🕷️ Crawler Inspector

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Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 102 (from laksa035)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa102.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.psychiatry.org/patients-families/stigma-and-discrimination\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.psychiatry.org/patients-families/stigma-and-discrimination\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.psychiatry.org\/patients-families\/stigma-and-discrimination","crawl_time":1776156243,"first_indexed_time":1602417099,"http_code":200,"src_unparsed":"org,psychiatry!www,\/patients-families\/stigma-and-discrimination s443","src_root_hash":"3208705627035071702","history_drop_reason":null,"meta_title":"Psychiatry.org - Stigma, Prejudice and Discrimination Against People with Mental Illness","meta_descriptions":["Learn about Stigma, Prejudice and Discrimination Against People with Mental Illness"],"attrs_boilerpipe_text":"More than\nhalf of people with mental illness\ndon't receive help for their disorders. Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against people with mental illness are still very much a problem.\nStigma, prejudice and discrimination against people with mental illness can be subtle or obvious—but no matter the magnitude, they can lead to harm. People with mental illness are marginalized and discriminated against in various ways, but understanding what that looks like and how to address and eradicate it can help.\nStigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of\nstudies on stigma\nshows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness.\nStigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members.\nStigma around mental illness especially an issue in some diverse racial and ethnic communities and it can be a major barrier to people from those cultures accessing mental health services. For example, in some Asian cultures, seeking professional help for mental illness may be counter to cultural values of strong family, emotional restraint and avoiding shame. Among some groups, including the African American community's, distrust of the mental healthcare system can also be a barrier to seeking help. (See more on\nmental health in Diverse Populations\n.)\n \nPublic\nSelf\nStructural\nStereotypes & Prejudices\nPeople with mental illness are dangerous, incompetent, to blame for their disorder, unpredictable\nI am dangerous, incompetent, to blame\nStereotypes are embodied in laws and other institutions\nDiscrimination\nTherefore, employers may not hire them, landlords may not rent to them, the health care system may offer a lower standard of care\nThese thoughts may lead to lowered self-esteem and self-efficacy: \"Why try? Someone like me is not worthy, or unable to work, live independently, or have good health.\"\nLeads to intended and unintended loss of opportunity\nSource: Adapted from Corrigan, et al., 2014.\nMedia representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate or violent representations. A study published by Scarf, et. al. in 2020 looked at a recent example, the popular film\nJoker\n(2019), which portrays the lead character as a person with mental illness who becomes extremely violent. The study found that viewing the film \"was associated with higher levels of prejudice toward those with mental illness.\" Additionally, the authors suggest, \"\nJoker\nmay exacerbate self-stigma for those with a mental illness, leading to delays in help seeking.\"\nThe stigma of mental illness is universal. A\n2016 report on stigma\nconcluded \"there is no country, society or culture where people with mental illness have the same societal value as people without mental illness.\"\nHarmful Effects of Stigma and Discrimination\nStigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. A recent extensive\nreview of research\nfound that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses. Effects can include:\nreduced hope\nlower self-esteem\nincreased psychiatric symptoms\ndifficulties with social relationships\nreduced likelihood of staying with treatment\nmore difficulties at work\nA 2017 study by Oexle et al\n involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years.\nAn\neditorial in the\nLancet\nnotes that the impacts of stigma are pervasive, affecting political enthusiasm, charitable fundraising and availability, support for local services and underfunding of research for mental health relative to other health conditions.\nSome of the other harmful effects of stigma can include:\nReluctance to seek help or treatment and reduced likelihood of staying with treatment.\nSocial isolation.\nLack of understanding by family, friends, coworkers, or others.\nFewer opportunities for work, school or social activities or trouble finding housing.\nBullying, physical violence or harassment.\nHealth insurance that doesn't adequately cover your mental illness treatment.\nThe belief that you'll never succeed at certain challenges or that you can't improve your situation.\nSource: Adapted from Mayo Clinic 2017\nStigma Can Also Impact Family and Friends\nFamily members and friends, who often provide essential help and support for people with mental illness, can also experience stigma. They may internalize stigma and blame themselves, or they may fear that people will blame them for causing a loved one’s illness or reject the family socially. This stigma can lead to reduced emotional support, social isolation, and reluctance to seek care for their relative. (Yanos, 2023; Mclean, 2023)\nStigma in Diverse Communities\nStigma around mental illness is especially an issue in some diverse racial and ethnic communities, and it can be a major barrier to people from those cultures accessing mental health services. For more information, please see\nMental Health Disparities: Diverse Populations.\nStigma in the Workplace\nA\n2022 national poll\nfrom the American Psychiatric Association (APA) found that mental health stigma is still a major challenge in the workplace. About half (48%) of workers say they can discuss mental health openly and honestly with their supervisor, down from 56% in 2021 and 62% in 2020. Half (52%) also say they feel comfortable using mental health services with their current employer, compared to 64% in 2021 and 67% in 2020. In a more positive trend, fewer adults are worried about retaliation if they take time off or seek care for their mental health. About one in three (36%) worried about retaliation if they took time off, compared to 48% in 2021 and 52% in 2020. Less than one-third (31%) were worried about retaliation for seeking care, compared to 43% in 2021 and 2020. (APA, 2022)\nReducing Stigma\nPublic Health Approaches\nMany years of research on anti-stigma interventions has found that successful interventions (Yanos, 2023):\nInclude contact (in person, but video can also be a feature if done right).\nFocus on a range of disorders, not just depression or mental illness broadly.\nInvolve participation of people with “lived experience.”\nTarget groups that have the most interaction or where lack of help-seeking is most problematic (e.g., young people, undocumented communities, military communities).\nAre tailored to be credible to specific language and cultural signifiers of the target group.\nLast several years in order to be effective.\nSubstantial research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable.\nTeens are searching for health information online and mental health issues are among the top searches, according to a\nnational survey from Hope Lab\n(Hope Lab, 2021). About four in 10 teens said they have looked for people with similar health concerns. Many celebrities, such as Demi Lovato, Dwayne \"The Rock\" Johnson, Michael Phelps, Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges and brought the discussion much more into the general media and everyday conversation. Young people are looking for information and for these personal stories online.\nRecent studies have also shown the effectiveness of brief videos in reducing stigma.\nOne study\ntracked more than 700 students across two years in a randomized controlled trial and found that watching videos of people sharing their personal experiences and videos with information on mental health improved students' mental health care access (da Conceição, et al 2023). The researchers found that the intervention was particularly effective for those in need, enabling them to recognize their need for care and behave accordingly.\nAnother study\nfound that a video featuring an actor sharing a story was as effective as a person with lived experience. (Amsalem, et al 2023).\nSocial marketing campaigns can also be effective. For example, a\nresearch study\nlooked at the effectiveness of an anti-stigma social marketing campaign in California and found that the campaign increased service use by helping people better understand symptoms of distress and increasing awareness that help is available. (Collins, et al 2019). The researchers suggest that widespread exposure to the mental health campaign could significantly increase access to treatment.\nIndividual Actions to Reduce Stigma\nThe\nNational Alliance on Mental Illness\n(NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:\nTalk openly\nabout mental health, such as sharing on social media.\nEducate yourself and others\n– respond to misperceptions or negative comments by sharing facts and experiences.\nBe conscious of language\n– remind people that words matter.\nEncourage equality\nbetween physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes.\nShow compassion\nfor those with mental illness.\nBe honest about treatment\n– normalize mental health treatment, just like other health care treatment.\nLet the media know\nwhen they are using stigmatizing language presenting stories of mental illness in a stigmatizing way.\nChoose empowerment\nover shame – \"I fight stigma by choosing to live an empowered life. To me, that means owning my life and my story and refusing to allow others to dictate how I view myself or how I feel about myself.\" – Val Fletcher.\nReducing Stigma in the Workplace While stigma and discrimination are still prevalent in the workplace, employers are increasingly addressing stigma against mental illness. The APA Foundation's Center for Workplace Mental Health emphasizes the importance of both robust healthcare services and specific efforts to break the silence that surrounds the topic of mental illness. The Center suggests organizations strive to \"create a culture in which mention of depression, anxiety, post-trauma, and other common illnesses become as mentionable as diabetes, hypertension, and migraines.\"\nEmployers who are leading efforts to address stigma offer some suggestions (CWMH):\nTailor programs\/approaches\nto your company culture and existing strengths.\nMention your commitment\nto leading a behaviorally healthy workplace every time you mention the company's commitment to its overall culture of health, attracting and retaining the best talent, and valuing its employees, etc.\nTrain leaders\nto identify emotional distress and make referrals and to responding promptly and constructively to behavioral performance issues.\nBe welcoming\nof the need for accommodations. Train managers to respond appropriately\nOrganizations and Campaigns\nAcross the country numerous organizations and campaigns focus on addressing the issue of mental health stigma and discrimination. A few examples are highlighted below:\nStop Stigma Together\n is working to unite organizations to create resources, generate funding, bring clarifying awareness, and address the issues around mental health and substance use disorders. They will pose a grand challenge to our friends, family, employers, healthcare providers and governments to end the stigma around mental health and substance-use disorders to establish true well-being.\nThis is My Brave\nis a storytelling theatre show where individuals from the community share their stories of living a successful life despite mental illness. Since 2014, This Is My Brave has produced nearly 800 storytellers sharing true, personal stories on overcoming depression, anxiety, bipolar disorder, PTSD and other illnesses. In spring 2020, the organizers developed BraveTV to bring stories of hope online during the COVID-19 pandemic.\nOne recent effort is the\nMental Health Coalition\n, spearheaded by Kenneth Cole in partnership with handful of partners. Partner organizations and celebrities include Active Minds, NAMI, The JED Foundation, Anxiety and Depression Association of America, Kendall Jenner, Kesha, and others. The focus of the coalition is fighting stigma through the sharing of stories with the tag line \"How are you really?\"\nBring Change to Mind\nis a nonprofit organization focused on encouraging dialogue about mental health and raising awareness, understanding, and empathy. Actress and activist Glenn Close co-founded Bring Change to Mind in 2010 after her sister and nephew were diagnosed with mental illnesses. It offers resources and tools to learn more and take action to reduce stigma.\nNAMI's StigmaFree\ncampaign is working to end stigma and create hope for those affected by mental illness: \"Through powerful words and actions, we can shift the social and systemic barriers for those living with mental health conditions.\" As part of the campaign, people can take a stigma quiz at\nCureStigma.org\nand learn more about becoming stigma free.\nStamp Out Stigma\nis an initiative spearheaded by the Association for Behavioral Health and Wellness to reduce the stigma surrounding mental illness and substance use disorders. The campaign encourages people to start the conversation and to talk openly about mental illness and substance use.\nHealthy Minds with Dr. Jeffrey Borenstein\naims to remove the stigma of mental illness and demonstrate that with help, there is hope. The series focuses on common psychiatric conditions through inspiring personal stories, as well as, experts sharing cutting edge information, including new approaches and next-generation therapies in diagnostics, treatment and research. Series is produced by the Brain & Behavior Research Foundation.\nHow So We Stop Stigma?\nConversation\nTry these simple tips for talking.\nDo Say\n\"Thanks for opening up to me.\"\n\"Is there anything I can do to help?\"\n\"I'm sorry to hear that. It must be tough.\"\n\"I'm here for you when you need me.\"\n\"I can't imagine what you're going through.\"\n\"People do get better.\"\n\"Oh man, that sucks.\"\n\"Can I drive you to an appointment?\"\n\"How are you feeling today?\"\n\"I love you.\"\nDon't Say\n\"It could be worse.\"\n\"Just deal with it.\"\n\"Snap out of it.\"\n\"Everyone feels that way sometimes.\"\n\"You may have brought this on yourself.\"\n\"We've all been there.\"\n\"You've got to pull yourself together.\"\n\"Maybe try thinking happier thoughts.\"\nSource: MakeItOK.org\nPhysician Review\nNikhita Singhal, M.D.