical trial–based antistigma research often reports positive findings in typical inoculation-style programs but confronts effects that are extinguished over time. 3 , 38

The NSSs have served as the de facto primary data source about public stigma in the US for the past 2 decades. In this analysis of 22 years of survey data, we found a significant decrease in public stigma toward major depression and increased scientific attribution for schizophrenia, major depression, and alcohol dependence. Our findings are consistent with the claims of Braslow et al 5 that what the public believes and knows often aligns with science (ie, increasing agreement with scientific attributions) but may fail to influence their attitudes and behavior (ie, desire for social distance from individuals with mental illness, except depression). The societal and individual effects of stigma are broad and pervasive. Stigma translates into individual reluctance to seek care, mental health professional shortages, and societal unwillingness to invest resources into the mental health sector. Yet, the research, teaching, and programming resources targeted to redress prejudice and discrimination remain a low priority, small in scale, and individually focused. 39 With indications that the level of stigma may be reducing, strategies to identify factors associated with the decrease in stigma for depression, to address stagnation or regression in other disorders, and to reach beyond current scientific limits are essential to confront mental illness’s contribution to the global burden of disease and improve population health.

Accepted for Publication: October 27, 2021.

Published: December 21, 2021. doi:10.1001/jamanetworkopen.2021.40202

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2021 Pescosolido BA et al. JAMA Network Open .

Corresponding Author: Bernice A. Pescosolido, PhD, Department of Sociology, Indiana University, 1022 E Third St, Bloomington, IN 47401 ( [email protected] ).

Author Contributions: Drs Pescosolido and Halpern-Manners had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Pescosolido, Halpern-Manners, Luo.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Pescosolido, Halpern-Manners.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Halpern-Manners, Luo.

Obtained funding: Pescosolido, Perry.

Administrative, technical, or material support: Pescosolido, Perry.

Supervision: Pescosolido.

Conflict of Interest Disclosures: Dr Luo reported receiving grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.

Funding/Support: Support for the study was provided by the Brain & Behavior Research Foundation (formerly National Alliance for Research on Schizophrenia & Depression) Distinguished Investigator Award and from Indiana University Network Science Institute (Dr Pescosolido), and base support and supplement from the National Science Foundation to the National Opinion Research Center (NORC) for the General Social Survey (GSS) and the National Stigma Studies.

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: All GSS data are available from NORC ( https://gss.norc.org ) and the GSS data explorer ( https://gssdataexlporer.norc.org ).

Additional Contributions: We thank Alejandra Laszlo Capshew, MS (Indiana Consortium for Mental Health Services Research), who assisted with project management; the College of Arts and Sciences and the Sociomedical Sciences Research Institute at Indiana University provided infrastructural support; and Tom W. Smith, PhD, and Jaesok Son, PhD (NORC at the University of Chicago), provided project assistance as key members of the NORC GSS Team. No financial compensation was provided.

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Home — Essay Samples — Nursing & Health — Mental Health — Breaking the Stigma of Mental Health: Awareness and Acceptance

Breaking The Stigma of Mental Health: Awareness and Acceptance

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The complex nature of mental health stigma, the role of awareness in dismantling stigma, the transformative power of acceptance, impact on prevention, treatment, and recovery.

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Mental health: overcoming the stigma of mental illness.

False beliefs about mental illness can cause significant problems. Learn what you can do about stigma.

Stigma is when someone views you in a negative way because you have a distinguishing characteristic or personal trait that's thought to be, or actually is, a disadvantage (a negative stereotype). Unfortunately, negative attitudes and beliefs toward people who have a mental health condition are common.

Stigma can lead to discrimination. Discrimination may be obvious and direct, such as someone making a negative remark about your mental illness or your treatment. Or it may be unintentional or subtle, such as someone avoiding you because the person assumes you could be unstable, violent or dangerous due to your mental illness. You may even judge yourself.

Some of the harmful effects of stigma can include:

• Reluctance to seek help or treatment
• Lack of understanding by family, friends, co-workers or others
• Fewer opportunities for work, school or social activities or trouble finding housing
• Bullying, physical violence or harassment
• Health insurance that doesn't adequately cover your mental illness treatment
• The belief that you'll never succeed at certain challenges or that you can't improve your situation

Steps to cope with stigma

Here are some ways you can deal with stigma:

• Get treatment. You may be reluctant to admit you need treatment. Don't let the fear of being labeled with a mental illness prevent you from seeking help. Treatment can provide relief by identifying what's wrong and reducing symptoms that interfere with your work and personal life.
• Don't let stigma create self-doubt and shame. Stigma doesn't just come from others. You may mistakenly believe that your condition is a sign of personal weakness or that you should be able to control it without help. Seeking counseling, educating yourself about your condition and connecting with others who have mental illness can help you gain self-esteem and overcome destructive self-judgment.
• Don't isolate yourself. If you have a mental illness, you may be reluctant to tell anyone about it. Your family, friends, clergy or members of your community can offer you support if they know about your mental illness. Reach out to people you trust for the compassion, support and understanding you need.
• Don't equate yourself with your illness. You are not an illness. So instead of saying "I'm bipolar," say "I have bipolar disorder." Instead of calling yourself "a schizophrenic," say "I have schizophrenia."
• Join a support group. Some local and national groups, such as the National Alliance on Mental Illness (NAMI), offer local programs and internet resources that help reduce stigma by educating people who have mental illness, their families and the general public. Some state and federal agencies and programs, such as those that focus on vocational rehabilitation and the Department of Veterans Affairs (VA), offer support for people with mental illness.
• Get help at school. If you or your child has a mental illness that affects learning, find out what plans and programs might help. Discrimination against students because of a mental illness is against the law, and educators at primary, secondary and college levels are required to accommodate students as best they can. Talk to teachers, professors or administrators about the best approach and resources. If a teacher doesn't know about a student's disability, it can lead to discrimination, barriers to learning and poor grades.
• Speak out against stigma. Consider expressing your opinions at events, in letters to the editor or on the internet. It can help instill courage in others facing similar challenges and educate the public about mental illness.

Others' judgments almost always stem from a lack of understanding rather than information based on facts. Learning to accept your condition and recognize what you need to do to treat it, seeking support, and helping educate others can make a big difference.

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• StigmaFree me. National Alliance on Mental Illness. https://www.nami.org/Get-Involved/Take-the-stigmafree-Pledge/StigmaFree-Me. Accessed April 25, 2017.
• What is stigma? Why is it a problem? National Alliance on Mental Illness. https://www.nami.org/stigmafree. Accessed April 25, 2017.
• Stigma and mental illness. Centers for Disease Control and Prevention. https://www.cdc.gov/mentalhealth/basics/stigma-illness.htm. Accessed April 25, 2017.
• Sickel AE, et al. Mental health stigma: Impact on mental health treatment attitudes and physical health. Journal of Health Psychology. http://journals.sagepub.com/doi/pdf/10.1177/1359105316681430. Accessed April 25, 2017.
• Americans with Disabilities Act and mental illness. Womenshealth.gov. https://www.womenshealth.gov/mental-health/your-rights/americans-disability-act.html. Accessed April 25, 2017.
• Picco L, et al. Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem. Psychiatric Research. 2016;246:500.
• The civil rights of students with hidden disabilities under Section 504 of the Rehabilitation Act of 1973. U.S. Department of Education. https://www2.ed.gov/about/offices/list/ocr/docs/hq5269.html. Accessed May 2, 2017.
• Wong EC, et al. Effects of stigma and discrimination reduction trainings conducted under the California Mental Health Services Authority. Rand Health Quarterly. 2016;5:9.

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Mental Health Stigma

Rewrite your story: let go of mental health stigma and shame, by letting go of stigma and shame, you can embrace the life you deserve..

Posted May 10, 2024 | Reviewed by Monica Vilhauer

• Stigma can profoundly change how others see a person and how an individual feels about themself.
• Shame is a by-product of stigma; it is how we internalize the outside world’s beliefs about us.
• Each of us has the capacity to pick up the pen and write our own story to overcome stigma and shame.

The mental health movement has significantly contributed to normalizing and continuing the conversation around mental health, yet despite progress in recent years, a stigma around mental health challenges continues to persist in our society.

Stigma, by definition, is a mark of disgrace associated with a particular circumstance, quality, or person. Mental health stigma is just one form of stigmatization that gets in the way of living a resilient life.

Patrick W. Corrigan and John R. O’Shaughnessy have identified three types of stigma:

Structural stigma is when there are policies or practices within private and public institutions that restrict opportunities or disallow participation for someone distinguished from the norm.

Social stigma is when people within a society hold a bias, avoidance, discomfort, or overt discrimination against a person who is somehow distinguished from the norm.

Self-stigma is when a person internalizes all the messaging about what the norm is, believes the stereotypes, sees how they don’t belong, and then lives with deep shame and social rejection.

A fourth type of stigma has also emerged, called association stigma. This is when a person is stigmatized for being linked to someone else who is stigmatized.

The Effects of Stigma

It is not often that researchers agree, but when it comes to the effects of stigma, they are quite unanimous. Stigma hurts. Stigma is damaging. Stigma ruins lives. Stigma harms potential. The mental health literature demonstrates that the stigma associated with mental health conditions prevents people from accessing services and getting help.

Although we know the stigma is real, how we suffer from it is in our minds, bodies, and souls. It is not imagined, but it can be invisible. And despite our best-laid plans, once we experience stigma, our ability to maintain our sense of self is deeply challenged and our resiliency decreases. We are left living within the blast radius of a force that hits from outside and within.

Stigma Creates Shame

Each one of the four types of stigma creates the same by-product: shame. Stigma is the outside world holding a belief about us; shame is how we internalize that belief. When we explore shame, the conversation often includes guilt . Shame and guilt are not the same thing. Guilt is the feeling that you did something wrong. Shame is the feeling that you are wrong. Guilt means we broke a rule, an expectation, or a standard. Shame is the belief that we are broken. It screams that we are flawed, irreparable, and ultimately unlovable. Shame keeps us in the shadows.

Early in my life, I felt branded as someone who became broken in her childhood and adolescence and was therefore an unlikely candidate for a healthy future. Labels like, “addicted,” “crazy,” “troubled,” and “lost cause” came from the outside world. These labels then moved from the conscious to the subconscious , resulting in the embodied belief that they defined who I was. I internalized the message that people who navigate fractured self-esteem or mental health are broken. I carried this story that the outside world wrote for me for far too long.

