1.4 Stigma

Despite a recent focus on mental health in the United States, there are still many harmful attitudes and misunderstandings surrounding mental illnesses that can cause people to ignore their mental health and make it more difficult for them to reach out for help.^[1],[2] Stigma has been defined as a cluster of negative attitudes and beliefs that motivates the general public to fear, reject, avoid, and discriminate against people with mental health disorders.^[3]

It estimated that nearly two-thirds of people with diagnosable mental health disorders do not seek treatment due to the stigma of mental illness. The U.S. Surgeon General’s Report in 1999 was a milestone report that sought to dispel the stigma of mental illness and its impact on those seeking care.^[4] The National Alliance on Mental Illness (NAMI) seeks to improve the lives of those with mental illness and reduce stigma through education, support, and advocacy. NAMI encourages people to share their stories to discredit stereotypes, break the silence, and document discrimination.^[5]

Take a quiz in the following box to separate facts from myths about mental illness.

However, stigma and negative attitudes toward mental illness can still be found among nurses. A review of nursing literature by Ross and Golder explored negative attitudes and discrimination towards mental illness in the nursing profession. Several studies from a variety of countries indicated that health care professionals can be classified in three categories in relation to stigma, including “’stigmatizers,” “the stigmatized,” and “de-stigmatizers.” “Stigmatizers” refer to nurses in medical settings with stereotypical attitudes towards clients with mental illnesses, psychiatric-mental health nurses, and/or psychiatry. Nurses classified as “the stigmatized” have mental health disorders or perceive stigma regarding their roles as psychiatric-mental health nurses. “De-stigmatizers” actively work to reduce stigma surrounding mental health disorders. The authors found that many nurses share commonly held stereotypical beliefs portrayed in the media. For example, clients with mental health disorders have been portrayed in the media as dangerous, unpredictable, violent, or bizarre, and these portrayals can cause fearful attitudes. Nurses in the studies were also concerned about inadvertently saying or doing “the wrong thing” or “setting off” uncontrollable behavior. Many nurses in general medical settings felt they lacked the skills to confidently and competently manage behavioral symptoms of clients with mental health disorders. The authors of the review reported that nursing literature supports additional mental health education for entry-level nurses and practicing nurses to enhance their knowledge base on mental health.^[6]

Nurses can reduce stigma and advocate for a client’s needs and dignity by establishing a therapeutic nurse-client relationship. A therapeutic nurse-client relationship is essential in all settings, but it is especially important in mental health care where the therapeutic relationship is considered the foundation of client care and healing. Although nurse generalists are not expected to perform advanced psychiatric-mental health nursing interventions, all nurses are expected to engage in compassionate, supportive relationships with their clients.^[7] In fact, in Nursing: Scope and Standards of Practice (2021), the American Nurses Association states, “The nursing profession, rooted in caring relationships, demands that nurses reflect unconditional positive regard for every patient.” ^[8]

The first step in resolving stigma is to become aware of one’s personal beliefs. Take the survey in the following box to become more aware of your own attitudes and biases toward mental health care.