What is mental health stigma? Are there different types of mental health stigmas? Are you aware of the specific type of mental health stigma you experience and its potential impact on you?

Kalichman (2019) defines mental health stigma as “the disgrace, social disapproval, or social discrediting of individuals with a mental health problems.” Additionally, research has identified four types of mental health-related stigma (Subu et al., 2021),

Self-stigma – Often referred to as internalized stigma, self-stigma encompasses negative attitudes towards one’s own mental health or illness which may lead to lack of self-efficacy with coping or perceived ability to recover; hesitancy to access treatment or help; and feelings of powerlessness or general lack of control when experiencing a mental health challenge.

Public stigma – Public stigma or perceived stigma are negative attitudes demonstrated by the community or public towards individuals with mental illness or challenges. Stemming from fear or misunderstandings, public stigma can lead to negative outcomes at home and beyond.

Professional stigma – Particularly worrisome, professional stigma occurs among healthcare professionals who hold stigmatizing attitudes towards their patients with mental illness-related symptoms thus negatively impacting integrated care and treatment services. Professional stigma may also arise towards those healthcare professionals who provide mental health services to patients.

Institutional stigma – Institutional stigma refers to an organization’s policies or culture of negative attitudes and beliefs toward individuals who present with mental health problems. These negative attitudes are further reinforced or deepened by legal frameworks, public policy, and professional practices (Livingston, 2013).

It is important to take stigmas into consideration because they are known to impact:

1. the ways in which one talks about their own or others’ mental health,
2. the ways in which one seeks treatment or help to improve mental health, and
3. the ways in which one seeks to cope with or recover from mental health challenges/crises in themselves or others.

How do we know we are being impacted by mental health stigma? Has any of the below happened to you?

1. You have heard someone say – “I have no patience with people’s mood changes. Just do your work and get over your issues” – public stigma
2. You have seen a family member’s frustrations with her doctor who says “you are just experiencing hormonal issues – it will get better over time. Just be patient” – professional stigma
3. You are hesitant to tell someone at work or at home that you are sad, unhappy, frustrated for many days now for fear of looking weak or attention-seeking – self-stigma
4. A colleague tells you that they are getting mental health therapy but “please don’t tell anyone at work because you know they are going to lay me off”– institutional stigma

To better understand stigmas as they may apply to you:

1. Begin with assessing your attitudes toward mental health.
   1. Are you ok with someone talking to you or asking advice that is mental health-related?
   2. Are you ok with a family member telling you about their feelings and emotions?
   3. Are you ok with having a “personal” conversation with a colleague?
   4. Are you ok when you hear others self-disclose that they are getting help or therapy to improve their mental health?
   5. Are you ok when someone mentions they practice mindfulness or meditation or yoga to better manage their moods?
   6. Are you ok with talking about your own feelings with friends, family, or colleagues?
   7. Are you ok if someone talks to you about what they have perceived as your moods or behaviors at work or home?
   8. Are you ok with asking yourself – “I Feel or Think...what is going on?”
   9. Are you ok with telling yourself – “I can’t do this alone…I need help (professional or self-care)”
2. Next, assess public stigma:

Do you feel concerned about being perceived as “nuts” or “crazy” or weak or helpless by your community – friends, family, colleagues?

1. Next, assess institutional stigma:

Do you feel worried that you may get disciplined, medically labelled, or dismissed because of disclosing your mental health challenges at your workplace or another organization important to you?

9 tips to reduce the impact of stigma:

1. Get educated: Knowledge is a powerful tool. Educate yourself and others about mental health conditions, their prevalence, and their causes. Understanding that mental health challenges are common medical conditions can help dispel myths and reduce stigma. Read up about self-stigma and ways to manage. Understand your own mental health and any conditions you may be dealing with. Reflect on your needs, triggers, and the strategies that work best for you in maintaining your mental well-being. Reach out for peer support through your local NAMI or create/facilitate a peer support group – that allows you to feel less alone, connect with like-minded people who are recovering from similar lived experiences or take advantage of “group think” so that you can self-care and recover from mental health challenges.
2. Communicate:
   1. Encourage open and honest conversations about mental health within your circle of friends and family.
   2. Normalize discussing mental health concerns without judgment or shame. When people feel comfortable talking about their experiences, it can reduce the stigma surrounding these issues. If comfortable enough, ask a friend or family member about their experiences with managing their mental health – for e.g. self-care techniques or counseling help. If the conversation leads to them asking you “Why” – you can choose to say, “I am not yet ready to share” or “just asking, thanks for sharing”.
   3. Consider sharing your story online - you can remain anonymous through the process.
   4. Write or speak out loud about how you are feeling in privacy and when you are alone. Get used to saying or writing the words, for e.g. “Lately I feel listless, sad, unhappy or unenthusiastic and I don’t know why.” – Consider using a tool to accurately describe your feelings.
3. Challenge Stereotypes: Challenge and confront stereotypes and misconceptions about mental health when you encounter them. Share accurate information and personal stories to counteract stigma.
4. Advocate for Policy Change: Get involved in advocacy efforts to change policies and laws that perpetuate mental health stigma. Support initiatives that promote mental health awareness and access to care. Resource: Advocacy for Mental Health
5. Use Positive Language: Be mindful of the language you use when discussing mental health. Avoid derogatory or stigmatizing terms, and instead use language that is respectful and person-centered – for e.g. “a person living with mental illness” v/s a “mentally ill person”.
6. Seek Professional Help: If stigma is taking a toll on your mental health or the well-being of someone you care about, consider seeking help from a mental health professional. Therapy can provide coping strategies and emotional support.
7. Know Your Rights and Resources: Educate yourself about your legal rights and protections related to mental health. Familiarize yourself with applicable laws, such as the Americans with Disabilities Act (ADA), which provides protection against discrimination based on mental health conditions. Understand your healthcare coverage, including mental health benefits.
8. Document Your Needs: Keep a record of your mental health journey, including your goals, progress, and the support you receive. This can be helpful for tracking your well-being and advocating for your needs.
9. Self-Advocate with Employers: Communicate your needs with supervisors, or administrators. Familiarize yourself with relevant policies and procedures for requesting accommodations.

Reducing the impacts of stigma on mental health requires ongoing effort and a collective commitment to change attitudes and perceptions. By taking these steps, you can contribute to a more compassionate and understanding society regarding mental health issues. Keep in mind that you have the power to initiate the process – start by making a commitment to "Engage in Conversations About Mental Health."

References:

Kalichman S., (2019). Stigma and prejudice teaching tip sheet. In: American Psychological Association. 2019. https://www.apa.org/pi/aids/re...ion/stigma-prejudice .

Livingston, J.D.  (2013) Mental illness-related structural stigma: The downward spiral of systemic exclusion Final Report: Mental Health Commission Canada

Subu, M.A., Wati, D.F., Netrida, N. et al. (2021). Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: A qualitative content analysis. International Journal of Mental Health Systems 15 (77). https://doi.org/10.1186/s13033-021-00502-x