More than 50% of people with a mental illness do not seek psychological care, according to the American Psychiatric Association. Stigma, a key reason for this care-hesitancy, is engrained in much of society and is rooted in fear, misunderstanding, misleading media, and consumption of inaccurate information.¹ Researchers typically identify three different types of stigma: institutional, public/social, and self.¹ Stigma that is found in hospitals, government, universities, corporations, and prisons is termed institutional; this type lingers in practically every institution that interacts with people who have mental health illnesses.² Public or social stigma involves the negative attitudes and discriminatory practices that societies exude. Internalized shame and derogatory self-thoughts is a manifestation of self-stigma towards mental illness.To facilitate a society with less stigma towards seeking psychological care, all of these dimensions of stigma must be addressed.

The scope of institutional stigma and how it is exuded is difficult to measure, therefore, limited research has been done in this important area of public health. However, existing research reveals that institutional stigma is pervasive in our societies and affects health nationally. For example, a United Kingdom study noted that patients being treated for mental health issues felt inferior to those being treated for physical health issues and were more likely to disregard their own, potentially life-threatening, behaviors (i.e. suicidal ideation, self-harm, binge-eating) as a result.² In a Canadian study, those with mental illnesses report feeling “devalued, dismissed, and dehumanized”.³ The same study found that 53% of patients witnessed discrimination from medical providers and 79% of patients reported first-hand experience with discrimination.³ While one may assume that health professionals would not have preconceived biases towards individuals with mental illnesses, multiple studies have found that health professionals do not necessarily have less bias than the general population.⁹ Institutional stigma creates distrust of medical providers and decreases the chance that patients with mental illness will see practitioners for both their mental and physical health issues.

Societal or public stigma is also difficult to measure, as it mostly relies on surveys which are not always representative of the entire population. Despite these limitations of research, there are key conclusions that can be made. One study found that, amongst college campuses with high self-reported stigma levels, stigma was negatively associated with proper medication use, usage of therapists, quality informal support systems, and suicidal ideation.⁴ Similar to societal stigma, self-stigma is particularly troublesome, as those with mental illnesses such as anxiety, depression, or schizophrenia are more vulnerable to internalize negative thoughts.⁸ This internalization of negative stereotypes often worsens their own illness. This continues cyclically and increases the risk of people with mental illnesses to have poorer health outcomes.⁸

To combat institutional, public, and self-stigma, one must be ready to deploy evidence-based methods across all levels. One of the most effective methods to reducing stigma surrounding mental health is education.⁴ Education efforts range from books and brochures to in-person training and audiovisual resources, and can be implemented on an institutional level or initiated individually to gradually reduce stigma.⁵ One of the easiest ways to reduce stigma on an individual level is to use person-first language.⁷

*Adapted from National Council for Mental Wellbeing - Mental Health First Aid⁷

Though person-first language may seem like a small change, it helps reduce stigma greatly by ensuring that the focus is on the individual, therefore reducing dismissal and dehumanization.^{3, 7} This one simple word-swap, in conjunction with additional educational campaigns across institutions, can help reduce stigma towards mental health and create a healthier population. Additional steps individuals can take to counter their bias and stigma and ensure that they are supporting people with mental illness are being honest about their own treatment, being compassionate towards those with any mental illness, and treating mental illnesses at the same level as physical ailments.⁶ 

The pervasive stigma against individuals with mental health issues is extremely detrimental. The effects of stigma range from endorsements of discrimination to inadequate medical treatment of individuals with a diagnosed or perceived mental illness. This results in people not seeking out care for their mental health issues, which consequently causes these individuals’ illnesses to worsen. Across all types - institutional, public/societal, and self - work needs to be done to foster a less stigmatizing environment. Education, organizational restructuring, and open conversation about mental health are key ways to counter this stigma and must be implemented to ease the burden stigma causes.

References

1. Stigma, Prejudice and Discrimination Against People with Mental Illness. (2022). American Psychiatric Association. Retrieved October 17, 2022, from https://www.psychiatry.org/patients-families/stigma-and-discrimination

2. Huggett, C., Birtel, M. D., Awenat, Y. F., Fleming, P., Wilkes, S., Williams, S., & Haddock, G. (2018, September 1). A qualitative study: experiences of stigma by people with mental health problems. Psychology and psychotherapy, 91(3), 380-397. 10.1111/papt.12167

3. Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum, 30(2), 111–116. https://doi.org/10.1177/0840470416679413

4. Gaddis, S. M., Ramirez, D., Hernandez, E. L. (2018). Contextualizing public stigma: Endorsed mental health treatment stigma on college and university campuses. Social Science & Medicine, 197, 183-191. https://doi.org/10.1016/j.socscimed.2017.11.029.

5. a Silva AG, Baldaçara L, Cavalcante DA, Fasanella NA and Palha AP (2020) The Impact of Mental Illness Stigma on Psychiatric Emergencies. Front. Psychiatry 11:573. doi: 10.3389/fpsyt.2020.00573

6. Greenstein, L. (2017, October 11). 9 ways to fight mental health stigma | nami: National alliance on mental illness. National Alliance on Mental Illness. https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma

7. Nelson, Al. (2022, April 12). Use person-first language to reduce stigma. Mental Health First Aid. https://www.mentalhealthfirstaid.org/2022/04/use-person-first-language-to-reduce-stigma

8. Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: stages, disclosure, and strategies for change. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 57(8), 464–469. https://doi.org/10.1177/070674371205700804

9. Ahmedani B. K. (2011). Mental Health Stigma: Society, Individuals, and the Profession. Journal of social work values and ethics, 8(2), 41–416.