More than half of people with mental illness don't receive help for their disorders. Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against people with mental illness is still very much a problem.
Stigma, prejudice and discrimination against people with mental illness can be subtle or it can be obvious—but no matter the magnitude, it can lead to harm. People with mental illness are marginalized and discriminated against in various ways, but understanding what that looks like and how to address and eradicate it can help.
The Facts on Stigma, Prejudice and Discrimination
Stigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of studies on stigma shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness.
Researchers identify different types of stigma: (See chart below.)
- Public stigma involves the negative or discriminatory attitudes that others have about mental illness.
- Self-stigma refers to the negative attitudes, including internalized shame, that people with mental illness have about their own condition.
- Institutional stigma, is more systemic, involving policies of government and private organizations that intentionally or unintentionally limit opportunities for people with mental illness. Examples include lower funding for mental illness research or fewer mental health services relative to other health care.
Stigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members.
Stigma around mental illness especially an issue in some diverse racial and ethnic communities and it can be a major barrier to people from those cultures accessing mental health services. For example, in some Asian cultures, seeking professional help for mental illness may be counter to cultural values of strong family, emotional restraint and avoiding shame. Among some groups, including the African American community's, distrust of the mental healthcare system can also be a barrier to seeking help. (See more on mental health in Diverse Populations.)
Types of Stigma
|Stereotypes & Prejudices||People with mental illness are dangerous, incompetent, to blame for their disorder, unpredictable||I am dangerous, incompetent, to blame||Stereotypes are embodied in laws and other institutions|
|Discrimination||Therefore, employers may not hire them, landlords may not rent to them, the health care system may offer a lower standard of care||These thoughts lead to lowered self-esteem and self-efficacy: "Why try? Someone like me is not worthy of good health."||Intended and unintended loss of opportunity|
Source: Adapted from Corrigan, et al.
Media representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate or violent representations. A study published in April 2020 looked at a recent example, the popular film Joker (2019), which portrays the lead character as a person with mental illness who becomes extremely violent. The study found that viewing the film "was associated with higher levels of prejudice toward those with mental illness." Additionally, the authors suggest, "Joker may exacerbate self-stigma for those with a mental illness, leading to delays in help seeking."
The stigma of mental illness is universal. A 2016 study on stigma concluded "there is no country, society or culture where people with mental illness have the same societal value as people without mental illness."
Harmful Effects of Stigma and Discrimination
Stigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. A recent extensive review of research found that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses. Effects can include:
- reduced hope
- lower self-esteem
- increased psychiatric symptoms
- difficulties with social relationships
- reduced likelihood of staying with treatment
- more difficulties at work
A 2017 study involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years.
An editorial in the Lancet notes that the impacts of stigma are pervasive, affecting political enthusiasm, charitable fundraising and availability, support for local services and underfunding of research for mental health relative to other health conditions.
Some of the other harmful effects of stigma can include:
- Reluctance to seek help or treatment and less likely to stay with treatment
- Social isolation
- Lack of understanding by family, friends, coworkers, 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
Source: Adapted from Mayo Clinic
Stigma in the Workplace
A 2019 national poll from the American Psychiatric Association (APA) found that mental health stigma is still a major challenge in the workplace. About half of workers were concerned about discussing mental health issues at their jobs. More than one in three were concerned about retaliation or being fired if they sought mental health care.
Only about only about one in five workers were completely comfortable talking about mental health issues. The poll found a generational divide: millennials were almost twice as likely as baby boomers to be comfortable (62% vs. 32%) discussing their mental health.
On a more positive note, about half of workers were at least somewhat comfortable talking about mental health and most workers said they would help guide a troubled co-worker to mental health resources. However, even among those willing to help, about one in four workers said they would not know where to turn for mental health help.
Research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable.
A 2016 review of research on addressing stigma concluded that efforts to reduce stigma and discrimination can work at the personal and population levels. The strongest evidence was for anti-stigma efforts involving contact with individuals with lived experience with mental illness and efforts with a long-term commitment.