Rewriting Your Story

We need to be able to let go of stigma and shame. Is there something you are carrying subconsciously that is holding you back or keeping you stuck? Those parts inevitably bleed into the rest of our lives and hinder the things that actually matter. Letting go of stigma and shame is not only hard work; it is heart work. No one can do this for you.

The reality is that when you own your own story, no one can use it against you. The day I released my story with Unsinkable, an organization working to break down stigma, was the day I truly embraced this idea. I decided I wouldn’t let anyone else hold against me my mistakes, setbacks, mental health challenges, or anything else they do not think is good enough about me. My story is mine. My life is mine.

And you know what? Something amazing happens when you look shame in the eye and say, no more. When you pull yourself out of the shadows and reclaim all of your life, shame loses power over you. You regain your footing. You stand in your truth, fall in love with your imperfect self, and become your own protector and warrior. You stop fighting yourself and start fighting for yourself. You become the person you needed all your life. The one that sees your vulnerability and accepts you completely as you are.

Once you start to believe in your own worth, the voices and the power you let others hold over you begin to fade away. Sometimes, the bravest thing you can do is make the decision to forgive yourself, let go of stigma and destructive self-narratives, and write your own story.

Corrigan, P. W., & O’Shaughnessy, J. R. (2007). Changing mental illness stigma as it exists in the real world. Australian Psychologist, 42(2), 90-97. doi.org/10.1080/00050060701280573

Hanley-Dafoe, R. (2021). Calm within the storm: A path to everyday resiliency. Page Two.

Robyne Hanley-Dafoe, Ed.D. , is a resiliency and wellness scholar and speaker, author of Calm Within the Storm and Stress Wisely , and award-winning instructor and adjunct professor at Trent University.

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What Is Stigma?

Views of Mental Health, Physical Disabilities, and More

A stigma is a negative attitude or idea about a mental, physical, or social feature of a person or group of people that implies social disapproval. Stigmas are a major concern because they can lead to poor treatment of groups of people, impaired mental and physical health of those groups, and other negative effects such as discrimination.

While there are many different kinds of social stigmas, mental health stigma tends to be very common. It can be strong, and it can impact both mental and physical health outcomes in serious ways. Some impacts of stigma include social withdrawal or isolation, compromised employment and financial security, physical violence, and more.

This article will discuss what stigma is and examples and types of stigma. It also addresses the impacts and how to cope.

Martin Dimitrov / Getty Images

Examples of Stigma

Signs of stigma may be obvious, or they may be so subtle that they go unnoticed. For example, a stigma can be presented as a joke that not everyone recognizes as a negative view. Even when stigmas go unnoticed, the effects can be damaging.

Examples of stigma include:

• Using slang or labels to exclude people or groups of people
• Assuming that someone with a mental illness is dangerous
• Believing that people with physical health conditions are unable to contribute to society
• Jokes about a physical or mental health condition or race, ethnicity, religion, etc.
• Halloween costumes that portray people or groups of people in a negative way
• Assumptions made about a person's intelligence or behavior based on a physical or mental health condition or race, ethnicity, religion, etc.
• People of certain groups repeatedly being shown in the media in a negative way
• Different treatment that is either isolating or harmful because of a mental, physical, or social feature of a person or group of people
• Laws or institutional regulations that isolate or negatively impact certain groups of people

What Causes Stigma?

A few different theories try to explain why some people stigmatize others. These include:

• Labeling: Labeling a person as "good" or "bad" is a natural way to avoid the effort involved in trying to understand someone else's challenges or experiences.
• Social identity: People base their identities on the specific groups they belong to, and therefore perceive members of other groups less favorably. Stigmatizing members of other groups can be a way to justify privilege, exploit others for personal gain, or boost a person's perceived importance.
• Terror management: People are naturally fearful of developing a mental illness or disability. If the stigmatized person can be blamed for their own condition, it may ease fears that the condition could happen to anyone.

Types of Stigma

There are three primary types of stigma. They were first described in 1963 by sociologist Erving Goffman, though Goffman's types were slightly different than those identified today.

The three types of stigma include mental illness stigma, physical deformation stigma, and race, ethnicity, religion, ideology, etc., stigma. Within these categories, there are additional types of stigmas.

You may have also heard the expression "stigma in health," which can relate to physical health, mental health, or both. It occurs when someone with a physical or mental health concern is viewed negatively because of that health challenge.

Mental Health Stigma

Mental health stigma is a negative attitude or idea about a mental health feature of a person or group of people. It relates to social disapproval of the person or group based on the mental health feature.

The negative beliefs can come from a variety of sources, including the person with that mental health feature. For example, stigmas are often associated with mental illnesses such as depression . This stigma may prevent people with depression from pursuing educational and career goals due to a belief of being less capable than people without depression.

Types of mental health stigma include:

• Social stigma or public stigma : When society or the general public share negative thoughts or beliefs about a person or group of people with a mental health condition
• Structural stigma or institutional stigma : Systemic stigma of mental illness at a higher level of government or organization that impacts policies or decision-making
• Self-perceived stigma or self-stigma : When a person with a mental health condition has negative thoughts or beliefs about themselves based on that mental illness
• Health practitioner stigma : When the care of a person is negatively impacted by stereotypes, thoughts, or associations of the provider about mental illness
• Associative stigma or courtesy stigma : A stigma that impacts people connected with someone with a mental health condition, such as friends or family members

Stigma Associated With Physical Deformation

Physical deformation stigma is a negative attitude or idea about a feature of a person or group of people related to a physical difference or disability. It relates to social disapproval of the person or group based on the physical feature or condition. This can lead to serious negative effects.

Like mental health stigma, there are different types of physical deformation stigma. Examples of this type of stigma include negative associations with deafness and blindness , or stigma associated with certain health conditions like HIV or sexually transmitted infections (STIs).

Stigma Associated With Race, Ethnicity, Religion, Ideology, etc.

Stigma associated with race, ethnicity, religion, ideology, etc., is a negative attitude or idea about one of these, or similar, features of a person or group of people. It relates to social disapproval of the person or group based on the feature or features.

Like mental health stigma, there are different types of race, ethnicity, religion, ideology, etc., stigma. This type of stigma can impact generations and has influenced laws and politics throughout history.

For example, the United States continued to enforce "separate but equal" laws for decades after the abolition of slavery, and in the 1980s, laws criminalizing sexual activity between same-sex couples were upheld as constitutional by the Supreme Court.

Effects of Stigma

Social stigma, or public stigma, occurs when society or the general public shares negative thoughts or beliefs about a person or group of people. For example, a mental health social stigma may be an association between mental illness and danger or a belief that people with mental illness lose control and hurt others.

People who are experiencing stigma and discrimination as a result of stigma can be harmed in multiple ways, both psychologically and in their daily lives. For example, someone who has been stigmatized may:

• Experience feelings of distress and loss of hope
• Develop a low sense of self-esteem
• Experience a worsening of psychiatric symptoms
• Stop treatment or decide not to seek treatment

They may also experience difficulties in their work or personal life, such as:

• Trouble maintaining social relationships
• Difficulty maintaining employment or problems at work
• Social isolation, exclusion from social activities
• Discrimination when seeking housing or employment
• Bullying and harassment
• Health insurance that isn't adequate to treat the condition

Social stigma can also have larger problems that go beyond impacts on the individual. For example, people who have been stigmatized may become homeless or develop substance use disorders. Some may become victims of violent crime.

Stigma Can Create a Stereotype

This type of stigma and the negative effects can harm the people with the condition, people close to them such as friends, family, caregivers, community members, and people who share attributes with them but do not have the condition. It is often seen in the form of stereotypes and discrimination of those with the condition and others.

For example, in addition to someone with depression being discriminated against, someone who is going through a hard time and is sad, but does not have depression, may also be discriminated against. Despite the challenges, there are ways to cope with stigmas.

Coping With Stigma

It is important to understand how to cope when you are facing stigma but also how to avoid stigmatizing others.

Coping With Stigma From Others

It's important to first take care of your own health by seeking treatment for any mental health concerns you may be experiencing as a result of the stigmatizing behavior of others. You can also:

• Find out if your employer offers Employee Assistance Programs (EAPs) to support employees with work and life concerns including stigmas, discrimination, and issues that negatively impact mental and emotional well-being.
• Look for support from community or school resources.
• Join a support group for those with similar mental health conditions who may also be experiencing the effects of stigma.

Preventing Stigma

There are some steps you can take to support people who are experiencing stigma, to avoid stigmatizing others, and/or to avoid spreading stigmatizing ideas:

• Notice signs of social withdrawal and reach out to family, friends, and health professionals.
• Talk openly about the facts and realities of mental illness.
• Understand that mental health conditions are illnesses like physical health conditions.
• Be careful with word choices to remain sensitive to others.
• Bring awareness to language and actions that represent stigmas so they can be changed.
• Educate others to help destigmatize mental illness.
• Choose to believe and show others that stigmas are not accurate.

A stigma is a negative attitude or idea about a mental, physical, or social feature of a person or group of people that involves social disapproval. This issue is a significant concern for people with mental health conditions and for society as a whole. It can lead to discrimination and negatively impact mental health and overall wellbeing.

Mental illness stigma, physical deformation stigma, and race, ethnicity, religion, ideology, etc., stigma are the three primary types of stigma. Despite the negative effects of stigma, there are strategies to help cope with and overcome these challenges.

American Psychological Association. Stigma .

Hart J, Richman S. Why do we joke about killing ourselves? Suicide, stigma, and humor .  Modern Psychological Studies . 2020;25(2).

Bhanot D, Singh T, Verma SK, Sharad S. Stigma and discrimination during COVID-19 pandemic . Front Public Healt h. 2021;8:577018. doi:10.3389/fpubh.2020.577018

Harvard University. Stigma .

Dilkov D, Dimitrova M, Marinova Y, Ulchar M. Investigation of attitudes/stigma/towards people with mental illness and opportunities to access psychiatric health care . Int J Surg Med . 2020;6(6):42-. doi:10.5455/ijsm.stigma-mental-illness

National Alliance on Mental Illness. Overcoming stigma .

White S. From Bowers to Obergefell: The US Supreme Court’s erratic, yet correct, jurisprudence on gay rights . J Philos Polit Econ. 2022;4(1):111-125.

