We’ve come along way toward reducing stigma around mental illness, mental health disorders, and treatment for mental health and mental health disorders. However, one fact evident in the most recent statistics on mental health treatment teaches us we still have a long way to go before we eliminate stigma completely:
Over 50% of people diagnosed with a mental health disorder – 28 million people – don’t receive the treatment they need.
If you’re unsure exactly what we mean by stigma around mental health, here’s a simple way to think about stigma in this context: stigma is a cultural norm that says mental illness=something bad and therefore there must be something bad about/wrong with people who have mental illness.
That’s a way in. But stigma is far mor complex than that basic binary. Mental health experts discuss three distinct types of stigma people with mental health disorders/mental illness experience:
- Public stigma: Negative attitudes toward people with mental health issues and discrimination against people with mental health issues.
- Self-stigma: Negative attitudes people with mental health issues have toward themselves, such as shame/embarrassment about experiencing mental health challenges.
- Structural/institutional stigma: Policies put in place by both private and public institutions that create barrier to care for people with mental illness, including lack of treatment infrastructure in underserved rural and urban areas, restrictive rules around some types of substance use treatment, and a deficit in necessary research funding for mental health research.
It’s clear stigma still exists. However, many people may think okay sure, there’s still some stigma – but is it really that bad?
The Negative Consequences of Stigma Toward People With Mental Illness
Recent research on stigma and mental health among people with severe mental illness – read the studies here, here, and here – identifies several significant negative consequences of stigma. People with severe mental illness who experience stigma report the following:
- Decreased self-esteem
- Loss of hope
- Exacerbation of symptoms
- Social problems/negative attitudes of friend
- Decreased time-in-treatment
- Problems at work
- Impaired treatment progress
In addition, the studies identify these potential consequences of stigma toward people with mental illness/mental health disorders:
- Reduced motivation to seek, commit to, and stick with treatment
- Withdrawal from friends and family, i.e. social isolation
- Absence of empathy, compassion, and understanding from others, including coworkers, family, and peers.
- Decreased opportunities related to:
- School
- Employment
- Housing
- Social events/activities
- Violence, intimidation, harassment, and bullying
- Problems getting insurance to cover mental health treatment
We know stigma exists. We know it causes problems for people with mental health issues. But we know something else, too: how to reduce stigma. We know because advocates in the U.S and around the world work to reduce stigma every day. In fact, we published three articles recently with details about nationwide mental health awareness initiatives:
July is Minority Mental Health Awareness Month (MMHAM)
June is Post-Traumatic Stress Disorder (PTSD) Awareness Month: PTSD in Teens and Young Adults
BPD Awareness Month: How Can I Tell if my Teen has Borderline Personality Disorder (BPD)?
Awareness months are a good way to increase knowledge and understanding about the mental health challenges individuals and various demographic groups face. There are also specific anti-stigma interventions that can reduce the prevalence and impact of stigma.
Anti-Stigma Interventions: What Works to Reduce Mental Health Stigma?
Treatment providers and researcher have evaluated the ways we can reduce stigma that go beyond awareness days, public initiatives, and social media campaigns. While the short-but-focused awareness days and months create positive change and increase our overall knowledge about mental health and mental health issues, they’re not enough. The fact that over half the people with mental health disorders don’t get treatment demonstrates the need for comprehensive, organized approaches to reducing stigma.
Research conducted over the past five years shows that systematic interventions that include the following elements are the most successful.
Anti-Stigma Interventions: Necessary Elements
- Direct, in-person contact and communication with a person with a mental health disorder. In lieu of direct contact, evidence shows video messages from people living with mental health disorders are effective.
- Discussion and attention to a wide variety of mental health issues, rather than focusing on one disorder, such as depression, or talking generally about all mental illness.
- Direct involvement of people with lived experience with mental health disorders/mental illness, including people with mental illness, family members of people with mental health disorders, and experience treatment providers.
- Intentional outreach to communities where seeking help happens least often, such as youth/young adults, rural communities, people without official documents, and military families.
- Organized efforts to establish trust and credibility among specific cultural groups, with a focus on using relevant languages – i.e. Spanish for Spanish-speaking people – and genuine respect and understanding of different cultural approaches to mental health and mental illness.
- Maintenance of interventions over time, rather than one-off workshops or events of short duration. Interventions that last years, rather than days or months, are the most effective.
We see common themes in these elements: communication, inclusion, and respect for the people who are both the target and the subject of the interventions. These themes play out not only in the way individuals interact with on another when discussing, teaching, or learning about mental health, but also in the structure of the programs. For instance, an intervention designed to counter stigma built up over decades – or possibly centuries – that lasts two and a half hours on one weekend afternoon might be helpful, but doesn’t come close to matching the weight and impact of prolonged stigma.
That’s why efforts to reduce stigma need to persist year-round, and advocates need to convince policymakers to shift from one-off annual event to long-term programs to address stigma.
