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
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:
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
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
Employee Assistance Programs (EAP), commonly available through employers, help employees deal with a variety of concerns such as work-life stressors, issues affecting mental and emotional well-being, family issues, financial concerns, relationship problems, or legal concerns. However, the services often go unused—only about 3-5% of employees use available EAP services, according to the Centre for Workplace Mental Health.
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.
Originally appeared on psychiatry.org