Healthcare Stigma Still Affects Those With Mental Illness

This article was co-authored by Maria Auxiliadora Sanchez Ledesma and Robert Muller, Ph.D.

Many healthcare professionals continue to lack training on how to deal with the healthcare needs of people with serious mental illness.

Stigma toward mental illness may be a significant influence when healthcare professionals think that patients are making up their symptoms or seeking attention. Yet the mortality rate in people with severe mental illness is two to three times higher than in the general population.

There are still stereotypes that individuals with mental health issues are dangerous, incompetent, and lack credibility. Health systems and health professionals are not immune to this. When patients internalize these negative stereotypes and the rejection and discrimination they have faced, this amounts to a form of “self-stigma.”

Research suggests that self-stigma in people with serious mental illness leads to self-discrimination and self-isolation, making it more difficult for them to access health care. Self-stigma reduces quality of life and promotes poor health outcomes.

Self-stigma is also linked to the “why try” effect, which occurs when someone refuses to pursue some goals because of diminished self-efficacy and low self-esteem. People with severe mental illness may avoid going to health facilities if they anticipate that they are not going to be well received or will be judged by health professionals.

Pilar Nadales Rubio, mental health nurse and supervisor of mental health nurses in training for the health department of the province of Valencia in Spain, adds that self-stigma poses an important limitation for people with severe mental illness to access primary care.

Rubio says that sometimes patients with severe mental illness tend to consult with the professional they already know and trust, usually a mental health professional. This may sometimes delay the help they need from the appropriate health professional.

For example, Rubio remembers when one of her patients with bipolar disorder came to her office after two weeks of vomiting. His problem had nothing to do with his mental health diagnosis; he should have gone to primary care. He ended up being diagnosed with a bacterial infection in the digestive tract.

Psychiatrist Maria José Alonso notes that some health professionals assume they will have trouble communicating, exploring, and discussing health issues with people experiencing serious mental illness. These assumptions, Alonso shares, impact the interaction and the result of the service.

Other times, professionals infantilize people with severe mental illness by studying them through family members or companions, greatly limiting what should be a dignified, collaborative interaction. Experiences like this may increase the likelihood that those who struggle with their mental health may hesitate to seek support in the future.

As one participant stated in a 2020 qualitative study aimed at understanding what the experience of accessing physical health care is like for people diagnosed with severe mental illness, “When it comes to psychiatry, they approach it differently in society. But now there is a moderation compared with the past. They used to consider you crazy in the past, now they don’t do it that much. But it still bothers us. They see us as second class.”

Source: Maddy from Celeste/Wikimedia Commons/CC by-SA 4.0

At a systemic level, Alonso says that healthcare systems should consider the needs of people with severe mental illness. For example, such patients may find the appointment scheduling system and follow-up very rigid, and this can cause them to miss opportunities for care.

Alonso also says we need to work to demystify preconceived ideas. Health professionals need specific training and tools to feel qualified in attending to people with severe mental illness and normalizing their general health care. For example, promoting interdisciplinary activities and having nurses in training rotate through mental health services contributes significantly to reducing the stigma around those with mental health problems.

Rubio notes that improving collaboration between mental health professionals and primary care services can help ease stigma around mental illness and improve access to physical care.