\nUniversity of Toronto, Psychiatry Resident\nMarch 2024","attrs_markdown":"[Skip to content](https:\/\/www.psychiatry.org\/patients-families\/stigma-and-discrimination#main)\n\n[Advocacy Action Center for Members: Federal Policy Updates. 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Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against people with mental illness are still very much a problem.\n\nStigma, prejudice and discrimination against people with mental illness can be subtle or obvious—but no matter the magnitude, they can lead to harm. People with mental illness are marginalized and discriminated against in various ways, but understanding what that looks like and how to address and eradicate it can help.\n\n## **The Facts on Stigma, Prejudice and Discrimination**\nStigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of [studies on stigma](https:\/\/pubmed.ncbi.nlm.nih.gov\/26410341\/) shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness.\n\nResearchers identify different types of stigma: (See chart below.)\n\n- **Public stigma** involves the negative or discriminatory attitudes that others may have about mental illness.\n- **Self-stigma** refers to the negative attitudes, including internalized shame, that people with mental illness may have about their own condition.\n- **Structural stigma** is more systemic, involving policies of government and private organizations that intentionally or unintentionally limit opportunities for people with mental illness. Examples include lower funding for mental illness research or fewer mental health services relative to other health care.\n\nStigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members.\n\nStigma around mental illness especially an issue in some diverse racial and ethnic communities and it can be a major barrier to people from those cultures accessing mental health services. For example, in some Asian cultures, seeking professional help for mental illness may be counter to cultural values of strong family, emotional restraint and avoiding shame. Among some groups, including the African American community's, distrust of the mental healthcare system can also be a barrier to seeking help. (See more on [mental health in Diverse Populations](https:\/\/www.psychiatry.org\/psychiatrists\/diversity).)\n\n## **Types of Stigma**\n|   | Public | Self | Structural |\n|---|---|---|---|\n| Stereotypes & Prejudices | People with mental illness are dangerous, incompetent, to blame for their disorder, unpredictable | I am dangerous, incompetent, to blame | Stereotypes are embodied in laws and other institutions |\n| Discrimination | Therefore, employers may not hire them, landlords may not rent to them, the health care system may offer a lower standard of care | These thoughts may lead to lowered self-esteem and self-efficacy: \"Why try? Someone like me is not worthy, or unable to work, live independently, or have good health.\" | Leads to intended and unintended loss of opportunity |\n\n*Source: Adapted from Corrigan, et al., 2014.*\n\nMedia representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate or violent representations. A study published by Scarf, et. al. in 2020 looked at a recent example, the popular film *Joker* (2019), which portrays the lead character as a person with mental illness who becomes extremely violent. The study found that viewing the film \"was associated with higher levels of prejudice toward those with mental illness.\" Additionally, the authors suggest, \"*Joker* may exacerbate self-stigma for those with a mental illness, leading to delays in help seeking.\"\n\nThe stigma of mental illness is universal. A [2016 report on stigma](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5007563\/) concluded \"there is no country, society or culture where people with mental illness have the same societal value as people without mental illness.\"\n\n## **Harmful Effects of Stigma and Discrimination**\nStigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. A recent extensive [review of research](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0165178120301682?dgcid=raven_sd_via_email) found that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses. Effects can include:\n\n- reduced hope\n- lower self-esteem\n- increased psychiatric symptoms\n- difficulties with social relationships\n- reduced likelihood of staying with treatment\n- more difficulties at work\n\n[A 2017 study by Oexle et al](https:\/\/pubmed.ncbi.nlm.nih.gov\/28188369\/) involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years.\n\nAn [editorial in the *Lancet*](https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736\\(16\\)00687-5\/fulltext) notes that the impacts of stigma are pervasive, affecting political enthusiasm, charitable fundraising and availability, support for local services and underfunding of research for mental health relative to other health conditions.\n\nSome of the other harmful effects of stigma can include:\n\n- Reluctance to seek help or treatment and reduced likelihood of staying with treatment.\n- Social isolation.\n- Lack of understanding by family, friends, coworkers, or others.\n- Fewer opportunities for work, school or social activities or trouble finding housing.\n- Bullying, physical violence or harassment.\n- Health insurance that doesn't adequately cover your mental illness treatment.\n- The belief that you'll never succeed at certain challenges or that you can't improve your situation.\n\n*Source: Adapted from Mayo Clinic 2017*\n\n### **Stigma Can Also Impact Family and Friends**\nFamily members and friends, who often provide essential help and support for people with mental illness, can also experience stigma. They may internalize stigma and blame themselves, or they may fear that people will blame them for causing a loved one’s illness or reject the family socially. This stigma can lead to reduced emotional support, social isolation, and reluctance to seek care for their relative. (Yanos, 2023; Mclean, 2023)\n\n**Stigma in Diverse Communities**\n\nStigma around mental illness is especially an issue in some diverse racial and ethnic communities, and it can be a major barrier to people from those cultures accessing mental health services. For more information, please see [Mental Health Disparities: Diverse Populations.](https:\/\/www.psychiatry.org\/psychiatrists\/diversity\/education\/mental-health-facts)\n\n## **Stigma in the Workplace**\n**Employee Assistance Programs (EAP)**, commonly available through employers, help employees deal with a variety of concerns such as work-life stressors, mental and emotional well-being issues, family and relationship issues, or financial or legal concerns. However, the services often go unused—only about 3-5% of employees use EAP services, according to the Center for Workplace Mental Health.\n\nA [2022 national poll](https:\/\/staging.psychiatry.org\/News-room\/News-Releases\/APA-Poll-Employee-Mental-Health) from the American Psychiatric Association (APA) found that mental health stigma is still a major challenge in the workplace. About half (48%) of workers say they can discuss mental health openly and honestly with their supervisor, down from 56% in 2021 and 62% in 2020. Half (52%) also say they feel comfortable using mental health services with their current employer, compared to 64% in 2021 and 67% in 2020. In a more positive trend, fewer adults are worried about retaliation if they take time off or seek care for their mental health. About one in three (36%) worried about retaliation if they took time off, compared to 48% in 2021 and 52% in 2020. Less than one-third (31%) were worried about retaliation for seeking care, compared to 43% in 2021 and 2020. (APA, 2022)\n\n## **Reducing Stigma**\n### Public Health Approaches\nMany years of research on anti-stigma interventions has found that successful interventions (Yanos, 2023):\n\n- Include contact (in person, but video can also be a feature if done right).\n- Focus on a range of disorders, not just depression or mental illness broadly.\n- Involve participation of people with “lived experience.”\n- Target groups that have the most interaction or where lack of help-seeking is most problematic (e.g., young people, undocumented communities, military communities).\n- Are tailored to be credible to specific language and cultural signifiers of the target group.\n- Last several years in order to be effective.\n\nSubstantial research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable.\n\nTeens are searching for health information online and mental health issues are among the top searches, according to a [national survey from Hope Lab](https:\/\/assets.hopelab.org\/wp-content\/uploads\/2021\/03\/2021-coping-with-covid19-full-report.pdf) (Hope Lab, 2021). About four in 10 teens said they have looked for people with similar health concerns. Many celebrities, such as Demi Lovato, Dwayne \"The Rock\" Johnson, Michael Phelps, Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges and brought the discussion much more into the general media and everyday conversation. Young people are looking for information and for these personal stories online.\n\nRecent studies have also shown the effectiveness of brief videos in reducing stigma. [One study](https:\/\/pubmed.ncbi.nlm.nih.gov\/38113809\/) tracked more than 700 students across two years in a randomized controlled trial and found that watching videos of people sharing their personal experiences and videos with information on mental health improved students' mental health care access (da Conceição, et al 2023). The researchers found that the intervention was particularly effective for those in need, enabling them to recognize their need for care and behave accordingly. [Another study](https:\/\/ps.psychiatryonline.org\/doi\/10.1176\/appi.ps.20230215) found that a video featuring an actor sharing a story was as effective as a person with lived experience. (Amsalem, et al 2023).\n\nSocial marketing campaigns can also be effective. For example, a [research study](https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.2019.305129) looked at the effectiveness of an anti-stigma social marketing campaign in California and found that the campaign increased service use by helping people better understand symptoms of distress and increasing awareness that help is available. (Collins, et al 2019). The researchers suggest that widespread exposure to the mental health campaign could significantly increase access to treatment.\n\n### **Individual Actions to Reduce Stigma**\nThe [National Alliance on Mental Illness](https:\/\/www.nami.org\/Blogs\/NAMI-Blog\/October-2017\/9-Ways-to-Fight-Mental-Health-Stigma) (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:\n\n- **Talk openly** about mental health, such as sharing on social media.\n- **Educate yourself and others** – respond to misperceptions or negative comments by sharing facts and experiences.\n- **Be conscious of language** – remind people that words matter.\n- **Encourage equality** between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes.\n- **Show compassion** for those with mental illness.\n- **Be honest about treatment** – normalize mental health treatment, just like other health care treatment.\n- **Let the media know** when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way.\n- **Choose empowerment** over shame – \"I fight stigma by choosing to live an empowered life. To me, that means owning my life and my story and refusing to allow others to dictate how I view myself or how I feel about myself.\" – Val Fletcher.\n\nReducing Stigma in the Workplace While stigma and discrimination are still prevalent in the workplace, employers are increasingly addressing stigma against mental illness. The APA Foundation's Center for Workplace Mental Health emphasizes the importance of both robust healthcare services and specific efforts to break the silence that surrounds the topic of mental illness. The Center suggests organizations strive to \"create a culture in which mention of depression, anxiety, post-trauma, and other common illnesses become as mentionable as diabetes, hypertension, and migraines.\"\n\n### Employers who are leading efforts to address stigma offer some suggestions (CWMH):\n- **Tailor programs\/approaches** to your company culture and existing strengths.\n- **Mention your commitment** to leading a behaviorally healthy workplace every time you mention the company's commitment to its overall culture of health, attracting and retaining the best talent, and valuing its employees, etc.\n- **Train leaders** to identify emotional distress and make referrals and to responding promptly and constructively to behavioral performance issues.\n- **Be welcoming** of the need for accommodations. Train managers to respond appropriately\n## **Organizations and Campaigns**\nAcross the country numerous organizations and campaigns focus on addressing the issue of mental health stigma and discrimination. A few examples are highlighted below:\n\n- ![Love, your mind logo](https:\/\/www.psychiatry.org\/getmedia\/5e63166d-1d62-4cad-bc68-b239beb9ac5b\/Love-your-mind-logo.jpg)\n  \n  The [“Love, Your Mind”](https:\/\/loveyourmindtoday.org\/)campaign, from the [Huntsman Mental Health Institute](https:\/\/huntsmanmentalhealthfoundation.org\/#HMHID&reserved=0) and the [Ad Council](https:\/\/www.adcouncil.org\/), offers inspiration, community and educational resources to encourage people across the U.S. to be more open and proactive when it comes to their mental health. Read about the campaign in the [APA journal Focus.](https:\/\/www.psychiatryonline.org\/doi\/10.1176\/appi.focus.20240039)\n- ![Stop Stigma together logo](https:\/\/www.psychiatry.org\/getmedia\/124824e1-2509-4f4c-9005-73732be4f067\/Stop-stigma-together-logo.jpg)\n  \n  [Stop Stigma Together](https:\/\/stopstigmatogether.org\/) is working to unite organizations to create resources, generate funding, bring clarifying awareness, and address the issues around mental health and substance use disorders. They will pose a grand challenge to our friends, family, employers, healthcare providers and governments to end the stigma around mental health and substance-use disorders to establish true well-being.\n- ![This is my brave logo](https:\/\/www.psychiatry.org\/getmedia\/bab57aaf-241f-4dfd-a87f-63fc308b47ac\/this-is-my-brave.png)\n  \n  [This is My Brave](https:\/\/thisismybrave.org\/) is a storytelling theatre show where individuals from the community share their stories of living a successful life despite mental illness. Since 2014, This Is My Brave has produced nearly 800 storytellers sharing true, personal stories on overcoming depression, anxiety, bipolar disorder, PTSD and other illnesses. In spring 2020, the organizers developed BraveTV to bring stories of hope online during the COVID-19 pandemic.