Thesis

Running head: MENTAL HEALTH STIGMATIZATION 1
The Systematic Stigmatization of Mental Health in Medical Care
Alyssa R. Broome
Wells College

MENTAL HEALTH STIGMATIZATION 2
Abstract
There is currently a lack of training, resources and educational initiatives among healthcare
providers that is leading to the systematic stigmatization of individuals with mental disorders.
There are several levels of stigmatization including discrimination, dismissiveness, social
distancing and stereotyping. This leads to adverse outcomes for the people with mental illness
including physical, social and emotional consequences. The United States healthcare system
perpetuates these stigmas by solidifying the individuals internal perceived public stigma. Along
with healthcare providers lack of training and empathy, the United States healthcare system
forces diagnoses for a patient to be treated leading to the stigmatization of being labeled in a
particular group. Changes in the US healthcare system including increasing training and
educational initiatives of healthcare providers and moving towards an integrated healthcare
system could potentially lead to a decrease in the systematic discrimination of individuals with a
mental disorder.

The Systematic Stigmatization of Mental Health in Medical Care
Living with a mental disorder can be a terrifying experience filled with fear, sadness, and
hopelessness. These concerns are further solidified by the United States healthcare system
through systematic stigmatization and discrimination of people who have a mental illness.
Before we can understand the role of stigmatization of an individual with a mental disorder, we
must understand what a mental disorder is.
What is a Mental Disorder?
According to the DSM-5, a mental disorder is a combination of concurring behavioral,
physical and cognitive symptoms that affects a person’s everyday functioning and causes
significant distress. The diagnostic and statistical manual of mental disorders (DSM) defines and
characterizes all mental disorders that are currently recognized in the United States (McNally,
2011). The manual lists 297 diagnosable mental illnesses (APA, 2013); among these diagnoses
include varying mood, personality, and psychosocial disorders.
Each diagnosis can vary on the type and how severe the mental disorder is. For example,
a person who has obsessive-compulsive disorder (OCD) may be afraid to leave their house due
to contamination. This will more than likely have grave psychological and social consequences
while interfering severely with that individual’s daily life. Compare this to a person who has a
snake phobia. This person will general be able to have a normal work and social life, with little
interference in their everyday activities, except possibly avoiding wooded areas. Despite this,
sometimes it can be difficult to distinguish what is a mental disorder and what is just mental
distress.

The key to understanding this difference is examining the effect the individual’s current
situation plays in their daily functioning. If there is a person who is having marital problems and
seeking help from a counselor, does it necessarily mean that individual has a mental disorder?
Possibly, but more likely this individual is experiencing mental distress. Psychological distress is
common and part of our everyday lives. It can occur because of a variety of social and economic
situations, such as too much homework or working through a break-up. These are unavoidable
life circumstances that individuals with coping skills can effectively manage. Mental disorders
have a biopsychosocial base, meaning multiple factors such as genetics, social status, and
emotions play a role in developing a disorder (Sue, Sue & Sue, 2016). These disorders, while
externally influenced, cannot be controlled by the individual and they will have to receive
treatment from an outside source such as a psychologist or psychiatrist.
Currently in the United States, one in five people have a mental disorder, with one in
seventeen people suffering from a severe mental illness such as schizophrenia or bipolar
disorder. The disorders prevalent in the United States can range from mild to severe with
anxiety related disorders, depression, bipolar disorder, and schizophrenia being the most
common (“Mental Health Conditions, n.d.).
Mental health diagnoses rates are at an all-time high (McNally, 2011), with around 50%
of young adults (age 15-29) having met the criteria for a diagnosable mental illness. So why are
these rates higher than ever before? Currently, the DSM-5 has listed the most diagnosable mental
disorder than ever before. This makes it easier for healthcare professionals to diagnose mental
disorders that used to not be considered a diagnosis.

