Stigma and bias toward mental illness can be major barrier to people accessing needed care. When that stigma and bias exists within the health care system, it can have an especially harmful impact. The Mental Health Commission of Canada has undertaken a multi-year effort to better understand equity and the systemic implicit bias against mental health and substance use, how it impacts health outcomes and quality of life, and what can be done to reshape and improve care for people with mental illness.

Stigma can be present at multiple levels:

• Individual – a person’s feeling of shame or being less worthy; reluctance to seek help
• Interpersonal – endorsing negative stereotypes or prejudicial ideas about others with mental illness; speaking or acting in discriminatory ways
• Structural – established within formal and informal rules, policies and cultural norms

Structural stigma in the health care system is often enacted “unknowingly, through implicit cognitive biases.” * Some examples of how structural stigma exists in &health care systems include:

• People with mental illness or substance use disorder being made to feel “less than” (deprioritized, undertreated, receiving no empathy).
• Inequitable investment in mental health services and underfunding of mental health research compared to those of physical health services and research.
• Inadequate training of health care professionals (such as culturally responsible care and trauma- informed care).
• Stigma within the staff/workplace (such as staff feeling unable to disclose mental health problems and mental health/substance use professionals feeling less respected and valued than those providing physical health care).

The multiyear Canadian effort on structural stigma includes a comprehensive literature review, a series of focus groups, and interviews with key individuals from many different health care related organizations. Based on their research so far, the Canadian researchers have developed a series of priorities for ending structural stigma in health-care environments, including:

• Ensuring greater involvement of people with mental illness or substance use disorder, such as participation in advisory groups on the development of services, polices, actual care and training of professionals.
• Building a supportive and stigma-free workplace culture, such as ongoing training to increase awareness of implicit bias and structural stigma for all staff. In addition, encourage and support mental health care for staff and improve workplace culture through policies and training.
• Adopting integrated, recovery oriented, holistic, accessible, client-centered models of care.
• Distributing resources for mental health and substance use care on par with physical health.