The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

Read the Full Text (PDF, HTML)

Mental illness has wide-reaching effects on people’s education, employment, physical health, and relationships. Although many effective mental health interventions are available, people often do not seek out the care they need. In fact, in 2011, only 59.6% of individuals with a mental illness — including such conditions as anxiety, depression, schizophrenia, and bipolar disorder — reported receiving treatment.

In the second issue of Psychological Science in the Public Interest (Volume 15, Number 2), Patrick W. Corrigan (Illinois Institute of Technology), Benjamin G. Druss (Emory University), and Deborah A. Perlick (Mount Sinai Hospital) discuss the role of stigma in limiting access to care and in discouraging people from pursuing mental health treatment.

Commentary: Creating and Changing Public Policy to Reduce the Stigma of Mental Illness

By Former U. S. First Lady Rosalynn Carter, Rebecca Palpant Shimkets, and Thomas H. Bornemann, The Carter Center Mental Health Program

Read the Full Text (PDF, HTML)

From a public standpoint, stereotypes depicting people with mental illness as being dangerous, unpredictable, responsible for their illness, or generally incompetent can lead to active discrimination, such as excluding people with these conditions from employment and social or educational opportunities. In medical settings, negative stereotypes can make providers less likely to focus on the patient rather than the disease, endorse recovery as an outcome of care, or refer patients to needed consultations and follow-up services.

These displays of discrimination can become internalized, leading to the development of self-stigma: People with mental illness may begin to believe the negative thoughts expressed by others and, in turn, think of themselves as unable to recover, undeserving of care, dangerous, or responsible for their illnesses. This can lead them to feel shame, low self-esteem, and inability to accomplish their goals. Self-stigma can also lead to the development of the “why try” effect, whereby people believe that they are unable to recover and live normally so “why try?” To avoid being discriminated against, some people may also try to avoid being labeled as “mentally ill” by denying or hiding their problems and refusing to seek out care.

Structural stigma (i.e., stigma that is part of social and institutional policies and practices) presents additional large-scale barriers to mental care by undermining opportunities for people to seek help. A lack of parity between coverage for mental health and other health care, lack of funding for mental health research, and use of mental health history in legal proceedings, such as custody cases, all present structural reasons that people might not seek treatment.

Studies have shown that knowledge, culture, and social networks can influence the relationship between stigma and access to care. For example, myths about mental illness and its treatment can lead to the development of stigma and discriminatory practices. Cultural factors can influence the types of behaviors that are thought to violate social norms and the degree to which discrimination against people who display nonconformative behavior is accepted. Social networks, including family members, friends, and coworkers, can also have a big impact on people’s decisions to pursue treatment, serving either to enhance feelings of stigma or to encourage care seeking.

Because of the impact of knowledge, culture, and networks on people’s decisions to access care, many public-health and policy initiatives meant to encourage care usage have focused on educating people about mental health to combat harmful stereotypes related to illness and treatment. Addressing cultural barriers to care and including supportive networks in treatment plans can also encourage treatment.

At the structural level, legislation such as the Americans with Disabilities Act of 1990, the Mental Health Parity Act of 1996, the Medicare Improvements for Patients and Providers Act, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, and, most recently, the Affordable Care Act of 2010, have served to protect people with mental illness from discriminatory practices.

In a commentary accompanying this report, former U. S. First Lady Rosalynn Carter, along with Rebecca Palpant Shimkets and Thomas H. Bornemann of the Carter Center Mental Health Program, describe the challenges faced in trying to reduce the stigma of mental illness and increase access to care. The many legislative efforts spearheaded by the Carter Center have helped create or change public law to protect the rights of people with mental illness and ensure parity for mental health services. Although these laws often serve to force structural changes, the hope is that legislative efforts will eventually lead to true changes in attitudes toward mental illness.

Despite the Carter Center’s many successes, more work needs to be done. Integrative research that connects the mental health, public health, education, and primary care fields is necessary. The authors of this report and commentary believe that such integrative efforts can help build a strong network of systems and services that encourage access to care without the fear of discrimination or prejudice.