Even with the prevalence of mental disorder in the USA, a majority of individuals who
have a mental disorder will never seek out treatment (SAMHSA, 2016). The current US
healthcare system is failing people. The system lacks appropriate mental health coverage from
insurance, combined with too few appropriately trained mental health care providers. These
lapses in our health care system are leading to the systematic stigmatization and discrimination
of individuals with mental disorders.
What Is Stigma?
The mental health commission has defined stigma as a negative image that differentiates
individuals leading to discrimination, stereotyping and prejudice. Four levels characterize
defined public stigma; labeling, stereotyping, separation and status loss (Bjorkman, Angelman &
Jonsson, 2008).
Labeling occurs when an individual’s disorder is identified due to the recognition that
their behaviors are not “normal” for society. Once this label is given to a person, stereotyping
begins to occur. Stereotyping is when negative connotations are giving to an individual based on
a label. For example, many people believe that people who have been diagnosed with
schizophrenia are automatically dangerous and someone to be feared. Generally, by being
labeled with a mental disorder, a person may automatically get the stereotypical label of being
“crazy.” People may unknowingly begin to elicit bias towards the individual with a mental
disorder. Through dramatization and societal standards, individuals who have a mental disorder
are viewed as strange, unpredictable, violent, aggressive and lacking self-control. These
individuals are treated differently out of fear.

By having negative connotations associated with a mental disorder, society begins to
group individuals into two separate categories: society’s normal standard versus those who are
different (Bjorkman et al., 2008). This grouping can lead to many negative consequences
including mistreatment, social distancing, and dismissiveness. Mistreatment stems from the fact
that individuals who do not have a mental disorder think they are better than the individual with
a mental disorder as society perceives them as being normal. Mistreatment can explicitly be
stated through rude and hurtful comments or actions an individual may conduct such as hateful
looks. Social distancing occurs when people purposefully avoid the individual after mental
health disclosure. When a person discloses a mental illness, it puts the other individuals on edge
and fearful that society will categorize them as being “not normal.” Dismissiveness, on the other
hand, can be categorized into two separate categories: people who do not believe that an
individual has a mental disorder or individuals with a mental disorder are not believed in other
circumstances where they are stating the truth. This can have a huge effect on the way the
individual perceives themselves and their ability to want to seek out treatment (Hamilton, Lewis-
Holmes, Pinfold, Henderson, Rose & Thornicroft, 2014).
The final stage of stigmatization is status loss and discrimination (Bjorkman et al., 2008).
Stigma is power; meaning that an individual who is systematically discriminated against can
only lose their status, as other individual gains theirs. Discrimination is when an individual or
group is unjustifiable passed over or dismissed for various opportunities. Mental illness related
discrimination negatively affects many individuals, including the development of relationships,
employment opportunities, and the ability to gain an education. In turn, this can lead to poverty
and social marginalization which can significantly impact an individual’s ability to seek out and
use different services (Gabbidon, Farrelly, Hatch, Henderson, Williams, & Clement, 2014).

The US health care system plays a pivotal role in enforcing the discrimination and
stigmatization of individuals with a mental disorder. The system lacks adequate training for
health care professionals, families, and the general public, well also lacking necessary resources
to help these individuals. The lack of resources, training, and education healthcare providers
receive leads to the systematic stigmatization of individuals with a mental disorder, which is
further perpetuated by the USA healthcare system.
Levels of Stigmatization
Within the definition of stigma, there are different classes of stigmatization including
relationships, public, and healthcare professionals. Each role played has a significant impact on
the individual and their perception of themselves and their disorder.
Relationships: How Family and Friends Solidify These Stigmas
Relationships play a pivotal role in a person’s life. When an individual has healthy
relationships it can lead to higher self-efficacy, independence, better long-term health outcome,
reduce stress and feel more fulfilled in life (Umberson & Montez, 2010). Healthy social and
familial relationships play a pivotal role in the treatment of a mental disorder. When an
individual feels as if they are supported in their diagnoses they may be more likely to seek out
and continue with treatment. A significant number of people report discrimination and
stigmatization from their family and friends.
Family. One of the highest reported aspects of stigmatization comes from the idea of
over-protectiveness. Families may believe they are helping the individual and are working in
their best interests, but unknowingly they are hurting the individual with a mental illness.
Overprotectiveness includes being handled carefully or always being asked if they are sticking to

