The 7 kinds of mental health stigma
Oxford Languages defines stigma as “a mark of disgrace associated with a particular circumstance, quality, or person.” Stigmatised individuals face varying degrees of prejudice (preconceived negative attitudes) and discrimination (unfair treatment based on prejudice).
Many are aware of the particularly strong, persistent, and universal stigma associated with mental illness. This knowledge is one of the numerous reasons that employees choose not to disclose their mental ill-health at work. But did you know that there are multiple kinds of mental health stigma?
Writing for NAMI, social worker Gretchen Grappone has identified seven stigma varieties surrounding mental health, which will be discussed in this post.
1. Health Practitioner/Provider Stigma
The Black Dog Institute writes that 54% of those with mental health troubles do not seek professional help. When individuals do turn to healthcare providers and services for support, they are placing a lot of trust that they will be treated fairly and decently.
Unfortunately, though, stigma against the mentally ill exists among health practitioners, such as certain doctors, psychologists, nurses, and so on. Hence, it’s been identified as a particular variant of stigma. Negative attitudes about mental ill-health and/or particular health conditions can and do lead to discriminatory practices and treatment.
Experiencing health practitioner stigma, or other discrimination from healthcare workers, can discourage and dissuade people from seeking better help.
2. Label Avoidance
As indicated earlier, the prejudice against those with mental health conditions (which are health conditions like any other) is especially persistent. Although there is growing awareness of and discussion around mental ill-health, these disorders can still be perceived as “marks of disgrace.” And we know what that can lead to.
As a result, some people are worried that they will receive a diagnosis or label that bears a heavy stigma. Rather than risk it, they choose to avoid treatment altogether. This is called label avoidance. It can also involve self-denial that you have a mental illness; you don’t want to associate yourself with that concept and its negative connotations.
Some experts consider label avoidance the worst type of mental health stigma, as it prevents people from attaining the support they need.
3. Perceived Stigma
Perceived stigma is another of the seven kinds of mental illness stigma. Basically, it is the impression held by those with psychological conditions that “others have negative beliefs about people with mental illness.”
When you consider public stigma and self-stigma, discussed below, along with the other types, it is easier to see why these individuals may perceive stigma everywhere. Due to numerous harmful past experiences, or unconsciously internalised prejudicial attitudes, they may be long conditioned to view the world that way.
4. Public Stigma
When we think of mental health stigma, what first comes to mind is probably what’s known as “public stigma.” It is societal disapproval and devaluation originating from the widely held, negative stereotypes and preconceptions, spread throughout the general public, about those with mental health disorders.
These prejudicial opinions and attitudes are often fostered by a lack of awareness, misinformation, gossip, and fear. They can be promoted via harmful representations in the mass media (such as forms of news coverage and pop culture).
Common stigmatising stereotypes about those with mental ill-health include that they are responsible for their conditions, unpredictable, dangerous or violent, “crazy” or “psycho,” unlikely to recover, hopeless, untrustworthy, childish, weak, cowardly, just "bad people," hard to understand, and attention seeking, among many others.
As one example, a 2020 study found that nearly 50% of participants were unwilling to work closely with those experiencing major depression, and nearly 75% did not want to work closely with those living with alcohol dependence (alcohol use disorder).
Public stigma results in myriad consequences for the stigmatised individual. These include exclusion, bullying, discrimination (such as at work or school), isolation, shame, and self-stigma.
Over the years, people with lived experience of mental ill-health may have unknowingly internalised society’s dominant prejudices against them. Usually existing on an unconscious level, self-stigma involves the psychologically unwell individual’s acceptance of public stigma as true. Like public stigma, it has been associated with worsening symptoms, shame, self-blame, and treatment avoidance.
While some experts believe label avoidance to be the worst of the seven kinds of mental health stigma, it could be said that self-stigma is especially insidious. We can limit our exposure to those holding discriminatory opinions, but we can only fight against our own self-stigma when we are aware of it. Some people are never aware of it.
Additionally, self-stigma can lead to perceived stigma. If an affected person unconsciously stigmatises themselves, they are more inclined to think every other person holds the same beliefs, too.
6. Stigma by Association
Simply by being close to a mentally unwell individual, you may encounter public devaluation and negative preconceptions. Stigma by association (“courtesy” or “associative” stigma) affects the families, partners, carers, and friends of those with mental ill-health, as well as others connected to them. The person you know becomes that “mark of disgrace.”
Unfortunately, fears of associative stigma can result in discriminatory practices against people with psychological conditions themselves. For instance, in a work context, employers may be unwilling to hire or retain an individual because they wish to avoid potential societal disapproval.
As another example, someone experiencing mental health conditions may find it more challenging to receive recommendation letters.
7. Structural/Institutional Stigma
Lastly, the public’s deeply entrenched preconceived notions against those with mental ill-health often become enshrined in the policies, procedures, institutes, and laws of society. Thus, public and structural stigma reinforce one another.
In a healthcare provision setting, for instance, institutional stigma encompasses the “policies, cultural norms, and organizational practices that limit consumers’ access to health services, quality of care, and capacity to achieve optimal health and well-being.”
On a more hopeful note, systemic improvements to combat structural stigma, prejudice, and discrimination – in whatever arena – can have positive effects, cascading down to the general public.
Challenge all kinds of mental health stigma by signing The United Project’s United Pledge. Our non-profit seeks to eliminate workplace mental health discrimination at all levels, macro and micro, facilitating psychologically safe work environments from the top down and bottom up.
Written by Monique Moate