How stigma is making us less likely to seek help

Despite significant changes in recent years to access to mental health services, open discussions about mental health and various campaigns to raise awareness of mental health issues, many still experience stigma when considering seeking help.

What is stigma?

Stigma is one of the greatest barriers when it comes to seeking mental health services and can be broadly divided into two categories:

External or public stigma is the harm that occurs when a population or community endorses negative attitudes and beliefs about a group leading to stereotypes, prejudice and discrimination.

Internal or self stigma is what happens when an individual applies these prejudices and stereotypes to themselves and internalises them, leading to lowered self-esteem, health issues, social withdrawal and shame.

Research has indicated that both external and internal stigma have an effect on people’s willingness to seek help.

How does it affect help-seeking?

Many people with serious mental illnesses may refuse to seek help in order to escape stigma labels.

• A study of 1312 adults randomly sampled from the Australian community found that 73% were likely to visit a general practitioner while only 40% were likely to seek a counsellor if required (1).

• 44% reported embarrassment associated with seeing mental health professionals, and 46% believed others would think less of them for seeing a psychiatrist (1).

• Depressed older adults experience a high level of public stigma and are not likely to be currently engaged in or intending to seek mental health treatment (2).

• African American older adults are more likely to internalise stigma and are less positive toward seeking mental health treatment, seeking treatment at half the rate of their White counterparts (2).

• Individuals who endorse negative attitudes toward treatment are five times less likely to seek mental health services (2).

• In a study of 870 medical students with burnout, approximately half strongly agreed that firstly, residency program directors would pass over their application if they were aware the student had a mental health problem, and secondly that patients would not want them as a doctor if they were aware of a mental health problem. Only 3 out of 10 participants sought help for burnout within the last twelve months (3).



• A study of college students found that mental health stigma interacts with stress, negatively affecting depression and suicidal behaviour (4).

How to reduce stigma?

Research suggests that providing resources to address mental health is only half the battle. Combating stigma should be a critical component in making mental health services accessible to all. But how can stigma be reduced? Various techniques have been tested and shown positive results:

• The use of nostalgia (remembering an encounter with someone with mental illness), contact with stigmatised groups and experiences such as mental health clinics has been shown to be effective for public stigma. (7)

• Techniques from acceptance and commitment therapy have been effective, notably cognitive diffusion, acceptance and mindfulness (5). Using these techniques when dealing with clients or family members battling stigma could be useful tools for the professional during therapy.

• Stigma can be addressed in the wider community by raising awareness and understanding, promoting knowledge of and access to mental health resources, informing and changing policies and addressing sociocultural and institutional underpinnings of stigma (6).

It is important for practices to consider how they are contributing and helping to reduce stigma in the community as a whole, perhaps by taking part in active campaigns and initiatives.

How can the professional help?

For the professional it is also important to consider ways to adapt services to encourage help-seeking.

• One study suggests that the potential for anonymity in internet-based interventions such as online therapy have the potential to reach more individuals by avoiding the potential for social judgement and disclosure (6)

• Not needing to physically access buildings such as hospitals and therapy centres where one be seen and judged could be the deciding factor for many as to whether or not they seek help.

Offering remote therapy as an option for your clients could therefore help to reach these individuals that are unlikely to seek therapy in person.

References:

1. Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about Depression and its Impact on Help-Seeking Intentions. Australian & New Zealand Journal of Psychiatry, 40(1), 51–54. https://doi.org/10.1080/j.1440-1614.2006.01741.x
2. Conner, K. O., Copeland, V. C., Grote, N. K., Koeske, G., Rosen, D., Reynolds, C. F., & Brown, C. (2010). Mental Health Treatment Seeking Among Older Adults With Depression: The Impact of Stigma and Race. The American Journal of Geriatric Psychiatry, 18(6), 531–543. https://doi.org/10.1097/JGP.0b013e3181cc0366
3. Dyrbye, L. N., Eacker, A., Durning, S. J., Brazeau, C., Moutier, C., Massie, F. S., Satele, D., Sloan, J. A., & Shanafelt, T. D. (2015). The Impact of Stigma and Personal Experiences on the Help-Seeking Behaviors of Medical Students With Burnout. Academic Medicine, 90(7), 961–969. https://doi.org/10.1097/ACM.0000000000000655
4. Hirsch, J. K., Rabon, J. K., Reynolds, E. E., Barton, A. L., & Chang, E. C. (2019). Perceived stress and suicidal behaviors in college students: Conditional indirect effects of depressive symptoms and mental health stigma. Stigma and Health, 4(1), 98–106. https://doi.org/10.1037/sah0000125
5. Masuda, A., Hayes, S. C., Fletcher, L. B., Seignourel, P. J., Bunting, K., Herbst, S. A., Twohig, M. P., & Lillis, J. (2007). Impact of acceptance and commitment therapy versus education on stigma toward people with psychological disorders. Behaviour Research and Therapy, 45(11), 2764–2772. https://doi.org/10.1016/j.brat.2007.05.008
6. Thomas, N., McLeod, B., Jones, N., & Abbott, J.-A. (2015). Developing Internet interventions to target the individual impact of stigma in health conditions. Internet Interventions, 2(3), 351–358. https://doi.org/10.1016/j.invent.2015.01.003
7. Turner, R. N., Wildschut, T., Sedikides, C., & Gheorghiu, M. (2013). Combating the mental health stigma with nostalgia. European Journal of Social Psychology, 43(5), 413–422. https://doi.org/10.1002/ejsp.1952

Suggestions for further reading

• Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S. L., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129



• Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest, 15(2), 37–70. https://doi.org/10.1177/1529100614531398