\n- ![How are you really campaign logo](https:\/\/www.psychiatry.org\/getmedia\/fbad59a5-cea8-45e3-80e3-1bee5f0244e7\/how-are-you-really.jpeg)\n  \n  One recent effort is the [Mental Health Coalition](https:\/\/www.thementalhealthcoalition.org\/), spearheaded by Kenneth Cole in partnership with handful of partners. Partner organizations and celebrities include Active Minds, NAMI, The JED Foundation, Anxiety and Depression Association of America, Kendall Jenner, Kesha, and others. The focus of the coalition is fighting stigma through the sharing of stories with the tag line \"How are you really?\"\n- ![](https:\/\/www.psychiatry.org\/getmedia\/5e115e61-b6ad-4a61-8a4c-1d65f963fec1\/Bring-change-logo.png)\n  \n  [Bring Change to Mind](https:\/\/www.bringchange2mind.org\/) is a nonprofit organization focused on encouraging dialogue about mental health and raising awareness, understanding, and empathy. Actress and activist Glenn Close co-founded Bring Change to Mind in 2010 after her sister and nephew were diagnosed with mental illnesses. It offers resources and tools to learn more and take action to reduce stigma.\n- ![Stigma free campaign logo](https:\/\/www.psychiatry.org\/getmedia\/5e75812b-ad59-4006-be1b-0f5834f30172\/stigma-free-logo.png)\n  \n  [NAMI's StigmaFree](https:\/\/www.nami.org\/Get-Involved\/Pledge-to-Be-StigmaFree) campaign is working to end stigma and create hope for those affected by mental illness: \"Through powerful words and actions, we can shift the social and systemic barriers for those living with mental health conditions.\" As part of the campaign, people can take a stigma quiz at [CureStigma.org](http:\/\/www.curestigma.org\/) and learn more about becoming stigma free.\n- ![Stamp out stigma logo](https:\/\/www.psychiatry.org\/getmedia\/8b969c09-91b7-422f-8aa1-89ebd7f4d55a\/stamp-out-stigma.png)\n  \n  [Stamp Out Stigma](https:\/\/stampoutstigma.com\/) is an initiative spearheaded by the Association for Behavioral Health and Wellness to reduce the stigma surrounding mental illness and substance use disorders. The campaign encourages people to start the conversation and to talk openly about mental illness and substance use.\n- ![PBS Healthy Minds logo](https:\/\/www.psychiatry.org\/getmedia\/498f449e-660e-402a-9562-150730dba3ed\/healthy-minds-pbs-logo.jpg)\n  \n  [Healthy Minds with Dr. Jeffrey Borenstein](https:\/\/www.pbs.org\/show\/healthy-minds-with-dr-jeffrey-borenstein\/) aims to remove the stigma of mental illness and demonstrate that with help, there is hope. The series focuses on common psychiatric conditions through inspiring personal stories, as well as, experts sharing cutting edge information, including new approaches and next-generation therapies in diagnostics, treatment and research. Series is produced by the Brain & Behavior Research Foundation.\n## How So We Stop Stigma? *Conversation*\nTry these simple tips for talking.\n\n### Do Say\n- \"Thanks for opening up to me.\"\n- \"Is there anything I can do to help?\"\n- \"I'm sorry to hear that. It must be tough.\"\n- \"I'm here for you when you need me.\"\n- \"I can't imagine what you're going through.\"\n- \"People do get better.\"\n- \"Oh man, that sucks.\"\n- \"Can I drive you to an appointment?\"\n- \"How are you feeling today?\"\n- \"I love you.\"\n\n### Don't Say\n- \"It could be worse.\"\n- \"Just deal with it.\"\n- \"Snap out of it.\"\n- \"Everyone feels that way sometimes.\"\n- \"You may have brought this on yourself.\"\n- \"We've all been there.\"\n- \"You've got to pull yourself together.\"\n- \"Maybe try thinking happier thoughts.\"\n\n*Source: MakeItOK.org*\n\nReferences\n\n- Amsalem, D. et al. 2023. [Stigma Reduction Via Brief Video Interventions: Comparing Presentations by an Actor Versus a Person With Lived Experience.](https:\/\/ps.psychiatryonline.org\/doi\/10.1176\/appi.ps.20230215) Psychiatric Services. https:\/\/doi.org\/10.1176\/appi.ps.20230215\n- APA News Release: Employees Say Workplaces Are Offering Fewer Mental Health Services in 2022, According to APA Poll. May 22, 2022.\n- Barnett, D. 2023. [‘Tis the Season: Opportune Time to Help Reduce Stigma of Substance Use Disorders](https:\/\/psychnews.psychiatryonline.org\/doi\/10.1176\/appi.pn.2023.12.12.35) Psychiatric News. Nov. 27, 2023. https:\/\/doi.org\/10.1176\/appi.pn.2023.12.12.35\n- Center for Workplace Mental Health. [Working Well Toolkit](https:\/\/workplacementalhealth.org\/employer-resources\/the-working-well-toolkit). 2016.\n- Collins, R.L., et al. [Social Marketing of Mental Health Treatment: California's Mental Illness Stigma Reduction Campaign](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6595511\/). *Am J Public Health*. 2019 June; 109(Suppl 3): S228–S235.\n- Corrigan, Pw, Druss, BG, Perlick, DA. [The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care](https:\/\/journals.sagepub.com\/stoken\/rbtfl\/dDpyhM2zRi.Fg\/full). *Psychological Science in The Public Interest*. 2014, 15(2);37-70.\n- da Conceição, V., Mesquita, E., & Gusmão, R. (2023). [Effects of a stigma reduction intervention on help-seeking behaviors in university students: A 2019-2021 randomized controlled trial](https:\/\/pubmed.ncbi.nlm.nih.gov\/38113809\/). Psychiatry research, 331, 115673. Advance online publication. https:\/\/doi.org\/10.1016\/j.psychres.2023.115673\n- Forde, K. 2020. [By Sharing Their Own Struggles, Celebs Help Teens Tear Down Mental Health Stigma](https:\/\/www.ozy.com\/the-new-and-the-next\/by-sharing-their-own-struggles-celebs-help-teens-tear-down-mental-health-stigma\/253556\/).\n- Greenstein, L. [9 Ways To Fight Mental Health Stigma](https:\/\/www.nami.org\/blogs\/nami-blog\/october-2017\/9-ways-to-fight-mental-health-stigma). NAMI blog, Oct. 11, 2017.\n- Hope Lab, Common Sense, and California HealthCare Foundation. 2021. [Coping With Covid-19: How Young People Use Digital Media To Manage Their Mental Health.](https:\/\/assets.hopelab.org\/wp-content\/uploads\/2021\/03\/2021-coping-with-covid19-full-report.pdf)\n- Mayo Clinic. [Mental health: Overcoming the stigma of mental illness](https:\/\/www.mayoclinic.org\/diseases-conditions\/mental-illness\/in-depth\/mental-health\/art-20046477). 2017.\n- McLean\/Mass General Brigham, 2023. [Let’s Face It, No One Wants To Talk About Mental Health](https:\/\/www.mcleanhospital.org\/essential\/lets-face-it-no-one-wants-talk-about-mental-health)\n- Oexle N, Müller M, Kawohl W, et al. [Self-stigma as a barrier to recovery: a longitudinal study](https:\/\/pubmed.ncbi.nlm.nih.gov\/28188369\/). *European Archives of Psychiatry and Clinical Neuroscience*. October 2017. doi: 10.1007\/s00406-017-0773-2.\n- Pescosolido, BA. [The public stigma of mental illness: what do we think; what do we know; what can we prove?](https:\/\/pubmed.ncbi.nlm.nih.gov\/23325423\/) *J Health Soc Behav*. 2013 Mar;54(1):1-21. doi: 10.1177\/0022146512471197.\n- Scarf, D., et al. [Association of Viewing the Films Joker or Terminator: Dark Fate With Prejudice Toward Individuals With Mental Illness](https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2764842). *JAMA Network Open*. April 24, 2020.\n- Yanos, P., Amsalem, D., Dixon, L. 2023. Brief video interventions to reduce self-, public, and affiliate stigma among\/toward young individuals with psychosis. Presentation at APA 2023 Mental Health Services Conference\n## Physician Review\nNikhita Singhal, M.D.  \n University of Toronto, Psychiatry Resident\n\nMarch 2024\n\n![Mental Health Care Works](https:\/\/www.psychiatry.org\/getmedia\/b7fbdea8-1eb8-4391-b3b7-3df7a17072e8\/MHCW-Feature.png?width=799&height=540&ext=.png)\n\n## Mental Health Care Works\nThe APA Foundation’s public awareness campaign, \"Mental Health Care Works,\" focuses on empowering those with mental health concerns to take the first step toward getting help.\n\n[Explore the campaign](https:\/\/mentalhealthcareworks.org\/)\n\nAPA resources\n\n## Myths and Facts About Mental Health\nRead more in an APA blog post:\n\n[Myths and Facts and Mental Health](https:\/\/www.psychiatry.org\/News-room\/APA-Blogs\/Myths-and-Facts-About-Mental-Health)\n\n## Medical leadership for mind, brain and body.\n[Join Today](https:\/\/www.psychiatry.org\/membership\/join-apa)\n\n### Explore APA Toggle List\n- [Psychiatrists](https:\/\/www.psychiatry.org\/psychiatrists)\n- [Residents & Medical Students](https:\/\/www.psychiatry.org\/residents-medical-students\/residents)\n- [Patients & Families](https:\/\/www.psychiatry.org\/patients-families)\n- [About APA](https:\/\/www.psychiatry.org\/about-apa)\n- [Work At APA](https:\/\/www.psychiatry.org\/about-apa\/work-at-apa)\n- [Annual Meeting](https:\/\/www.psychiatry.org\/psychiatrists\/meetings)\n\n### Newsroom Toggle List\n- [News Releases](https:\/\/www.psychiatry.org\/news-room\/news-releases)\n- [Psychiatric News](http:\/\/psychnews.psychiatryonline.org\/)\n- [Message from President](https:\/\/psychnews.psychiatryonline.org\/topic\/news-president?sortBy=Ppub&)\n- [APA Blogs](https:\/\/www.psychiatry.org\/news-room\/apa-blogs)\n\n### Join APA Toggle List\n- [General Members](https:\/\/www.psychiatry.org\/membership\/join-apa\/general-members)\n- [Early Career Psychiatrists](https:\/\/www.psychiatry.org\/membership\/join-apa\/early-career-psychiatrists)\n- [Residents & Fellows](https:\/\/www.psychiatry.org\/membership\/join-apa\/residents-and-fellows)\n- [Medical Students](https:\/\/www.psychiatry.org\/membership\/join-apa\/medical-students)\n- [International](https:\/\/www.psychiatry.org\/membership\/join-apa\/international)\n- [International Resident-Fellows](https:\/\/www.psychiatry.org\/membership\/join-apa\/international-resident-fellows)\n- [Semi-Retired & Retired](https:\/\/www.psychiatry.org\/membership\/join-apa\/semi-retired-and-retired)\n\n### APA Sites Toggle List\n- [APA Annual Meeting](https:\/\/www.psychiatry.org\/psychiatrists\/meetings\/annual-meeting)\n- [APA Communities](http:\/\/community.psychiatry.org\/)\n- [APA Foundation](https:\/\/www.apaf.org\/)\n- [APA JobCentral](https:\/\/jobs.psychiatry.org\/)\n- [APA Learning Center](https:\/\/education.psychiatry.org\/SSOLogin)\n- [APA Publishing](https:\/\/www.appi.org\/)\n- [Center for Workplace Mental Health](http:\/\/workplacementalhealth.org\/)\n- [Melvin Sabshin, M.D. Library & Archives](https:\/\/www.apaf.org\/library-archives\/)\n- [Psychiatric News](http:\/\/psychnews.psychiatryonline.org\/)\n- [Psychiatry Online](http:\/\/www.psychiatryonline.org\/)\n\n- [Terms of Use and Privacy Policy](https:\/\/www.psychiatry.org\/terms-of-use-and-privacy-policy)\n- [Copyright](https:\/\/www.psychiatry.org\/copyright)\n- [Contact](https:\/\/www.psychiatry.org\/about-apa\/contact-us)\n- [Conflict of Interest Policy](https:\/\/www.psychiatry.org\/conflict-of-interest-policy)\n- [Accessibility](https:\/\/www.psychiatry.org\/accessibility)\n- [Cookie Policy](https:\/\/www.psychiatry.org\/cookie-policy)\n- [Your Cookie Preference Settings](Javascript:OneTrust.ToggleInfoDisplay\\(\\);)\n\n- © 2026 American Psychiatric Association. 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Disorders**](https:\/\/www.psychiatry.org\/patients-families\/anxiety-disorders)\n- [What are Anxiety Disorders?](https:\/\/www.psychiatry.org\/patients-families\/anxiety-disorders\/what-are-anxiety-disorders)\n- [Expert Q\\&A: Anxiety Disorders](https:\/\/www.psychiatry.org\/patients-families\/anxiety-disorders\/expert-q-and-a)\n\n- Back\n- [**Attention-Deficit\/Hyperactivity Disorder (ADHD)**](https:\/\/www.psychiatry.org\/patients-families\/adhd)\n- [What is ADHD?](https:\/\/www.psychiatry.org\/patients-families\/adhd\/what-is-adhd)\n- [Expert Q\\&A: ADHD](https:\/\/www.psychiatry.org\/patients-families\/adhd\/expert-q-and-a)\n- [ADHD in Adults](https:\/\/www.psychiatry.org\/patients-families\/adhd\/adhd-in-adults)\n\n- Back\n- [**Autism Spectrum Disorder**](https:\/\/www.psychiatry.org\/patients-families\/autism)\n- [What Is Autism Spectrum Disorder?](https:\/\/www.psychiatry.org\/patients-families\/autism\/what-is-autism-spectrum-disorder)\n- [Expert Q\\&A: Autism Spectrum Disorder](https:\/\/www.psychiatry.org\/patients-families\/autism\/expert-q-and-a)\n\n- Back\n- [**Bipolar Disorders**](https:\/\/www.psychiatry.org\/patients-families\/bipolar-disorders)\n- [What Are Bipolar Disorders?](https:\/\/www.psychiatry.org\/patients-families\/bipolar-disorders\/what-are-bipolar-disorders)\n- [Expert Q\\&A: Bipolar Disorder](https:\/\/www.psychiatry.org\/patients-families\/bipolar-disorders\/expert-q-and-a)\n\n- Back\n- [**Climate Change and Mental Health Connections**](https:\/\/www.psychiatry.org\/patients-families\/climate-change-and-mental-health-connections)\n- [How Extreme Weather Events Affect Mental Health](https:\/\/www.psychiatry.org\/patients-families\/climate-change-and-mental-health-connections\/affects-on-mental-health)\n- [Who Is Affected by Climate Change?](https:\/\/www.psychiatry.org\/patients-families\/climate-change-and-mental-health-connections\/who-is-affected-by-climate-change)\n\n- Back\n- [**Dementia and Alzheimer's Disease**](https:\/\/www.psychiatry.org\/patients-families\/alzheimers)\n- [What Are Dementia and Alzheimer’s Disease?](https:\/\/www.psychiatry.org\/patients-families\/alzheimers\/what-is-alzheimers-disease)\n- [Expert Q\\&A: Dementia and Alzheimer's Disease](https:\/\/www.psychiatry.org\/patients-families\/alzheimers\/expert-q-and-a)\n\n- Back\n- [**Depression**](https:\/\/www.psychiatry.org\/patients-families\/depression)\n- [What Is Depression?](https:\/\/www.psychiatry.org\/patients-families\/depression\/what-is-depression)\n- [Expert Q\\&A: Depression](https:\/\/www.psychiatry.org\/patients-families\/depression\/expert-q-and-a)\n\n- Back\n- [**Disruptive, Impulse-Control and Conduct Disorders**](https:\/\/www.psychiatry.org\/patients-families\/disruptive-impulse-control-and-conduct-disorders)\n- [What are Disruptive, Impulse Control and Conduct Disorders?](https:\/\/www.psychiatry.org\/patients-families\/disruptive-impulse-control-and-conduct-disorders\/what-are-disruptive-impulse-control-and-conduct)\n- [Expert Q\\&A: Disruptive, Impulse Control and Conduct Disorders](https:\/\/www.psychiatry.org\/patients-families\/disruptive-impulse-control-and-conduct-disorders\/expert-q-and-a)\n\n- Back\n- [**Dissociative Disorders**](https:\/\/www.psychiatry.org\/patients-families\/dissociative-disorders)\n- [What Are Dissociative Disorders?](https:\/\/www.psychiatry.org\/patients-families\/dissociative-disorders\/what-are-dissociative-disorders)\n- [Expert Q\\&A: Dissociative Disorders](https:\/\/www.psychiatry.org\/patients-families\/dissociative-disorders\/expert-q-and-a)\n\n- Back\n- [**Eating Disorders**](https:\/\/www.psychiatry.org\/patients-families\/eating-disorders)\n- [What are Eating Disorders?](https:\/\/www.psychiatry.org\/patients-families\/eating-disorders\/what-are-eating-disorders)\n- [Expert Q\\&A: Eating Disorders](https:\/\/www.psychiatry.org\/patients-families\/eating-disorders\/expert-q-and-a)\n\n- Back\n- [**Gambling Disorder**](https:\/\/www.psychiatry.org\/patients-families\/gambling-disorder)\n- [What is Gambling Disorder?](https:\/\/www.psychiatry.org\/patients-families\/gambling-disorder\/what-is-gambling-disorder)\n- [Expert Q\\&A: Gambling