Chipping Away at Stigma

Is Mental Health Stigma Decreasing as the Pandemic Wears On?

Could the pervasive stigma around mental health finally be abating? A new study raises hope, along with a few concerns. And an enduring question remains: are the rising rates of mental health concerns in the Covid era driving a change in attitudes?

Bernice A. Pescosolido and colleagues at Indiana University examined public attitudes about mental illnesses over a period of 22 years (1996-2018) and found the first evidence to date of significant decreases in public stigma toward depression. That was the good news. During the same period, they also found increased prejudicial attitudes about people with schizophrenia and alcohol use disorder. 

Pescosolido, a sociology researcher who developed the National Stigma Studies 25 years ago, is recognized as a leading expert on stigma. She defines stigma as the negative attitudes, prejudices and discrimination attached to mental health problems. “Stigma is not just what people believe but what they do,” she says.

Whether self-directed or culturally prevalent, conscious or not, mental health stigma is a major obstacle to better mental health care worldwide. It keeps people from seeking help, worsens serious mental illness, and interferes with recovery. 

Greater Mental Health Literacy, Less Stigma?

The study suggests a widespread softening in attitudes about depression, one of the most prevalent psychiatric conditions. This was particularly true for “social distance” questions, a measure of stigma commonly used in scientific studies. These questions probe respondents’ willingness to engage with a person with a particular mental illness in various ways: working closely with them on a job; living next door to them; spending an evening socializing with them; marrying into their family; making friends with them, or living near a group home where they lived. 

Other questions gauged respondents’ views about scientifically supported causes of mental illness, such as chemical imbalance or genetics. Respondents were also generally able to distinguish between diagnosable mental illness and day-to-day troubles. These results indicate a growing recognition of the biological bases of mental illnesses and better mental health literacy overall. 

The Persistence of Stigmatizing Myths

In contrast to the depression findings, Pescosolido’s team found stagnant beliefs around other mental illnesses and a troubling increase in two particular areas. First, the false belief that schizophrenia might make people violent increased over the study period. A substantial portion of survey respondents (13 percent) indicated they would be unwilling to have a person with schizophrenia as a neighbor. Second, a persistent stigma linking moral attributes such as “bad character” to alcohol dependence gained momentum. 

The authors concluded that the findings raise concerns and “call for rethinking stigma and retooling reduction strategies to increase service use, improve treatment resources, and advance population health.”

What Is Covid’s Effect on Stigma?

A big question now is how the sharp increase in depression, anxiety, and other mental health problems during the pandemic has affected stigma. Pescosolido’s analysis period ended pre-Covid, but she suspects the trend will continue and is pursuing that data. 

“If there is one silver lining of COVID-19 it is how the lockdown and crisis opened our eyes to how common mental health problems are and how critical mental health is to our overall health,” Pescesolido says. “The trauma of the pandemic shows us that mental health problems can affect anyone, that social connectedness is critical to our well-being, and that it is so important to support the care providers in the mental health system.” 

At the least, she expects that stigma around depression will continue to fall because depression “was the major fallout of Covid” in terms of mental health. What happens with other mental disorders is a lot less clear, she says. “One of the major factors associated with the public’s response to schizophrenia is their [erroneous] belief that individuals with schizophrenia are more likely to be violent to others, as our research documented,” Pescosolido, said in an email. “There is nothing obvious in the Covid pandemic that might push that one way or the other.”

Either way, Pescosolido hopes to find out. Face-to-face follow-up surveys are underway with the 3,000 or so study participants. That should provide a reading on how stigma might be changing in step with rising mental health challenges during Covid — eventually. Results won’t be available anytime soon. No other research appears to be directed at the question, partly because funding for stigma research is sorely limited. 

Views from the Mental Health Front Lines

Anecdotal reports from some mental health care workers on the front lines of the ongoing crisis also suggest a softening of stigma – though the experience is not universal. Danielle Lindley, director of children, youth and family services at Northwest Counseling & Support Services (NCSS), shared the view from the northwesternmost part of Vermont in a recent interview on Here for You, a public-access television program.

“[It’s] an interesting upside to the pandemic – because everyone’s mental health is being challenged right now, in some ways I do believe it helps reduce stigma around mental health,” Lindley said. “It’s helped people understand the impact [of mental health] and the link to physical health. People are way more willing to have conversations about it, and to prioritize it.”

John Sargent, a child psychiatrist at Tufts Medical Center in Boston, shared a similar sentiment in a recent Q&A for TuftsNow. “It seems as though stigma has significantly declined, so that people are more willing to say that they’re experiencing mental health challenges, anxiety, or mood problems, and are more willing to seek help,” Sargent said. 

These attitudinal shifts are contributing to unprecedented demand for mental health services at all points of the care spectrum. Mental health systems both rural and urban are struggling to keep up.

What Not to Do, Stigma Edition 

Unfortunately for many Vermonters, stigma persists throughout the Green Mountains. Cath Burns, a Vermont-based licensed psychologist and COVID Support VT clinical supervisor, says that makes getting the right care more difficult. “It can be really hard for young people who are struggling to talk to their friends or even their parents about what they’re feeling,” says Burns, who is also the quality director for Vermont Care Partners. “At the same time, parents whose kids are struggling may feel shame or blame themselves for their child’s problems. That can impede them from seeking support for their child or even talking about it with someone they trust.”

It doesn’t help, she says, when people turn away in embarrassment, brush off problems, or shut down conversations. “We may be gaining on stigma but from my view we have a long way to go yet,” she says. “We need to all be willing to have the awkward conversation, to be available for it, ready for it, even invite it in – without judgment. Simply put, we need to be there for each other.” 

Learn More and Find Resources

Read the research paper on stigma perceptions by Bernice Pescosolido and colleagues at the University of Indiana. 

Watch the Here for You episode with Danielle Lindley, NCSS director of Child, Youth and Family Services. 

Read To Fight Mental Health Stigma, Words Matter on the COVID Support VT blog.

Learn about the Deconstructing Stigma exhibition at BTV airport in Shattering Mental Health Stigma.

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Blog written by Brenda Patoine on behalf of VCN/Vermont Care Partners for COVID Support Vermont, a grant funded by FEMA and the Vermont Department of Mental Health

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COVID Support VT is funded by the Substance Abuse and Mental Health Services Administration and Federal Emergency Management Agency, managed by Vermont’s Department of Mental Health, and administered by Vermont Care Partners, a statewide network of 16 non-profit community-based agencies providing mental health, substance use, and intellectual and developmental disability services and supports.