Yanos PT, DeLuca JS, Roe D, Lysaker PH. The impact of illness identity on recovery from severe mental illness: A review of the evidence . Psychiatry Res . 2020;288:112950. doi:10.1016/j.psychres.2020.112950

American Psychiatric Association. Stigma, prejudice and discrimination against people with mental illness . 

Wogen J, Restrepo MT. Human rights, stigma, and substance use . Health Hum Rights . 2020;22(1):51-60.

World Health Organization. A guide to preventing and addressing social stigma associated with COVID-19 .

By Ashley Olivine, Ph.D., MPH Dr. Olivine is a Texas-based psychologist with over a decade of experience serving clients in the clinical setting and private practice.

• Essay Editor

Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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The Mental Health Stigma

This essay will discuss the stigma surrounding mental health, examining its causes, effects, and the challenges it presents. It will explore how stigma can prevent individuals from seeking help, impact public perceptions of mental illness, and contribute to discrimination. The piece will discuss efforts to combat mental health stigma, including awareness campaigns, education, and advocacy. It will also consider the role of media, cultural attitudes, and social norms in perpetuating or challenging stigma. On PapersOwl, there’s also a selection of free essay templates associated with Mental Health.

How it works

Mental health holds no bias on who it targets, no matter your gender, race, religion, sexual orientation or country you reside in, you or someone you know can suffer from a mental health disorder. Regardless of how merciless mental disorders can be, there is still an overbearing stigma behind it all. Some say it doesn’t exist, others say you are “crazy” and most importantly it is not acceptable to talk about in schools or at work without fear of being ostracized.

The stigma behind mental health needs to be changed in our workplace, in our schools and in our homes.

The workplace can be an isolating place, fraternizing amongst colleagues is discouraged, workers must remain within the confines of a six-by-six-foot cubicle and provide the upmost customer satisfaction. How can employees provide great service if they feel so unhappy? Even those with the best of work ethics cannot be expected to continue a perfect streak of satisfaction and consistency without getting the much-needed interaction of their peers. Companies and corporations should be putting their employees first, making sure they are satisfied with their work environment and engaging with them in order to receive the output they are looking for. A satisfied customer starts with a satisfied employee, but unfortunately mental health is often put on the back burner in the cogs of consumer giants.

What is this doing to society as a whole? Being told consistently that mental health should be left at home and keeping up company standards and appearances are of the upmost importance, sufferers feel if they disclose their mental illness to their employer, they are at risk of possibly losing their job or being treated differently by colleagues. Instead of seeking the help they need they suppress their emotions due to the stigma surrounding invisible illness. These feelings at work is only the tip of the iceberg, they clock out and take their loneliness, anger, anxiety and depression from their unsatisfactory occupational environments home with them.

High school students today are facing the highest stress and anxiety rates seen in any other generation, yet mental health issues are still taboo. In all of the roughly 50 million children in public schools, upwards of 20 percent or 5 million kids, are showing signs of a mental health disorder. Schools lacking proper resources, lacking mental health education and the cultural stigma are contributing to the student mental health crisis. Teachers, who are investing the most time into their students, are majority of the time not trained in mental health. They are also so overloaded with other students, classes, and grading that they can often miss the subtle signs that can save students lives. Furthermore, psychology and health education are rarely part of student’s curriculum, leaving children uneducated and in the dark with their own mental health.

School counselors are not receiving any prizes in this regard either, with a case load averaging around 500 students and specializing in academics, they rarely see the student and cannot decipher a change in behavior. So, what is to be done? Students suffering from mental illness have a harder time keeping up with their peers regarding academics. They can be fearful of speaking up in the classroom and have a harder time making friends, isolating them even further into their ailments and making them feel like no one is there to help them. Ridding the stigma behind mental illness in schools, educating staff and students, and making more options of help available to these students will significantly benefit those in need.

Mental illness does not stop once the workday is finished, it will not go away because you left the halls of the school, it follows you wherever you turn. Where you once felt safe, you felt nothing could hurt you in the warm walls of your home, mental illness has begun to take over and turn your beautiful, eggshell white walls-pitch black. The darkness begins to sink in, the walls begin to close in on you and your body becomes cold to the touch. Who can you turn to? In fear of being treated as if you are a freshly broken glass on the floor, you tell no one and suffer in silence until the silence becomes unbearable.

In families with no knowledge on mental illness, the fear of telling someone shakes them to their core. What will their families think of them? Some will say they are just going through a phase and to get over it, everyone feels sad sometimes. Others will think their relative is on the verge of suicide and treat them like a newborn baby bird who has not yet gotten their flight feathers. Any reaction of the sort is a result of one common factor, the lack of education behind mental illness. How can we as a society combat this epidemic? We need to educate, show the recourse available to those of all income levels. Educate not only suffers but family members, friends, colleagues, peers, and even the educators themselves. There is help and it should never be shamed to seek it. The stigma behind mental illness all stems from a lack of knowledge.  

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The last great stigma

Workers with mental illness experience discrimination that would be unthinkable for other health issues. can this change.

by Pernille Yilmam   + BIO

It is not difficult to find stories about the burdens and barriers faced by employees or job-seekers with mental illness. For example, it was recently reported that Scotland’s police denied a position to a promising trainee because of her use of antidepressants – in keeping with a rule that officers must be without antidepressant treatment for at least two years. In other cases, people have reported being fired from jobs at a university, a nursing home facility, a radio station, and a state agency following requests for medical leave due to postpartum depression, anxiety, depression and bipolar disorder, respectively. A US government commission maintains a select list of resolved lawsuits against companies that involved claims of mistreatment based on a worker’s mental health condition.

Often, the impact of negative attitudes toward mental illness is less overt than in these examples. More than a decade ago, a university professor named Suzanne published a book in which she openly discussed her life with bipolar disorder. The personal details that she revealed in the book, she told me, became a foundation for discriminatory treatment at her workplace. She said she experienced professional isolation in the hallways and meeting rooms: that colleagues stopped inviting her to collaborate with them, that she was shut down in department meetings and cut off from participating in decision-making committees. She attributes these developments to knowledge of her mental illness.

‘I experienced a very noticeable chill, averted eyes, actually being cut off when speaking in meetings,’ Suzanne recalled. ‘Lots of loaded language, of the “Well, SOME people just need to take their meds” variety, in meetings. This was the stage of my professional career where I started calling myself “the crazy lady in the corner”.’ At one point, when she had to take medical leave to address symptoms associated with her condition, a colleague opined that she was ‘lucky’ to have the option.

I n light of such stories, it’s not surprising that concerns about revealing mental health problems at work are commonplace. It’s estimated that 15 per cent of working-age adults have a mental health condition, and in a 2021 survey in the US, three-quarters of workers reported one or more symptoms of mental illness. One study surveying more than 800 people with major depressive disorder worldwide found that between 30 and 45 per cent reported experiencing discrimination in the workplace, with people in high-income countries reporting it at higher rates. A third of US employees polled by the American Psychiatric Association said they were worried about the consequences at work if they sought help for their mental health condition. In England, 61 per cent of survey respondents who were severely affected by mental illness said that ‘the fear of being stigmatised or discriminated against’ stopped them from applying for jobs and promotions. While there are signs that stigma related to mental illness has decreased over time (at least in some countries), stigma and discrimination continue to pose a problem in many workplaces.

Since the 1990s, a number of laws around the world have prohibited discrimination against employees with physical and mental disabilities. Among these are the Americans with Disabilities Act of 1990 in the US, the Disability Discrimination Act 1992 in Australia, and Article 13 of the Amsterdam Treaty of 1997 in the European Union. While these laws have done much to advance protections for people with disabilities, their impact on the treatment of people with mental illness – which constitutes a form of disability for many – has clearly had limits.

Mental illness-related discrimination persists as a multilayered problem characterised by fear, misconceptions and underenforced laws. The encouraging news is that scientists have been developing interventions to help reduce stigma and discrimination related to mental illness – approaches that should receive much more attention if advocates, employers and governments want to make workplaces fairer for all.

Job seekers reluctant to mention a mental illness history were more likely to be employed six months later

Discrimination against people with mental illness is often rooted in preconceived notions about what mental illness is and how it affects someone’s ability to work. These negative misconceptions are forms of mental illness stigma . Research has found that stigma is sometimes expressed by employers and colleagues as an issue of trust: eg, a belief that people with mental illness need more supervision, that they lack initiative, or that they are unable to deal with clients directly. Some might believe that people with mental illness are dangerous, or that they should hold only manual, lower-paying jobs. Research also suggests that many employers and coworkers believe people with mental illness should participate in the workforce, but are reluctant to work with them directly – which has been described as a type of ‘not in my backyard’ phenomenon.

Discriminatory behaviours have been investigated as well. In the US, researchers found that fictitious job applications that mentioned an applicant’s hospitalisation for mental illness led to fewer callbacks than applications noting a hospitalisation for a physical injury. Similar results were observed in Norway. In Germany, scientists found that job seekers who were more reluctant to mention their mental illness history in applications and interviews were more likely to be employed six months later. In addition to the potential impact on hiring, some people with mental illness have told researchers they believe they have been refused a promotion due to their condition.

In one revealing study , Matthew Ridley, an economist at Warwick University in the UK, had pairs of strangers collaborate on a virtual task. Before the task, each participant was shown characteristics of the person they had been matched with, which in some cases included mental illness. Ridley then asked if they wanted to be paired with someone else instead. The participants, he found, tended to be willing to give up some of their anticipated financial compensation to avoid working with a person who had significant depression or anxiety symptoms. When asked why, they indicated that they thought people with a mental illness would be less efficient in completing the task, would require more support, and would be less fun to work with. (For their part, among the participants who revealed to Ridley that they had a mental illness, a majority said they would pay to not have that fact revealed to their partner.)

In the end, participants were paired randomly and, when Ridley analysed the results, he found no differences in task success or enjoyment, regardless of whether someone worked with a person who had a mental illness. The findings capture how negative assumptions can come into play – and prove to be inaccurate – even in the context of a temporary collaboration.