Many celebrities, such as Demi Lovato, Dwayne "The Rock" Johnson, Michael Phelps, Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges and brought the discussion much more into the general media and everyday conversation. Young people are looking for information and for these personal stories online.
A 2020 national survey of 14- to 22-year-olds found that 90 percent of teens and young adults experiencing symptoms of depression are researching mental health issues online and most are accessing other people's health stories through blogs, podcasts, and videos. About three in four young teens seeking information online about depression said they were looking for personal anecdotes from people who had suffered in the past.
Social marketing campaigns can also be effective. For example, a research study looked at the effectiveness of an anti-stigma social marketing campaign in California and found that the campaign increased service use by helping people better understand symptoms of distress and increasing awareness that help is available. The researchers estimated that if all adults with probable mental illness were exposed to the California mental health campaign, 47% would receive mental health treatment. If the same adults were not exposed to the campaign, 36% would receive treatment.
The National Alliance on Mental Illness (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:
- Talk openly about mental health, such as sharing on social media.
- Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences.
- Be conscious of language – remind people that words matter.
- Encourage equality between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes.
- Show compassion for those with mental illness.
- Be honest about treatment – normalize mental health treatment, just like other health care treatment.
- Let the media know when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way.
- Choose empowerment over shame - "I fight stigma by choosing to live an empowered life. to me, that means owning my life and my story and refusing to allow others to dictate how I view myself or how I feel about myself." – Val Fletcher, responding on Facebook to the question, How do you fight stigma?
While stigma and discrimination are still prevalent in the workplace, employers are increasingly addressing stigma against mental illness. The APA Foundation's Center for Workplace Mental Health emphasizes the importance of both robust health care services and specific efforts to break the silence that surrounds the topic of mental illness.
Employers who are leading efforts to address stigma offer some suggestions:
- Tailor programs/approaches to your company culture and existing strengths.
- Mention your commitment to leading a behaviorally healthy workplace every time you mention the company's commitment to its overall culture of health, attracting and retaining the best talent, and valuing its employees, etc.
- Train leaders to identify emotional distress and make referrals and to responding promptly and constructively to behavioral performance issues.
- Be welcoming of the need for accommodations. Train managers to respond appropriately
Source: Working Well Toolkit
Organizations and Campaigns
Across the country numerous organizations and campaigns focus on addressing the issue of mental health stigma and discrimination. A few examples are highlighted below:
Bring Change to Mind is a nonprofit organization focused on encouraging dialogue about mental health and raising awareness, understanding, and empathy. Actress and activist Glenn Close co-founded Bring Change to Mind in 2010 after her sister and nephew were diagnosed with mental illnesses. It offers resources and tools to learn more and take action to reduce stigma.
Stamp Out Stigma is an initiative spearheaded by the Association for Behavioral Health and Wellness to reduce the stigma surrounding mental illness and substance use disorders. The campaign encourages people to start the conversation and to talk openly about mental illness and substance use.
"Make It OK" is a campaign to reduce the stigma of mental illnesses. The campaign offers personal stories, tips on what to say when talking about mental health, and resources to help fight stigma in the community. (See some tips on what to say and what not to say below.)
This is My Brave is a storytelling theatre show where individuals from the community share their stories of living a successful life despite mental illness. Since 2014, This Is My Brave has produced nearly 800 storytellers sharing true, personal stories on overcoming depression, anxiety, bipolar disorder, PTSD and other illnesses. In spring 2020, the organizers developed BraveTV to bring stories of hope online during the COVID-19 pandemic.
One recent effort is the Mental Health Coalition, spearheaded by Kenneth Cole in partnership with handful of partners. Partner organizations and celebrities include Active Minds, NAMI, The JED Foundation, Anxiety and Depression Association of America, Kendall Jenner, Kesha, and others. The focus of the coalition is fighting stigma through the sharing of stories with the tag line "How are you really?"