their treatment regimen. By being treated with care or always asked about what they are doing
and whether or not they should be doing that, it can be very demeaning (Hamilton et al., 2014).
Over-protectiveness leads the individual to feel as if they are not capable of caring for
themselves, which itself is a stereotyping behavior and leads to lower self- esteem and
independence.
While some family and friends may become overprotective, many individuals may
dismiss the idea of a relative having a mental disorder or that there are real life consequences of
having a disorder. Without the support of their family, individuals with a mental illness may not
seek out the help they need to begin or continue with treatment (Hamilton et al., 2014). They
start to feel even more isolated as the people who are supposed to support them unconditionally
are not, and enforces the public stigmas associated with a mental disorder (Pederson & Paves,
2014).
Friends. As well as receiving discrimination from their family, many individuals report
stigmatization from friends. The most common form of stigmatization associated with friends is
social distancing. Many people who receive the diagnosis of a mental disorder lose friends,
diminishing their social life (Hamilton et al., 2014). Social isolation stems from the fact of
avoiding the individual with a mental illness out of fear and un-normalization a mental disorder
label brings to the individual.
In general, many individuals who have a mental disorder believe their friends lack an
overall understanding of what their mental disorder is unless they have a mental illness
themselves. This leads to dismissiveness, with their friends not believing that they have a mental
disorder that has an impact on their life.

People who have a mental disorder may feel a lack of social support. A majority of a
lack of support comes from not understanding the mental disorder and the overall lack of public
knowledge on mental health (Hamilton et al., 2014). Our current healthcare system is doing little
to address these public health concerns and provide support not only to the individual suffering
from the mental illness but the family and friends as well.
The General Public: The Lack of Knowledge Enforcing Stigmatization
Public stigmatization is defined as “the degree to which the general public holds negative
views and discriminates against a specific group,” (Pedersen & Paves, 2014, p. 143). These
views then influence the beliefs the individual has about themselves. One study performed by
Pederson and Paves demonstrated that public stigma, while present is an internalized feeling
(2014). Within the study public stigma was portrayed as the way individuals believe they would
be treated and viewed if they sought out treatment for a mental disorder (Pederson & Paves,
2014). Within the study, there was also a comparison of personal stigma, which is defined by
how individuals will view themselves if they seek out treatment for a mental disorder.
The results of the study showed that individuals perceive higher public stigma than
personal stigma (Pederson & Paves, 2014). Perceived public stigma is perpetuated through the
general lack of knowledge and social normalities. From early childhood, ideas such as “boys
don’t cry,” enforce the idea that by showing emotions and being different from other individuals
is a sign of weakness. In the U.S.A, it is believed that to be a great person one must be strong,
and a mental disorder is a sign of weakness. These public social constraints lead to the idea that
having a mental illness is bad, and if an individual seeks out treatment then they will be treated
differently (Pederson & Paves, 2014).

Not only do social norms influence public stigmatization, so does the general lack of
knowledge of what a mental disorder is. By not understanding what a mental illness is, people
perceive individuals who have a disorder as “strange, frightening, unpredictable, aggressive and
lacking self-control” (Bjorkman et al., 2008, p. 170). The lack of knowledge on mental illness
leads to stereotyping, judgment, mistreatment, and dismissiveness among employers the general
public (Hamilton et al., 2014).
One survey conducted showed that 24% of individuals with a mental illness experienced
discrimination when finding or keeping a job due to their mental illness (Hamilton et al., 2014).
This is believed mainly to come from the employers stereotyping the individual as incompetent
or unsuitable for the job, as wells as not believing that mental disorders are real and may require
sick days. As well as being dismissed for a job, it was also reported that individuals were often
overlooked for helping make organizational decisions (Hamilton et al., 2014).
Perceived public stigma does not always lead to direct discrimination, but is rather
influenced by the thought of what “if’s.” The perceived stigmas are further solidified when
individuals who are viewed by the public as the most knowledgeable in the area of mental health,
further perpetuate these stigmatizations due to lack of knowledge, stereotyping, mistreatment and
dismissiveness.
Healthcare Providers: Perpetuating Stigma
Healthcare providers are individuals who are trained to provide both physical and mental
healthcare. These individuals include medical doctors, psychologists, nurses, and social workers.
They may provide care in a variety of settings such as an emergency room, primary care office,
mental health office, psychiatric ward and internal medicine. Each position has a different

