Health Education

Mental health stigma—and how to overcome it

Cropped SingleCare logo By | September 1, 2019

Defining stigma | Why it’s a problem | Action steps to end it | Treatment options available | Supporting friends & family

Mental health stigma is a huge problem that makes a lot of people who need treatment ashamed to get it. Here’s what you can do to reduce it and the options available if you need help.

“The single most important barrier to overcome in the community is the stigma and associated discrimination towards persons suffering from mental and behavioral disorders.” – Chapter 4, 2001 World Health Report, World Health Organization (WHO)

Around the world, mental health is on the minds of medical professionals and ordinary citizens alike. It’s become obvious that mental health conditions affect millions—and awareness is growing that people with mental health problems aren’t just “crazy,” “dangerous,” or “bad people.” But this progress towards a more transparent and accepting future is not without setbacks.

Stigma remains among the most persistent hurdles for people living with a mental health condition. Medical research demonstrates that mental illness is real, and nothing to be ashamed of—but many people reject this idea, and any sign of mental health problems in society or their personal lives. There are many reasons people reject mental illness, from basic misinformation to targeted discrimination.

Sometimes uninformed people spread myths and aspersions about mental health problems. This makes the stigma surrounding general mental health even more persistent. It can be especially detrimental for those without regular access to honest and thoughtful mental health information that refutes common misconceptions. It can even cause self-stigma, the internalization of negative attitudes in those suffering from mental disorders.

It’s essential to actively reject mental health stigma and negative stereotypes in all of their forms. Knowing that stigma is a big problem isn’t enough. Change only happens with actions.

Social groups and communities need to band together to dismantle mental health stigma. That means persistently sharing up-to-date mental health information with friends and neighbors. Learn to listen effectively to those living with mental illness and to speak up on the topic in daily life. These actions can build support networks that effectively lower the stigmatic barrier and better enable those in need to seek the help that they deserve.

Defining the mental health stigma

Most people don’t fully understand mental health stigma. Before jumping head-first into stigma-fighting efforts, you might need to take a step or two backwards. First, try to understand the broad scope and context in which current discourse is taking place. For example, it is worthwhile to learn and use with the appropriate vocabulary. It can help you be a better ally to those living with mental illness.

Stigmas in general

To understand mental health stigma, you must understand what stigma means, and how it can hurt people. A social stigma is an active or passive measure used to discriminate against an individual based on their perceived characteristics. Social stigmas can target both mutable and immutable personal characteristics, including everything from race to mental health status.

Extensive research about the stigmatizer-stigmatized relationship exists. But the most important thing to know is that the stigmatized almost always feel some degree of social devaluation because of their characteristics. This can cause ostracization and isolation over time, or even fuel outright discrimination at the hands of authority figures.

Mental health stigma falls into this category. People living with mental illness experience active and passive discrimination in daily life. It affects everything from social engagements to housing options. This unequal treatment can greatly decrease quality of life and make it more difficult to seek out proper treatment.

Stigmas relating to mental health

Mental health stigma has existed in different forms for centuries. It’s perpetuated by individuals, but popular media and societal norms also reinforce stigma in communities worldwide.

Mental health stigma has two parts. First, there is the “invisible” (or rather, not-obviously physical) nature of mental illness. Meaning, unlike a broken arm, you can’t easily see when someone is depressed. Second, some manifestations of mental illness break established social norms. For example, someone in a manic bipolar phase might talk too much when out with others. Taken together, these factors can make an individual’s untreated or poorly-managed mental health condition appear unpredictable, or even scary. In turn, some people (improperly) internalize this unpredictability as a threat, which can make them believe or spread stigma.

Though it’s common, mental health stigma shouldn’t be accepted as a natural part of daily life. Mental health stigmas, both major and minor, are harmful in all of their manifestations and can significantly diminish an individual’s ability to recognize their own mental health condition and seek appropriate help when necessary.

Why stigma is a big problem

Saying that mental health stigmas are a “big” problem is an oversimplification. In reality, mental health stigmas are broad and pervasive problems that can touch nearly any aspect of an individual’s life. If you plan to address mental health stigmas in your community and social circles, make sure to take time to fully understand the deep impact of stigma before trying to fight it.

Mental health stigmas fall into two broad categories: the ways stigma spreads and the effects of stigmatization on individuals who experience it. Both categories are crucial to holistically address and correct stigma.