 

About the Authors (PDF, HTML)

Leave a comment below and continue the conversation.

Comments

Will overcoming associated stigma produce meaningful results if the majority of “professional” care providers continue to be ineffective at best and incompetent at worst? Please. The field is full of flakes who need treatment as much or more than their clients / patients. I have been a CADC since the late ’80s, an MFT since the late ’90s, and a Psy.D. since the late ’00s. I have spent way too much time cleaning up messes made by others, many of whom graduated from waaaaaay less than ethical degree mills. Unless or until the “profession” catches up with the late Arthur Deikman et al, I don’t see this changing.

why is there stihma about mental illness and not physical illness like diabetes? on my oponoion it is because mental illness is about behaviot and diabetes is not. we expect people to be able to control their behaviot but not their physical bodies

PSYCHIATRY IS NOT A SCIENCE. THE MEDICAL MODEL IS NOT A FACT THAT CAN BE DISCOVERED. IT IS A METAPHOR THAT IS USED TO “DUB” PEOPLE FOR SOCIAL REASONS, LIKE DUBBING A SHIP ” THE QUEEN MARY!!!

mental illness is stigmatized because psychiatry is stigmatized and not respected

I was recently in an emergency room devoted to behavioral health. I was discriminated against because of my mental illness. I had all my belongs taken away, I was made to strip and be examined head to toe, my breasts were touched and I was made to squat and cough while undressed. I was asked about any criminal involvement, drug tested and asked what I was coming down from. Also was I homeless. Talk about stigma. I can’t just have a mental illness I have to be classified as an addict, criminal and a homeless person. That’s what mental health care people think of us.

Am a nurse in Butabika National referral hospital(Uganda) but we always find a problem wide spread relapse among the discharged patients and most cause is stigma in the community. fellow psychiatrists we need to something on stigma for the development of our field.

I have been suffering with mental illness for years. Thank god for the help of my family and friends. Right now I’m going through psychosis and hallucinations. It is not an easy road. My wife is currently caring for me. Thank god for her help and support. I have two kids…a 14 year old and 10 year old. I worry so much that my mental illness will impact them negatively. I love them so much yet I feel more disconnected every day. Does anyone have advice on relationships with family and especially wife and children?

