A Critical Review of Approaches to Erasing the Stigma of Mental Illness

Abstract

AbstractStrategies to diminish stigma’s harm are driven by three agendas. (1) A services agenda, which seeks to decrease stigma so people better engage in care, (2) a rights agenda, which seeks to stem the injustice of stigma so people are able to meet life goals and aspirations, and (3) a self-worth agenda, which strives to replace shame with self-affirming attitudes in people impacted by stigma. With these agendas in mind, we summarize research on anti-stigma strategies in terms of public stigma and self-stigma. Two approaches have dominated efforts to lessen public stigma approaches: education and contact. Contrary to the predominance of education in public health approaches to attitude change, education effects are relatively muted, especially compared to contact. Research consistently shows that public encounters with people in recovery lead to significant improvements in stigma. Several approaches to self-stigma change have emerged, including psychoeducation, cognitive-behavioral, and strategic disclosure. Psychoeducation teaches people who internalize stereotypes about how these stereotypes are false. Cognitive-behavioral strategies then guide participants in challenging the false stereotypes they have used to cause personal shame. Strategic disclosure reflects insights on how being in the stigma closet harms self-esteem and self-efficacy. People who decide to come out with their mental health experiences report less self-stigma and greater empowerment. Unlike public stigma, research is unclear about the success of these self-stigma approaches vis-à-vis the others.