The ways stigma spreads

The ways stigma spreads are more visible than its effects on individuals. These are the actions and words that become internalized biases against individuals with mental illness—and seep into everything from daily speech to policy-making. Though the following list is not exhaustive, these are several of the most common ways that mental health stigma spreads:

Microaggressions

Words, and their negative meanings, can have a real impact on how an individual living with mental illness perceives themselves, and on how the larger society views that individual. The way society talks about mental health and mental illness can directly impact how it acts towards people experiencing it.

Microaggressions are small verbal indications (both intentional and unintentional) that communicate hostility or negative prejudice against a targeted group. Microaggressions can be accidental, or even well-intentioned, but still be offensive to the affected group’s members.

Calling someone “crazy” or asking them if they have taken their medication are examples of microaggressions against the mental health community.

Microaggressions targeted at individuals living with a mental health condition share similarities with language traditionally used to marginalize people with physical disabilities (though with far less subtlety). The precise words and phrases vary from setting to setting, but nearly all microaggressions intend to invalidate or shame the affected individual or group. Some microaggressions also communicate misplaced fear about mental illness in general.

Microaggressions are one way that pervasive social stigmas—like mental health stigma— spread through social circles. Some people say that microaggressions require excessive self-censoring, that the people affected are too sensitive. But that opinion is not productive in a discourse focused on supporting individuals living with mental illness.

Negative messaging

Microaggressions are specific instances of language perpetuating the mental health stigma. Negative messaging is a broader method of spreading mental health stigmas. It is the communicative content (often in popular media) that serves the larger purpose of spreading fear and misinformation about mental health and individuals living with mental illness.

For example, television shows that portray someone with schizophrenia as dangerous spread negative messaging about people with the condition.

Negative messaging can stem from unintentional ignorance. This form occurs often in children and young adults who don’t fully understand the appropriate societal norms relating to mental illness terminology. This type of ignorance can last into adulthood if it is not tactfully corrected.

Yet, most negative messaging is intentional ignorance on the part of individuals or groups who understand the consequences, but use harmful language anyways. Traditional media and social media both operate in this domain, authoritatively repeating misconceptions about mental health.

One study published in the Natural Institute of Health (NIH) found that 39% of major U.S. newspaper coverage of mental health was about danger and violence.

One example is the debate surrounding gun control and regulation in the United States. It’s a nuanced subject, but certain news sources and advocacy groups reduce the discourse to a matter of treating mental illness. While improving mental health standards is important, using people living with mental health problems as a scapegoat in mass shootings spreads violent stigmas targeted at all people with mental health conditions.

Improper labeling can be part of negative messaging. This is most often seen when discussing mental illness and its presence in an individual’s life. Traditionally, phrases such as “schizophrenic man” or “bipolar woman” were commonplace. Now, person-first language across disability-related discourse is preferred. Phrases like “person with depression” are the accepted (or required, as seen in multiple and government style guides) terms to use.

Socioeconomics, employment, and housing

People living with mental health conditions (both diagnosed and undiagnosed) tend to fall into lower socioeconomic brackets are often susceptible to the long-term impacts of mental illness. This can lead to crossover discrimination from those with negative biases towards the poor.

Lower socioeconomic status among individuals with mental illness stems from a variety of factors, including structural discrimination in employment and in housing. The National Alliance on Mental Illness reports that the presence of mental illness (or the perception thereof) can prevent an individual from receiving equitable employment opportunities.

Broadly speaking, this disparity in hiring occurs because of employer perceptions that individuals with mental illness are not fully in control of their actions, says NAMI writer Luna Greenstein. Simultaneously, these same employers place full blame for unusual actions on the prospective employee instead of a health condition, which can mean excluding otherwise qualified candidates from consideration.

As a result of these discriminatory hiring practices, workers with mental illness tend to earn lower wages than their neurotypical coworkers. This can make it harder to move up the ladder, and earn higher successive wages in future positions. People with certain mental health conditions experience these discriminatory hiring practices more directly. For example, there is a 70% to 90% unemployment rate among individuals with schizophrenia, according to the National Institute of Mental Health.

Fewer financial assets make it more difficult to find appropriate housing. Lawful and unlawful discrimination among housing institutions and property owners make the problem even worse. When left unaddressed, this structural discrimination can cause homelessness and even imprisonment in areas with harsh homelessness regulations.

Federal legislation, such as the Fair Housing Act of 1968, is designed to prevent structural discrimination against individuals in certain protected classes from biased housing rental and sale practices. Individuals with disabilities were added to these protections as part of the Americans with Disabilities Act (ADA) legislation in 1990. But, these protections aren’t foolproof. Non-explicit housing discrimination against individuals with mental illness still occurs.

