Stigma surrounding mental health continues to be a significant barrier to receiving quality mental health care despite increased awareness and advocacy. Stigma includes the negative attitudes, beliefs, and discrimination directed at people who experience mental health challenges. These perceptions often lead to feelings of shame, isolation, and fear, discouraging people from seeking the help they need. This blog post will explore the effects of stigma on mental health care, shedding light on its consequences while highlighting strategies to foster a more inclusive and supportive approach to mental wellness.
In this article:
Understanding mental health stigma
Stigma often stems from fear or lack of knowledge, which can manifest through prejudice and discrimination. Stigma in the context of mental health care doesn’t just affect the individual with mental health concerns, but their support system and the community at large as well. It’s influenced by sociocultural values that change over time. To understand what mental health stigma is, we have to take a brief look at the origins of psychiatry.
Western psychiatry emerged in the late 1800s as a medical field that sought to explain and manage people’s behavior that deviated from social norms and expectations. People who were labeled as “lunatics” or “insane” were hid from society–families would keep them in basements or send them to asylums. As humorism medicine declined, there was a rise in moral therapy in asylums. “Moral treatment” asylums in the early to mid-1800s sought to provide compassion in peaceful settings; however, as institutions became crowded in the latter half of the century, there became an overuse in physical restraints.
The early 1900s saw a lack of progress in the field of psychiatry, concurrent to growing needs for psychiatric care. The coining of “shell shock” after World War I brought about more discussion of mental illness to the general population. After World War II, the World Health Organization included mental disorders in the sixth edition of the International Classification of Diseases (ICD-6). A few years later, the American Psychiatric Association (APA) developed the first edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders as an alternative to the ICD-6. It was published in 1952.
The DSM became the standard in North American psychiatry. Unlike the rest of medical specialties, psychiatry is unique because mental health and mental illness cannot be reduced to objective biological factors alone. The conceptualization of mental disorders is inherently reflective of the contributors’ personal values, their interpretation of clinical observations, and their expectations of what makes a person “normal”. Despite the DSM undergoing multiple revisions since the 1950s, the revisions are nonetheless revisions of the ideas of a committee that consisted of white men.
The development of drugs used for managing mental health symptoms helped to bring home the everydayness of mental health struggles1. At the same time, these medications were used as blanket solutions to reduce the disruptions to society and hindrances to productivity. Specifically, this meant stifling the bizarre behavior of someone with a psychotic disorder, or removing the hesitation in someone with an anxiety disorder. Drug development was a catalyst for the deinstitutionalization movement in the mid 20th century.
Moving into the 21st century, we’re regularly seeing new developments in medications, imaging techniques, and other discoveries about the brain and its relationship with mental health and illness. Anti-stigma campaigns, such as Bell Let’s Talk, strive to make mental health a topic that is not taboo to discuss. There are conversations about trauma-informed care, recovery-oriented approaches, and peer-led services.
Whether these events in the history of mental health have both pros and cons, it is acknowledged that the field is still young. We are far from a stigma-free world, and even within the nuances of the field there are inklings of othering. From the panopticon design of modern mental health inpatient units to the mental health laws that allow for forced treatment, society today still perpetuates stigmatizing ideas about mental health that have been ingrained since centuries ago.
How the different types of stigma affect mental health care
Public stigma
Public stigma refers to the negative or discriminatory beliefs and attitudes that society holds toward mental illness. These perceptions often portray people with mental illness as unpredictable, dangerous, or incapable, which leads to prejudice and discrimination. Inaccurate media portrayals, cultural narratives, and social norms reinforce harmful stereotypes. This stigma creates barriers to open conversations about mental health, discourages individuals from seeking care, and fosters an environment of exclusion and misunderstanding.
Public stigma also highly impacts the attitudes and behaviors of health care professionals. Some workers, even those who work in mental health contexts, may hold biases toward people with mental illness. This can stem from lack of education and understanding or exposure to or working amongst stigmatizing narratives. Unfortunately, this can result in low quality of care through lack of empathy for clients, dismissiveness, minimizing of client concerns, and misdiagnosis.
Self-stigma
Self-stigma refers to the negative attitudes that people with mental illness may internalize about their own condition, which can lead to feelings of shame, low self-esteem, and feelings of unworthiness. People experiencing self-stigma may view their mental health condition as a personal failure–this can discourage them from seeking help or engaging in treatment. Judgment and labeling are also other fears. Existing mental health challenges could also worsen as a result of isolation and self-doubt. Additionally, family and friends can also experience a form of self-stigma whereby they feel that they are to blame for their loved one’s illness.
A systematic review conducted by Yanos et al. (2020) found that self-stigma leads reduced hope, lower self-esteem, increase in psychiatric symptoms, occupational and social difficulties, and lower treatment adherence. Similarly, a longitudinal study by Oexle et al. (2018) demonstrated correlations between self-stigma and less recovery progress.
Institutional stigma
Institutional stigma refers to when a government, society, or community intentionally or unintentionally limits opportunities for people with mental illness. It can appear in the form of systemic policies, practices, and structures within organizations or institutions. As it is embedded in societal systems, institutional stigma reduces access to care, resources, and opportunities for people with mental illness. Examples include inadequate funding for mental health services, coercive interventions, and unprofessional practices. Another way that institutional stigma reinforces negative stereotypes is by valuing mental health concerns as less significant than physical health concerns. This creates a cycle of neglect, where people are not only discouraged from seeking help but also struggle to access appropriate care when they do seek help.
Breaking down stigma and supporting individuals affected by stigma
The impact of stigma goes beyond personal experiences. It affects healthcare systems, workplaces, and communities and perpetuates a cycle of neglect and misunderstanding, making it harder to address mental health concerns openly. Breaking the cycle of stigma requires a collective effort to challenge misconceptions, promote education, and create environments where mental health is treated with the same urgency and compassion as physical health.
Promoting education and awareness is the core of combating stigma toward mental illness. Mental health deserves as much attention in schools, public health initiatives, workplace initiatives, and general discourse as much as physical health does. Anti-stigma campaigns should be diverse, covering a range of mental health topics, rather than being limited to depression and anxiety. The topic of mental wellness should be introduced in schools–the earlier a person learns about the topic, the more open-minded their perception would be. Educational and awareness programs should also equip people to advocate for themselves and others.
Conversations surrounding mental health should be normalized. Rather than mimicking our history of hiding mental illness, it should be brought to light and discussed openly and freely, with representation from individuals with lived experience. There should be more access to peer support groups and resources within communities that cater to different goals and preferences. Additionally, normative discourse amongst health care professions should also be challenged as to discourage stigmatizing language and attitudes toward clients with mental illness. As psychiatry shares many overlaps with other societal oppressions, it is worth for institutions to collaborate with equity, diversity, and inclusion (EDI) consultants to improve policies, practices, and services.
Each individual is a piece to the puzzle of fighting against stigma. Even as one person alone, we can make small but significant changes by being mindful of our language, practicing reflection, keeping an open mind, and staying curious about new ideas related to mental health.
READ MORE: Stigma and Advocacy blog posts
References
- Herzberg, D. (2009). Happy pills in America: From Miltown to Prozac. Johns Hopkins University Press. ↩︎