responsibility within the medical setting and influences the perpetuation of mental health
stigmatization.
Like the general public, healthcare professionals are influenced by social norms regarding
mental disorders, and also receive a general lack of training surrounding diagnosing, treating and
working with an individual who has a mental disorder.
Many studies examine the relationship that emergency department (ED) staff have on
perpetuating stigma and providing a negative experience to the individual who was seeking out
help. In the USA, it is estimated that approximately ten to fifteen percent of emergency room
(ER) visits are for mental health or psychiatric crisis. These can range from insomnia, panic
attacks, and suicidal thoughts and self-harm, overdoses and psychotic episodes (Clarke, Usick,
Sanderson, Giles-Smith & Baker, 2014).
One of the first experiences a person may have with receiving treatment for a mental
disorder is when they come to the ED. The ED tends to be readily available as it is open twenty-
four hours a day seven days a week with no prior appointment being necessary, and community
mental health services are often not available on the weekend. These individuals do not fit into
the treatment norms of the ER, as they tend to require more attention and longer stays. Once
getting to the hospital, a patient will be triaged by a nurse or other healthcare professional. This
in itself begins to make the individual in the crisis wonder whether or not receiving treatment
will be beneficial. Right away these people are judged and stereotyped by the medical
professionals (Clarke et al., 2014).
Individuals who present to the ER feel embarrassed and ashamed right from the
beginning. There is a general lack of privacy in the triage and waiting room which increases the

stress of the individual in a mental health crisis. Even after being triaged, individuals then have
to wait a long time to be seen and may feel abandoned as their mental health crisis may not be
considered a priority of the ED. Further, out of the healthcare professional’s fear of danger and
unpredictability these individuals are treated as criminals rather than a patient (Clarke, Duomo &
Hughes, 2007).
There is a general lack of empathy among ER staff and other healthcare professionals,
which is noticed by patients, who often feel ashamed, embarrassed and as if they are a burden to
be at the hospital. When an individual feels these emotions while in a crisis, they will be less
inclined to receive help outside the ER and will possibly end up back in the ER later on. This, in
turn, increases ER staff tension, as they begin to feel as they are just wasting their time by
helping these individuals. (Clarke et al., 2014).
The varying treatment individuals receive while in the ER is affected by the type of
mental disorders or crisis the person is presenting with and whether or not nurses and other
medical staff believe that the individual is dangerous, unpredictable, hard to talk to, if the
disorder is self-caused, whether they think treatment will lead to improvement, and whether the
disorder is perceived as unusual. One study showed that the nurses have the highest negative
attitudes towards individuals with drug and alcohol addiction and schizophrenia as they view
them as dangerous, unpredictable, hard to talk to and a majority of staff do not believe these
individuals will get better with treatment (Bjorkman et al., 2008). Specifically referring to
addiction, a majority of the staff in the study saw this disorder as being controlled and caused by
the individual who is receiving help. The least negative attitudes presented by health care
professionals were panic disorder, depression and eating disorders as these are seen as normal
and not dangerous (Bjorkman et al., 2008).

Along with not receiving proper treatment for mental disorders, individuals with a
diagnosed mental illness often are discriminated and dismissed in the medical setting when
presenting with somatic symptoms. They often feel mistreated, and disrespected, as their
physical symptoms are dismissed as a symptom of their mental illness and the often have to fight
for proper care (Bjorkman et al., 2008).
Along with medical health professionals, studies have shown that mental health care
providers also perpetuate stigma. The healthcare providers include social workers, psychologists,
psychiatrists, and counselors. In one study, 38% of the participants felt disrespected by mental
health staff, while a majority of the mental health workers believed that they were reducing
stigmatizing behaviors (Harangozo, Reneses, Brohan, Sebes, Csukly, Lopez-Ibor, & Thornicroft,
2014).
There is a general lack of knowledge among healthcare providers and one way to combat
this stigmatization of individuals with a mental illness is to increase overall training that health
care providers receive. Nurses and other healthcare providers who had regular contact and
training on mental disorders are less likely to have negative attitudes towards individuals with a
psychiatric disorder (Bjorkman et al., 2008). ER staff and other healthcare providers feel as if
they lack skills to access and treat patients with mental disorders, which in turn make them
reluctant to help these individuals (Clarke et al., 2007).
Healthcare providers are supposed to be the most knowledgeable on mental disorders.
When a healthcare provider discriminates and stereotypes an individual with a mental disorder,
they are solidifying the internalization of perceived public stigma; making the individual fearful
of a diagnosis and to receive treatment. The healthcare system in the United States influences