T he perpetuation of mental illness stigma and discrimination comes at a cost not only to the affected individual, but also to companies and societies. The World Health Organization (WHO) estimates that mental illness costs the global economy $1 trillion annually. Among the reasons for these astronomical costs are the higher rates of sick days and unemployment among people with mental illness. The increased absences are partly due to lack of access to treatment; in 2021, it was estimated that only half of all US adults with mental illness had received mental health services in the past year. But a potential aggravating factor is that some employees with mental illness refrain from using their work-associated health insurance for treatment, out of fear that their employer will learn about their condition, resulting in their dismissal, or other forms of discrimination.

The denial of reasonable workplace accommodations could also make a person’s job more difficult and absences more likely. For a person who uses a wheelchair, an accommodation might be a ramp where there are stairs; for a person with a mental health condition, such as an anxiety disorder or ADHD, it could mean having a private office or noise-cancelling headphones to help with concentration problems, or flexibility in one’s work hours in order to attend healthcare appointments or accommodate heightened symptoms. It could also mean requesting leave for a mental health condition – up to 12 weeks in the US, similar to medical leave for physical injuries or for sickness. But some employees might avoid requesting the accommodations they are legally allowed to receive, simply because they suspect that doing so puts their job security and potential for advancement at risk.

The greater amount of absences among people with mental illness can make firings more likely. Losing a job can worsen mental illness, and people often stop applying for new jobs because they anticipate stigma and discrimination.

A list of the top 10 disabilities in US discrimination claims included depression, anxiety disorder and PTSD

Of course, one’s experience of work itself – a major cause of stress for many people – can also contribute to mental illness. One woman I spoke with, whom I’ll call Sara, shared that unsupportive and hostile work environments have made her anxiety even worse than it used to be. She believes that having to take time off work for her mental health led to her sudden termination from her previous job.

Under the Americans with Disabilities Act (ADA), US employers are legally prohibited from discriminating based on physical or mental disabilities at any point during hiring, firing or professional evaluation. The same is true in Australia, based on the Disability Discrimination Act. Other countries have passed antidiscrimination legislation since then too, including South Africa’s Mental Health Care Act 17 of 2002 and India’s Equality Bill, 2019.

Yet, as we’ve seen, decades after the implementation of the ADA, problems remain. Studies continue to document stigma and discrimination against workers with mental illness. In 2020, a list of the top 10 disabilities in US discrimination claims included depression, anxiety disorder and PTSD. In Australia, a commission concluded back in 2004 that the country’s antidiscrimination legislation had been less effective in helping people with mental illness than those with mobility and sensory disabilities. In the EU, where Article 13 of the Amsterdam Treaty created a binding agreement to illegalise discrimination based on disabilities, researchers and clinical professionals were quick to point out its vagueness and lack of defined scope. An EU-funded consensus paper from 2010 documented the continued problem of discrimination against employees and job-seekers with mental illness.

Reports such as these call into question whether even a major law like the ADA can adequately address discrimination related to employee mental illness. And they should prompt us to reconsider how best to combat the problem. One question we can ask is: what might limit the impact of such laws in curbing discrimination against people with mental illness, compared with discrimination against people with physical disabilities? Let’s consider three potential answers.

F irst, discriminatory behaviour is not always obvious, and sometimes it is not even intentional. Compared with an employee who uses a wheelchair, it might be easier to dismiss a socially anxious person’s need to work from home. Compared with someone who is getting treatment for cancer, it might be easier to question whether an employee newly diagnosed with bipolar disorder will ever return as a valuable employee after their medical leave. Compared with a trauma-induced concussion, it might be easier to wonder whether a hypersensitivity to noise, related to PTSD, is really legitimate. Mental illnesses and their effects on people’s daily lives are often less apparent to others than the effects of a physical disability.

Second, laws like the ADA work only if people open up about their disabilities. The physical disability community has in the past decades led a cultural shift from exclusion and shame toward inclusivity and empowerment. People with physical disabilities have community, speak up and exercise their rights. Although there are ongoing efforts by people with mental illness to raise awareness about their experiences, many individuals stay quiet due to shame about their own condition or fear of how others will respond.

Even employers who want to hire people with mental illness can be subject to misguided beliefs

Lastly, the public stigma against mental illness bleeds into what people are expected to be able to handle and achieve. While physical disability is commonly perceived as a challenge with movement, mental illness is perceived as a challenge with thinking. Physical disabilities are seen as being caused by accidents or other unfortunate circumstances, while mental illnesses are often incorrectly seen as a choice or an inherent character flaw. Other misconceptions are that mental illness generally is untreatable or renders people violent or unable to work. An employer might therefore deem a person with mental illness unable to meet their job responsibilities, even when this assumption is unfounded.

Antidiscrimination laws are important, but they do not eliminate the tolls of stigma and capitalism. Employers want to make money, and a mental illness can be seen as a financial liability. Even employers who say they want to hire people with mental illness can be subject to misguided beliefs. And even when companies do grant accommodations, they might be limited. Sara, who in addition to struggling with anxiety has long had difficulty with focusing in distracting environments, was recently diagnosed with ADHD. Together with her psychiatrist, she submitted a request to her large corporate employer to work from home on two weekdays of her choosing, which would enable her to better focus on computer tasks – something that for her is much more difficult in a distracting open-office environment. She told me that it took six months for the accommodation request to be processed; in the end, she was allowed to work from home only on Mondays.

If people can develop the compassion needed to understand why ramps should be installed for use by employees with wheelchairs, there must be a way to heighten compassion for those who would benefit from, for example, a less distracting work environment. But history suggests it won’t be enough to make discriminatory practices illegal. It will require a change in perceptions.

F or many employees or job candidates with a mental illness, the prospect of workplaces free of stigma and discrimination may seem unattainable. ‘I cannot say anything definite that helps [reduce discrimination],’ Suzanne tells me. ‘If you keep your head down and do your job, then good people will eventually accept that this person is still fulfilling their job.’ There are, however, scientifically supported strategies that could be used in efforts to reduce mental illness stigma – and, consequently, discrimination – in workplaces. To the frustration of many anti-stigma advocates, these strategies have not yet been widely implemented.

One basic stigma-reducing strategy is based on social contact. Research suggests that people who have regularly interacted with someone who has personal experience with mental illness (such as a family member, friend or colleague) are often less likely to stigmatise and discriminate, and may be more likely to engage in empathic conversations about mental illness with employees. A law like the ADA should in theory have facilitated more social contact: if it freed more employees to disclose their mental illness and ask for reasonable accommodations, their coworkers would have learned that someone can have a mental illness and still be smart and productive. But, again, many people still do not disclose their mental illness (for fear of discrimination or other reasons), and coworkers cannot learn from what is not disclosed.

Educating HR professionals about mental illness could help reduce discriminatory practices

Another promising method for improving attitudes and behaviour toward employees with mental illness is psychoeducation. Broadly speaking, psychoeducation, also known as mental health education or mental health literacy, is a method of teaching what mental health is, why people might develop mental illnesses, and how these illnesses can be prevented and treated. It can also include the sharing of actionable strategies for coping with symptoms and crises, both acutely and preventatively. Psychoeducation incorporates components of group therapy and cognitive behavioural therapy, and is frequently used by psychiatrists and therapists in clinical settings. It was originally developed to support patients with severe mental illnesses, such as schizophrenia or bipolar disorder, and their families.

Excitingly, psychoeducation can also be used to help change the way workers with mental illness are perceived. While it has been most studied among patient groups as a method to reduce symptom severity and increase healthy coping strategies, it has been employed in professional settings too. For example, a systematic review of studies indicated that psychoeducational training for managers can improve their ‘knowledge, attitudes and self-reported behaviour in supporting employees experiencing mental health problems’. One study reported that managers who received psychoeducational training felt more confident in talking with employees about mental illness and were more likely to reach out to an employee who had an extended absence due to mental illness or stress. Researchers have also suggested that educating human-resources professionals about mental illness could help reduce discriminatory practices. Recently, the implementation of psychoeducational programmes in six companies within high-stress industries (such as hospitality) was found to reduce ratings of stress among workers and mental illness stigmatisation among workers.

The results from these studies are encouraging. Because psychoeducation can be delivered virtually in group settings and can be led by non-experts who’ve received appropriate training, it is also a cost-effective, scalable method. (Full disclosure: last year, I founded a nonprofit that has started to offer psychoeducational services in schools and other organisations.) But, for now, this approach appears to be rarely deployed in workplaces outside of research studies.

T he psychoeducation programmes in these studies typically take place in weekly, one- to two-hour sessions, lasting from a few weeks to months, and they are most often led by mental health professionals. They tend to focus on teaching people about and facilitating conversations on the causes, types, presentation and treatments of mental illness. The programmes often spend a considerable amount of time debunking common myths about mental health, and provide exercises to enable participants to help themselves or others with a mental illness. These exercises might include cognitive-behavioural tools for ‘fact-checking’ thought patterns, problem-solving skills, daily mood journals, and breathing exercises. A major goal is to challenge ideas about mental illness that underlie stigma and discrimination.

In a 2022 policy brief on mental health at work, the WHO argued for greater efforts to improve mental health literacy and support employees with mental illness. Psychoeducational programmes could be a prime tool for pursuing these goals, a staple for companies that aim to comply with antidiscrimination law and improve employee wellbeing. If psychoeducation helps key stakeholders, such as employers and human-resources professionals, to treat employees and job candidates with greater understanding, that might also lead to fewer sick days, enhanced productivity and more employment among people with mental illness. Perhaps work itself will become a less prominent driver of stress.

Some companies currently provide offerings such as unlimited vacation days, meditation apps or yoga sessions as a way to show support for employees’ wellbeing. But these sorts of benefits likely do little to address stigma or discrimination in workplaces. Moreover, implicit in this strategy is the idea that mental illness is a problem that can and should be addressed by individual employees, without putting broader workplace conventions and beliefs into question.

‘In contrast to my mental illness, my concussion was immediately accommodated’

While a severe version of a state such as psychosis or mania can be devastating for the person experiencing it, most people who have a mental health condition are not dealing with crises from day to day. Yes, someone with mental illness might be more easily distracted, more sensitive to noise or less social, but that doesn’t mean that their symptoms will inevitably hamper their job performance. What does hamper performance is when companies neglect to provide reasonable accommodations, even when studies suggest that the benefits associated with providing such accommodations outweigh the costs.

