In the 1980s and 90s, growing up in a household where mental health disorders were discussed fairly frequently was not the norm. My dad worked as a mental health professional and administrator for his entire professional career, and he never hesitated to make sure his children understood the importance of what he did. My brother and I were carefully taught that mental illness was not something to be ashamed of or something to fear. Mental illness was no different than a medical condition, and people with mental health disorders deserved to be treated like everyone else.
When mental health services and/or funding were on the ballot in our local community, my dad was often the primary voice of these campaigns. My family put up signs, passed out flyers, and he was often featured in the local newspaper discussing the importance of increased funding for mental health services. I can recall a few occasions when my brother and I went to school during these campaigns and faced teasing because of my dad’s occupation and his role in promoting improved services. I remember being shocked at how many teenagers had any opinion, let alone a strong, negative opinion, about mental illness and mental health care. It was clear that other households were not discussing stigma and/or mental illness at their dinner tables, to say the least.
Recalling these times during my childhood nearly 40 years ago, I now find myself wondering, “Are things getting any better?” Are the regularly advertised ‘Mental Health Matters’ campaigns having a positive impact on today’s youth? Are we changing the narrative regarding mental health disorders and the treatment they require?
The Background of Stigma and Mental Illness
For years, the negative implications of mental illness have been twofold. Individuals struggle with various symptoms resulting from their illness, and they also face stereotypes, prejudice, and discrimination resulting from common misconceptions regarding mental health disorders. As you might imagine, stigma involves not only negative reactions from the public (i.e., public stigma), but it also involves negative attitudes and shame that people possess about themselves and their illness (self-stigma). Together, the impact of stigma on the lives of individuals with mental health disorders can prove to be more distressing than the symptoms themselves.
According to Dr. Patrick Corrigan (2016), a leader in education and research on stigma and mental illness, the misconceptions leading to stigma often stem from fear and lack of knowledge. Combined, those two things lead the public to exclude individuals with mental health disorders from various aspects of community life and even blame them for their illness, which manifests in significant discrimination. Individuals with mental health disorders often struggle to find or maintain employment. Employers may not hire someone with a mental illness, and/or they may fail to support them on the job. Housing and health care are other key aspects of community life where stigma often prevents individuals with mental illness from meeting their basic needs.
Looking inward, stigma can result in low levels of hope and self-esteem and increased problems with socialization, even among family and close friends. Perhaps most importantly, self-stigma often leads people to not receive the help they need for their illness. People may delay getting help, fail to stay with treatment, or fail to get any help at all, and that is often prompted by an internal fear of being treated poorly and facing discrimination in various aspects of community life (American Psychiatric Association, 2024).
Is Mental Health Stigma Improving?
Since stigma has such a far-reaching, negative impact on the lives of people with mental health disorders, it seems critical to determine if and how things are improving. According to Dr. Kevin Antshel at Syracuse University, the Covid-19 pandemic led to a slight improvement in mental health stigma. As a result of the pandemic, more people experienced mental health conditions, and that had a two-prong impact on stigma. First, many individuals experienced a mental health condition firsthand, which increased the knowledge base regarding mental illness leading to decreased stigma. In addition, those who did not have a personal experience with a mental health condition likely had contact with someone who did. ‘Contact’ with individuals with mental health conditions has long been an effective strategy for addressing stigma, and the pandemic provided an opportunity for more Americans to have contact with someone living with a mental health condition because of the increased rates of various disorders.
Dr. Antshel also points out that younger generations (Gen Z and Millennials) are more likely to treat mental health like physical health. Younger people are more likely to share mental health struggles with friends and family and speak openly about receiving mental health treatment. Additional research supports this idea that public perspectives of most mental health conditions may be improving. For example, results of a longitudinal study suggest that stigma towards depression has improved over the last 30 years (Schomerus et al., 2023). Depression is less likely to evoke negative emotions from others or lead to social distancing than it once was. Again, increased exposure is likely the primary reason for improvements in stigma related to depression. Rates of depression are far higher than they once were, and as a result, many of us have either experienced it or know someone close to us who has, which, in turn, decreases stigma related to depression.
Unfortunately, this slightly positive turn is not all encompassing. The longitudinal research study mentioned above also uncovered that stigma toward schizophrenia, a severe mental illness resulting in various psychotic symptoms, has actually gotten worse in the last 30 years. Despite multiple campaigns to educate the public that schizophrenia is a disease resulting from chemical imbalances in the brain, among other things, and has a strong biological basis, public fear of people with schizophrenia has increased. As a result, the stigma-related problems outlined above continue to plague these individuals, which ultimately leads to sporadic treatment, if any, greatly limiting effectiveness.
Where Do We Go from Here?
While the days of being teased at school for just mentioning mental illness or mental health treatment may be mostly behind us, the negative impact of stigma toward mental illness is certainly not a thing of the past, and it requires increased attention. Interventions to reduce stigma that have proven useful include:
- Contact with people with mental illness. In-person is most effective, but videos can also be helpful.
- Focus education and awareness campaigns on a range of disorders, not just depression and anxiety, and include those that are significantly misunderstood.
- Emphasize the psychosocial factors of mental illness which may be easier for members of the public to relate to.
- Target groups that often fail to seek help.
- Provide recent and accurate information.
- Encourage equality between physical and mental illness.
- Show compassion for anyone struggling with a mental illness.
The ongoing work that is needed to decrease the impact of stigma and thus improve mental health care can no longer be someone else’s problem. It is not solely the responsibility of treatment professionals, advocates, policy makers, or legislators. It is the responsibility of the public to learn more about mental illness, report misconceptions, and counter messages of fear with real life experience and factual information.
This blog is courtesy of Jill L. Bezyak, PhD, CRC, Licensed Psychologist, Professor and Program Coordinator with the Rehabilitation Counseling and Sciences at the University of Northern Colorado. Jill is also the Principal Investigator and Center Director for the Rocky Mountain ADA Center.
References
American Psychiatric Association. (2024). Stigma, prejudice, and discrimination against people with mental illness. https://www.psychiatry.org/patients-families/stigma-and-discrimination
Corrigan, P.W. (2016). Principles and Practice of Psychiatric Rehabilitation: An Empirical Approach (2nd ed.). Guilford Press.
Lovell, D. (2022). Mental health stigma has weakened, but there is still more work to do. https://news.syr.edu/blog/2022/10/10/mental-health-stigma-has-weakened-but-theres-still-more-work-to-do/
Schomerus, G., Schindler, S., Baumann, E., & Angermeyer, M.C. (2023). Changes in continuum beliefs for depression and schizophrenia in the general population 2011-2020: A widening gap. Social Psychiatry and Psychiatric Epidemiology, 58(1), 17-23. 10.1007/s00127-022-02272-4