Results of stigmatization

Stigmatization has serious implications for individuals living with mental illness. Its effects can range in severity from decreased self-worth to a lasting unwillingness to seek out proper mental health care. The following list includes some of the potential impacts of continuous exposure to the mental health stigma.

Decreased access to treatment

It’s commonly accepted that most forms of disability and chronic illness are worth treating. And, people living with illness and disabilities that cannot be treated should be given every opportunity to live a fully enriching lifestyle on their own terms. Unfortunately, this understanding has not fully spread to mental health issues.

Individuals with mental illness are less likely to receive assistance or treatment opportunities because of the existing stigmatization. For example, individuals with mental illness are inaccurately perceived as responsible for, or in control of, their disability. As a result, they are seen as less deserving of treatment opportunities.

Even though there is less stigma for certain conditions, accessibility deficits occur across the board—for people with chronic illness, disability, and mental illness. If you’re working to remedy these deficits in your local community try to be as inclusive and cross-sectional as possible.

Mental health services should be readily available to those who need them; this kind of condition is no different than one caused by a physical illness. If you or a loved one lives with a mental health condition, it is important to fight stigma and seek the help of mental health professionals. Children and young adults often struggle to communicate their feelings with precision, so health care professionals and parents often miss the early signs of mental health problems or write them off as being “all in their head.” This can mean that struggling adolescents don’t receive proper mental health care until much later in life.

When they do seek help, people with undiagnosed or untreated mental illness can face structural deficits of affordable assistance. Often, there is a lack of public health care resources specifically allocated for mental illness in a certain region. Efforts to resolve this problem are ongoing in many areas, but mental health stigma slows down the expansion.

Isolation and villainization

Mental health stigma has always and continues to cause feelings of interminable isolation among those who experience it. It’s not just people diagnosed with mental health problems. Anyone with direct connections to mental illness, such as family members of those living with a mental health condition, can experience isolation.

This sense of isolation echoes the stigmatized isolation of everyone with health challenges, whether they are mental or physical. But it can be even more challenging for people with mental health conditions because of their “invisible” nature. When an illness cannot be seen with the naked eye, it’s easy to feel separate, or alone in your struggles.

This sense of isolation can harm social skills and make it harder to cope with difficult events without support from loved ones or the community. Over extended periods of time, isolation becomes a normal part of the individual’s worldview, and can degrade self-esteem or perception of self-worth. These negative effects can severely impact the individual’s quality of life.

In some cases, individuals living with mental illness are villainized. Meaning, their chronic condition is used to prejudice others. This distinct form of social stigmatization implies that an individual living with a mental illness is somehow “less human” than their neurotypical counterparts, and only serves to isolate an individual further.

Popular media historically attributed a villain’s evil intentions to some degree of “derangement.” Even today, news media (both intentionally and unintentionally) sometimes links mental illness with violence (despite numerous scientific conclusions that debunk the connection).

Recognition and seeking treatment

Mental health stigma causes feelings of social inadequacy. Stigma motivates some individuals to seek out qualified assistance. For many others, stigmatization prevents identification and treatment of mental health conditions.

Patrick Corrigan, Benjamin Druss, and Deborah Perlick call this the “why try?” effect. It’s a type of self-stigmatization that makes an individual believe that their mental illness is an interminable burden that can never be lifted. People may try to hide their illness or over-compensate for its presence. This can make their condition worse until they seek proper treatment.

In 2011, only about 60% of individuals with a mental illness received any type of treatment for their condition. This is because of a variety of structural weaknesses in a mental healthcare system, but it also stems from self-stigmatization that prevents people from seeking proper treatment.

Lack of diagnosis and treatment leads to worse outcomes, just as it would for any other type of chronic illness. Mental health problems take time to treat and manage, especially given that most diagnosed individuals will need to manage the condition throughout their adult lives. When ongoing mental health stigma delays timely treatment, it decreases quality of life.

Actionable steps to end the stigma

Mental health stigma, and its detrimental effects, don’t have to be permanent. There are many steps you can take to support the efforts of advocacy organizations worldwide. Though these methods won’t stamp out mental health stigma overnight, they will improve present and future mental health discourse in your local community.

Listen and educate yourself

Before you can make a difference in how your community understands mental health, you must listen and educate yourself. Mental health is extremely personal and mental health problems affect each individual differently. It’s essential to learn from people who have experienced it.

