Stigma & talking about mental health

Stigma can be

• Public: negative attitudes from others, which can lead to unfair treatment in jobs, housing or health care.
• Self: shame people turn inward, believing the negative messages about themselves.
• Structural: rules and systems that limit opportunities, like less funding for mental health services.

Self-stigma is linked to less hope and lower self-esteem. One study found that people with more self-stigma had poorer recovery over two years.

Person-first language describes what a person has, not who they are. It reminds everyone that a person is much more than a diagnosis.

Try saying

• “A person living with schizophrenia” instead of “a schizophrenic”
• “Someone with a substance use disorder” instead of “an addict”
• “A person with depression” instead of “a depressive”

Words like “crazy”, “psycho” or “nuts” are often used as insults or jokes. They can make people living with mental health conditions feel mocked and less likely to talk about what they’re going through.

Phrases to avoid

• “Snap out of it.”
• “Just deal with it.”
• “You brought this on yourself.”

Phrases that help

• “Is there anything I can do to help?”
• “People do get better.”
• “I’m here, and I’m not going anywhere.”

Getting to know someone with lived experience is one of the most powerful ways to reduce stigma.

Things anyone can do

• Talk openly about mental health.
• Learn the facts and share them.
• Treat mental health like physical health.
• Show compassion.
• Speak up when you see stigma in the media or around you.

Care can include talking therapies, support groups, lifestyle changes, community and faith support, hospital care, medical treatment, or a mix. What works depends on the person, what they are going through, and what they choose with their clinical provider.

Physical health works the same way. No one tells a person with asthma or diabetes they’re weak for following their care plan. Mental health care deserves the same respect.

• “You don’t need therapy, just talk to your friends.” Friends matter, but therapists have training friends don’t
• “Real strength is handling it alone.” Asking for help takes courage
• “Hospital is only for people who are really ‘crazy’.” Hospital care is a safe place to get through a crisis
• “You’ll be in treatment forever.” Many people use care for a season of life, and others use it longer. Both are okay
• “Medical treatment for mental health is a crutch.” Decisions about medical care belong to you and your clinical provider

Self-stigma happens when people take in negative ideas about mental illness and turn them on themselves: “Someone like me can’t get better.” It can lead to lower hope and self-esteem, and to dropping out of care.

What can help

• Notice the harsh voice, and ask: “Would I say this to a friend?”
• Remember why you chose your care, and write down any progress, even small
• Connect with others who have used similar care. Peer groups can ease shame
• Talk openly with your provider about doubts, rather than stopping care on your own

• Ask “How is it going?” rather than “Do you really need that?”
• Don’t share stories about how someone else “got off” or “didn’t need” treatment
• Avoid jokes about therapy, hospital stays or “being on something”
• Keep what they share private
• Celebrate the courage it took to get help

A trusted person might be a parent, relative, friend, teacher, faith leader or health care provider. SAMHSA describes a good support person as someone who respects your privacy and lets you share feelings without judgment.

Signs someone may be a good choice

• They give advice when you ask, not before
• They help you plan for the next hard moment
• They keep things private
• They listen without judging

You don’t owe anyone your full story or a diagnosis. You might start small, like “I’ve been having a hard time lately,” and share more if it feels safe.

Things you might decide ahead of time

• How much detail you want to give
• What kind of support you’re hoping for
• Whether you want them to keep it private
• Where and when you’ll talk

Openers you can borrow

• “Can I talk to you about something personal?”
• “I don’t need you to fix it. I just want you to know.”
• “I’ve been struggling and I’m starting to get help.”
• “Something has been on my mind and I trust you.”

Some people react with shock, worry or unhelpful advice, often because they don’t know much about mental health. That says more about stigma than about you.

What can help

• Give them time. Many people come round
• Share a trusted article or this guide
• Try someone else you trust
• Talk it through with a counselor or peer group

People with similar experiences can support each other, and peers who have recovered can show that recovery is possible. Self-help and peer support groups are one option.

Getting involved in your own care helps too. SAMHSA encourages shared decision-making, where you and your provider weigh options together as equals.

The U.S. Equal Employment Opportunity Commission (EEOC) says that in most situations you can keep a mental health condition private. Employers can ask medical questions only in limited cases, such as when you ask for an accommodation.

If you do share, your employer must keep that information confidential, even from co-workers.

Under the Americans with Disabilities Act, you can ask a supervisor or HR for a change at work at any time. You don’t need to know exactly what to ask for, and your employer may ask for a note from your health care provider.

Examples the EEOC gives

• Changed break or work schedules, such as around therapy appointments
• Permission to work from home
• Quiet office space or devices that reduce noise
• Specific shift assignments

Harassment because of a disability is not allowed, and it is illegal for an employer to retaliate against you for contacting the EEOC.

Many employers offer an Employee Assistance Program (EAP) with free, confidential counseling. Yet only about 3–5% of employees use EAP services, according to the Center for Workplace Mental Health.

SAMHSA encourages educators to know the warning signs, know whom to contact about a student, and help students reach school-based mental health support.

People students can talk to

• A school counselor
• A school nurse
• A school psychologist or social worker
• A teacher they trust

The Center for Workplace Mental Health encourages workplaces to make talking about depression, anxiety and other common conditions as routine as talking about diabetes or high blood pressure.

Small things anyone can do

• Check in with a colleague or classmate who seems off
• Mention mental health days or EAPs in team meetings
• Share your own experience, if you feel safe to
• Speak up when someone jokes about mental illness

Knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. In a two-year trial with more than 700 students, brief videos of people sharing their experiences improved access to care.

Family members can take in stigma too, and may blame themselves. Support groups for families and friends can ease that weight.

A 2016 report found there is no country, society or culture where people with mental illness have the same social value as people without. Efforts that fit local culture work best.

Things anyone can do

• Be honest about treatment, if you feel safe to
• Choose empowerment over shame
• Correct myths kindly when you hear them
• Let media outlets know about stigmatizing coverage