Mental Health Stigma: It’s Time to Start Listening and Stop Judging

The demand for mental health services is increasing. The number of individuals seeking help through traditional and online therapy is increasing, according to the American Psychological Association’s Practitioner Impact Survey. What’s more, people are reporting more severe mental health symptoms, the survey found.

Yet negative feelings about people with mental illness remain. The National Alliance on Mental Health (NAMI) defines these feelings as “stigma,” which it says can profoundly affect individuals and reduce their likelihood of reaching out for support. Here, we provide examples of various mental health stigmas and their consequences, while sharing expert solutions for reducing and eventually eliminating the problem.

According to the American Psychiatric Association, mental health stigmas stem from a lack of understanding and mischaracterizations of mental illness in the media. The American Psychiatric Association describes three different types of mental health stigma: public stigma, self-stigma, and institutional stigma.

Public Stigma

Public stigma refers to negative attitudes and discrimination against individuals with mental illness. Public mental health stigma leads to stereotypes and prejudice toward individuals with mental health disorders. For example, those with mental health illnesses may be considered a threat, unreliable, incapable, and responsible for their disorder.

Self-Stigma

Self-stigma involves negative feelings, including shame, that people with mental health conditions feel about themselves. They internalize and believe public perceptions about them and feel that they are to blame for their problems.

Institutional Stigma

Institutional stigma refers to government and organizational policies restricting the rights and opportunities of those with mental health conditions. Institutional stigma around mental health results in poor funding for mental health resources and fewer work and housing opportunities for people with mental health conditions.

According to NAMI, stigmas negatively affect nearly 1 in 5 Americans with mental health conditions. Feelings of shame and isolation add to the mental illness burden and can inhibit efforts to seek professional help. The American Psychiatric Association says self-stigma negatively impacts those affected by severe mental illness by:

• Increasing feelings of hopelessness
• Lowering self-esteem
• Increasing symptoms
• Adding to relationship difficulties
• Reducing participation in treatment

The Mental Health Foundation in the United Kingdom observed that people with mental health conditions were less likely to have a job, be in a stable relationship, reside in adequate housing, and be socially accepted. An analysis of two McKinsey & Company surveys, conducted in 2020, about the effects of mental illness stigma and how it can exacerbate existing mental health conditions, found far-reaching consequences in the workplace. These included things like lower productivity levels and the following statistics:

• Thirty-seven percent of employees with a behavioral health condition don’t seek treatment due to fear that their mental health condition will be discovered.
• Fifty-two percent of employees diagnosed with a substance use disorder avoid treatment.
• Nearly 70 percent of employees with high self-stigma levels miss at least one day of work a year due to burnout or stress.

When feelings associated with the stigma around mental health become negative, they can cross into mental health discrimination. According to a Lancet Commission report published in 2022, the impacts of mental health discrimination can affect all areas of a person’s life, with consequences that are often underestimated.

Personal Effects of Mental Health Stigma and Discrimination

The Lancet report found that people affected by mental illness stigma experienced discrimination in various areas of their lives, such as social settings, school, work, and relationships. As a result, feelings of loneliness, shame, and isolation increased, worsening mental health conditions and increasing reluctance to seek help. The tendency to avoid treatment is most common among minorities, young people, those living with their parents, military personnel, and health professionals.

Mental Health Stigma and Discrimination in the Workplace

In an American Psychiatric Association public opinion poll of 1,005 U.S. adults in 2019, more than 1 in 3 workers in the United States were concerned about retaliation or being fired if they sought mental health care. But the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973 both protect people with mental health disabilities from discrimination and harassment at work, and the U.S. Equal Employment Opportunity Commission (EEOC) encourages workers who suspect workplace discrimination to file a discrimination charge with the EEOC or with their state or local Fair Employment Practice Agency.

Healthcare-Related Mental Health Stigma and Discrimination

It’s not just people with mental health conditions who experience the effects of stigma — the professionals who care for them do as well. A study published in January 2023 by the International Journal of Africa Nursing Sciences found a high degree of evidence that both the public and other healthcare providers held unfavorable views of mental health professionals. The effects of this stigma on mental health professionals include:

• Burnout
• Low resilience
• A desire to change professions
• Poor job satisfaction
• Emotional exhaustion
• Reduced earning capacity

Mental Health Stigma and Discrimination in Schools

Young people with mental health conditions report experiencing common stigma around their diagnosis. According to the Lancet report, students reported negative feelings from school staff, such as fear, dislike, and not believing in their abilities. As a result, those students often felt excluded from school and community activities.

The stigma surrounding depression decreased for the first time between 1996 and 2018, according to a study published in 2021 in JAMA. The findings may be evidence of a historic change in the way mental health issues are viewed by the public, but experts caution that stigmas remain a barrier for many people who need help.

The American Psychiatric Association offers the following tips to professionals for reducing mental health stigmas:

• Talk openly about mental health and share positive experiences and outcomes with others. Use social media to reach a wider audience.
• Be aware that language can add to stigmatization and prejudice. For example, the association suggests replacing terms like “anxious” with “they have anxiety.”
• Show compassion for individuals with mental illness and the mental health care providers who treat them by listening without judgment.

There are also things employers can do to eliminate mental health stigma. The Lancet Commission report made the following recommendations:

• Provide a work environment that supports gainful employment for people with mental health conditions and prohibits mental health stigmatization and discrimination in the workplace.
• Implement evidence-based training designed to eliminate mental health stigma for healthcare providers, social workers, and vocational training personnel.
• Engage the media in efforts to eliminate mental health stereotypes and mischaracterizations.
• Provide teaching and educational system professionals and students with training to reduce mental health stigmatization and discrimination.

Several organizations dedicated to helping combat mental health stigmatization and discrimination exist. Some examples include the following:

• Bring Change to Mind This organization founded by actress Glenn Close encourages a diverse cultural conversations around mental health.
• Healthy Minds This public television series focuses on common psychiatric conditions through personal stories and expert research.
• Make It OK This campaign offers tips for addressing misperceptions and encouraging open conversations about mental health.
• Stamp Out Stigma This Association for Behavioral Health and Wellness initiative reduces the stigma surrounding mental illness and substance use disorders.
• This Is My Brave This organization has produced more than 75 theatrical productions across the United States featuring storytellers who share true stories about mental illness.

Mental health stigmas exist at the public, personal, and institutional levels. These attitudes have negative effects on individuals in need of mental health care and their communities. The more we understand mental health issues, the more we realize how society can become part of the solution.