these ideas and not only are people afraid to receive treatment; the current healthcare system
makes it hard for treatment and diagnosis to occur.
Physician Based Stigma in the Medical Practice
Physicians play a critical role in the healthcare setting. Their job is to examine both the
patient’s history and physical symptoms to make diagnoses and then develop a treatment plan to
manage the disease or disorder. The physician's responsibility changes based on the doctor's
scope of practice, but overall a medical doctor is trained to be a leader and supervise the patient's
overall treatment plan (“Physicians Role”, n.d.). Because of this, it is important to examine the
specific role physicians play in the systematic stigmatization of individuals with a mental
disorder and how these influences perpetuate the person's internal stigmatization and effect their
overall treatment and health.
Lack of Training
Stigmatizing attitudes or behaviors by physicians leads to lack of quality access to care,
under-treatment, social marginalization, and disruption in the relationships between the patient
and physician. One study performed examined the current attitudes of healthcare providers in the
healthcare setting. The study revealed three areas of widespread stigmatization including
negative attitudes, disclosure and help-seeking stigmatization and social distancing (Modgill,
Knaak, Kassam & Szeto, 2014).The patients reported a general lack of support for social
recovery and felt as if they were intrusive in the medical field (Harangozo et al., 2014).
One form of stigmatization of people with a mental disorder by a physician is the lack of
consistent treatment due to the physician's belief that their patient will not adhere to the treatment
they are providing. One study examines a primary care physician decision-making process when

deciding the outcome of treatment for a patient with schizophrenia. The patient in the study
while having a variety of physical ailments was also diagnosed with schizophrenia. The patient
was taking Naproxen, a pain medication, to help his lower back pain due to arthritis but ran out
of his medication a few days early. The results showed that physicians who held stigmatizing
beliefs were more likely to think the patient would not follow the doctor’s treatment plan and
refused to refill the patient’s medication (Corrigan, Mittal, Reaves, Haynes, Han, Morris &
Sullivan, 2014).
Due to exposure, it has been shown that healthcare providers who are comfortable with
seeking out treatment for themselves and have mental health training are less likely to have
stigmatizing views (Corrigan et al. 2014) Within this study, the physicians exposed to more
patients with mental disorders or had training were more likely to prescribe the medication to
help the patients back pain, while simultaneously referring the patient to a mental health
specialist (Corrigan et al. 2014).
This study’s results indicated that physicians might not provide efficient and equal
treatment to a patient with a mental illness due to the belief that they will not adhere to their
treatment plan. This view is discriminatory and a form of stereotyping. All patients no matter
whether or not they have a mental disorder, may and are allowed to decide to go against medical
advice, hence not following the treatment plan. This does not give the physician the right to
provide inadequate and neglectful treatment. The stereotyping beliefs that a patient with a mental
disorder will not follow their treatment plan has been shown to change the way a physician
decides on a treatment plan for the patient (Corrigan et al. 2014). This is problematic and leads to
further internalization of personal stigma.

