Public	Self	Structural
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 may lead to lowered self-esteem and self-efficacy: "Why try? Someone like me is not worthy, or unable to work, live independently, or have good health."	Leads to intended and unintended loss of opportunity

Source: Adapted from Corrigan, et al., 2014.

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 by Scarf, et. al. in 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 report 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."

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 by Oexle et al 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 reduced likelihood of staying 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 2017

Stigma Can Also Impact Family and Friends

Family members and friends, who often provide essential help and support for people with mental illness, can also experience stigma. They may internalize stigma and blame themselves, or they may fear that people will blame them for causing a loved one’s illness or reject the family socially. This stigma can lead to reduced emotional support, social isolation, and reluctance to seek care for their relative. (Yanos, 2023; Mclean, 2023)

Stigma in Diverse Communities

Stigma around mental illness is 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 more information, please see Mental Health Disparities: Diverse Populations.

A 2022 national poll from the American Psychiatric Association (APA) found that mental health stigma is still a major challenge in the workplace. About half (48%) of workers say they can discuss mental health openly and honestly with their supervisor, down from 56% in 2021 and 62% in 2020. Half (52%) also say they feel comfortable using mental health services with their current employer, compared to 64% in 2021 and 67% in 2020. In a more positive trend, fewer adults are worried about retaliation if they take time off or seek care for their mental health. About one in three (36%) worried about retaliation if they took time off, compared to 48% in 2021 and 52% in 2020. Less than one-third (31%) were worried about retaliation for seeking care, compared to 43% in 2021 and 2020. (APA, 2022)

Public Health Approaches

Many years of research on anti-stigma interventions has found that successful interventions (Yanos, 2023):

• Include contact (in person, but video can also be a feature if done right).
• Focus on a range of disorders, not just depression or mental illness broadly.
• Involve participation of people with “lived experience.”
• Target groups that have the most interaction or where lack of help-seeking is most problematic (e.g., young people, undocumented communities, military communities).
• Are tailored to be credible to specific language and cultural signifiers of the target group.
• Last several years in order to be effective.

Substantial 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.

Teens are searching for health information online and mental health issues are among the top searches, according to a national survey from Hope Lab (Hope Lab, 2021). About four in 10 teens said they have looked for people with similar health concerns. 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.

Recent studies have also shown the effectiveness of brief videos in reducing stigma. One study tracked more than 700 students across two years in a randomized controlled trial and found that watching videos of people sharing their personal experiences and videos with information on mental health improved students' mental health care access (da Conceição, et al 2023). The researchers found that the intervention was particularly effective for those in need, enabling them to recognize their need for care and behave accordingly. Another study found that a video featuring an actor sharing a story was as effective as a person with lived experience. (Amsalem, et al 2023).

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. (Collins, et al 2019). The researchers suggest that widespread exposure to the mental health campaign could significantly increase access to treatment.

Individual Actions to Reduce Stigma

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.

Reducing Stigma in the Workplace 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 healthcare services and specific efforts to break the silence that surrounds the topic of mental illness. The Center suggests organizations strive to "create a culture in which mention of depression, anxiety, post-trauma, and other common illnesses become as mentionable as diabetes, hypertension, and migraines."

Employers who are leading efforts to address stigma offer some suggestions (CWMH):

• 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

Across the country numerous organizations and campaigns focus on addressing the issue of mental health stigma and discrimination. A few examples are highlighted below:

• 

  The “Love, Your Mind”campaign, from the Huntsman Mental Health Institute and the Ad Council, offers inspiration, community and educational resources to encourage people across the U.S. to be more open and proactive when it comes to their mental health.
• 

  Stop Stigma Together is working to unite organizations to create resources, generate funding, bring clarifying awareness, and address the issues around mental health and substance use disorders. They will pose a grand challenge to our friends, family, employers, healthcare providers and governments to end the stigma around mental health and substance-use disorders to establish true well-being.
• 

  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?"
• 

  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.
• 

  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.
• 

  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.
• 

  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.

  References

Physician Review

Nikhita Singhal, M.D.
University of Toronto, Psychiatry Resident

March 2024