The stigma of mental illness

CALGARY—Imagine that you or a family member is struggling with a mental disorder. Now add to that health problem the difficulties associated with shame, embarrassment, silence, and isolation that often surround such a condition. It is not surprising that many people who have the lived experience of a mental disorder say that stigma is often worse than the disorder itself. Stigma can take a number of forms. We often think about social stigma, which are the negative attitudes, feelings and discriminatory behaviours that can be directed towards other people who are suspected or known to have a mental health problem. Many people also internalize stigma, and self-stigma may include negative thoughts and feelings about oneself, or even acting in ways that are self-limiting, like not applying for a deserved promotion at work. In addition to social and self- stigma, structural stigma exists as a reflection of the wide range of policies and practices that work limit the engagement of people with mental health problems in society. The Mental Health Commission of Canada (MHCC) has long recognized that stigma is a critical challenge faced by many people with a mental disorder. The Opening Minds program of the MHCC has been studying the issues related to stigma and has significantly advanced methods to reduce stigma. Its programs include 'The Working Mind,' which has been successfully deployed in a wide variety of public and private workplaces, and 'The Inquiring Mind' which has been used across Canada in post-secondary and high-school settings. Both of the above programs use a combination of education, open discussion, and video stories of people who have successfully lived with mental disorders to address stigma. They also utilize a colour-coded mental health continuum model that encourages participants to view mental health as something that can be maintained or enhanced, or that can be seen to move towards problematical signs and symptoms, or even mental disorders. The programs also confirm that everyone is somewhere on the mental health continuum, and that it is of value to periodically assess one’s mental health status. Importantly, the programs also encourage the use of common and effective coping strategies based on health science. Both programs have been extensively studied and have been shown to reduce stigma when deployed. The Stigma of Mental Illness: Models and Methods of Stigma Reduction, edited by Keith S. Dobson and Heather Stuart, Oxford. Much of the work of the Opening Minds program has been recently documented in a volume (The Stigma of Mental Illness, edited by Keith Dobson and Heather Stuart, Oxford University Press, 2021). Materials found in that volume can be used widely as a set of templates for stigma reduction. The issue of stigma is unfortunately alive and well in Canada. A national survey conducted in the summer of 2022 revealed that fully 66 per cent of a representative sample of 2,005 people with the lived experience of a mental or substance use disorder indicated that they had stopped socializing as much as they would like because of the fear of stigma. Further, 43 per cent of this same group reported that they had been rejected or estranged by friends. In this same survey, both those participants with the experience having a mental or substance use disorder, as well as a matched sample of 2,024 people without this experience agreed that there were three mental health priorities in Canada. First, there is a need for greater access to mental health services. Both groups also rated the prevention of mental disorders and stigma reduction as the second and third priorities, although stigma reduction was rated as somewhat more important for people with the lived experience of a mental or substance use disorder than the population at large. Overall, despite recent developments in screening, prevention and treatment of mental disorders, it is clear that stigma related to mental illness remains in Canada. There is a clear and compelling need for evidence-based programs in a wide variety of things, both to reduce the stigma of people with mental challenges and disorders, but also to improve their participation in society. Dr. Keith Dobson is a professor emeritus of clinical psychology at the University of Calgary and a principal investigator with the Opening Minds program of the Mental Health Commission of Canada. Among other distinctions, he is a Fellow of both the Canadian Academy of Health Sciences and the Royal Society of Canada. The Hill Times