Stigmatizing attitudes from physicians increase the patient’s self-stigmatization and have
an adverse impact on the patient’s help-seeking behaviors when it comes to getting help for
health problems. Many doctors associate physical symptoms of a physical illness with a patient’s
mental disorder. For example, they may not believe that a patient who has borderline personality
disorder has stomach pain, but rather associate this symptom with the attention seeking behavior
related to borderline personality disorder.
Patients with a mental disorder view going to the doctors as a negative experience. These
experiences make the patient reluctant to seek out treatment for physical symptoms (Harangozo
et al., 2014), leading to help-seeking stigma. Help-seeking stigma is caused by an individual not
feeling as if they are an actual person with a physical ailment, but rather an individual suffering
from a disorder. This decreases the likelihood of a person to seek out treatment. Many people
while having the resources to seek out timely treatment do not (Gangi, Yuen, Levie & McNally,
2016), which leads to higher rates of physical illness and higher mortality rates among
individuals with a mental disorder. One example of this is a person with a mental disorder is at
an increased risk of developing heart disease. Patients with a mental disorder, who has a
physical condition such as heart disease, are less likely to receive quality and optimum care from
a physician (Cai & Li, 2013).
These stigmatizing behaviors can be linked back to the inadequate training a doctor
receives while in medical school and the lack of continuing education after graduating from
medical school. One study examined medical residents and their attitude towards patients with a
mental disorder label. Residents were assigned two identical case studies, except one of the
patients in the case study, had been diagnosed with a psychiatric condition in the ER. Residents
reported a higher percentage of social distancing and unwillingness to treat the patient. These are

in line with the general public views (Neurport, Rodgers, Simon, Birmes, Schmitt & Bui, 2011).
This study proved that there needs to be more training and anti-stigma interventions to increase
the type and quality of care a patient with a mental disorder receives.
Stigmas in the United States Health Care System
The United Sates Healthcare system, while improving, has a drastic influence in
perpetuating mental health stigma in the United States. The current way diagnosing occurs to
satisfy insurance companies and allow coverage for treatment is negatively impacting the way
disorder are treated and how the public views mental disorder.
The U.S. public health department is lacking in educational initiatives to reduce mental
health stigmas. This in return increases the likelihood an individual will not seek out treatment.
Systematic Overview of Mental Health Services
To understand the United States current mental health system, it would be useful to
examine the past system and the influence it has on a modern day. The first known mental health
care system in the United States dates back to the 18th century in which Virginia was the first
state in the US to establish an asylum. In the early 19th century, many other states followed suit
and began to build shelters to hospitalize patient with untreatable and chronic illnesses. The idea
of asylums continues into the 20th century, where during the great depression and WWII the
condition of these facilities drastically deteriorated leading to the introduction of the National
Mental Health Act which for the first time allowed for federal funding for research and treatment
of mental disorders. This act also led to the development of the National Institute of Mental
Health (NIMH) in 1949. Due to the deteriorating conditions of the asylums, in the late 20th
century, a plan for deinstitutionalization began to take effect (Sundararaman, 2009).

Deinstitutionalizing led to federal funding for community mental health centers. The idea
of deinstitutionalizing had both positive and negative consequences. While patients with mental
illnesses are no longer exposed to the harsh and unlivable treatment of the asylum, there was
inadequate services available and community support for these individuals. While these
individuals were no longer in an asylum, they were shifted to the criminal justice system or
ended up homeless. Throughout the years, new and more efficient treatment plans have been
developed (Sundararaman, 2009). Even with the advancements made, still, today policymakers
and mental health experts are still struggling with an ineffective system that does not meet the
needs of individuals with mental disorders.
Some of these problems include the lack of proper insurance that recognizes the
treatment for mental health disorder. Although the Affordable Care Act has allowed for the
largest expansion in the coverage of mental health and substance use disorders, still, 56% of
adults in the US who have a mental disorder do not receive treatment (“Health Insurance and
Mental Health Services”, n.d.; “The State of Mental Health”, n.d.). The Affordable Care Act
requires that most individual and small employer health plans include a policy that covers mental
health and substance use disorder.
To have insurances cover certain medications and allow for coverage of treatment, a
diagnosis needs to be made. Currently, the DSM-5 is used to make mental health diagnoses.
Medical insurance and the DSM-5 classify mental disorders as if they are a physical illness
leading to primary care physicians diagnosing mental illness, without providing adequate therapy
due to the lack of providers and stigmatizing attitudes surrounding seeing a therapist.
The Systematic Stigma