Reducing Stigma During Minority Mental Health Awareness Month
One of the awareness efforts we focus on is Minority Mental Health Awareness Month (MMHAM). We published an article about MMHAM – see link above – and we’ll add to it here. Information published in the article “Cultural Diversity and Mental Health: Considerations for Policy and Practice.” The MMHAM themes in 2024 revolve around the ways stigma appears in minority communities, and discusses how people in minority cultures can communicate across generations to reduce stigma around mental illness.
This article suggests ways we can better understand mental health, mental illness, and treatment for mental health disorders and mental illness in minority cultures. Here’s what the study authors encourage mental health advocates and providers to consider:
Society as patient.
In some cases, the causes of disrupted wellbeing are not internal, but rather, the result of external forces such as racism, marginalization, and discrimination.
Positive resources within communities.
It helps recognize that different culture have approaches to mental illness that don’t align with the disease model of mental illness, but it helps more to understand that “community-based ethno-cultural services” can be a valid part of the treatment process. Partnering with communities to identify and utilize these positive resources can help reduce stigma around mental health treatment.
Cultural partnership more than cultural competence.
Cultural competence is a catchphrase/popular notion in treatment and stigma reduction movements. It’s important: providers are encouraged to gain some level of fluency and comfort with the cultures of the people they treat. However, the concept foregrounds the work of the provider and institutions rather than the people from the cultures mental health providers serve.
Let’s explore that last bullet point for a moment. When we talk about cultural competence, the competence part is all on the side of the dominant culture, where the power already resides. When we talk about and actively cultivate genuine collaborative cultural partnerships, on the other hand, we empower people from minority cultures and take steps toward creating “interdependent and synergistic relationships” that are more balanced and have a greater chance of transcending stigma.
How We Can All Work to Reduce Stigma
People who work in mental health treatment or related fields like education or community and social services know what they need to do to reduce stigma, because part of their job every day is creating an atmosphere of equity and inclusion that increases the likelihood that people who need treatment will seek out and engage in treatment.
The rest of us might need some pointers about how we can help. Thankfully, organizations like the National Alliance on Mental Illness provide us with five good ideas we can all use, starting right now:
- Share what you know about mental health freely and openly with friends, family, and on social media
- Prioritize accurate knowledge. When you see or hear misunderstandings, negative talk about mental heal, or incorrect assumptions, share whatever facts you know or experiences you might have
- Words matter. Avoid throwing around outdated, judgmental language about mental health. Sometimes offhand comments – due to their casual, dismissive nature – can cause more damage than language intended to marginalize.
- Use language that creates parity between mental health issues and physical health issues. For instance, someone with a physical condition may need to take medication every day and visit the doctor consistently, in the same way a person with a mental health condition may need to take medication and visit a therapist consistently.
- Always lead with compassion, empathy, and kindness.
In addition, if you’ve ever been in treatment, or had a close friend or family member in treatment, we encourage to talk freely about it – if you’re comfortable with talking about it, of course. The idea is to normalize treatment, so that a person should not feel weird or wonder how people will react or think people might judge me when they talk about mental health.
People should be able to say, “I have an appointment with my therapist” just as easily as they say, “I have a checkup with my doctor.”
When we get to that place, we’ll know we’re making real progress.
About Language: Ideas for What to Say and What Not to Say
When we talk about mental health, particularly when we talk to people who have a mental health disorder/illness/diagnosis, we need to use language that doesn’t unintentionally marginalize or discriminate against people with mental illness.
But it’s easy to make mistakes, because stigmatizing language has been normalized, and non-stigmatizing, non-discriminatory language might feel/sound awkward or strange.
We have to get over that.
The words we use matter because they can cause harm: if a person defers treatment because of a casual comment, it could cause them more emotional and psychological pain, exacerbate their symptoms, and extend the duration of their illness. No one wants to do that, and no one want to be on the receiving end of that.
The non-profit MakeItOK.org has compiled this brief list of Dos and Don’ts for talking about mental health. Look at these examples as just that: examples. You can come up with your own ideas about how to replace stigmatizing language with non-stigmatizing language once you understand the difference between the two.
Practice saying things like:
“How ya doin?”
“Thanks for sharing that with me.”
“How can help?”
“That must be hard – I’m sorry that happened to you.”
“Whenever you need me, I’m here.”
“People do get better.”
“That sucks, no lie detected. ”
“Do you need a ride to your appointment?”
Avoid saying things like:
“Suck it up, you can handle it.”
“Could be a lot worse.”
“There are people in way worse shape than you.”
“Sounds like a first-world problem.”
“Deal with it.”
“Get over it.”
“This really is your own fault.”
“We’ve all been there.”
“Get it together.”
“Try thinking good thoughts.”
The idea is to be supportive and loving. Put yourself in their shoes: if you were really hurting, what would you rather hear? What would encourage you to open up more? We think the questions in the first list are far more helpful than those in the second.
We’ll end by paraphrasing the physician’s oath, which can guide you in any conversations you have about mental health:
