[This is the second in a series that examines what stigma looks like and how it damages those who receive it.]

A major goal of mental health policy in the United States is to reduce barriers to service utilization, Psychiatric Services, a monthly publication of the American Psychiatric Association.

The April, 2008 article states that the policy focus has been motivated by research that documenting that most mental health disorders go untreated, or are untreated only after extensive delays, while effective treatments exist for the majority of these disorders. Researchers have identified a number of barriers to receiving mental health care, including financial, knowledge-related, and attitudinal barriers.

“The importance of stigma as a barrier to mental health care is also consistent with theoretical models of help seeking,” the article, titled: Perceived Stigma and Mental Health Care Seeking, states.

Utah State University’s article, Substance Use Disorder Stigma: What it is and How You Can Prevent it, states that stigma can be a prejudice or discrimination; it can promote fear and shame; it can cause distrust or disgrace; it can lead to anger or frustration; it can exclude and deny rights, and it can reduce support for policies that would improve equitable treatment of this population.

The Australian Better Health Channel provides health and medical information to improve the health and wellbeing of people and the communities they live in. Better Health defines it succinctly:

“Stigma is when someone sees you in a negative way because of your mental illness. Discrimination is when someone treats you in a negative way because of your mental illness.”

Stigma happens when a person defines someone by their illness rather than who they are as an individual, the article, titled Stigma, discrimination and mental illness further states.

As a result, more than half of people with mental illness do not receive help for their disorders, the American Psychiatric Association reports. Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. This is because stigma, prejudice and discrimination against people with mental illness are still very much a problem.

Stigma often comes from lack of understanding or fear, states the article, titled Stigma, Prejudice and Discrimination Against People with Mental Illness. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of studies on stigma shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness.

Researchers, the article says, identify different types of stigma:

• Public stigma involves the negative or discriminatory attitudes that others may have about mental illness.

• Self-stigma refers to the negative attitudes, including internalized shame, that people with mental illness may have about their own condition.

• Structural stigma is more systemic, involving policies of government and private organizations that intentionally or unintentionally limit opportunities for people with mental illness. Examples include lower funding for mental illness research or fewer mental health services relative to other health care.

With public stigma, people with mental illness are dangerous, incompetent, and to blame for their disorder. They are viewed as unpredictable. This stigma is then internalized, causing the person with the illness so see themselves as dangerous, incompetent, and responsible for their condition. With structural stigma, stereotypes are embodied in laws and other institutions.

With discrimination, employers may not hire someone with mental illness, landlords may not rent to them, the healthcare system may offer a lower standard of care. Again, the person may internalize that, the article explains. These thoughts may lead to lowered self-esteem and self-efficacy: “Why try? Someone like me is not worthy, or unable to work, live independently, or have good health.” The consequence leads to both intended and unintended losses of opportunity.