Diagnosing is important in forming labels, which leads to stigmatization. Mental
Healthcare professionals and other healthcare providers use the Diagnostic and Statistical
Manual to diagnose and describe individuals with a mental disorder. The purpose of the DSM is
to classify people based on the notion that all the subjects are homogenous, and that specific
criterion distinguish all the groups. By categorizing the people into a diagnosis, it allows the
provider to determine prognosis, etiology, identify patterns of family history and develop a
treatment plan that can be covered by insurance.
While the idea behind the DSM-V has good intentions, there are many downfalls to this
system which include perpetuating the systematic stigmatization of mental disorders (Ben-Zeev,
Young & Corrigan, 2010). The stigmatization of individuals with a psychiatric disorder involves
a process of groupness, homogeneity, and stability.
Groupness is best described as the way a group is perceived as an entire unified and
meaningful entity. A group is a way to be different from the general population. When an
individual is diagnosed, it differentiates them from the public at large and solidifies the idea of
groupness. Groupness is directly related to the concept of stereotyping (Ben-Zeev et al., 2010).
By categorizing an individual into a group, such as those with a mental disorder, it strengthens
the stereotypes associated with that group. Even when symptoms are absent, due to the diagnosis
and being placed in a group, the stereotypes will still be perpetuated by the general public (Ben-
Zeev et al., 2010).
Also, by putting people into groups, it leads to the perception of homogenous, which is
the idea that everyone in a particular group is the same. This causes overgeneralization or the
idea that all members of the group must exhibit the same characteristics for diagnosis (Ben-Zeev

et al., 2010). This leads to medical providers and the general public to making general
assumptions about what a mental disorder should look like. For example, that everyone who has
depression is suicidal or that everyone who has schizophrenia has dangerous hallucinations.
The DSM exhibits the idea of stability. Stability leads to the belief that the disorder is
static and unchanging (Ben-Zeev et al., 2010). This is extremely problematic as it suggests that
the individual who has these disorders cannot recover and leads to the negative outlook on
treatment. Mental illness, when compared to physical illness, are viewed as incurable.
To change the way, the public perceives mental disorders a new dynamic and multi-
dimensional approach to diagnosis need to be developed. In return, this should decrease the
stigma associated with diagnoses (Ben-Zeev et al., 2010). While changing the way mental
disorders are diagnosed can reduce mental health stigma, there needs to be a greater push to
educate the public.
Stigma in a medical setting is a public health concern as it prevents individuals with a
mental disorder seeking and continuing treatment (Corrigan et al., 2014). While there is more
insurance coverage for treatment, there is an overall lack of providers to provide therapy, so
instead under trained medical professionals, specifically primary care physicians are diagnosing
and treating mental health disorders.
While there has been an increase in services available over the years, they are still
inadequate to fulfill the need of the U.S. population, specifically in low socioeconomic urban and
rural settings. There is currently around one provider for every 1000 individuals (“The State of
Mental Healthcare”, n.d.). Also, while there has been an increase in insurance coverage due to
the Affordable care act, the current insurance policies value the idea of reduction, meaning they

are looking for short-term outcomes from medications, rather than long-term therapeutic
outcomes such as undergoing cognitive behavioral therapy (Jain, 2014). Mental health care is not
a priority in the United States health care system, and mental disorders are often treated as if they
are a physical ailment. This further perpetuates the systematic stigmatization of mental disorders
and leads to the thought that the current healthcare system plays a significant role in public and
personal stigma. An overall systematic change needs to occur to combat these ideas.
Conclusion
There is currently a need for change in the United States healthcare system to combat
mental health stigma. These changes include systematically altering the way mental disorders are
diagnosed and treated. Until a new system can be developed, there needs to be an increase in
access to mental healthcare and training healthcare providers recieve to reduce systematic
discrimination.
Increase in Training for Physicians and other Health Care Providers
Currently, most training conducted in the USA includes an educational component that
consists of understanding the cause, treatment and the effects of mental disorders. While this
form of training is necessary, there have been studies that have shown that combining both
education initiatives with contact may be the most effective form of intervention. In a study that
examined nurses in a psychiatric and somatic care setting showed a positive correlation between
the experience and contact a nurse had with individuals who had a mental disorder that led to a
decrease in negative attitudes they had about that person (Bjorkman et al. 2008).
New training techniques, such stigma-change programs can be used to educate and
decrease mental health stigma among healthcare providers (Corrigan et al., 2014). This form of

