Linkage to Care Blog: Stigma



Public stigma is a negative societal reaction that results in prejudice toward a group of people with a negatively viewed trait such as mental illness (Corrigan, 2004). Public stigma reinforces a greater desire for social distance from people with mental illnesses, leading to lost employment and housing opportunities, as well as decreased social support from family and friends (Pescosolido et al., 2010). (


Stigma by association represents the process through which the companions of stigmatized persons are discredited. Conduits for stigma by association range from the strong and enduring bonds of kinship to the arbitrary occasions of being seen in the company of someone who is stigmatized. (


People who engage in label avoidance refrain from associating with individuals and/or institutions that may connect them to a stigmatized group (e.g. mental health consumers, providers, and treatment facilities). People engage in label avoidance to escape the negative consequences of public and self-stigma, even when it means foregoing available services that have been shown to have a lasting impact on recovery (Corrigan & Wassel, 2008; Rodrigues et al., in press). Thus, fear of stigmatization, a well-established and persistent barrier to care, creates a community of people who often suffer in silence until emergency intervention is necessary and recovery becomes a much more challenging and lengthy endeavor. (

Structural stigma refers to particular policies of large entities (e.g., governments, companies, schools) that place restrictions on the rights or opportunities of persons living with mental illness. For example, in Lithuania, citizens with long-term mental health problems are excluded from home owndership.

Perceived stigma and self-stigma affect willingness to seek help in both genders and races. Perceived public stigma refers to discrimination and devaluation by others. Public stigma refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people

Self-stigma occurs when patients agree with and internalize social stereotypes. Patients often think that their illness is a sign of character weakness or incompetence. Patients develop feelings of low self-esteem and become less willing to seek or adhere to treatment. Patients anticipate that they will be discriminated against, and to protect themselves they limit their social interactions and fail to pursue work and housing opportunities. Prevalence of self- stigma among psychiatric patients is high ranging from 22.5 to 97.4% in different countries. Overall prevalence of self-stigma was 54.44%. Among those who had self-stigma 48% had mild self-stigma, 34.7% had moderate self-stigma and 17.3% had severe self-stigma. Among the five components of self-stigma scale, the highest mean score was on stereotype endorsement, followed by discrimination experience, social withdrawal, stigma resistance, and the lowest for the component of alienation. For instance, it was 36% in USA, 97.4% in Ethiopia, 22.5% in Nigeria, 49.5% in China and 50–66% in India. Furthermore, self-stigma among psychiatric patients is associated with poor quality of life, low treatment adherence, decreased self-esteem, increase in severity of symptoms, low level of self-efficacy and poor recovery. In extreme conditions, self-stigma is associated with the higher rate of suicidality.

Health Practitioner Stigma – Mental health practitioners should disclose their own struggles and welcome their colleagues to do the same. Everyone deserves the freedom to seek help for their mental health if they’re struggling, and mental health practitioners are not an exception to that right. Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, has been identified as a major barrier to access treatment and recovery, as well as poorer quality physical care for persons with mental illnesses.1–5 Stigma also impacts help-seeking behaviors of health providers themselves and negatively mediates their work environment.6–9 What follows is a consideration of the literature on the main sources of personal and interpersonal stigma in healthcare, impacts for both patients and providers, and evidence-based solutions that can be implemented to improve patient-provider interactions and quality of care.


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