Safe Space Radio combines compelling storytelling with practical expert guidance to give you the tools you need to start finding your own courage. The Profiles in Mental Health Courage series explores the experience of living with mental illness—such as depression, anxiety, schizophrenia, and borderline personality disorder.
NAMI's StigmaFree campaign is working to end stigma and create hope for those affected by mental illness: "Through powerful words and actions, we can shift the social and systemic barriers for those living with mental health conditions." As part of the campaign, people can take a stigma quiz at CureStigma.org and learn more about becoming stigma free.
Healthy Minds with Dr. Jeffrey Borenstein aims to remove the stigma of mental illness and demonstrate that with help, there is hope. The series focuses on common psychiatric conditions through inspiring personal stories, as well as, experts sharing cutting edge information, including new approaches and next-generation therapies in diagnostics, treatment and research. Series is produced by the Brain & Behavior Research Foundation.
How So We Stop Stigma? Conversation
Try these simple tips for talking.
- "Thanks for opening up to me."
- "Is there anything I can do to help?"
- "I'm sorry to hear that. It must be tough."
- "I'm here for you when you need me."
- "I can't imagine what you're going through."
- "People do get better."
- "Oh man, that sucks."
- "Can I drive you to an appointment?"
- "How are you feeling today?"
- "I love you."
- "It could be worse."
- "Just deal with it."
- "Snap out of it."
- "Everyone feels that way sometimes."
- "You may have brought this on yourself."
- "We've all been there."
- "You've got to pull yourself together."
- "Maybe try thinking happier thoughts."
- National Institute of Mental Health Mental Illness
- The Lancet Editorial. The health crisis of mental health stigma. The Lancet, 2016, 387:1027.
- Well-being Trust. Digital Health Practices, Social Media Use, and Mental Well-Being Among Teens and Young Adults in the U.S. 2018.
- Rossler, W. The stigma of mental disorders: A millennia-long history of social exclusion and prejudices. EMBO Reports, 2016. 17(9); 1250-1253.
- APA Press Release: About Half of Workers Are Concerned about Discussing Mental Health Issues in the Workplace; A Third Worry about Consequences if They Seek Help.
- Philip T., et al. The impact of illness identity on recovery from severe mental illness: A review of the evidence. Journal of Psychiatric Research.
- Center for Workplace Mental Health. Working Well Toolkit. 2016.
- Forde, K. 2020. By Sharing Their Own Struggles, Celebs Help Teens Tear Down Mental Health Stigma.
- Greenstein, L. 9 Ways To Fight Mental Health Stigma. NAMI blog, Oct. 11, 2017.
- Corrigan, Pw, Druss, BG, Perlick, DA. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in The Public Interest. 2014, 15(2);37-70.
- Mayo Clinic. Mental health: Overcoming the stigma of mental illness. 2017.
- Pescosolido, BA. The public stigma of mental illness: what do we think; what do we know; what can we prove? J Health Soc Behav. 2013 Mar;54(1):1-21. doi: 10.1177/0022146512471197.
- Oexle N, Müller M, Kawohl W, et al. Self-stigma as a barrier to recovery: a longitudinal study. European Archives of Psychiatry and Clinical Neuroscience. October 2017. doi: 10.1007/s00406-017-0773-2.
- Scarf, D., et al. Association of Viewing the Films Joker or Terminator: Dark Fate With Prejudice Toward Individuals With Mental Illness. JAMA Network Open. April 24, 2020.
- Collins, R.L., et al. Social Marketing of Mental Health Treatment: California's Mental Illness Stigma Reduction Campaign. Am J Public Health. 2019 June; 109(Suppl 3): S228–S235.
- Supporting Students from Diverse Racial and Ethnic Backgrounds. The California Community Colleges Student Mental Health Program.
Jeffrey Borenstein, M.D.