Disorder](https:\/\/www.psychiatry.org\/patients-families\/gambling-disorder\/expert-q-and-a)\n\n- Back\n- [**Gender Dysphoria**](https:\/\/www.psychiatry.org\/patients-families\/gender-dysphoria)\n- [What is Gender Dysphoria?](https:\/\/www.psychiatry.org\/patients-families\/gender-dysphoria\/what-is-gender-dysphoria)\n- [Expert Q\\&A: Gender Dysphoria](https:\/\/www.psychiatry.org\/patients-families\/gender-dysphoria\/expert-q-and-a)\n\n- Back\n- [**Hoarding Disorder**](https:\/\/www.psychiatry.org\/patients-families\/hoarding-disorder)\n- [What is Hoarding Disorder?](https:\/\/www.psychiatry.org\/patients-families\/hoarding-disorder\/what-is-hoarding-disorder)\n- [Expert Q\\&A: Hoarding Disorder](https:\/\/www.psychiatry.org\/patients-families\/hoarding-disorder\/expert-q-and-a)\n\n- Back\n- [**Intellectual Disability**](https:\/\/www.psychiatry.org\/patients-families\/intellectual-disability)\n- [What is Intellectual Disability?](https:\/\/www.psychiatry.org\/patients-families\/intellectual-disability\/what-is-intellectual-disability)\n- [Expert Q\\&A: Intellectual Disability](https:\/\/www.psychiatry.org\/patients-families\/intellectual-disability\/expert-q-and-a)\n\n- Back\n- [**Neurodevelopmental Disorders**](https:\/\/www.psychiatry.org\/patients-families\/neurodevelopment-disorders)\n- [Neurodevelopmental Disorders - Communication Disorders](https:\/\/www.psychiatry.org\/patients-families\/neurodevelopment-disorders\/neurodevelopment-disorders-communication-disorders)\n- [Neurodevelopmental Disorders - Motor Disorders](https:\/\/www.psychiatry.org\/patients-families\/neurodevelopment-disorders\/neurodevelopmental-disorders-motor-disorders)\n\n- Back\n- [**Obsessive-Compulsive and Related Disorders**](https:\/\/www.psychiatry.org\/patients-families\/obsessive-compulsive-disorder)\n- [What Is are Obsessive-Compulsive and Related Disorders?](https:\/\/www.psychiatry.org\/patients-families\/obsessive-compulsive-disorder\/what-is-obsessive-compulsive-disorder)\n- [Expert Q\\&A: Obsessive-Compulsive and Related Disorders](https:\/\/www.psychiatry.org\/patients-families\/obsessive-compulsive-disorder\/expert-q-and-a)\n\n- Back\n- [**Perinatal Depression (formerly Postpartum)**](https:\/\/www.psychiatry.org\/patients-families\/peripartum-depression)\n- [What is Perinatal Depression (formerly Postpartum)?](https:\/\/www.psychiatry.org\/patients-families\/peripartum-depression\/what-is-peripartum-depression)\n- [Expert Q\\&A: Perinatal Depression](https:\/\/www.psychiatry.org\/patients-families\/peripartum-depression\/expert-q-and-a)\n\n- Back\n- [**Personality Disorders**](https:\/\/www.psychiatry.org\/patients-families\/personality-disorders)\n- [What are Personality Disorders?](https:\/\/www.psychiatry.org\/patients-families\/personality-disorders\/what-are-personality-disorders)\n- [Expert Q\\&A: Personality Disorders](https:\/\/www.psychiatry.org\/patients-families\/personality-disorders\/expert-q-and-a)\n\n- Back\n- [**Posttraumatic Stress Disorder (PTSD)**](https:\/\/www.psychiatry.org\/patients-families\/ptsd)\n- [What is Posttraumatic Stress Disorder (PTSD)?](https:\/\/www.psychiatry.org\/patients-families\/ptsd\/what-is-ptsd)\n- [Expert Q\\&A: Posttraumatic Stress Disorder (PTSD)](https:\/\/www.psychiatry.org\/patients-families\/ptsd\/expert-q-and-a)\n\n- Back\n- [**Schizophrenia**](https:\/\/www.psychiatry.org\/patients-families\/schizophrenia)\n- [What is Schizophrenia?](https:\/\/www.psychiatry.org\/patients-families\/schizophrenia\/what-is-schizophrenia)\n- [Expert Q\\&A: Schizophrenia](https:\/\/www.psychiatry.org\/patients-families\/schizophrenia\/expert-q-and-a)\n\n- Back\n- [**Sleep Disorders**](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders)\n- [What are Sleep Disorders?](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/what-are-sleep-disorders)\n- [Expert Q\\&A: Sleep Disorders](https:\/\/www.psychiatry.org\/patients-families\/sleep-disorders\/expert-q-and-a)\n\n- Back\n- [**Somatic Symptom Disorder**](https:\/\/www.psychiatry.org\/patients-families\/somatic-symptom-disorder)\n- [What is Somatic Symptom Disorder?](https:\/\/www.psychiatry.org\/patients-families\/somatic-symptom-disorder\/what-is-somatic-symptom-disorder)\n- [Expert Q\\&A: Somatic Symptom Disorder](https:\/\/www.psychiatry.org\/patients-families\/somatic-symptom-disorder\/expert-q-and-a)\n\n- Back\n- [**Specific Learning Disorders**](https:\/\/www.psychiatry.org\/patients-families\/specific-learning-disorder)\n- [What Are Specific Learning Disorders?](https:\/\/www.psychiatry.org\/patients-families\/specific-learning-disorder\/what-is-specific-learning-disorder)\n- [Expert Q\\&A: Specific Learning Disorders](https:\/\/www.psychiatry.org\/patients-families\/specific-learning-disorder\/expert-q-and-a)\n\n- Back\n- [**Technology Addictions: Social Media, Online Gaming, and More**](https:\/\/www.psychiatry.org\/patients-families\/technology-addictions-social-media-and-more)\n- [What is Technology Addiction?](https:\/\/www.psychiatry.org\/patients-families\/technology-addictions-social-media-and-more\/what-is-technology-addiction)\n- [Expert Q\\&A: Technology Addiction](https:\/\/www.psychiatry.org\/patients-families\/technology-addictions-social-media-and-more\/expert-q-a-technology-addiction)\n\n- Back\n- [**La Salud Mental**](https:\/\/www.psychiatry.org\/patients-families\/la-salud-mental)\n- [Adicción 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[Components](https:\/\/www.psychiatry.org\/about-apa\/Meet-Our-Organization\/Councils)\n\n- Back\n- [**District Branches**](https:\/\/www.psychiatry.org\/about-apa\/Meet-Our-Organization\/district-branches)\n- [Resources for DB\/SA Leadership](https:\/\/www.psychiatry.org\/membership\/district-branches\/district-branch-resources)\n- [District Branch Dues for General Members](https:\/\/www.psychiatry.org\/membership\/district-branches\/district-branch-dues-for-general-members)\n- [District Branch Dues for Residents and Fellows](https:\/\/www.psychiatry.org\/membership\/district-branches\/district-branch-dues-for-residents-and-fellows)","attrs_readable_markdown":"More than [half of people with mental illness](https:\/\/mhanational.org\/issues\/2023\/mental-health-america-access-care-data) don't receive help for their disorders. Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against people with mental illness are still very much a problem.\n\nStigma, prejudice and discrimination against people with mental illness can be subtle or obvious—but no matter the magnitude, they can lead to harm. People with mental illness are marginalized and discriminated against in various ways, but understanding what that looks like and how to address and eradicate it can help.\n\nStigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of [studies on stigma](https:\/\/pubmed.ncbi.nlm.nih.gov\/26410341\/) shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness.\n\nStigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members.\n\nStigma around mental illness especially an issue in some diverse racial and ethnic communities and it can be a major barrier to people from those cultures accessing mental health services. For example, in some Asian cultures, seeking professional help for mental illness may be counter to cultural values of strong family, emotional restraint and avoiding shame. Among some groups, including the African American community's, distrust of the mental healthcare system can also be a barrier to seeking help. (See more on [mental health in Diverse Populations](https:\/\/www.psychiatry.org\/psychiatrists\/diversity).)\n\n|   | Public | Self | Structural |\n|---|---|---|---|\n| Stereotypes & Prejudices | People with mental illness are dangerous, incompetent, to blame for their disorder, unpredictable | I am dangerous, incompetent, to blame | Stereotypes are embodied in laws and other institutions |\n| Discrimination | Therefore, employers may not hire them, landlords may not rent to them, the health care system may offer a lower standard of care | These thoughts may lead to lowered self-esteem and self-efficacy: \"Why try? Someone like me is not worthy, or unable to work, live independently, or have good health.\" | Leads to intended and unintended loss of opportunity |\n\n*Source: Adapted from Corrigan, et al., 2014.*\n\nMedia representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate or violent representations. A study published by Scarf, et. al. in 2020 looked at a recent example, the popular film *Joker* (2019), which portrays the lead character as a person with mental illness who becomes extremely violent. The study found that viewing the film \"was associated with higher levels of prejudice toward those with mental illness.\" Additionally, the authors suggest, \"*Joker* may exacerbate self-stigma for those with a mental illness, leading to delays in help seeking.\"\n\nThe stigma of mental illness is universal. A [2016 report on stigma](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5007563\/) concluded \"there is no country, society or culture where people with mental illness have the same societal value as people without mental illness.\"\n\n**Harmful Effects of Stigma and Discrimination**\n\nStigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. A recent extensive [review of research](https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0165178120301682?dgcid=raven_sd_via_email) found that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses. Effects can include:\n\n- reduced hope\n- lower self-esteem\n- increased psychiatric symptoms\n- difficulties with social relationships\n- reduced likelihood of staying with treatment\n- more difficulties at work\n\n[A 2017 study by Oexle et al](https:\/\/pubmed.ncbi.nlm.nih.gov\/28188369\/) involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years.\n\nAn [editorial in the *Lancet*](https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736\\(16\\)00687-5\/fulltext) notes that the impacts of stigma are pervasive, affecting political enthusiasm, charitable fundraising and availability, support for local services and underfunding of research for mental health relative to other health conditions.\n\nSome of the other harmful effects of stigma can include:\n\n- Reluctance to seek help or treatment and reduced likelihood of staying with treatment.\n- Social isolation.\n- Lack of understanding by family, friends, coworkers, or others.\n- Fewer opportunities for work, school or social activities or trouble finding housing.\n- Bullying, physical violence or harassment.\n- Health insurance that doesn't adequately cover your mental illness treatment.\n- The belief that you'll never succeed at certain challenges or that you can't improve your situation.\n\n*Source: Adapted from Mayo Clinic 2017*\n\n### **Stigma Can Also Impact Family and Friends**\nFamily members and friends, who often provide essential help and support for people with mental illness, can also experience stigma. They may internalize stigma and blame themselves, or they may fear that people will blame them for causing a loved one’s illness or reject the family socially. This stigma can lead to reduced emotional support, social isolation, and reluctance to seek care for their relative. (Yanos, 2023; Mclean, 2023)\n\n**Stigma in Diverse Communities**\n\nStigma around mental illness is especially an issue in some diverse racial and ethnic communities, and it can be a major barrier to people from those cultures accessing mental health services. For more information, please see [Mental Health Disparities: Diverse Populations.](https:\/\/www.psychiatry.org\/psychiatrists\/diversity\/education\/mental-health-facts)\n\n**Stigma in the Workplace**\n\nA [2022 national poll](https:\/\/staging.psychiatry.org\/News-room\/News-Releases\/APA-Poll-Employee-Mental-Health) from the American Psychiatric Association (APA) found that mental health stigma is still a major challenge in the workplace. About half (48%) of workers say they can discuss mental health openly and honestly with their supervisor, down from 56% in 2021 and 62% in 2020. Half (52%) also say they feel comfortable using mental health services with their current employer, compared to 64% in 2021 and 67% in 2020. In a more positive trend, fewer adults are worried about retaliation if they take time off or seek care for their mental health. About one in three (36%) worried about retaliation if they took time off, compared to 48% in 2021 and 52% in 2020. Less than one-third (31%) were worried about retaliation for seeking care, compared to 43% in 2021 and 2020. (APA, 2022)\n\n**Reducing Stigma**\n\n### Public Health Approaches\nMany years of research on anti-stigma interventions has found that successful interventions (Yanos, 2023):\n\n- Include contact (in person, but video can also be a feature if done right).\n- Focus on a range of disorders, not just depression or mental illness broadly.\n- Involve participation of people with “lived experience.”\n- Target groups that have the most interaction or where lack of help-seeking is most problematic (e.g., young people, undocumented communities, military communities).\n- Are tailored to be credible to specific language and cultural signifiers of the target group.\n- Last several years in order to be effective.\n\nSubstantial research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable.\n\nTeens are searching for health information online and mental health issues are among the top searches, according to a [national survey from Hope Lab](https:\/\/assets.hopelab.org\/wp-content\/uploads\/2021\/03\/2021-coping-with-covid19-full-report.pdf) (Hope Lab, 2021). About four in 10 teens said they have looked for people with similar health concerns. Many celebrities, such as Demi Lovato, Dwayne \"The Rock\" Johnson, Michael Phelps, Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges and brought the discussion much more into the general media and everyday conversation. Young people are looking for information and for these personal stories online.\n\nRecent studies have also shown the effectiveness of brief videos in reducing stigma. [One study](https:\/\/pubmed.ncbi.nlm.nih.gov\/38113809\/) tracked more than 700 students across two years in a randomized controlled trial and found that watching videos of people sharing their personal experiences and videos with information on mental health improved students' mental health care access (da Conceição, et al 2023). The researchers found that the intervention was particularly effective for those in need, enabling them to recognize their need for care and behave accordingly. [Another study](https:\/\/ps.psychiatryonline.org\/doi\/10.1176\/appi.ps.20230215) found that a video featuring an actor sharing a story was as effective as a person with lived experience. (Amsalem, et al 2023).