I was initially Dx rather misdiagnosed & treated when Bipolar was still in research stage. In effect, this meant I endured the lifestyle symptomatic of long term untreated &/or antidepressants which enhances the illness. In addition, environment also being a contributing factor of severity, as a child born biracial, in 1958, impoverished, abandoned &left to care for younger brothers before age 10 by a gay mother. We slept in cars, always hungry, sexually, emotionally, physically, etc abused by male family & b/c my moms knew she needed them when she disappeared she chose to believe them & my being aliar over me. prior to that I had a stable home but my moms used med one time too many b/c she would come take me away b/c ppl gave her money for me b/c I was very pretty & her only girl. Once she finished collecting the cash she dumped me at the closest house she knew & my god parents had to come find me & see a dirty snot nose smelly kid & unrecognizable as the one who left their home. Fedup they begged to deaf ears not to take me b/c its the last & I could not go back, THEY MEANT IT! mISSING MY CHILDHOOD & TEENS GOING FROM RAISING HER KIDS WHEN I WAS A KID RIGHT INTO A MOM OF 4 AT AGE 20. bUT, I FOUGHT LIKE A CHAMPDETERMINED TO GET MY DEGREE I DRUG KIDS TO WHOMEVER WOULD BABYSIT. When I finally accomplished it & start a career w/ Fed Govmt that seemed like GOD himself created & suitable just to me. After literally living an existence that felt & only be described as in the HELL from the bible & pulling myself out into a lifestyle & bliss of paradise. But it was short lived. After repeating this same routine over &over NO matter how & what difficulty or walls knocked down in my quest & refusal to accept this as my destiny & the reason I always had no choice but return, I was beat down to what I call outer body experience I witnessed of me doing drugs, convinced by the images in my head I now know was symptoms of being schitzophrenia causing me to believe that if I didn’t transfer my skills to illegal behavior for money my kids my 2 girls would repeat & endure the horrors I had to.My family supported med by putting me on a thrown I neither asked or wanted b/c the dark depths of my mental illness was creative & a geneuis at ways to make money & kept both hands full of cash & heart w/ love that justified any & every irrational act as right. but when the ride was over & I served no useful purpose to anyone Just like it happened as a child I was once again abandoned betrayed& I had self sabotaged my job, life in exchange for drugs & jail & as I watched myself doing all those things I had no control of & no way of stopping despite having begged & willingly volunteered for treatment b/c I didn’t feel right inside no body listened or help. but when I I walked toward the light & got out of the tunnel into a world that made me feel emotions of gratitude, appreciation, pouring of each & every person alive energy that I literally & physically felt sincerely thankful to have the justifiable reason to turn me away w/o thought or consideration, help or support that I suffered a cursed life & no say in my behavior that was controlled by a mental illness that waited until it destroyed my life that I fought so so hard to obtain to be correctly DX & treated that is until I lost my healthcare & Medicaid doesn’t provide for I finally learned everything thaqt happened to me was a result of Dx Bipolar 1 w/ schizophrenia & severe anxiety. A disease meant only for those who had money & able to start over once the ride in hell was over. But for those of use who lost everything we had somewhere down in the deep depths of hell w/o even a hand to grasp onto at the exit well we still live in hell just a different part or a single person who gives a damn about us, how why or what happened. Yet w/o giving almost any thought at all it’s still obvious & clearly visible to even a blind man that something went wrong in the brain of a person who knocked down walls, stepped into the fire & w/o hesitation did whatever necessary to rise above & find the path for the journey to success & better life for their children. Nobody in their right mind would do all those years of hardship required for success only to throw it away once there. A psychiatrist once told me that despite drugs abuse occurring after being Dx & documented as symptomatic of a person having long term untreated mental illness of this DX, once acknowledged as part of that person everything changes along w/ every decision rendered despite it being far more dangerous & not to provide the proper drug therapy which may include Benzo, it is biased & everything about that person ‘s behavior is for the purposes of knowing how to play the system for drug seeking. one Dr took me off the Xanax the only drug proven throught me as their guinea pig that stabilizes my anxiety & b/c as the Dr he knew better & had degrees to prove as much decided I could be treated just as affectively w/ a combo pill for both uses of anxiety & Bipolar. Well the idiot not only jeapordized my life when I went into a blackout rage knocking down close to 20 men trying to hold me back in effort to go after awomen who raised her cane in a threatening way & the last thing I remember before coming back to hearing the words we trying to hold her but she is too strong & in response to my asking who who I got the answer “You Bitch You”! after which I also learned I almost broke her back throwing her over a rail. NOW B/C IT’S SUCH A PROFITABLE COMMODITY, AS SOON AS YOU WALK THROUGH THE DOOR HE SAW IT WRITTEN ALL OVER YOUR FACE THAT YOUR dx IS BIPOLAR. tHAT IS THE REASON PPL SUCH AS MYSELF WHERE THE ILLNESS INSIDE IS REAL & NEEDS TO BE TREATED PRIOR TO OCCURANCE OF THE CRIMINAL ACT OR LIFE TAKEN THAT THE CORRUPT JUDICIAL SYSTEM WILL GET AWAY W/ HOLDING ME ACCOUNTABLE FOR AN ACT I CAN’T EVEN REMEMBER MORE OR LESS COMMITTING BUT B/C THE PUBLIC PRETENDER ASSIGNED TO REPRESENT ME IS REMINDED HE WORKS FOR THE STATE & THE JUDGE HAS JUST COMMITTED AN ACT OF JUDICIAL MISCONDUCT W/ HIS STATEMENT & EGO TELLS HIM HE CAN DO THAT & GET AWAY W/ IT B/C ANY PERSON REPRESENTED BY THE PD IS UNEDUCATED, IGNORANT OF THE LAW & PROBABLY EVERYTHING ELSE. hIS pd WAS JUST REMINDED OF THE SIDE HIS BREAD IS BUTTER & REMAN SILENT. i’V ESEEN IT HAPPEN,& THAT BS ABOUT KNOWLEDGE IS POWER IS JUST THAT BS & LACKS EVEN THE ENERGY OF CHALLENGE IN COMPARISON TO THE POWER OF THE COLOR GREEN& STRONG ENOUGH TO GIVE BLIND JUSTICE ITS SIGHTAND SPEECH

