The New Jersey Governor’s Council on Mental Health Stigma made the statement that stigma hurts everyone living with mental illness, along with their families, friends, colleagues and the communities in which they live.

The statement was bold, because it comes to the heart of the damage stigma inflicts.

“It is a primary barrier to the achievement of wellness, and recovery, as well as full social integration, and appears as distrust, fear, stereotyping and discrimination,” the Governor’s Council report states. “The prevalence of mental health stigma seriously undermines an individual’s ability to get the help they need because of their fear that their confidentiality will be breached.”

Mental illness and substance use disorders are the most stigmatized of all medical conditions. So, when someone receives a dual diagnosis of a mental illness and an SUD, the stigma becomes more intense and more damaging.

Stigma is consistently observed in the space of mental health and addiction and is associated with a multitude of negative consequences, such as treatment avoidance, lower employment rates, and social discrimination states a March 2022 Psychiatric Times special report that addresses the impacts stigma has on people with a dual diagnosis.

“Stigma is perpetuated toward those experiencing mental illness and SUD at the individual, interpersonal and institutional levels,” the report states, “all of which are associated with negative consequences toward one’s mental health and well-being (eg, societal and structural discrimination, worsened treatment outcomes and lowered self-esteem).”

The report continues, saying that research has further indicated differences in stigma when addressing individuals with a mental illness diagnosis in comparison to a SUD diagnosis.

“Evidence describes more negative attitudes surrounding those with SUDs in comparison to those with a mental illness,” the report says. “Some of these attitudes include the perception of those with SUDs as being more dangerous and less competent in navigating treatment, as well as the association of SUDs with personal or moral “shortcomings” rather than the underpinnings of a medical illness.”

Mariah Senecal-Reilly, writing for the Onondaga County, New York, Health Department in her article, End the Stigma: Mental Illness and Substance Use Disorders, wrote that when a person experiences stigma it can cause serious harm to their social lives. The chronic stress of discrimination may affect the mental and social health of individuals who use drugs or people with mental health conditions. They may lose touch with their community and family and experience loneliness and isolation. When a person does not have social ties or a person to talk to, they are less likely to reach out for health care or treatment.

“People who experience stigma regarding their substance use disorder or mental health condition,” Senecal-Reilly wrote, “are less likely to seek treatment due to the fear of being associated with something that is viewed negatively by society.”

In July 2022, Tony Salvatore, MA, reported that The Centers for Disease Control and Prevention cites stigma associated with mental illness as a risk factor for death by suicide.

“When stigma provokes suicidality,” Salvatore wrote, “it becomes more potent and dangerous by joining with the stigma attached to suicide.”

Stigma towards mental illness may be a significant contributor to the emergence of suicidal ideation, Salvatore says, to the progression from thoughts of suicide to suicidal behavior, and, in some cases, to dying by suicide, going on to say that mental health stigma may directly produce a sense of burdensomeness and disconnectedness to one’s support system that can lead to suicidal ideation and, in some cases, to suicidal intent.

“Intent to die may be brought on by an individual’s belief that he or she is a burden to those they care about and who would be better off if he or she were dead,” Salvatore explained. “Intent also originates in the feeling that someone is socially disconnected from family or friends.”

Mental health stigma can put an individual with mental illness in positions that weaken their resistance to self-harm, Salvatore cautions. Chief among these is discouraging treatment adherence, which can cause emotional, psychological and physical harm.

“Repeated and extended episodes of treatment nonadherence can gradually increase vulnerability to other forms of self-harm, including suicidal behavior,” he wrote.