The Impact of Stigma on Mental Health and Recovery Outcomes
There are two paths we can take when addressing issues of mental health and substance misuse. One is to expand and amplify conversations about these topics, and the other is to mute them. There are many reasons that people may choose to avoid or suppress truth-telling around behavioral health challenges. The main one is stigma. That silence can have a devastating ripple effect for those who struggle and their loved ones.
Cultural attitudes about mental health have evolved overtime to foster shame, guilt, and embarrassment about mental health and addiction. At Fairwinds, our clinicians hear clients over and over who believe their depression or anxiety is somehow a character flaw, a sign of weakness, a shameful blot. Many who suffer from a substance use disorder have not accepted that they have an illness. They realize that society often judges people like them. Is it any wonder they keep their struggles private? When they do that, their likelihood of seeking professional help goes down significantly.
As our executive director Jason Bridges recently wrote in a letter to the local paper, “In our world, the difficulty people have seeking help for their basic mental health needs stems, in large part, from the still-pervasive stigma that surrounds the topic.”
Types of Stigma
As reported by the American Psychiatric Association (APA), research has identified three distinct kinds of stigma: public stigma, self stigma, and institutional stigma.
1. Public stigma relates to the misguided beliefs, negative attitudes, and discriminatory behaviors others have about mental illness and addiction. These beliefs, for example that people with behavioral health disorders are to blame for them, not to be trusted, dangerous, and ineffective, often result in discrimination. For example, people won’t hire them, rent to them, or offer them credit. There is evidence that shows they may receive substandard care within the healthcare system.
2. Just as damaging is self stigma. Attitudes similar to those held by the public are internalized and can result in deep shame and self-hatred. Those feelings result in a lack of self-advocacy, help-seeking, and general self-esteem. A sense of unworthiness literally stands in the way of people seeking the treatment they need.
3. Institutional, or systemic, stigma is hardwired into government policies and guidelines within private companies and agencies that curb access to opportunities for those with behavioral health diagnoses. The discrepancies in funding, for instance, between mental health and other health research and the overall dearth of mental healthcare services in comparison to other health services are notable.
In a review of pertinent research, the APA found that self stigma has profound effects on both mental health symptoms and recovery outcomes, in large part because it prevents people from getting help. They list several specific outcomes of this kind of internalized stigma:
· Low self-esteem
· Increased psychiatric symptoms
· Reduced hope
· Reduced probability of seeking or remaining in treatment
· Lack of social relationships and support
· Difficulties at work
The National Alliance of Mental Illness (NAMI) reports that self stigma also results in self-sabotage, negative rumination, and suicidal ideation. Self-sabotage includes refusal to get help, quitting therapy, stopping medication, as well as isolating from relationships. It is based on firm belief in personal blame and the inevitability of failure.
Breaking Down Stigma
How do we shift the culture of stigma? Such a thing has to take place both at a grass roots level and at the policy level. For everyone, whether in the halls of power, an HR department, or simply interpreting what we read in the news, working to become self-aware and notice our intrinsic biases when it comes to substance use or mental health disorders is an important first step.
So is having honest conversations about your own mental health or recovery struggles. If you are comfortable sharing that you had shoulder surgery or have been diagnosed with an auto-immune disease, consider exhibiting the same level of trust and honesty when you speak to your friends or co-workers about your depression, anxiety, PTSD, substance use disorder, or any other diagnosis with which you struggle and for which you are receiving help.
When public figures such as Maryland congressman Jamie Raskin speak openly about mental health, we must hope that it inspires others to do the same. When his son, Thomas, died by suicide early in 2021 he said, “Tommy’s struggle showed me that our obligation to treat mental health needs is just as urgent as our obligation to treat physical health needs.” He saw an opportunity to shift his grief into action towards a better, more equitable world in which behavioral health comes out of the closet and into the mainstream where it belongs.
At Fairwinds, we are committed to fighting stigma at every opportunity. We want to amplify the honest voices of anyone who wants to share a story or inspire others. If you want to share your story using the Fairwinds platforms, please reach out. Contact information is below.
To speak to us about sharing your story anonymously and confidentially in a blog or on another Fairwinds platform, email our marketing and communications director Vanessa Park at firstname.lastname@example.org.
The information in this blog came from NAMI and the American Psychiatric Association