ONLY THE PPL OF POVERTY SUFFER THE AFFECTS OF MENTAL ILLNESS KNOWINGLY AND PURPOSELY BY THOSE IN CONTROL OF THE ABILITY TO HELP THEM BUT WONT.I WELCOME THE CHALLENGETO COMPARE THE EXPERIENCE OF THE BS DX OF BIPOLAR 1 THAT HAVE WEALTH AND THEIR CAKE WALK OF STORIES THAT CAUSED THEM SO MUCH HARDSHIP ON THEIR JOURNEY. I ALSO GUARANTEE THEY WILL CEASE THEIR CLAIMS OF BEING DX BIPOLAR ONCE THEY HEAR THE TRUE WAR STORIES OF REAL BIPOLAR B/C IT WILL BE FAR TO DIFFICULT TO BARE HEARING THE REALITY WHILE IN THE DEEPEST DEPTHS OF THE HELL I SUFFER ALONG W/ THE OTHERS WHO DIED INSIDE LONG AGO WHEN THEY CEASED TO LIVE AND DEATH CANT COME SOON ENOUGH SO THEY CAN STOP WITNESSING BEING SURROUNDED BY LIFE THEY ARE NOT ALLOWED ANY PART OF B/C THEY ARE MEERLY EXISTING

I deal with my illness every day…but now I’m seeking help…I’m SICK of being sick…can’t deal with any relationship…or people…it’s time for a Damn change..I’m in charge of my life..and only I can change what’s affecting me…I urge anyone dealing
With a illness of the mind to seek help ..I dont care.
What people think about me or my illness…I just want to feel. Like I’m normal…not like a freak..or wierdo..

When I, Clark-Williams, submitted the aforementioned commentaries in 2015,& b/c most if ny 58 yrs of life formed the most trustworthy, codependent, & overwhelming attachment to my longest last friendship w/ hurt, pain & tears. There is a point, however,even the strongest person, whose spirit overflowed with ambition, life & everything else required, & willing to commit, to achieve their desired goal for their mark to remain long after they’ve gone. But, they can no longer endure the pain that has also reduces that fire withing to a quickly dwindling spark. I had hoped someone would’ve acknowledged this fact as well as b/c I’d been wondering for so long in the darkness fight a battle alone that it has worn me down to the point of being lost & not even having the energy or capability to think of a course that would help find my way again. I had truely hoped someone would’ve read mypost w/ comprehension of the sg it held that just might want them to extend their hand just long enough for me to find my, so that I could stand once again & take it from there. But, like I needed anything or one else to add to my world of madness of which upon having sacrificed one’s self & whether in man’s eye deemed right, wrong or indifferent certainly of that in comparison to GOD”S law, not even he can deny the fact thatnotwithstanding, the simple sacrifices that have all but disappeared from humanity even the word cannot be defined by the young generation. For the unconditional love of my children, & despite sacrificing your life so that they may live would not be easily forgotten, when the consequences of those 3 decade old sacrifices are still ongoing forcing u to live within the confine of a square, the lifestyle, successful career all gone & the damage of ur sacrifice prevents ur ability to even rebuild b/ gone too are the finances, All thats left is u, ur Bipolar, Schiz, & anxiety & a husband whose illness has progressed to terminal & all he wants is in knowing this desires it only to happen living near his son. Who had to relocate to FL for a better life for his only family & it far too soon w/o throwing it all away & I cannot even help make that happen , which is called a ripple effect. Instead of the slow death I’ve been dying for 30 yrs, I wouldve preferred the bullet that ended it all quickly. While I am truly happy for those who benefited from the scientific & medical benefit of progress, controll of & render hellp to their mental health, the enhancements of my misdiagnosis & drug therapy & did not require much considerate of the trauma of rape & betrayal when I told my mom on the male family members, hunger, etc., etc., by the time the lights came on to progress of being capableof filling the whole w/ answers to fill the void in my belly I had no idea what, why, or how to fill it just that it made me feel empty & uncomfortably disconnected from my body. By the time the answers began to arrive my life as I knew it worked hard as hell to achieve was over. This being the first time since learning of my illness that had a doctor asked if I felt like committing suicide, my answer would have been yes, I just didn’t get the opportunity to take all the pills or any before something made me go to sleep like someone that had been partying hard w/o the benefit of doing or enjoying the effects. I feel life cheated me out of my life w/o asking if I wanted to play the game,

