The Impact of Stigma on Mental Health: Barriers, Consequences, and Solutions

By Victor M. Gardner, Psy.D., LP, ACT, Senior Staff Psychologist. Henry Ford Behavioral Health

Stigma surrounding mental illness and mental health disorders has detrimental effects on individuals and broader society. Stigma characterized by negative stereotypes, prejudice and discrimination often deters the timely pursuit and provision of mental health care and negatively impacts health outcomes. Fear of being labeled, ostracized or misunderstood are common reasons for delays in treatment seeking behaviors and can lead to the exacerbation of mental health conditions, worsening symptoms severity, diminished quality of life and a more challenging road to recovery. Stigma can also lead to shame and isolation, further impeding the pursuit of mental health treatment. Stigma can likewise negatively impact adherence to mental health treatment, including the avoidance or premature discontinuation of psychotherapy services or psychotropic medication.

Mental health stigma can take many forms, including public, self, structural and health practitioner stigma.

• Public stigma refers to the negative attitudes and beliefs toward people with mental health conditions. Public stigma can be reflected in the media, whereby negative perceptions, stereotypes and misinformation are promoted about persons with mental illness. Such misinformation can hinder public understanding and acceptance of people with mental health.
• Self-stigma refers to negative beliefs that persons with mental health conditions hold or have internalized about themselves. Self-stigma can also be reflected in one’s feelings of shame about having mental illness or blame for their psychiatric condition. The impact of self-stigma includes lower self-esteem and low self-efficacy. A substantial body of research has shown a negative relationship between stigma and help seeking behaviors. Self-stigma has also been found to be a barrier to recovery and community integration.
• Structural stigma Involves laws, regulations and institutional policies that limit the rights of people with mental health disorders and places them in a disadvantaged position. Structural stigma may be reflected in lower funding for research on mental health and substance use disorders compared to that of research for physical health conditions.
• Health provider stigma occurs when providers hold conscious or unconscious beliefs about race/ethnicity, gender or other stereotypes that negatively impact their ability to provide effective care. Examples of health provider stigma include assumptions that people with substance use disorders choose not to change their behavior or that substance use disorders are more of a moral rather the medical issue, which can subsequently lead to the withholding of necessary SUD treatment services and supportive resources.

Overcoming Stigma

Strategies to reduce stigma include the development of programs that foster a culture of understanding and acceptance of persons with mental illness, and encourage mental health seeking behaviors, early detection and intervention, which are critical to positive health outcomes. Public awareness campaigns that encourage empathy toward persons affected by mental illness, dispel myths and promote accurate information about mental health disorders, including prevalence rates, the continuum of mental illness and the possibility of recovery are also critical. Cultural competency training for health care providers and medical education that equip providers with the knowledge and skill to understand and respect their patients’ cultural background and experiences can likewise help reduce stigma in healthcare. Integrating mental health care into primary care and community settings have further been found to reduce stigma associated with seeking psychiatric care by making mental health services more accessible and less intimidating for patients. Cultural competency and sensitivity training for health care providers can also reduce stigma around mental illness and help foster positive therapeutic relationships between health providers and with their patients, which can lead to better treatment outcomes. Additionally, peer support groups, which offer persons with mental health disorders to share their stories, can help normalize mental health issues and challenge stigma.

Conclusion: Reducing stigma around mental illness is vital for providing equitable and effective psychiatric care. Strategies such as supportive policies, responsible media portrayals, open conversations about mental health, personal contact with individuals experiencing mental health conditions, cultural competency training for health providers and the expansion of integrative behavioral health services in primary care clinics and community settings can also significantly contribute to reducing stigma and improving mental health care.