Wouldn’t most companies be inclined to provide structural and logistical support for an employee who suddenly became paraplegic, or who suffered another disabling physical ailment? One former tech industry employee told me that she saw a marked difference in how her leave-taking was received depending on whether it was mental health-related or not. ‘A while after returning from my mental health leave,’ she says, ‘I got a concussion for which I needed partial leave. The symptoms I had were so similar to my PTSD but, in contrast to my mental illness, my concussion was immediately accommodated with a 90-day medical leave and temporary part-time work schedule without any stigma.’ Sara, too, noticed a stark difference when she needed medical leave and other task-related accommodations to recover from shoulder surgery, as opposed to accommodations related to her mental health.

The evidence of ongoing and unnecessary burdens on workers with mental illness calls for honest consideration of what previous antidiscrimination measures have and have not achieved. Employers and governments have yet to fulfil the promise of landmark antidiscrimination laws for the many millions of people who go to work with mental health conditions. Fortunately, there is hope that evidence-backed approaches such as psychoeducational programmes could – if more widely embraced – provide an effective tool for making workplaces fairer and more supportive.

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Stigmatization of mental illness existed well before psychiatry became a formal discipline, but was not formally labeled and defined as a societal problem until the publication of Goffman’s book (1963). Mental illnesses are among the most stigmatizing conditions, regardless of the specific psychiatric diagnosis. Unlike other illnesses, mental illness is still considered by some to be a sign of weakness, as well as a source of shame and disgrace. Many psychiatric patients are concerned about how people will view them if knowledge of their condition becomes public Mental health stigma can be divided into two distinct types: • social stigma is characterized by prejudicial attitudes and discriminating behavior directed towards individuals with mental health problems as a result of the psychiatric label they have been given and has those types stereotypes, prejudice, and discrimination Stereotypes are based on knowledge available to members of a group and provide a way to categorize information about other groups in society Prejudiced persons agree with these negative stereotypes, and these attitudes lead to discrimination through negative behaviors toward mentally ill individuals those negative perceptions create fear of and social distance from mentally ill persons. • perceived stigma or

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Opinion: Mental health’s stigma is wearing down our nation’s healers

T he month of May is usually associated with Mother’s Day and Memorial Day. It is also designated as Mental Health Awareness Month, though every month should be a reminder that we need to prioritize all aspects of our health.  

Fortunately, our focus on mental health care for  mothers ,  military members  and their families shines a spotlight on these issues for the general public. Unfortunately, that focus fails to include our nation’s physicians. 

Physicians are taught in medical school that the mind-body connection is powerful. We study how the brain works and the impact of genetics and the environment on the pathophysiology and development of diseases.

Medical innovation has revolutionized mental health treatment modalities from behavioral therapies to medications to devices and digital technologies such as telephone apps and  biometric monitoring  of speech and pupil dilation in response to stress. Today, mental health care can literally be accessed by the touch of a fingertip on a keypad. 

Yet the stigma and shame attached to physicians needing mental health care remains. I have colleagues who would rather talk about their rashes, blood glucose levels or the color of their urine than mental health. Mental health crises are viewed as a form of weakness — that one lacks the “right stuff” to be a health care professional, whose accurate and timely decision-making is critical to protecting patients’ lives. 

Stress and a need to highly excel, and even be perfect, don’t just happen during a physician’s medical training. The seeds are planted early on. As early as high school, students hoping to pursue medicine put immense pressure on themselves. They try to be at the top of their classes and also to be athletes, community leaders, researchers, entrepreneurs, authors and artists, among other pursuits. 

Getting into the best college is seen as a stepping stone to the best medical schools and training programs. Along the way, students are awarded for academic excellence and setting themselves apart from the pack.

We reward those who persevere against all odds, including overcoming physical challenges. But we rarely applaud those who have done so with mental health issues. In fact, these often go undiagnosed or are hidden away, for fear that they could derail one’s career before it even begins. 

It is not surprising that this prejudice persists — the roots are deep and shrouded in fear. But the result is staggering.  More than 50 percent  of physicians admit to burnout, which is characterized by “emotional exhaustion, depersonalization and a lack of a sense of personal accomplishment.” Compared to the general population,  suicide is far more common  among doctors. 

Substance abuse also often goes underdiagnosed or is only detected later, which can lead to disastrous consequences for the clinician, both personally and professionally. In  a study  of 27,276 physicians, 12.4 percent of male physicians and 21.4 percent of female physicians met diagnostic criteria for alcohol abuse or dependence. In another study , it was revealed that 10-15 percent of doctors develop a problem with drugs. 

The cone of silence surrounding clinicians protects them from three losses: a loss of respect, a loss of livelihood and the loss of a license to practice. This can be deadly.  

The COVID-19 pandemic has exacerbated this problem. Clinicians went from being revered to often being ostracized during the crisis. Images of neighbors  banging pots and pans  to honor clinicians’ contributions early in the pandemic have faded. Health professionals are now  harassed  for wearing masks, discussing methods to protect patients and having little to offer to treat Long COVID — adding to the growing sense of despair and grief.

Questions about how the psychological health of the practitioner impacts the health care system such as access to care, patient safety and quality care have been extensively studied.

An Agency for Health Care Research and Quality funded project,  Minimizing Error, Maximizing Outcomes  found that more than half of the primary care physicians surveyed felt stressed because of time pressures and other work conditions, though their reactions didn’t translate into poorer quality care. If there was a quality-of-care issue, it was due to the organization that burned the doctors out.

Fortunately, professional societies and the  National Academy of Medicine Collaborative on Clinician Well-Being and Resilience  now provide interventions to emotionally support health professionals. Recommendations include scheduling monthly meetings focused on work-life balance issues and providing medical assistants for record-keeping and logistics duties. 

The American Medical Women’s Association, has launched  Humans Before Heroes  to reframe medical licensure questions to remove barriers to seeking care.

The American Medical Women’s Association  says that its 10 recommendations “balance the medical board’s mission to protect patients from impaired physicians while allowing physicians to seek care without fear of losing one’s license.” 

How do we destigmatize mental health care for physicians? One of the first steps is to integrate it early on into all of our lives. Just as doctors ask questions about diet and exercise, we need to ask about mental health and easily provide access to treatment without future punishment or retribution. 

The biblical proverb, “Physician, heal thyself,” can only be attained when we normalize seeking care for all aspects of our well-being. 

Saralyn Mark, MD is a former senior medical and policy advisor to the White House, the Department of Health and Human Services and NASA. She is the American Medical Women’s Association’s lead for COVID-19 and health innovation and the founder and president of SolaMed Solutions, LLC and iGIANT.

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Mental Health Stigma: Society, Individuals, and the Profession

Mental health stigma operates in society, is internalized by individuals, and is attributed by health professionals. This ethics-laden issue acts as a barrier to individuals who may seek or engage in treatment services. The dimensions, theory, and epistemology of mental health stigma have several implications for the social work profession.

1. Introduction

In 2001, the World Health Organization (WHO) reported that an estimated 25 percent of the worldwide population is affected by a mental or behavioral disorder at some time during their lives. This mental and behavioral health issue is believed to contribute to 12 percent of the worldwide burden of disease and is projected to increase to 15 percent by the year 2020 ( Hugo, Boshoff, Traut, Zungu-Dirwayi, & Stein, 2003 ). Within the United States, mental and behavioral health conditions affect approximately 57 million adults ( National Institute of Mental Health [NIMH], 2006 ). Despite the high prevalence of these conditions, recognized treatments have shown effectiveness in mitigating the problem and improving individual functioning in society. Nonetheless, research suggests that (1) individuals who are in need of care often do not seek services, and (2) those that begin receiving care frequently do not complete the recommended treatment plan ( Corrigan, 2004 ). For example, it has been estimated that less than 40 percent of individuals with severe mental illnesses receive consistent mental health treatment throughout the year ( Kessler, Berglund, Bruce, Koch, Laska, Leaf, et al, 2001 ).

There are several potential reasons for why, given a high prevalence of mental health and drug use conditions, there is much less participation in treatment. Plausible explanations may include (1) that those with mental health or drug use conditions are disabled enough by their condition that they are not able to seek treatment, or (2) that they are not able to identify their own condition and therefore do not seek needed services. Despite these viable options, there is another particular explanation that is evident throughout the literature. The U.S. Surgeon General (1999) and the WHO (2001) cite stigma as a key barrier to successful treatment engagement, including seeking and sustaining participation in services. The problem of stigma is widespread, but it often manifests in several different forms. There are also varying ways in which it develops in society, which all have implications for social work – both macro and micro-focused practice.

In order to understand how stigma interferes in the lives of individuals with mental health and drug use conditions, it is essential to examine current definitions, theory, and research in this area. The definitions and dimensions of stigma are a basis for understanding the theory and epistemology of the three main ‘levels’ of stigma (social stigma, self-stigma, and health professional stigma).

2. Stigma Definitions & Dimensions

The most established definition regarding stigma is written by Erving Goffman (1963) in his seminal work: Stigma: Notes on the Management of Spoiled Identity . Goffman (1963) states that stigma is “an attribute that is deeply discrediting” that reduces someone “from a whole and usual person to a tainted, discounted one” (p. 3). The stigmatized, thus, are perceived as having a “spoiled identity” ( Goffman, 1963 , p. 3). In the social work literature, Dudley (2000) , working from Goffman’s initial conceptualization, defined stigma as stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms. Due to its use in social work literature, Dudley’s (2000) definition provides an excellent stance from which to develop an understanding of stigma.

It is important to recognize that most conceptualizations of stigma do not focus specifically on mental health or drug use disorders (e.g., Crocker, Major, & Steele, 1998 ; Goffman, 1963 ). Stigma is relevant in other contexts such as towards individuals of varied backgrounds including race, gender, and sexual orientation. Thus, it is important to provide a definition of mental disorders, which also include drug use disorders, so that it can be understood in relationship to stigma. While each mental health and drug use disorder has a precise definition, the often cited and widely used Diagnostic and Statistical Manual of Mental Disorders (4th Ed., Text Revision [DSM-IV-TR]; American Psychiatric Association [APA], 2000 ) offers a specific definition of mental disorder which will be used to provide meaning to the concept. In this text, a mental disorder is a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom,” which results from “a manifestation of a behavioral, psychological, or biological dysfunction in the individual” ( APA, 2000 , p. xxxi). While this definition provides a consistent base from which to begin understanding how stigma impacts individuals with mental health and drug use disorders, it is important to recognize the inherent danger in relying too heavily on specific mental health diagnoses as precise definitions ( Corrigan, 2007 ), which is why the term is being used just as a basis for understanding in this context.

