Stigma is a significant concern in mental health, and we should consider it a health crisis. People who suffer from mental health disorders experience stigma due to their diagnosis and frequently describe the effects of stigma as worse than those of the condition itself  (Vigo, D., 2016).

Stigma and discrimination can lead to disadvantages in many aspects of life, including personal relationships, education and work (Thornicroft, G. et al., 2016). According to the World Health Organisation (WHO), stigma is a major cause of discrimination and exclusion. It hinders the prevention of mental health disorders, the promotion of mental well-being and the provision of treatment and care. In addition, it affects people’s self-esteem, disrupts family relationships and limits their ability to socialise and obtain jobs.

People who suffer stigma and discrimination are more likely to experience (adapted from Verywell Mind, 2020):

• Reluctance to seek out treatment
• Delayed treatment
• Social rejection, avoidance, and isolation
• Worse psychological well-being
• Poor understanding among friends and family
• Harassment, violence, or bullying
• Poor quality of life and increased socioeconomic burden
• Increased feelings of shame and self-doubt

We can describe mental health stigma as the disgrace, social disapproval, or social discrediting of people who suffer from a mental health problem (Subu, M. A., et al., 2021).  There are several definitions and models of stigma as research on the topic has increased over the past decades.

Following Corrigan, P. W. et al. (2012), stigma includes stereotypes (negative beliefs about stigmatised groups), prejudice (agreement with stereotypes leading to emotional responses), and discrimination (the behavioural result of prejudice, such as exclusion from social opportunities). Link and Phelan (2001) describe stigma as the co-occurrence of labelling, separation (“us” from “them”), stereotype awareness, stereotype endorsement, prejudice and discrimination in a context in which social, economic or political power is exercised to the detriment of members of a social group.

Furthermore, we can talk about different types of stigma:

• Public stigma involves negative attitudes that others have about mental health problems. For example, beliefs that people with mental health issues are more dangerous or that mental health conditions are caused by “bad genes”.
• Self-stigma occurs when people with mental health conditions accept stereotypes, agree with prejudiced beliefs, and lose self-esteem and self-efficacy.
• Structural stigma (including workplace stigma) is more systemic. It involves policies limiting opportunities for people with mental health problems, such as having limited access to work or loss of advancement opportunities.

According to Corrigan, P. W. et al. (2014), stigma interferes with personal care-seeking decisions and behaviours, especially when public stigma leads to label avoidance. People try to avoid the unfair loss of opportunity caused by stigmatising labels (e.g., not reaching out to mental health professionals as they are associated with prejudice).

The following matrix illustrates the different components of stigma and how it can impact the person with mental health problems:

Following the International Labour Organization (ILO) Mental Health Background Report (2017), stigma and discrimination are among the most significant challenges around mental health. Furthermore, although several health conditions lead to stigma and discrimination, mental health conditions are second only to HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome).

• Although mental health stigma affects many aspects of a person’s life, it has the most significant impact on work and is experienced across all aspects of the employment process.
• Many employers believe that people with mental health problems are worse at their jobs or incompetent.
• Compared to physically ill employees, workers returning to work after sick leave due to mental health issues are likely to be more closely questioned, demoted or supervised, or even being dismissed.

As reported by the American Psychiatric Association (APA), in a recent national poll (APA Press Release, 2019), around half of the employees were worried about discussing mental health issues at work. Furthermore, more than one in three were concerned about the consequences of seeking mental health care, including being fired.

Combating stigma and raising awareness of mental health in the workplace is critical. Employers should recognise the importance of addressing the stigma around mental health and implement awareness and anti-stigma campaigns.

The APA  suggests different strategies to reduce mental health stigma, both at an individual and organisational level. Firstly, following the National Alliance on Mental Illness (NAMI) recommendations to stand up to stigma as individuals:

• Talk openly about mental health.
• Educate yourself and others.
• Be conscious of language.
• Encourage equality between physical and mental illness.
• Show compassion.
• Choose empowerment over shame.
• Be honest about treatment.
• Let the media know when they are stigmatising.
• Do not harbour self-stigma.

Secondly, employers and organisations can follow The Working Well Toolkit (APA Center for Workplace Mental Health, 2016), which provides human resource professionals and business leaders with strategies to address stigma, amongst other resources. For instance:

• Tailor programmes/approaches to your company culture and existing strengths.
• Mention your commitment to leading a behaviorally healthy workplace every time you mention the organisation’s commitment to its overall culture of health, attracting and retaining the best talent, and valuing its employees.
• Help leaders identify emotional distress and refer to mental health resources.
• Provide adequate vacation time.
• Model work/life balance. Pay attention to workload.
• Train managers/leaders to respond adequately and understand their role in supporting employees.

The Toolkit also describes different programmes that employers can implement to reduce stigma and start a conversation about mental health.

On the other hand, the ILO Global Business and Disability Network (Mental health at work resources) also offers resources employers can use to combat stigma and raise awareness of mental health.

In EMPOWER (The European Platform to Promote Wellbeing and Health in the workplace), we believe that reducing mental health stigma and discrimination in the workplace is a priority.

The EMPOWER Project is a European research and innovation effort, with an innovative pilot of implementation that focuses on developing and implementing a novel and low-cost eHealth platform to address mental health in the workplace from a multi-modal perspective. The eHealth platform will address the need to reduce stigma, increase help-seeking behaviour, raise awareness about mental health, and minimalize psychosocial risks and improve self-management strategies.

References

American Psychiatric Association (APA) (2020). Stigma, Stigma, Prejudice and Discrimination Against People with Mental Illness. https://www.psychiatry.org/patients-families/stigma-and-discrimination

American Psychiatric Association (APA) Press Release (2019): About Half of Workers Are Concerned about Discussing Mental Health Issues in the Workplace; A Third Worry about Consequences if They Seek Help.https://www.psychiatry.org/newsroom/news-releases/about-half-of-workers-are-concerned-about-discussing-mental-health-issues-in-the-workplace-a-third-worry-about-consequences-if-they-seek-help

Center for Workplace Mental Health. Working Well Toolkit. 2016. https://workplacementalhealth.org/Employer-Resources/The-Working-Well-Toolkit

Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37-70.

Corrigan, P. W., Powell, K. J., & Rüsch, N. (2012). How does stigma affect work in people with serious mental illnesses?. Psychiatric rehabilitation journal, 35(5), 381.

International Labour Organization (ILO) Mental Health in the Workplace. Key issues and good company practices (2017). http://www.businessanddisability.org/mental-health-at-work/

Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual review of Sociology, 27(1), 363-385.

National Alliance on Mental Illness (NAMI). NAMI Blog. Luna Greenstein (2017).  9 Ways to Fight Mental Health Stigma. https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma

Subu, M. A., Wati, D. F., Netrida, N., Priscilla, V., Dias, J. M., Abraham, M. S., … & Al-Yateem, N. (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(1), 1-12.

Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., … & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123-1132.

Verywell Mind. Social Psychology. What is Stigma? By Jenev Caddell, PsYD (2020) https://www.verywellmind.com/mental-illness-and-stigma-2337677#toc-impact-of-stigma

Vigo, D. (2016). The health crisis of mental health stigma. Lancet, 3, 171-178.

World Health Organization (WHO). Regional Office for Europe. Health topics. Mental health. Stigma and discrimination. https://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/priority-areas/stigma-and-discrimination

Kerry Rodríguez McGreevy, Psychologist, PhD

WHO Collaborating Centre for Mental Health Services Research and Training.
Department of Psychiatry. School of Medicine. Universidad Autónoma de Madrid. 
https://www.ccomsuam.org/