Read memoirs that describe daily life with a mental health condition. Talk to people living with mental health problems, if you know someone who is willing. Research non-fiction descriptions of mental health conditions. Use contemporary fiction media (including video games like Night in the Woods and Celeste) to help you understand the intricacies of mental health.

Even if you have experience with mental health, it’s important to keep learning. The mental healthcare field is rapidly evolving as more research explores its causes and treatments. If you want to spread awareness, you need to keep up to date on the latest developments.

Speak up

When you have the chance, talk about the importance of mental healthcare and the various stigmas that continue to surround it. If you hear someone speaking negatively about mental health, don’t stay silent.

It’s important to counteract language that spreads distrust of or antagonism towards individuals with mental illness. For example, if you hear someone call a classmate or coworker with a mental health condition“crazy,” it’s important to speak up. This kind of derogatory language (even as a joke) normalizes mental health stigma. It should be avoided or addressed whenever possible.

Advocate

Becoming a mental health advocate is a practical way of bringing attention to mental health issues and those living with mental illness. You can be an advocate in a variety of settings, including in a school or workplace, and across a variety of platforms, such as social media, blogs, and community events. Some organizations, like the National Alliance on Mental Illness and American Foundation for Suicide Prevention, offer more formal training for their ambassadors..

The primary goal of any advocacy initiative should be to bring awareness and support for the addition of support structures to better deal with mental healthcare. In this way, advocates can help to progressively roll back the long-lived mental health stigma and replace it with an environment of productive engagement.

Use non-stigmatizing language

One small action that anyone can take to fight mental health stigma is to change your personal vocabulary. Specifically, be mindful to avoid stigmatizing language whenever possible. Some common labels include crazy, psycho, and addict. This type of language is unproductive at best and outright offensive at worst (depending on the context).

In its place, use non-stigmatizing language. These words and phrases are more widely accepted within the mental healthcare community. Meaning, you can use them without risking negative connotations.

Always use person-first language. This is a structuring method designed to separate an individual’s condition or disability from their personhood. For example, saying “a man with schizophrenia” is more appropriate than saying a “schizophrenic man.”

Options available for those who need help

Mental healthcare improves every day, as more individuals gain access to treatment. There are three primary treatments for mental health conditions: therapy, medication, and support groups. Every method is not effective for everyone, so be sure to consult with your physician to find the best treatment for you.

Therapy

Therapy is one of the most accessible and productive methods of managing mental health conditions. There are many types of therapy, making it a viable option for a greater number of people living with mental health problems.

Cognitive-behavioral therapy (CBT) is among the most popular options because it can facilitate mental and actionable change in an individual’s life over time. Most often, CBT is used for managing depression, anxiety, and bipolar disorder—though it can be productive for a wide range of cognitive disorders.

Interpersonal therapy is also common and well-regarded because it facilitates the healthy expression of emotions. Regardless of the type chosen, therapy almost always involves one-on-one contact with a trained and certified specialist. That specialist may design exercises and activities to practice at home to manage mental health.

Support groups

Like therapy, support groups use face-to-face discussion to help cope with mental illness. Support groups often focus on a specific type of mental illness or demographic, like moms living with depression, or seniors living with bipolar.

They are a great resource for those looking for a broader network of friends to support their mental health management efforts.

There are a variety of support groups for different needs. For example, post-deployment military personnel join support groups for their specific experiences (especially those relating to PTSD). New mothers may meet in support groups in order to tackle various postpartum mental health issues together. Even well-known support groups like Alcoholics Anonymous can play a role in supporting mental health management.

Medication

Medications are one of the most popular methods of managing mental health. Medication is convenient and effective at treating conditions caused by a chemical imbalance in the brain. However, not all psychiatric medications work for all patients. Some prescriptions increase the chance of substance abuse or have side effects that negatively impact day-to-day mood and well-being.

Mental health medications fall into several broad categories: antipsychotics, antidepressants, and mood stabilizers. Each type of drug treats a different type of condition, and has different potential side effects. These medications are effective, but they don’t “cure” mental health conditions—they just alleviate the symptoms. Speak with your doctor about risks and benefits before beginning any new medication.

RELATED: Finding the right medication for your mental health starts with finding the right doctor

Supporting friends and family with mental health issues

Mental health is a serious issue. Mental health stigma is a significant barrier to treatment and opportunities for people living with a mental health condition. Breaking this stigma can be difficult, but it brings numerous benefits, including increased opportunities for those living with mental illness to receive the treatment they need to enjoy a fulfilling and productive lifestyle.

Supporting friends and family with mental issues is a crucial first step. It is time to change public attitudes in the United States and across the globe.