When I started practice in 1966, the public’s acceptance of mental illness was about zero. Jump to 2012 when I retired from practice and began volunteering at a free primary care clinic. The understanding and acceptance of mental illness had jumped from zero to about 10 percent and that was just in the medical staff. We have a very long way to do.

I’ve never rode the self pity wagon since for a very long time I wasn’t even aware it existed. It wasn’t until I began a mission of self sabotage of the best job & career one could be blessed to have. that was when I knew something was wrong, the only way to best describe it was not being able to do or control your action as you watched from the parallel dimension of an outer body experience, It use to be believed someone sacrificing their life for another’s with death was the ultimate sacrifice. But I am here to tell u that’s BULL. It’s been 30 yrs I’ve been living in & enduring the consequences of y actions on adaily basis still being denied the most simple request of hud housing so I can move around w/o eggshells under my feet in someone else house. The only thing that kept me sane w/o regret was whenever I went into mania I envisioned & believed wholeheartedly , if I did not to what I did &/or anything else necessitated kids especially my girls would endure every bit of the horrors of rape molestation, hunger &abandonment to sleep in cars being mother to my younger brothers, I promised them, GOD, & self no way would my girls know such betrayal as when I told my mom & I was called a liar she turn on me for the sake of a future sitter. I still can’t believe I went from earning almost 100G to $700 a mo. My ultimate pain though is now knowing my husband, James is dying & want his last days to be w/ our son, who relocated to FL for a better life for his fam & he. Our son cannot return here w/o giving up the life he just stabilized, And I wish I would not wake up most days b/c my heart aches w/ fear my husband & his dad wont be breathing before I find a way to move us to FL & end the misery that’s so obvious everyone speaks on it. I’ve spent the lst 30 yrs of my life in the hell of an illness that destroyed my life by the time it was properly Dx but its nothing compared to the hurt of being unable to help my husbands last wish become a reality!! Like the title of the booke I’m trying to write if I c an just focus b/c my ins, wont even pay for proper treatment which I certainly cant afford. It’s name will be ” Sometimes its darker in the light. Thosew of u who at least have had the opportunity to have a life , pls live it to the fullest b/c I just want it to be over. I have a God & that is the 1 & only reason I’ve lastest cant promise much more b/c I’m just so tired

I would say 80% of the mental illness symptoms are caused by stigma.If you mention you have a mental illness nobody will believe you about anything because you are “crazy”, a lot of people will end up discriminating more,or thinking of you as a child.Would they bully a person in a wheel chair?No, I wonder who is really sick then?If society had a better attitude towards mental illness, I think there would be less mental illness.

This for Gary. Sir, please stay positive for your kids. They and your wife are already going through testing times with your illness and caring for you. Worry and negativity are both contagious and will eventually ruin your children’s future. For their sake please stay positive. If you have access to the internet you can look up meditation. It really helps.
God bless you and your family.
Amen.

To the people who believe that mental illness is simply about behavior – – umm, aren’t you forgetting that mental illness is about disfunction in the brain that results in the behavior? It seems you’re saying people with mental illness can control their behavior like the majority of the rest of the world. But if you look at advanced scientific brain scans of people with these disorders, you’ll quickly see the ‘evidence’ of overactivity in some part and underactivity in another part…with the exception of bipolar mania, which lights up the entire brain like a christmas tree! Read Dr. Daniel Amen’s “Change Your Brain, Change Your Life” – an amazing read!

Leave a comment.

Comments go live after a short delay. Thank you for contributing.

(required)

(required)