The next important step is to understand the constructs underlying the concept of stigma. These constructs detail the multiple pathways through which stigma can develop. Building from Goffman’s initial conceptualization, Jones and colleagues (1984) identified six dimensions of stigma. These include concealability, course, disruptiveness, peril, origin, and aesthetics ( Feldman & Crandall, 2007 ; Jones et al, 1984 ). In addition, Corrigan and colleagues (2001 ; 2000 ) identified dimensions of stability, controllability, and pity. It is important to understand that these dimensions can either present independently or simultaneously to create stigma. Further, stigma is more than a combination of these elements impacting each person as an individual, since stigma is believed to be common in the structural framework of society ( Feldman & Crandall, 2007 ).

The first dimension of stigma is peril – otherwise known as dangerousness. Peril is often considered an important aspect in stigma development, and it is frequently cited in the research literature ( Corrigan, et al, 2001 ; Feldman & Crandall, 2007 ; Angermeyer & Matschinger, 1996 ). In this instance, the general public perceives those with mental disorders as frightening, unpredictable, and strange ( Lundberg, Hansson, Wentz, & Bjorkman, 2007 ). Corrigan (2004) also suggests that fear and discomfort arise as a result of the social cues attributed to individuals. Social cues can be evidenced by psychiatric symptoms, awkward physical appearance or social-skills, and through labels ( Corrigan, 2004 ; Link, Cullen, Frank, & Wozniak, 1987 ; Corrigan, 2007 ). This particular issue highlights the dimension of aesthetics or the displeasing nature of mental disorders ( Jones, et al, 1984 ). When society attributes, upon a person or group of people, perceived behaviors that do not adhere to the expected social norms, discomfort can be created. This often leads to the generalization of the connection between abnormal behavior and mental illness, which may result in labeling and avoidance. This also may be why society continues to avoid those with mental and behavioral disorders whenever possible ( Corrigan, Markowitz, Watson, Rowan, & Kubiak, 2003 ).

Another dimension of stigma that is often discussed in the research on stigma is origin. As in the definition provided earlier, mental and behavioral disorders are often believed to, at least in-part; develop from biological and genetic factors – i.e., origin ( APA, 2000 ). This has direct implications for the dimension of controllability ( Corrigan, et al, 2001 ). Within this dimension, it is often believed in society that mental and behavioral disorders are personally controllable and if individuals cannot get better on their own, they are seen to lack personal effort ( Crocker, 1996 ), are blamed for their condition, and seen as personally responsible ( Corrigan, et al, 2001 ).

A recent report by Feldman and Crandall (2007) , found that individuals with disorders such as pedophilia and cocaine dependence were much more stigmatized than those with disorders such as posttraumatic stress disorder. This supports the controllability hypothesis in which pedophilia and cocaine dependence could be viewed as more controllable in society than a disorder believed to be caused by a traumatic experience (PTSD). It also supports the pity dimension, in which disorders that are pitied to a greater degree are often less stigmatized ( Corrigan, et al, 2000 ; Corrigan, et al, 2001 ). In this case, individuals within a culture or society may have more sympathy for disorders that are perceived as less controllable ( Corrigan, et al, 2001 ).

Concealability , or visibility of the illness, is a dimension of stigma that parallels controllability , but also provides other insight into the stigmatization of mental and behavioral disorders. Crocker (1996) suggests that stigmatized attributes such as race can be easily identified, and are less concealable, allowing society to differentiate and stigmatize based on the visibility of the person. This is supported by research that shows that society attributes more stigmatizing stereotypes towards disorders such as schizophrenia, which generally have more visible symptoms, compared to others such as major depression ( Angermeyer & Matschinger, 2005 ; Lundberg, et al, 2007 ).

The final three dimensions, course, stability, and disruptiveness , also may have some similarities among each other and compared to the others presented. Course and stability question how likely the person with the disability is to recover and/or benefit from treatment ( Corrigan, et al, 2001 ; Jones, et al, 1984 ). Further the disruptiveness dimension assesses how much a mental or behavioral disorder may impact relationships or success in society. While disorders are frequently associated with an increased risk for poverty, lower socioeconomic status and lower levels of education ( Kohn, Dohrenwend, & Mirotznik, 1998 ), the stability and disruptiveness of the conditions have implications as to whether an individual will be able to hold down a successful job and engage in healthy relationships, as evidenced by differences in stigma based on social class status. This demonstrates that if disorders are less disruptive, in which case they may be perceived as more stable, they are also less stigmatized ( Corrigan, et al, 2001 ). This also expresses that some flexibility exists within each type of mental or behavioral disorder, as each diagnosed person is not stigmatized to the same extent ( Crocker, 1999 ). Figure 1 depicts stigma as a latent variable constructed from the dimensions discussed above.

The dimensions of stigma

3. Levels of Stigma: Theory & Epistemology

Illustrating the constructs underlying the formation of stigma helps us understand three specific levels of stigma – social stigma, self-stigma, and professional stigma. In this context, ‘levels’ does not refer to a hierarchy of importance for these varied stigmas, but rather to represent different social fields of stigma that can be differentiated from each other. In addition, further definition and theory behind these three ‘levels’ of stigma must be presented. First, stigmatized attitudes and beliefs towards individuals with mental health and drug use disorders are often in the form of social stigma, which is structural within the general public. Second, social stigma, or even the perception that social stigma exists, can become internalized by a person resulting in what is often called self-stigma. Finally, another, less studied level of stigma is that which is held among health professionals toward their clients. Since health professionals are part of the general public, their attitudes may in part reflect social stigma; however, their unique roles and responsibility to ‘help’ may create a specific barrier. The following theories are presented as an aid to understanding how each ‘level’ of stigma may develop in society.

Social Stigma

The first, and most frequently discussed, ‘level’ is social stigma. Social stigma is structural in society and can create barriers for persons with a mental or behavioral disorder. Structural means that stigma is a belief held by a large faction of society in which persons with the stigmatized condition are less equal or are part of an inferior group. In this context, stigma is embedded in the social framework to create inferiority. This belief system may result in unequal access to treatment services or the creation of policies that disproportionately and differentially affect the population. Social stigma can also cause disparities in access to basic services and needs such as renting an apartment.

Several distinct schools of thought have contributed to the understanding of how social stigma develops and plays out in society. Unfortunately, to this point, social work has offered limited contributions to this literature. Nonetheless, one of the leading disciplines of stigma research has been social psychology. Stigma development in most social psychology research focuses on social identity resulting from cognitive, behavioral, and affective processes ( Yang, Kleinman, Link, Phelan, Lee, & Good, 2007 ). Researchers in social psychology often suggest that there are three specific models of public stigmatization. These include socio-cultural, motivational, and social cognitive models ( Crocker & Lutsky, 1986 ; Corrigan, 1998 ; Corrigan, et al, 2001 ). The socio-cultural model suggests that stigma develops to justify social injustices ( Crocker & Lutsky, 1986 ). For instance, this may occur as a way for society to identify and label individuals with mental and behavioral illnesses as unequal. Second, the motivational model focuses on the basic psychological needs of individuals ( Crocker & Lutsky, 1986 ). One example of this model may be that since persons with mental and behavioral disorders are often in lower socio-economic groups, they are inferior. Finally, the social cognitive model attempts to make sense of basic society using a cognitive framework ( Corrigan, 1998 ), such that a person with a mental disorder would be labeled in one category and differentiated from non-ill persons.

Most psychologists including Corrigan and colleagues (2001) prefer the social cognitive model to explain and understand the concept of stigma. One such understanding of this perspective – Attribution Theory – is related to three specific dimensions of stigma including stability, controllability, and pity ( Corrigan, et al, 2001 ) that were discussed earlier. Using this framework, a recent study by these researchers found that the public often stigmatizes mental and behavioral disorders to a greater degree than physical disorders. In addition, this research found stigma variability based on the public’s “attributions.” For example, cocaine dependence was perceived as the most controllable whereas ‘mental retardation’ was seen as least stable and both therefore received the most severe ratings in their corresponding stigma category ( Corrigan, et al, 2001 ). These findings suggest that combinations of attributions may signify varying levels of stigmatized beliefs.

Sociologists have also heavily contributed to the stigma literature. These theories have generally been seen through the lens of social interaction and social regard. The first of these theorists was Goffman (1963) who believed that individuals move between more or less ‘stigmatized’ categories depending on their knowledge and disclosure of their stigmatizing condition. These socially constructed categories parallel Lemert’s (2000) discussion on social reaction theory. In this theory, two social categories of deviance are created including primary deviance, believing that people with mental and behavioral disorders are not acting within the norms of society, and secondary deviance, deviance that develops after society stigmatizes a person or group. Similarly, research demonstrating that higher levels of stigmatization are attributed towards individuals with more “severe” disorders ( Angermeyer & Matschinger, 2005 ) also resembles these hierarchical categories and the disruptiveness and stability dimensions of stigma.

Furthermore, Link and Phelan clearly illustrated the view of sociology towards stigma in their article titled Conceptualizing Stigma (2001). Link and Phelan (2001) argue that stigma is the co-occurrence of several components including labeling, stereotyping, separation, status loss, and discrimination. First, labeling develops as a result of a social selection process to determine which differences matter in society. Differences such as race are easily identifiable and allow society to categorize people into groups. The same scenario may occur when society reacts to the untreated outward symptoms of several severe mental illnesses; i.e., Schizophrenia. Labels connect a person, or group of people, to a set of undesirable characteristics, which can then be stereotyped. This labeling and stereotyping process gives rise to separation. Society does not want to be associated with unattractive characteristics and thus hierarchical categories are created. Once these categories develop, the groups who have the most undesirable characteristics may become victims of status loss and discrimination. The entire process is accompanied by significant embarrassment by the individuals themselves and by those associated with them ( Link & Phelan, 2001 ).

While social psychology and sociology are the primary contributors to the stigma literature, other disciplines have provided insight as well. Communications, Anthropology, and Ethnography all favor theories that revolve around threat. In Communications literature, stigma is the result of an “us versus them” approach ( Brashers, 2008 ). For example, the use of specific in-group language can reinforce in-group belongingness as well as promote out-group differentiation ( Brashers, 2008 ). This is referenced in research on peer group relationships such that youth often rate interactions with their same-age peers more positively than with older adults (whether family members or not) ( Giles, Noels, Williams, Ota, Lim, Ng, et. al., 2003 ). This can also be applied to those with mental disorders in that individuals in the out-group (mental disorders) are perceived less favorably than the non-ill in-group.