\n\nSocial marketing campaigns can also be effective. For example, a [research study](https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.2019.305129) looked at the effectiveness of an anti-stigma social marketing campaign in California and found that the campaign increased service use by helping people better understand symptoms of distress and increasing awareness that help is available. (Collins, et al 2019). The researchers suggest that widespread exposure to the mental health campaign could significantly increase access to treatment.\n\n### **Individual Actions to Reduce Stigma**\nThe [National Alliance on Mental Illness](https:\/\/www.nami.org\/Blogs\/NAMI-Blog\/October-2017\/9-Ways-to-Fight-Mental-Health-Stigma) (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:\n\n- **Talk openly** about mental health, such as sharing on social media.\n- **Educate yourself and others** – respond to misperceptions or negative comments by sharing facts and experiences.\n- **Be conscious of language** – remind people that words matter.\n- **Encourage equality** between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes.\n- **Show compassion** for those with mental illness.\n- **Be honest about treatment** – normalize mental health treatment, just like other health care treatment.\n- **Let the media know** when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way.\n- **Choose empowerment** over shame – \"I fight stigma by choosing to live an empowered life. To me, that means owning my life and my story and refusing to allow others to dictate how I view myself or how I feel about myself.\" – Val Fletcher.\n\nReducing Stigma in the Workplace While stigma and discrimination are still prevalent in the workplace, employers are increasingly addressing stigma against mental illness. The APA Foundation's Center for Workplace Mental Health emphasizes the importance of both robust healthcare services and specific efforts to break the silence that surrounds the topic of mental illness. The Center suggests organizations strive to \"create a culture in which mention of depression, anxiety, post-trauma, and other common illnesses become as mentionable as diabetes, hypertension, and migraines.\"\n\n### Employers who are leading efforts to address stigma offer some suggestions (CWMH):\n- **Tailor programs\/approaches** to your company culture and existing strengths.\n- **Mention your commitment** to leading a behaviorally healthy workplace every time you mention the company's commitment to its overall culture of health, attracting and retaining the best talent, and valuing its employees, etc.\n- **Train leaders** to identify emotional distress and make referrals and to responding promptly and constructively to behavioral performance issues.\n- **Be welcoming** of the need for accommodations. Train managers to respond appropriately\n\n**Organizations and Campaigns**\n\nAcross the country numerous organizations and campaigns focus on addressing the issue of mental health stigma and discrimination. A few examples are highlighted below:\n\n- ![Love, your mind logo](https:\/\/www.psychiatry.org\/getmedia\/5e63166d-1d62-4cad-bc68-b239beb9ac5b\/Love-your-mind-logo.jpg)\n- ![Stop Stigma together logo](https:\/\/www.psychiatry.org\/getmedia\/124824e1-2509-4f4c-9005-73732be4f067\/Stop-stigma-together-logo.jpg)\n  \n  [Stop Stigma Together](https:\/\/stopstigmatogether.org\/) is working to unite organizations to create resources, generate funding, bring clarifying awareness, and address the issues around mental health and substance use disorders. They will pose a grand challenge to our friends, family, employers, healthcare providers and governments to end the stigma around mental health and substance-use disorders to establish true well-being.\n- ![This is my brave logo](https:\/\/www.psychiatry.org\/getmedia\/bab57aaf-241f-4dfd-a87f-63fc308b47ac\/this-is-my-brave.png)\n  \n  [This is My Brave](https:\/\/thisismybrave.org\/) is a storytelling theatre show where individuals from the community share their stories of living a successful life despite mental illness. Since 2014, This Is My Brave has produced nearly 800 storytellers sharing true, personal stories on overcoming depression, anxiety, bipolar disorder, PTSD and other illnesses. In spring 2020, the organizers developed BraveTV to bring stories of hope online during the COVID-19 pandemic.\n- ![How are you really campaign logo](https:\/\/www.psychiatry.org\/getmedia\/fbad59a5-cea8-45e3-80e3-1bee5f0244e7\/how-are-you-really.jpeg)\n  \n  One recent effort is the [Mental Health Coalition](https:\/\/www.thementalhealthcoalition.org\/), spearheaded by Kenneth Cole in partnership with handful of partners. Partner organizations and celebrities include Active Minds, NAMI, The JED Foundation, Anxiety and Depression Association of America, Kendall Jenner, Kesha, and others. The focus of the coalition is fighting stigma through the sharing of stories with the tag line \"How are you really?\"\n- ![](https:\/\/www.psychiatry.org\/getmedia\/5e115e61-b6ad-4a61-8a4c-1d65f963fec1\/Bring-change-logo.png)\n  \n  [Bring Change to Mind](https:\/\/www.bringchange2mind.org\/) is a nonprofit organization focused on encouraging dialogue about mental health and raising awareness, understanding, and empathy. Actress and activist Glenn Close co-founded Bring Change to Mind in 2010 after her sister and nephew were diagnosed with mental illnesses. It offers resources and tools to learn more and take action to reduce stigma.\n- ![Stigma free campaign logo](https:\/\/www.psychiatry.org\/getmedia\/5e75812b-ad59-4006-be1b-0f5834f30172\/stigma-free-logo.png)\n  \n  [NAMI's StigmaFree](https:\/\/www.nami.org\/Get-Involved\/Pledge-to-Be-StigmaFree) campaign is working to end stigma and create hope for those affected by mental illness: \"Through powerful words and actions, we can shift the social and systemic barriers for those living with mental health conditions.\" As part of the campaign, people can take a stigma quiz at [CureStigma.org](http:\/\/www.curestigma.org\/) and learn more about becoming stigma free.\n- ![Stamp out stigma logo](https:\/\/www.psychiatry.org\/getmedia\/8b969c09-91b7-422f-8aa1-89ebd7f4d55a\/stamp-out-stigma.png)\n  \n  [Stamp Out Stigma](https:\/\/stampoutstigma.com\/) is an initiative spearheaded by the Association for Behavioral Health and Wellness to reduce the stigma surrounding mental illness and substance use disorders. The campaign encourages people to start the conversation and to talk openly about mental illness and substance use.\n- ![PBS Healthy Minds logo](https:\/\/www.psychiatry.org\/getmedia\/498f449e-660e-402a-9562-150730dba3ed\/healthy-minds-pbs-logo.jpg)\n  \n  [Healthy Minds with Dr. Jeffrey Borenstein](https:\/\/www.pbs.org\/show\/healthy-minds-with-dr-jeffrey-borenstein\/) aims to remove the stigma of mental illness and demonstrate that with help, there is hope. The series focuses on common psychiatric conditions through inspiring personal stories, as well as, experts sharing cutting edge information, including new approaches and next-generation therapies in diagnostics, treatment and research. Series is produced by the Brain & Behavior Research Foundation.\n## How So We Stop Stigma? *Conversation*\nTry these simple tips for talking.\n\n### Do Say\n- \"Thanks for opening up to me.\"\n- \"Is there anything I can do to help?\"\n- \"I'm sorry to hear that. It must be tough.\"\n- \"I'm here for you when you need me.\"\n- \"I can't imagine what you're going through.\"\n- \"People do get better.\"\n- \"Oh man, that sucks.\"\n- \"Can I drive you to an appointment?\"\n- \"How are you feeling today?\"\n- \"I love you.\"\n\n### Don't Say\n- \"It could be worse.\"\n- \"Just deal with it.\"\n- \"Snap out of it.\"\n- \"Everyone feels that way sometimes.\"\n- \"You may have brought this on yourself.\"\n- \"We've all been there.\"\n- \"You've got to pull yourself together.\"\n- \"Maybe try thinking happier thoughts.\"\n\n*Source: MakeItOK.org*\n## Physician Review\nNikhita Singhal, M.D.  \n University of Toronto, Psychiatry Resident\n\nMarch 2024","meta_canonical":null}

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URL	https://www.psychiatry.org/patients-families/stigma-and-discrimination
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Meta Title	Psychiatry.org - Stigma, Prejudice and Discrimination Against People with Mental Illness
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Boilerpipe Text	More than half of people with mental illness don't receive help for their disorders. Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against people with mental illness are still very much a problem. Stigma, prejudice and discrimination against people with mental illness can be subtle or obvious—but no matter the magnitude, they can lead to harm. People with mental illness are marginalized and discriminated against in various ways, but understanding what that looks like and how to address and eradicate it can help. Stigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of studies on stigma shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness. Stigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members. Stigma around mental illness especially an issue in some diverse racial and ethnic communities and it can be a major barrier to people from those cultures accessing mental health services. For example, in some Asian cultures, seeking professional help for mental illness may be counter to cultural values of strong family, emotional restraint and avoiding shame. Among some groups, including the African American community's, distrust of the mental healthcare system can also be a barrier to seeking help. (See more on mental health in Diverse Populations .) Public Self Structural Stereotypes & Prejudices People with mental illness are dangerous, incompetent, to blame for their disorder, unpredictable I am dangerous, incompetent, to blame Stereotypes are embodied in laws and other institutions Discrimination Therefore, employers may not hire them, landlords may not rent to them, the health care system may offer a lower standard of care These thoughts may lead to lowered self-esteem and self-efficacy: "Why try? Someone like me is not worthy, or unable to work, live independently, or have good health." Leads to intended and unintended loss of opportunity Source: Adapted from Corrigan, et al., 2014. Media representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate or violent representations. A study published by Scarf, et. al. in 2020 looked at a recent example, the popular film Joker (2019), which portrays the lead character as a person with mental illness who becomes extremely violent. The study found that viewing the film "was associated with higher levels of prejudice toward those with mental illness." Additionally, the authors suggest, " Joker may exacerbate self-stigma for those with a mental illness, leading to delays in help seeking." The stigma of mental illness is universal. A 2016 report on stigma concluded "there is no country, society or culture where people with mental illness have the same societal value as people without mental illness." Harmful Effects of Stigma and Discrimination Stigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. A recent extensive review of research found that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses. Effects can include: reduced hope lower self-esteem increased psychiatric symptoms difficulties with social relationships reduced likelihood of staying with treatment more difficulties at work A 2017 study by Oexle et al involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years. An editorial in the Lancet notes that the impacts of stigma are pervasive, affecting political enthusiasm, charitable fundraising and availability, support for local services and underfunding of research for mental health relative to other health conditions. Some of the other harmful effects of stigma can include: Reluctance to seek help or treatment and reduced likelihood of staying with treatment. Social isolation. Lack of understanding by family, friends, coworkers, or others. Fewer opportunities for work, school or social activities or trouble finding housing. Bullying, physical violence or harassment. Health insurance that doesn't adequately cover your mental illness treatment. The belief that you'll never succeed at certain challenges or that you can't improve your situation. Source: Adapted from Mayo Clinic 2017 Stigma Can Also Impact Family and Friends Family members and friends, who often provide essential help and support for people with mental illness, can also experience stigma. They may internalize stigma and blame themselves, or they may fear that people will blame them for causing a loved one’s illness or reject the family socially. This stigma can lead to reduced emotional support, social isolation, and reluctance to seek care for their relative. (Yanos, 2023; Mclean, 2023) Stigma in Diverse Communities Stigma around mental illness is especially an issue in some diverse racial and ethnic communities, and it can be a major barrier to people from those cultures accessing mental health services. For more information, please see Mental Health Disparities: Diverse Populations. Stigma in the Workplace A 2022 national poll from the American Psychiatric Association (APA) found that mental health stigma is still a major challenge in the workplace. About half (48%) of workers say they can discuss mental health openly and honestly with their supervisor, down from 56% in 2021 and 62% in 2020. Half (52%) also say they feel comfortable using mental health services with their current employer, compared to 64% in 2021 and 67% in 2020. In a more positive trend, fewer adults are worried about retaliation if they take time off or seek care for their mental health. About one in three (36%) worried about retaliation if they took time off, compared to 48% in 2021 and 52% in 2020. Less than one-third (31%) were worried about retaliation for seeking care, compared to 43% in 2021 and 2020. (APA, 2022) Reducing Stigma Public Health Approaches Many years of research on anti-stigma interventions has found that successful interventions (Yanos, 2023): Include contact (in person, but video can also be a feature if done right). Focus on a range of disorders, not just depression or mental illness broadly. Involve participation of people with “lived experience.” Target groups that have the most interaction or where lack of help-seeking is most problematic (e.g., young people, undocumented communities, military communities). Are tailored to be credible to specific language and cultural signifiers of the target group. Last several years in order to be effective. Substantial research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable. Teens are searching for health information online and mental health issues are among the top searches, according to a national survey from Hope Lab (Hope Lab, 2021). About four in 10 teens said they have looked for people with similar health concerns. Many celebrities, such as Demi Lovato, Dwayne "The Rock" Johnson, Michael Phelps, Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges and brought the discussion much more into the general media and everyday conversation. Young people are looking for information and for these personal stories online. Recent studies have also shown the effectiveness of brief videos in reducing stigma. One study tracked more than 700 students across two years in a randomized controlled trial and found that watching videos of people sharing their personal experiences and videos with information on mental health improved students' mental health care access (da Conceição, et al 2023). The researchers found that the intervention was particularly effective for those in need, enabling them to recognize their need for care and behave accordingly. Another study found that a video featuring an actor sharing a story was as effective as a person with lived experience. (Amsalem, et al 2023). Social marketing campaigns can also be effective. For example, a research study looked at the effectiveness of an anti-stigma social marketing campaign in California and found that the campaign increased service use by helping people better understand symptoms of distress and increasing awareness that help is available. (Collins, et al 2019). The researchers suggest that widespread exposure to the mental health campaign could significantly increase access to treatment. Individual Actions to Reduce Stigma The National Alliance on Mental Illness (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness: Talk openly about mental health, such as sharing on social media. Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences. Be conscious of language – remind people that words matter. Encourage equality between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes. Show compassion for those with mental illness. Be honest about treatment – normalize mental health treatment, just like other health care treatment. Let the media know when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way. Choose empowerment over shame – "I fight stigma by choosing to live an empowered life. To me, that means owning my life and my story and refusing to allow others to dictate how I view myself or how I feel about myself." – Val Fletcher. Reducing Stigma in the Workplace While stigma and discrimination are still prevalent in the workplace, employers are increasingly addressing stigma against mental illness. The APA Foundation's Center for Workplace Mental Health emphasizes the importance of both robust healthcare services and specific efforts to break the silence that surrounds the topic of mental illness. The Center suggests organizations strive to "create a culture in which mention of depression, anxiety, post-trauma, and other common illnesses become as mentionable as diabetes, hypertension, and migraines." Employers who are leading efforts to address stigma offer some suggestions (CWMH): Tailor programs/approaches to your company culture and existing strengths. Mention your commitment to leading a behaviorally healthy workplace every time you mention the company's commitment to its overall culture of health, attracting and retaining the best talent, and valuing its employees, etc. Train leaders to identify emotional distress and make referrals and to responding promptly and constructively to behavioral performance issues. Be welcoming of the need for accommodations. Train managers to respond appropriately Organizations and Campaigns Across the country numerous organizations and campaigns focus on addressing the issue of mental health stigma and discrimination. A few examples are highlighted below: Stop Stigma Together is working to unite organizations to create resources, generate funding, bring clarifying awareness, and address the issues around mental health and substance use disorders. They will pose a grand challenge to our friends, family, employers, healthcare providers and governments to end the stigma around mental health and substance-use disorders to establish true well-being. This is My Brave is a storytelling theatre show where individuals from the community share their stories of living a successful life despite mental illness. Since 2014, This Is My Brave has produced nearly 800 storytellers sharing true, personal stories on overcoming depression, anxiety, bipolar disorder, PTSD and other illnesses. In spring 2020, the organizers developed BraveTV to bring stories of hope online during the COVID-19 pandemic. One recent effort is the Mental Health Coalition , spearheaded by Kenneth Cole in partnership with handful of partners. Partner organizations and celebrities include Active Minds, NAMI, The JED Foundation, Anxiety and Depression Association of America, Kendall Jenner, Kesha, and others. The focus of the coalition is fighting stigma through the sharing of stories with the tag line "How are you really?" Bring Change to Mind is a nonprofit organization focused on encouraging dialogue about mental health and raising awareness, understanding, and empathy. Actress and activist Glenn Close co-founded Bring Change to Mind in 2010 after her sister and nephew were diagnosed with mental illnesses. It offers resources and tools to learn more and take action to reduce stigma. NAMI's StigmaFree campaign is working to end stigma and create hope for those affected by mental illness: "Through powerful words and actions, we can shift the social and systemic barriers for those living with mental health conditions." As part of the campaign, people can take a stigma quiz at CureStigma.org and learn more about becoming stigma free. Stamp Out Stigma is an initiative spearheaded by the Association for Behavioral Health and Wellness to reduce the stigma surrounding mental illness and substance use disorders. The campaign encourages people to start the conversation and to talk openly about mental illness and substance use. Healthy Minds with Dr. Jeffrey Borenstein aims to remove the stigma of mental illness and demonstrate that with help, there is hope. The series focuses on common psychiatric conditions through inspiring personal stories, as well as, experts sharing cutting edge information, including new approaches and next-generation therapies in diagnostics, treatment and research. Series is produced by the Brain & Behavior Research Foundation. How So We Stop Stigma? Conversation Try these simple tips for talking. Do Say "Thanks for opening up to me." "Is there anything I can do to help?" "I'm sorry to hear that. It must be tough." "I'm here for you when you need me." "I can't imagine what you're going through." "People do get better." "Oh man, that sucks." "Can I drive you to an appointment?" "How are you feeling today?" "I love you." Don't Say "It could be worse." "Just deal with it." "Snap out of it." "Everyone feels that way sometimes." "You may have brought this on yourself." "We've all been there." "You've got to pull yourself together." "Maybe try thinking happier thoughts." Source: MakeItOK.org Physician Review Nikhita Singhal, M.D. University of Toronto, Psychiatry Resident March 2024
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Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against people with mental illness are still very much a problem. Stigma, prejudice and discrimination against people with mental illness can be subtle or obvious—but no matter the magnitude, they can lead to harm. People with mental illness are marginalized and discriminated against in various ways, but understanding what that looks like and how to address and eradicate it can help. ## The Facts on Stigma, Prejudice and Discrimination Stigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of [studies on stigma](https://pubmed.ncbi.nlm.nih.gov/26410341/) shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness. Researchers identify different types of stigma: (See chart below.) - Public stigma involves the negative or discriminatory attitudes that others may have about mental illness. - Self-stigma refers to the negative attitudes, including internalized shame, that people with mental illness may have about their own condition. - Structural stigma is more systemic, involving policies of government and private organizations that intentionally or unintentionally limit opportunities for people with mental illness. Examples include lower funding for mental illness research or fewer mental health services relative to other health care. Stigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members. Stigma around mental illness especially an issue in some diverse racial and ethnic communities and it can be a major barrier to people from those cultures accessing mental health services. For example, in some Asian cultures, seeking professional help for mental illness may be counter to cultural values of strong family, emotional restraint and avoiding shame. Among some groups, including the African American community's, distrust of the mental healthcare system can also be a barrier to seeking help. (See more on [mental health in Diverse Populations](https://www.psychiatry.org/psychiatrists/diversity).) ## Types of Stigma \| \| Public \| Self \| Structural \| \|---\|---\|---\|---\| \| Stereotypes & Prejudices \| People with mental illness are dangerous, incompetent, to blame for their disorder, unpredictable \| I am dangerous, incompetent, to blame \| Stereotypes are embodied in laws and other institutions \| \| Discrimination \| Therefore, employers may not hire them, landlords may not rent to them, the health care system may offer a lower standard of care \| These thoughts may lead to lowered self-esteem and self-efficacy: "Why try? Someone like me is not worthy, or unable to work, live independently, or have good health." \| Leads to intended and unintended loss of opportunity \| Source: Adapted from Corrigan, et al., 2014. Media representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate or violent representations. A study published by Scarf, et. al. in 2020 looked at a recent example, the popular film Joker (2019), which portrays the lead character as a person with mental illness who becomes extremely violent. The study found that viewing the film "was associated with higher levels of prejudice toward those with mental illness." Additionally, the authors suggest, "Joker may exacerbate self-stigma for those with a mental illness, leading to delays in help seeking." The stigma of mental illness is universal. A [2016 report on stigma](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007563/) concluded "there is no country, society or culture where people with mental illness have the same societal value as people without mental illness." ## Harmful Effects of Stigma and Discrimination Stigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. A recent extensive [review of research](https://www.sciencedirect.com/science/article/abs/pii/S0165178120301682?dgcid=raven_sd_via_email) found that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses. Effects can include: - reduced hope - lower self-esteem - increased psychiatric symptoms - difficulties with social relationships - reduced likelihood of staying with treatment - more difficulties at work [A 2017 study by Oexle et al](https://pubmed.ncbi.nlm.nih.gov/28188369/) involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years. An [editorial in the Lancet](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(16\)00687-5/fulltext) notes that the impacts of stigma are pervasive, affecting political enthusiasm, charitable fundraising and availability, support for local services and underfunding of research for mental health relative to other health conditions. Some of the other harmful effects of stigma can include: - Reluctance to seek help or treatment and reduced likelihood of staying with treatment. - Social isolation. - Lack of understanding by family, friends, coworkers, or others. - Fewer opportunities for work, school or social activities or trouble finding housing. - Bullying, physical violence or harassment. - Health insurance that doesn't adequately cover your mental illness treatment. - The belief that you'll never succeed at certain challenges or that you can't improve your situation. Source: Adapted from Mayo Clinic 2017 ### Stigma Can Also Impact Family and Friends Family members and friends, who often provide essential help and support for people with mental illness, can also experience stigma. They may internalize stigma and blame themselves, or they may fear that people will blame them for causing a loved one’s illness or reject the family socially. This stigma can lead to reduced emotional support, social isolation, and reluctance to seek care for their relative. (Yanos, 2023; Mclean, 2023) Stigma in Diverse Communities Stigma around mental illness is especially an issue in some diverse racial and ethnic communities, and it can be a major barrier to people from those cultures accessing mental health services. For more information, please see [Mental Health Disparities: Diverse Populations.](https://www.psychiatry.org/psychiatrists/diversity/education/mental-health-facts) ## Stigma in the Workplace Employee Assistance Programs (EAP), commonly available through employers, help employees deal with a variety of concerns such as work-life stressors, mental and emotional well-being issues, family and relationship issues, or financial or legal concerns. However, the services often go unused—only about 3-5% of employees use EAP services, according to the Center for Workplace Mental Health. A [2022 national poll](https://staging.psychiatry.org/News-room/News-Releases/APA-Poll-Employee-Mental-Health) from the American Psychiatric Association (APA) found that mental health stigma is still a major challenge in the workplace. About half (48%) of workers say they can discuss mental health openly and honestly with their supervisor, down from 56% in 2021 and 62% in 2020. Half (52%) also say they feel comfortable using mental health services with their current employer, compared to 64% in 2021 and 67% in 2020. In a more positive trend, fewer adults are worried about retaliation if they take time off or seek care for their mental health. About one in three (36%) worried about retaliation if they took time off, compared to 48% in 2021 and 52% in 2020. Less than one-third (31%) were worried about retaliation for seeking care, compared to 43% in 2021 and 2020. (APA, 2022) ## Reducing Stigma ### Public Health Approaches Many years of research on anti-stigma interventions has found that successful interventions (Yanos, 2023): - Include contact (in person, but video can also be a feature if done right). - Focus on a range of disorders, not just depression or mental illness broadly. - Involve participation of people with “lived experience.” - Target groups that have the most interaction or where lack of help-seeking is most problematic (e.g., young people, undocumented communities, military communities). - Are tailored to be credible to specific language and cultural signifiers of the target group. - Last several years in order to be effective. Substantial