Anthropology and Ethnography also prefer the identity model. From this perspective, the focus is on the impact of stigma within the lived experience of each person. Stigma may impact persons with mental illnesses through their social network, including how it exists in the structures of lived experiences such as employment, relationships, and status. Further, the impact of stigma is a response to threat, which may be a natural or tactical self-preservation strategy. However, it only worsens the suffering of the stigmatized person ( Yang, et al, 2007 ). It is important to note again that while many disciplines have been leaders in social stigma theory, social work-specific literature has been mostly void of discussion on this topic. This is particularly unusual, since stigma is an obvious factor that impacts the lives of social work clients on a daily basis.

Self-Stigma

Crocker (1999) demonstrates that stigma is not only held among others in society but can also be internalized by the person with the condition. Thus, the continued impact of social/public stigma can influence an individual to feel guilty and inadequate about his or her condition ( Corrigan, 2004 ). In addition, the collective representations of meaning in society – including shared values, beliefs, and ideologies – can act in place of direct public/social stigma in these situations ( Crocker & Quinn, 2002 ). These collective representations include historical, political, and economic factors ( Corrigan, Markowitz, and Watson, 2004 ). Thus, in self-stigma, the knowledge that stigma is present within society, can have an impact on an individual even if that person has not been directly stigmatized. This impact can have a deleterious effect on a person’s self-esteem and self-efficacy, which may lead to altered behavioral presentation ( Corrigan, 2007 ). Nonetheless, Crocker (1999) highlights that individuals are able to internalize stigma differently based on their given situations. This suggests that personal self-esteem may or may not be as affected by stigma depending on individual coping mechanisms ( Crocker & Major, 1989 ).

Similarly, other theories have provided insight into the idea of self-stigma. In modified labeling theory, the expectations of becoming stigmatized, in addition to actually being stigmatized, are factors that influence psychosocial well-being ( Link, Cullen, Struening, Shrout, & Dohrenwend, 1989 ). In this context, it is primarily the fear of being labeled that causes the individual to feel stigmatized. Similarly, Weiner (1995) proposed that stigmatized beliefs provoke an emotional response. This can be interpreted from the standpoint of the afflicted individual, such that he or she may feel stigmatized and respond emotionally with embarrassment, isolation, or anger.

Health Professional Stigma

It may seem unlikely that social workers and other health professionals would carry stigmatized beliefs towards clients; especially those whom they know are affected by a variety of barriers to treatment engagement. Nonetheless, recent literature is beginning to document the initial impact of health professional stigma ( Nordt, Rössler, & Lauber, 2006 ; Volmer, Mäesalu, & Bell, 2008 ). While limited evidence exists specifically on social worker attitudes, pharmacy students who desire more social distance towards individuals with Schizophrenia are also less willing to provide them medications counseling ( Volmer, et al, 2008 ). In addition, one Swiss study (psychiatrists, nurses, and psychologists) found that mental health professionals did not differ from the general public on their desired social distance from individuals with mental health conditions ( Nordt, et al, 2006 ). Other studies have also come to similar conclusions ( Lauber, et al, 2006 ; Tsao, Tummala, & Roberts, 2008 ; Sriram & Jabbarpour, 2005 ; Ücok, Polat, Sartorius, Erkoc, & Atakli, 2004 ). Clients have also reported feeling ‘labeled’ and ‘marginalized’ by health professionals ( Liggins & Hatcher, 2005 ). Individuals with mental illnesses may not even receive equivalent care (compared to non-mentally ill patients) in general health settings once health professionals become aware of their mental health conditions ( Desai, Rosenheck, Druss, & Perlin, 2002 ).

Theory on health professional stigma is very limited, but some literature does provide insight into its possible development. In one way, stigma by health professionals may develop very much the same as the social stigma evident in the general public. Social workers may develop their own biases from their upbringing or even from burnout in their own working roles, particularly when working with individuals who have severe and persistent mental illnesses ( Acker & Lawrence, 2009 ). Nonetheless, some indications suggest that health professional stigma may also develop in a unique way. For instance, social workers and other health professionals, similar to persons in the general public, experience their own mental health and drug use problems and often have friends or family members who experience these same issues ( Siebert, 2004 ; Fewell, King, & Weinstein, 1993 ). Individuals may also self-select into a helping profession due in part to these experiences ( Stanley, Manthorpe, & White, 2007 ). When social workers and other health professionals deal with mental health and drug use problems they may experience burnout and/or become more or less likely to recognize similar problems among their clients ( Siebert, 2003 ). Some research suggests that mental health conditions are more prevalent among helping professionals than in the general public ( Schemhammer, 2005 ). This problem has also been shown to impair professional social work practice behaviors ( Siebert, 2004 ; Sherman, 1996 ). For example, Siebert (2003) found that social workers who used marijuana were less likely to recognize marijuana use as a problem among their clients.

The counter-transference that can develop as a result of personal experiences or behaviors may impact clients who may be vulnerable when participating in treatment and may not have the appropriate resources to determine when they are not being treated adequately ( Siebert, 2004 ; Hepworth, Rooney, & Larsen, 2002 ; Rayner, Allen, & Johnson, 2005 ). Clients may also be disenfranchised by the treatment process and become more likely to end current treatment and less likely to seek treatment in the future. This creates a barrier to the overall well-being of individuals by preventing adequate treatment, but it also may impact the acknowledgement of their disorder. Overall, health professionals may not provide adequate intervention, early detection, or community referral options for individuals with mental or behavioral disorders ( Gassman, Demone, & Albilal, 2001 ; Tam, Schmidt, & Weisner, 1996 ), because of their own stigmatizing beliefs and personal histories ( Siebert, 2004 ; 2005 ).

4. Implications for Social Work

While it is apparent that stigma (all three levels) impacts individuals’ lives, there are also several implications for stigma and health professionals. These implications are placed into context within social work practice, education, policy, and research. In practice, social workers make up between 60–70 percent of mental health professionals in the United States ( Proctor, 2004 ). While their roles may vary in different countries, they can nonetheless be important participants in mitigating stigma across the world. Since social workers often provide gatekeeping and triage functions in their roles, they are among the first to be in contact with individuals with psychiatric conditions ( Hall, et al, 2000 ). Their attitudes and treatment preferences in practice settings can thus either promote or disenfranchise treatment seeking among their clients.

Social workers may be able to address issues of stigma within themselves by recognizing and embracing values and personal biases. This may be a difficult transformation that requires significant personal work and/or therapy. They may also be able to work with their clients on issues of stigma through their treatment provisions, triage roles, and outreach efforts. Nonetheless, the National Association of Social Workers (NASW) Code of Ethics mandates that professionals promote self-determination, client rights, self-realization, empowerment, social justice, and the dignity and worth of every person ( National Association of Social Workers [NASW], 1999 ). These specific professional values pointedly call social workers to work to mitigate their own levels of stigma and work with others to dispel levels of social stigma and self-stigma.

While social workers have the opportunity to work with individuals, they also work with families. One additional way social workers may seek to mitigate social stigma on a micro-level is via the family. Family therapy may help relatives understand psychiatric conditions and how they can help/support the afflicted individual ( Lefley, 1989 ). Some research suggests that more attention to families of individuals with mental health conditions is needed ( Thornicroft, Brohan, Kassam, & Lewis-Holmes, 2008 ). If social workers are able to support an individual’s support system (family), it may help improve treatment seeking and treatment engagement for that person. Several studies have demonstrated the positive impact between family interventions and treatment engagement by the afflicted individual ( Copello, Velleman, & Templeton, 2005 ; Adeponle, Thombs, Adelekan, & Kirmayer, 2009 ; Glynn, Cohen, Dixon & Niv, 2006 ). While this does not replace group work or individual work with a particular client, families may be among the most stigmatizing groups towards the afflicted person ( Lee, Lee, Chiu, & Kleinman, 2005 ), and improved efforts towards the family system may be helpful.

On a macro level, social workers can also be instrumental in leading larger targeted educational efforts aimed at reducing stigma. Targeted programs have shown effectiveness in challenging misconceptions, improving attitudes, and reducing social distance ( Thornton &Wahl, 1996 ; Esters, et al, 1998 ; Corrigan, et al, 2001 ). One such program, lead by the network of the World Psychiatric Association, has focused on individuals that impact the larger structural attitudes of stigma such as medical personnel, police officers, and journalists ( Thornicroft, et al, 2008s ). Large macro-level stigma campaigns that can be facilitated by social workers include public advertisements, targeted educational efforts, and advocacy for agency change. Occasionally, other systematic changes need to accompany these targeted efforts ( Pinfold, Huxley, Thornicroft, Farmer, Toulmin, & Graham, 2003 ), but they have shown effectiveness and are important in mitigating stigma around the world. Nonetheless, more interventions and strategies must be developed to mitigate stigma in society.

Another important way to impact stigma is by educating individuals that have an opportunity to make a difference – i.e., social work education . For instance, when individuals have contact with those with mental illnesses, stigma can be diminished ( Corrigan, et al, 2001 ). This may be the result of stereotypical beliefs about psychiatric conditions that are consistent with dimensions of stigma such as dangerousness or aesthetics (see, Jones, et al, 1984 ). Exposing social workers to these population groups may increase their willingness to treat the afflicted clients. This can be implemented through the field practicum experience at the undergraduate and graduate level. Education on stigma also fits into the practice sequences (macro- and micro- level), elective courses on substance abuse, and clinical diagnosis and assessment courses. Nonetheless, Bina and colleagues (2008) found that improving the knowledge and education of social workers about clients with drug use conditions will increase their interest in working with that population in practice. Furthermore, social work educational research has demonstrated that training social workers improves the likelihood that they will intervene, assess, and provide treatment for persons in an afflicted population, seek employment in that area, and feel confident and competent about their work ( Amodeo, 2000 ).