research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable. Teens are searching for health information online and mental health issues are among the top searches, according to a [national survey from Hope Lab](https://assets.hopelab.org/wp-content/uploads/2021/03/2021-coping-with-covid19-full-report.pdf) (Hope Lab, 2021). About four in 10 teens said they have looked for people with similar health concerns. Many celebrities, such as Demi Lovato, Dwayne "The Rock" Johnson, Michael Phelps, Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges and brought the discussion much more into the general media and everyday conversation. Young people are looking for information and for these personal stories online. Recent studies have also shown the effectiveness of brief videos in reducing stigma. [One study](https://pubmed.ncbi.nlm.nih.gov/38113809/) tracked more than 700 students across two years in a randomized controlled trial and found that watching videos of people sharing their personal experiences and videos with information on mental health improved students' mental health care access (da Conceição, et al 2023). The researchers found that the intervention was particularly effective for those in need, enabling them to recognize their need for care and behave accordingly. [Another study](https://ps.psychiatryonline.org/doi/10.1176/appi.ps.20230215) found that a video featuring an actor sharing a story was as effective as a person with lived experience. (Amsalem, et al 2023). Social marketing campaigns can also be effective. For example, a [research study](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2019.305129) looked at the effectiveness of an anti-stigma social marketing campaign in California and found that the campaign increased service use by helping people better understand symptoms of distress and increasing awareness that help is available. (Collins, et al 2019). The researchers suggest that widespread exposure to the mental health campaign could significantly increase access to treatment. ### Individual Actions to Reduce Stigma The [National Alliance on Mental Illness](https://www.nami.org/Blogs/NAMI-Blog/October-2017/9-Ways-to-Fight-Mental-Health-Stigma) (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness: - Talk openly about mental health, such as sharing on social media. - Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences. - Be conscious of language – remind people that words matter. - Encourage equality between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes. - Show compassion for those with mental illness. - Be honest about treatment – normalize mental health treatment, just like other health care treatment. - Let the media know when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way. - Choose empowerment over shame – "I fight stigma by choosing to live an empowered life. To me, that means owning my life and my story and refusing to allow others to dictate how I view myself or how I feel about myself." – Val Fletcher. Reducing Stigma in the Workplace While stigma and discrimination are still prevalent in the workplace, employers are increasingly addressing stigma against mental illness. The APA Foundation's Center for Workplace Mental Health emphasizes the importance of both robust healthcare services and specific efforts to break the silence that surrounds the topic of mental illness. The Center suggests organizations strive to "create a culture in which mention of depression, anxiety, post-trauma, and other common illnesses become as mentionable as diabetes, hypertension, and migraines." ### Employers who are leading efforts to address stigma offer some suggestions (CWMH): - Tailor programs/approaches to your company culture and existing strengths. - Mention your commitment to leading a behaviorally healthy workplace every time you mention the company's commitment to its overall culture of health, attracting and retaining the best talent, and valuing its employees, etc. - Train leaders to identify emotional distress and make referrals and to responding promptly and constructively to behavioral performance issues. - Be welcoming of the need for accommodations. Train managers to respond appropriately ## Organizations and Campaigns Across the country numerous organizations and campaigns focus on addressing the issue of mental health stigma and discrimination. A few examples are highlighted below: - ![Love, your mind logo](https://www.psychiatry.org/getmedia/5e63166d-1d62-4cad-bc68-b239beb9ac5b/Love-your-mind-logo.jpg) The [“Love, Your Mind”](https://loveyourmindtoday.org/)campaign, from the [Huntsman Mental Health Institute](https://huntsmanmentalhealthfoundation.org/#HMHID&reserved=0) and the [Ad Council](https://www.adcouncil.org/), offers inspiration, community and educational resources to encourage people across the U.S. to be more open and proactive when it comes to their mental health. Read about the campaign in the [APA journal Focus.](https://www.psychiatryonline.org/doi/10.1176/appi.focus.20240039) - ![Stop Stigma together logo](https://www.psychiatry.org/getmedia/124824e1-2509-4f4c-9005-73732be4f067/Stop-stigma-together-logo.jpg) [Stop Stigma Together](https://stopstigmatogether.org/) is working to unite organizations to create resources, generate funding, bring clarifying awareness, and address the issues around mental health and substance use disorders. They will pose a grand challenge to our friends, family, employers, healthcare providers and governments to end the stigma around mental health and substance-use disorders to establish true well-being. - ![This is my brave logo](https://www.psychiatry.org/getmedia/bab57aaf-241f-4dfd-a87f-63fc308b47ac/this-is-my-brave.png) [This is My Brave](https://thisismybrave.org/) is a storytelling theatre show where individuals from the community share their stories of living a successful life despite mental illness. Since 2014, This Is My Brave has produced nearly 800 storytellers sharing true, personal stories on overcoming depression, anxiety, bipolar disorder, PTSD and other illnesses. In spring 2020, the organizers developed BraveTV to bring stories of hope online during the COVID-19 pandemic. - ![How are you really campaign logo](https://www.psychiatry.org/getmedia/fbad59a5-cea8-45e3-80e3-1bee5f0244e7/how-are-you-really.jpeg) One recent effort is the [Mental Health Coalition](https://www.thementalhealthcoalition.org/), spearheaded by Kenneth Cole in partnership with handful of partners. Partner organizations and celebrities include Active Minds, NAMI, The JED Foundation, Anxiety and Depression Association of America, Kendall Jenner, Kesha, and others. The focus of the coalition is fighting stigma through the sharing of stories with the tag line "How are you really?" - ![](https://www.psychiatry.org/getmedia/5e115e61-b6ad-4a61-8a4c-1d65f963fec1/Bring-change-logo.png) [Bring Change to Mind](https://www.bringchange2mind.org/) is a nonprofit organization focused on encouraging dialogue about mental health and raising awareness, understanding, and empathy. Actress and activist Glenn Close co-founded Bring Change to Mind in 2010 after her sister and nephew were diagnosed with mental illnesses. It offers resources and tools to learn more and take action to reduce stigma. - ![Stigma free campaign logo](https://www.psychiatry.org/getmedia/5e75812b-ad59-4006-be1b-0f5834f30172/stigma-free-logo.png) [NAMI's StigmaFree](https://www.nami.org/Get-Involved/Pledge-to-Be-StigmaFree) campaign is working to end stigma and create hope for those affected by mental illness: "Through powerful words and actions, we can shift the social and systemic barriers for those living with mental health conditions." As part of the campaign, people can take a stigma quiz at [CureStigma.org](http://www.curestigma.org/) and learn more about becoming stigma free. - ![Stamp out stigma logo](https://www.psychiatry.org/getmedia/8b969c09-91b7-422f-8aa1-89ebd7f4d55a/stamp-out-stigma.png) [Stamp Out Stigma](https://stampoutstigma.com/) is an initiative spearheaded by the Association for Behavioral Health and Wellness to reduce the stigma surrounding mental illness and substance use disorders. The campaign encourages people to start the conversation and to talk openly about mental illness and substance use. - ![PBS Healthy Minds logo](https://www.psychiatry.org/getmedia/498f449e-660e-402a-9562-150730dba3ed/healthy-minds-pbs-logo.jpg) [Healthy Minds with Dr. Jeffrey Borenstein](https://www.pbs.org/show/healthy-minds-with-dr-jeffrey-borenstein/) aims to remove the stigma of mental illness and demonstrate that with help, there is hope. The series focuses on common psychiatric conditions through inspiring personal stories, as well as, experts sharing cutting edge information, including new approaches and next-generation therapies in diagnostics, treatment and research. Series is produced by the Brain & Behavior Research Foundation. ## How So We Stop Stigma? Conversation Try these simple tips for talking. ### Do Say - "Thanks for opening up to me." - "Is there anything I can do to help?" - "I'm sorry to hear that. It must be tough." - "I'm here for you when you need me." - "I can't imagine what you're going through." - "People do get better." - "Oh man, that sucks." - "Can I drive you to an appointment?" - "How are you feeling today?" - "I love you." ### Don't Say - "It could be worse." - "Just deal with it." - "Snap out of it." - "Everyone feels that way sometimes." - "You may have brought this on yourself." - "We've all been there." - "You've got to pull yourself together." - "Maybe try thinking happier thoughts." Source: MakeItOK.org References - Amsalem, D. et al. 2023. [Stigma Reduction Via Brief Video Interventions: Comparing Presentations by an Actor Versus a Person With Lived Experience.](https://ps.psychiatryonline.org/doi/10.1176/appi.ps.20230215) Psychiatric Services. https://doi.org/10.1176/appi.ps.20230215 - APA News Release: Employees Say Workplaces Are Offering Fewer Mental Health Services in 2022, According to APA Poll. May 22, 2022. - Barnett, D. 2023. [‘Tis the Season: Opportune Time to Help Reduce Stigma of Substance Use Disorders](https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2023.12.12.35) Psychiatric News. Nov. 27, 2023. https://doi.org/10.1176/appi.pn.2023.12.12.35 - Center for Workplace Mental Health. [Working Well Toolkit](https://workplacementalhealth.org/employer-resources/the-working-well-toolkit). 2016. - Collins, R.L., et al. [Social Marketing of Mental Health Treatment: California's Mental Illness Stigma Reduction Campaign](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595511/). Am J Public Health. 2019 June; 109(Suppl 3): S228–S235. - Corrigan, Pw, Druss, BG, Perlick, DA. [The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care](https://journals.sagepub.com/stoken/rbtfl/dDpyhM2zRi.Fg/full). Psychological Science in The Public Interest. 2014, 15(2);37-70. - da Conceição, V., Mesquita, E., & Gusmão, R. (2023). [Effects of a stigma reduction intervention on help-seeking behaviors in university students: A 2019-2021 randomized controlled trial](https://pubmed.ncbi.nlm.nih.gov/38113809/). Psychiatry research, 331, 115673. Advance online publication. https://doi.org/10.1016/j.psychres.2023.115673 - Forde, K. 2020. [By Sharing Their Own Struggles, Celebs Help Teens Tear Down Mental Health Stigma](https://www.ozy.com/the-new-and-the-next/by-sharing-their-own-struggles-celebs-help-teens-tear-down-mental-health-stigma/253556/). - Greenstein, L. [9 Ways To Fight Mental Health Stigma](https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma). NAMI blog, Oct. 11, 2017. - Hope Lab, Common Sense, and California HealthCare Foundation. 2021. [Coping With Covid-19: How Young People Use Digital Media To Manage Their Mental Health.](https://assets.hopelab.org/wp-content/uploads/2021/03/2021-coping-with-covid19-full-report.pdf) - Mayo Clinic. [Mental health: Overcoming the stigma of mental illness](https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477). 2017. - McLean/Mass General Brigham, 2023. [Let’s Face It, No One Wants To Talk About Mental Health](https://www.mcleanhospital.org/essential/lets-face-it-no-one-wants-talk-about-mental-health) - Oexle N, Müller M, Kawohl W, et al. [Self-stigma as a barrier to recovery: a longitudinal study](https://pubmed.ncbi.nlm.nih.gov/28188369/). European Archives of Psychiatry and Clinical Neuroscience. October 2017. doi: 10.1007/s00406-017-0773-2. - Pescosolido, BA. [The public stigma of mental illness: what do we think; what do we know; what can we prove?](https://pubmed.ncbi.nlm.nih.gov/23325423/) J Health Soc Behav. 2013 Mar;54(1):1-21. doi: 10.1177/0022146512471197. - Scarf, D., et al. [Association of Viewing the Films Joker or Terminator: Dark Fate With Prejudice Toward Individuals With Mental Illness](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2764842). JAMA Network Open. April 24, 2020. - Yanos, P., Amsalem, D., Dixon, L. 2023. Brief video interventions to reduce self-, public, and affiliate stigma among/toward young individuals with psychosis. Presentation at APA 2023 Mental Health Services Conference ## Physician Review Nikhita Singhal, M.D. University of Toronto, Psychiatry Resident March 2024 ![Mental Health Care Works](https://www.psychiatry.org/getmedia/b7fbdea8-1eb8-4391-b3b7-3df7a17072e8/MHCW-Feature.png?width=799&height=540&ext=.png) ## Mental Health Care Works The APA Foundation’s public awareness campaign, "Mental Health Care Works," focuses on empowering those with mental health concerns to take the first step toward getting help. 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Readable Markdown	More than [half of people with mental illness](https://mhanational.org/issues/2023/mental-health-america-access-care-data) don't receive help for their disorders. Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against people with mental illness are still very much a problem. Stigma, prejudice and discrimination against people with mental illness can be subtle or obvious—but no matter the magnitude, they can lead to harm. People with mental illness are marginalized and discriminated against in various ways, but understanding what that looks like and how to address and eradicate it can help. Stigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of [studies on stigma](https://pubmed.ncbi.nlm.nih.gov/26410341/) shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness. Stigma not only directly affects individuals with mental illness but also the loved ones who support them, often including their family members. Stigma around mental illness especially an issue in some diverse racial and ethnic communities and it can be a major barrier to people from those cultures accessing mental health services. For example, in some Asian cultures, seeking professional help for mental illness may be counter to cultural values of strong family, emotional restraint and avoiding shame. Among some groups, including the African American community's, distrust of the mental healthcare system can also be a barrier to seeking help. (See more on [mental health in Diverse Populations](https://www.psychiatry.org/psychiatrists/diversity).) \| \| Public \| Self \| Structural \| \|---\|---\|---\|---\| \| Stereotypes & Prejudices \| People with mental illness are dangerous, incompetent, to blame for their disorder, unpredictable \| I am dangerous, incompetent, to blame \| Stereotypes are embodied in laws and other institutions \| \| Discrimination \| Therefore, employers may not hire them, landlords may not rent to them, the health care system may offer a lower standard of care \| These thoughts may lead to lowered self-esteem and self-efficacy: "Why try? Someone like me is not worthy, or unable to work, live independently, or have good health." \| Leads to intended and unintended loss of opportunity \| Source: Adapted from Corrigan, et al., 2014. Media representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate or violent representations. A study published by Scarf, et. al. in 2020 looked at a recent example, the popular film Joker (2019), which portrays the lead character as a person with mental illness who becomes extremely violent. The study found that viewing the film "was associated with higher levels of prejudice toward those with mental illness." Additionally, the authors suggest, "Joker may exacerbate self-stigma for those with a mental illness, leading to delays in help seeking." The stigma of mental illness is universal. A [2016 report on stigma](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007563/) concluded "there is no country, society or culture where people with mental illness have the same societal value as people without mental illness." Harmful Effects of Stigma and Discrimination Stigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. A recent extensive [review of research](https://www.sciencedirect.com/science/article/abs/pii/S0165178120301682?dgcid=raven_sd_via_email) found that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses. Effects can include: - reduced hope - lower self-esteem - increased psychiatric symptoms - difficulties with social relationships - reduced likelihood of staying with treatment - more difficulties at work [A 2017 study by Oexle et al](https://pubmed.ncbi.nlm.nih.gov/28188369/) involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years. An [editorial in the Lancet](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(16\)00687-5/fulltext) notes that the impacts of stigma are pervasive, affecting political enthusiasm, charitable fundraising and availability, support for local services and underfunding of research for mental health relative to other health conditions. Some of the other harmful effects of stigma can include: - Reluctance to seek help or treatment and reduced likelihood of staying with treatment. - Social isolation. - Lack of understanding by family, friends, coworkers, or others. - Fewer opportunities for work, school or social activities or trouble finding housing. - Bullying, physical violence or harassment. - Health insurance that doesn't adequately cover your mental illness treatment. - The belief that you'll never succeed at certain challenges or that you can't improve your situation. Source: Adapted from Mayo Clinic 2017 ### Stigma Can Also Impact Family and Friends Family members and friends, who often provide essential help and support for people with mental illness, can also experience stigma. They may internalize stigma and blame themselves, or they may fear that people will blame them for causing a loved one’s illness or reject the family socially. This stigma can lead to reduced emotional support, social isolation, and reluctance to seek care for their relative. (Yanos, 2023; Mclean, 2023) Stigma in Diverse Communities Stigma around mental illness is especially an issue in some diverse racial and ethnic communities, and it can be a major barrier to people from those cultures accessing mental health services. For more information, please see [Mental Health Disparities: Diverse Populations.](https://www.psychiatry.org/psychiatrists/diversity/education/mental-health-facts) Stigma in the Workplace A [2022 national poll](https://staging.psychiatry.org/News-room/News-Releases/APA-Poll-Employee-Mental-Health) from the American Psychiatric Association (APA) found that mental health stigma is still a major challenge in the workplace. About half (48%) of workers say they can discuss mental health openly and honestly with their supervisor, down from 56% in 2021 and 62% in 2020. Half (52%) also say they feel comfortable using mental health services with their current employer, compared to 64% in 2021 and 67% in 2020. In a more positive trend, fewer adults are worried about retaliation if they take time off or seek care for their mental health. About one in three (36%) worried about retaliation if they took time off, compared to 48% in 2021 and 52% in 2020. Less than one-third (31%) were worried about retaliation for seeking care, compared to 43% in 2021 and 2020. (APA, 2022) Reducing Stigma ### Public Health Approaches Many years of research on anti-stigma interventions has found that successful interventions (Yanos, 2023): - Include contact (in person, but video can also be a feature if done right). - Focus on a range of disorders, not just depression or mental illness broadly. - Involve participation of people with “lived experience.” - Target groups that have the most interaction or where lack of help-seeking is most problematic (e.g., young people, undocumented communities, military communities). - Are tailored to be credible to specific language and cultural signifiers of the target group. - Last several years in order to be effective. Substantial research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable. Teens are searching for health information online and mental health issues are among the top searches, according to a [national survey from Hope Lab](https://assets.hopelab.org/wp-content/uploads/2021/03/2021-coping-with-covid19-full-report.pdf) (Hope Lab, 2021). About four in 10 teens said they have looked for people with similar health concerns. Many celebrities, such as Demi Lovato, Dwayne "The Rock" Johnson, Michael Phelps, Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges and brought the discussion much more into the general media and everyday conversation. Young people are looking for information and for these personal stories online. Recent studies have also shown the effectiveness of brief videos in reducing stigma. [One study](https://pubmed.ncbi.nlm.nih.gov/38113809/) tracked more than 700 students across two years in a randomized controlled trial and found that watching videos of people sharing their personal experiences and videos with information on mental health improved students' mental health care access (da Conceição, et al 2023). The researchers found that the intervention was particularly effective for those in need, enabling them to recognize their need for care and behave accordingly. [Another study](https://ps.psychiatryonline.org/doi/10.1176/appi.ps.20230215) found that a video featuring an actor sharing a story was as effective as a person with lived experience. (Amsalem, et al 2023). Social marketing campaigns can also be effective. For example, a [research study](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2019.305129) looked at the effectiveness of an anti-stigma social marketing campaign in California and found that the campaign increased service use by helping people better understand symptoms of distress and increasing awareness that help is available. (Collins, et al 2019). The researchers suggest that widespread exposure to the mental health campaign could significantly increase access to treatment. ### Individual Actions to Reduce Stigma The [National Alliance on Mental Illness](https://www.nami.org/Blogs/NAMI-Blog/October-2017/9-Ways-to-Fight-Mental-Health-Stigma) (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness: - Talk openly about mental health, such as sharing on social media. - Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences. - Be conscious of language – remind people that words matter. - Encourage equality between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes. - Show compassion for those with mental illness. - Be honest about treatment – normalize mental health treatment, just like other health care treatment. - Let the media know when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way. - Choose empowerment over shame – "I fight stigma by choosing to live an empowered life. To me, that means owning my life and my story and refusing to allow others to dictate how I view myself or how I feel about myself." – Val Fletcher. Reducing Stigma in the Workplace While stigma and discrimination are still prevalent in the workplace, employers are increasingly addressing stigma against mental illness. The APA Foundation's Center for Workplace Mental Health emphasizes the importance of both robust healthcare services and specific efforts to break the silence that surrounds the topic of mental illness. The Center suggests organizations strive to "create a culture in which mention of depression, anxiety, post-trauma, and other common illnesses become as mentionable as diabetes, hypertension, and migraines." ### Employers who are leading efforts to address stigma offer some suggestions (CWMH): - Tailor programs/approaches to your company culture and existing strengths. - Mention your commitment to leading a behaviorally healthy workplace every time you mention the company's commitment to its overall culture of health, attracting and retaining the best talent, and valuing its employees, etc. - Train leaders to identify emotional distress and make referrals and to responding promptly and constructively to behavioral performance issues. - Be welcoming of the need for accommodations. Train managers to respond appropriately Organizations and Campaigns Across the country numerous organizations and campaigns focus on addressing the issue of mental health stigma and discrimination. A few examples are highlighted below: - ![Love, your mind logo](https://www.psychiatry.org/getmedia/5e63166d-1d62-4cad-bc68-b239beb9ac5b/Love-your-mind-logo.jpg) - ![Stop Stigma together logo](https://www.psychiatry.org/getmedia/124824e1-2509-4f4c-9005-73732be4f067/Stop-stigma-together-logo.jpg) [Stop Stigma Together](https://stopstigmatogether.org/) is working to unite organizations to create resources, generate funding, bring clarifying awareness, and address the issues around mental health and substance use disorders. They will pose a grand challenge to our friends, family, employers, healthcare providers and governments to end the stigma around mental health and substance-use disorders to establish true well-being. - ![This is my brave logo](https://www.psychiatry.org/getmedia/bab57aaf-241f-4dfd-a87f-63fc308b47ac/this-is-my-brave.png) [This is My Brave](https://thisismybrave.org/) is a storytelling theatre show where individuals from the community share their stories of living a successful life despite mental illness. Since 2014, This Is My Brave has produced nearly 800 storytellers sharing true, personal stories on overcoming depression, anxiety, bipolar disorder, PTSD and other illnesses. In spring 2020, the organizers developed BraveTV to bring stories of hope online during the COVID-19 pandemic. - ![How are you really campaign logo](https://www.psychiatry.org/getmedia/fbad59a5-cea8-45e3-80e3-1bee5f0244e7/how-are-you-really.jpeg) One recent effort is the [Mental Health Coalition](https://www.thementalhealthcoalition.org/), spearheaded by Kenneth Cole in partnership with handful of partners. Partner organizations and celebrities include Active Minds, NAMI, The JED Foundation, Anxiety and Depression Association of America, Kendall Jenner, Kesha, and others. The focus of the coalition is fighting stigma through the sharing of stories with the tag line "How are you really?" - ![](https://www.psychiatry.org/getmedia/5e115e61-b6ad-4a61-8a4c-1d65f963fec1/Bring-change-logo.png) [Bring Change to Mind](https://www.bringchange2mind.org/) is a nonprofit organization focused on encouraging dialogue about mental health and raising awareness, understanding, and empathy. Actress and activist Glenn Close co-founded Bring Change to Mind in 2010 after her sister and nephew were diagnosed with mental illnesses. It offers resources and tools to learn more and take action to reduce stigma. - ![Stigma free campaign logo](https://www.psychiatry.org/getmedia/5e75812b-ad59-4006-be1b-0f5834f30172/stigma-free-logo.png) [NAMI's StigmaFree](https://www.nami.org/Get-Involved/Pledge-to-Be-StigmaFree) campaign is working to end stigma and create hope for those affected by mental illness: "Through powerful words and actions, we can shift the social and systemic barriers for those living with mental health conditions." As part of the campaign, people can take a stigma quiz at [CureStigma.org](http://www.curestigma.org/) and learn more about becoming stigma free. - ![Stamp out stigma logo](https://www.psychiatry.org/getmedia/8b969c09-91b7-422f-8aa1-89ebd7f4d55a/stamp-out-stigma.png) [Stamp Out Stigma](https://stampoutstigma.com/) is an initiative spearheaded by the Association for Behavioral Health and Wellness to reduce the stigma surrounding mental illness and substance use disorders. The campaign encourages people to start the conversation and to talk openly about mental illness and substance use. - ![PBS Healthy Minds logo](https://www.psychiatry.org/getmedia/498f449e-660e-402a-9562-150730dba3ed/healthy-minds-pbs-logo.jpg) [Healthy Minds with Dr. Jeffrey Borenstein](https://www.pbs.org/show/healthy-minds-with-dr-jeffrey-borenstein/) aims to remove the stigma of mental illness and demonstrate that with help, there is hope. The series focuses on common psychiatric conditions through inspiring personal stories, as well as, experts sharing cutting edge information, including new approaches and next-generation therapies in diagnostics, treatment and research. Series is produced by the Brain & Behavior Research Foundation. ## How So We Stop Stigma? Conversation Try these simple tips for talking. ### Do Say - "Thanks for opening up to me." - "Is there anything I can do to help?" - "I'm sorry to hear that. It must be tough." - "I'm here for you when you need me." - "I can't imagine what you're going through." - "People do get better." - "Oh man, that sucks." - "Can I drive you to an appointment?" - "How are you feeling today?" - "I love you." ### Don't Say - "It could be worse." - "Just deal with it." - "Snap out of it." - "Everyone feels that way sometimes." - "You may have brought this on yourself." - "We've all been there." - "You've got to pull yourself together." - "Maybe try thinking happier thoughts." Source: MakeItOK.org ## Physician Review Nikhita Singhal, M.D. University of Toronto, Psychiatry Resident March 2024
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