Stigma is a global issue, and efforts to mitigate stigma through policy may be another effective strategy. On the macro-level, social workers can be very influential in advocating for policy change. Corrigan and colleagues (2001) suggest that policy change is one of the three strategies to mitigate stigma in society. For instance, stigma may impact lawmakers and permeate throughout government. One of the most important reasons why mental health care is not adequate is due to a lack of resources. In this case, it appears that economic factors may play a role in access to treatment. However, there is also a low priority placed on mental health within government and other funding bodies to support services ( Knapp, Funk, Curran, Prince, Grigg, & McDaid, 2006 ). The WHO (2003) showed that while neuropsychiatric conditions make up 13 percent of the global burden of disease, only a median 2 percent of health care budgets in countries around the world are appropriated for mental illness. The lack of governmental support combined with the lack of support from other funding bodies (insurance companies) can in part be attributed to stigma ( Knapp, et al, 2006 ). The debate about mental health parity in the United States is another example. Insurance companies in the U.S. have traditionally not funded mental health treatment to the same degree as general physical health illnesses ( U.S. Surgeon General, 1999 ), which promotes that devaluation of mental illness in society. These disparate policies also act as a barrier to afflicted individuals and their ability to access social work services. Social workers and other policy makers can advocate for change in society. Social workers can be specifically instrumental in this process as they often serve disadvantaged populations such as those with mental illnesses, and should work to assist with the needs of their clients.

Social workers, as social scientists, are in position to develop research programs that seek to understand and influence stigma. More research is needed to understand the impact of different cultural traditions, attitudes, values, and beliefs on stigma, as it may vary between and within countries. This is also true among health professionals and their attitudes towards treating individuals in their community. As social scientists that practice and conduct research with different client populations, social workers have the ability to measure stigma among not only different race/ethnicity groups, but also in relation to individuals’ sexual orientation, gender, and age. In addition, limited research has specifically addressed the dimensions of stigma as discussed in the theoretical literature ( Corrigan, et al, 2000 ; Jones, et al, 1984 ). More precise measures are needed to adequately assess stigma, across its varying dimensions and levels. The use of current stigma-related measures such as the Psychiatric Disability Attribution Questionnaire ( Corrigan, et al, 2001 ) and the development of alternative scales to measure health professional stigma are needed to address dimensions of stigma across all three levels simultaneously. Also, larger studies of health professional stigma are needed, to understand how the attitudes of health professionals, and specifically social workers, influence treatment engagement and access.

5. Conclusions

Mental health conditions are pervasive around the world. In addition, the burden of these conditions is expected to grow over the next 20 years ( Mathers & Loncar, 2006 ). Unfortunately, few individuals receive the psychiatric treatment they need, as individuals often do not seek services and frequently do not remain in care once they begin. The WHO (2001) has suggested that stigma is one of the largest barriers to treatment engagement, even though treatment has shown to be effective, even in low income countries ( Patel, et al, 2007 ). While stigma remains evident in society, within individuals themselves, and among health professionals, the ethical problem of health professional stigma places an additional barrier on clients who seek needed mental health services.

Acknowledgments

This work was partially supported by a National Institute of Drug Abuse (NIDA) Institutional Training Award Grant (T32DA021129). The content in this manuscript is the sole responsibility of the author and does not necessarily represent the official views of NIDA.

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of White Hat Communications

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Mental Health Awareness Month: Improving well-being in the workforce

by Guest Author | May 28, 2024 | CAI , Community Associations | 0 comments

Contributed by Bill Overton, PCAM

When I wrote an  essay on burnout and mental health in the community association management workplace in late 2021, I did so with a mixture of hope and trepidation. I hoped that my story would help others in need and lower the stigma related to mental health issues, and I worried that publishing my mental illness for all to see might be committing career suicide. Far from that, in the 18 months that have followed, the reception of this topic has been nothing less than extraordinary.

When I’ve spoken on mental health, I’ve always been surprised and overwhelmed by the number of folks who’ve come to me and said they are struggling with stress, anxiety, and burnout, too. My mind had me convinced that I was “in this alone.” That hasn’t been true at all.

I’m also incredibly moved by the way CAI and management company executives have begun to embrace and address this important issue . In my original essay, I posited a theory that, in addition to the monumental human cost of depression and burnout in our society, there also is a huge financial cost. It turns out I was right. Studies from Gallup and Deloitte  prove my point.

Stress and mental health issues in the workplace are a pandemic that is far larger than COVID-19 or any other disease currently or recently dealt with in the world. Stigma about mental health still exists and discourages individuals from coming forward and workplaces from taking constructive action.

There is some good news:

❚ A major step forward to improve and address mental health issues is simply to manage employees and workplace culture better.

❚ Awareness is improving, and the stigma of mental health is being lowered.

❚ More employers and insurance companies are recognizing this as an important issue to be managed, and programs are improving and growing in number.

❚ Young people get how important this is and are prioritizing their mental health at much higher levels than previous generations.

❚ This is actually low-hanging fruit. The solution is simply to manage our employees better, create more positive workplace cultures, and manage the work we do more equitably and sensibly.

We can lead from the top as executives and managers by prioritizing our own well-being and providing support for all.

My go-to tips to manage my mental health at work are:

❚ Get good sleep, eat well, exercise, and meditate.

❚ Seek the assistance of a counselor and medical doctors, as needed.

❚ Prioritize work tasks to ensure the most important work is done on time. Small things can wait.

❚ Communicate regularly with my superiors about what is going on day to day with my work and with me personally.

❚ Staff reasonably to achieve the stated service objectives . I don’t have super powers; none of us do. If we need a bigger team, we need a bigger team. Or, we need to curb expectations.

❚ Help others. This isn’t just part of a recovery program: It is also the key to happiness in life.

The commitment we make to improving mental health awareness is a crusade that will improve our industry and change the quality of workplace life for all.

>>May is Mental Health Awareness Month. Please email me if I can ever listen or help.

Bill Overton is a manager with Desert Resort Management in Palm Desert, Calif. He serves on CAI’s Community Association Managers Council.

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Updated: May 29, 2024

Emergence of Mental Health Awareness

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Peru Issued a Decree Calling Trans Identity a ‘Disorder.’ A Backlash Followed.

Government officials say the regulation was intended to expand mental health care access for transgender people. Activists say it will increase discrimination.

By Genevieve Glatsky and Mitra Taj

Genevieve Glatsky reported from Bogotá, Colombia, and Mitra Taj from Lima, Peru.

The bulletin appeared without much fanfare in an official government newspaper in Peru that publishes new laws and regulations. Peruvian health officials say they had no idea the response it would trigger.

They say they wanted to expand access to privately insured mental health care for transgender Peruvians. So the government decree included language classifying transgender identity as a “mental health problem.”

But as news of the regulation filtered out, it provoked outrage among the country’s L.G.B.T.Q. population and advocates.

Many critics said the rule was another blow in a country where gay marriage and civil unions are illegal; transgender identity is not legally recognized; there is no legislation recognizing hate crimes; and trans Peruvians say they face widespread discrimination and violence.

“What they’re doing is labeling an entire community as sick,” said Cristian González Cabrera, who researches L.G.B.T.Q. rights in Latin America for Human Rights Watch.

But health officials said that the anger and backlash was the result of miscommunication and that they had not intended to offend trans people.

The Peruvian government this month added seven diagnostic codes from the World Health Organization’s medical classification system to a list of conditions in Peru that must be covered by private and public insurance.

But the law used language from an outdated version of the W.H.O.’s classification system that had listed “transsexualism” and “gender identity disorder” as “mental and behavioral disorders.”

A new version of W.H.O.’s system, put into effect in 2022, replaced those terms with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” under a chapter titled, “Conditions Related to Sexual Health.”

The change, according to the W.H.O., was meant to reflect “current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.”

Peruvian health officials said in an interview that they were aware of the W.H.O.’s changes but were only now starting the process of adopting them and incorporating a new rule because of bureaucratic obstacles.

“It is a path that we have already started to walk,” said Henry Horna, the communications director for Peru’s Health Ministry, though officials did not say how long the process would take. So, for now, the current classification remains in place.

In response to the uproar, the ministry clarified in a statement that “gender and sexual diversity are not illnesses” and that it rejects discrimination.

Dr. Carlos Alvarado, the ministry’s health insurance director, said the regulation was intended to make it easier to bill insurers for treatment related to transgender identity.

“We did not expect the reaction, honestly,” he said.

“The problem has obviously arisen from a misinterpretation of the meaning of the rule,” Mr. Horna said. “The rules are written in legal language, in cold language, in technical language.”

But Leyla Huerta, a trans activist, said access to private insurance is irrelevant to most trans Peruvians because of discriminatory hiring practices by many private-sector employers.

She said that any benefits for the trans community were outweighed by the stigmatization from the language used in the government regulation.

Classifying transgender people as mentally ill, activists and experts say, could open the door to the promotion by some conservative groups of the widely discredited practice of conversion therapy, intended to change a person’s gender identity or sexual orientation.

But health officials noted previous government guidelines stating that transgender identity was not a mental illness and discouraging conversion therapy.

The current controversy is just one of the many struggles to expand gay and transgender rights and health care across Latin America, a region with high levels of violence against L.G.B.T.Q. people.

Still, even in such an environment, Peru stands out because its system of laws provides almost no rights for gay and transgender people, Mr. González said.

Same-sex marriage has been legal for years in other South American countries, like Brazil, Colombia, Chile, Argentina and Ecuador. “Peru is miles behind its South American neighbors,” Mr. González said.

The head of the Peruvian government’s human rights office, during testimony last year before the country’s Congress, referred to homosexuality as “deformities that must be corrected.”

And last year, a trans woman working as a prostitute was kidnapped and shot 30 times on the streets of Lima, a killing that was captured on video. One person has been arrested so far, but there has yet to be a trial.

The Peruvian government does not collect data on acts of bias or violence against transgender people.

But a study published in 2021 by a Peruvian human rights group, More Equality, found that among a sample of 323 L.G.B.T.Q. Peruvians, 83 percent said they had experienced some kind of verbal or physical abuse and 75 percent said they had been subject to discrimination.

The president of More Equality, Alexandra Hernández, a psychologist, said she believed that some Health Ministry officials had good intentions in issuing this rule, but failed to consult with experts on L.G.B.T.Q. mental health.

“They say it was beneficial for us,” said Gianna Camacho García, a trans activist and journalist. “Actually, it was a minimal benefit compared to how much we have to lose in other areas or aspects of life by calling us people with mental disorders.”