training is a strategic model that uses a local, targeted, and continuous contact training to change
a provider’s perspective on mental disorders.
The idea of contact comes from interactions of healthcare providers with people who
have lived with a mental disorder. Contact and training would start early on in the physicians or
other healthcare provider’s career, with training beginning while the student is still in school
(Corrigan et al. 2014). By exposing physicians or other healthcare providers to patients with
mental disorders, it will seem less “scary” when treating a patient with a mental illness. Along
with contact with patients with a mental illness, healthcare providers must undergo educational
initiatives to understand what is like to diagnose, treat and live with a psychiatric disorder, which
in return should help reduce stigma.
By targeting the training to specific healthcare groups, such as nurses and doctors in the
primary care setting, they can get specific training based on what they may see on a daily basis.
By starting with healthcare providers, instead of attempting to change the entire populations
believes, patients will be more willing to seek out treatment and decrease perceived public
stigma. By also targeting specific providers, the training can be formulated to meet the needs of
the public (Corrigan et al. 2014). The training should be continuous for the target group, as
mental disorders and public healthcare are always changing (Corrigan et al. 2014).
Many studies have also examined the effectiveness of early intervention educational
initiatives, such as while students are still in medical school, on reducing public stigma (Collins,
Wong, Cerully, Schultz & Eberhart, 2012). A study conducted in Australia examined the
effectiveness of a structured tutor program during the first year field period of occupational
therapist. The results showed positive overall impact on the students in reducing the mental

health stigma (Beltran, Scanlan, Hancock & Luckett, 2007). This study supports that early
intervention training can lead to a positive change in attitudes of healthcare providers even after
only several weeks of exposure and training.
Holistic View on Medicine: Integrating Mental and Physical health
Along with increased training of health care providers, there needs to be an increase in
access to mental health care, while enhancing communication between providers. This can be
accomplished through integrating mental and physical health. An integrated care system is the
philosophy that both physical and mental health should be simultaneously treated in the same
facility. Traditionally, the healthcare system is fragmented, which means that mental and
physical health issues are treated at separate facilities. This system is often costly and frustrating
for both the patient and their families. All aspects of care suffer as patients’ needs get lost,
needed services do not happen or are delayed, and often is costly (Kodner & Spreeuwenber,
2002).
By integrating care, the access, quality, and efficiency of care provided is improved. A
key aspect of integrated care is the increase in communication and collaboration of a variety of
healthcare professionals to develop a comprehensive treatment plan for the patient that addresses
their physical, psychological and social needs (“Integrated Healthcare,” n.d.).
By combining mental health care with primary care, families will only need to visit one
office; allowing for greater access to mental health services and decrease the overall cost of
receiving care. Within the pediatric primary care setting, it is estimated that fewer than 5% of
families referred to off-site counseling will follow through with their mental health referrals,
while in an integrated practice more then 66% of families follow through with the referral. In

addition to this, 78% of children served in-house completed their treatment where none
completed their treatment elsewhere (Stacin & Perrin, 2014). By having an integrated office, the
barriers of getting to another facility are eliminated, the stigma associated with receiving
treatment for a mental illness is decreased, and the overall cost of receiving services is reduced.
In the United States, more than 93% of children had contact with a primary care provider
in 2013 (Stacin & Perrin, 2014). This is viewed as a necessity for the child’s wellbeing.
Integrating primary care and mental health care increases the chance that an individual will seek
out treatment. When a person goes to see a mental health counselor it will be viewed as going to
their doctor's office, rather than a mental health facility. This helps reduce the perceived public
stigma of seeking out and accessing mental health services because the care is viewed as an
important aspect of the individual's overall well-being, the same way it is viewed as a necessity
to go to the doctors for a physical.
By integrating practices issues of cost, lack of accessibility and stigma in the mental
healthcare setting could drastically decrease. Stigma is the most important problem facing the
entire mental health field. The stigma associated with mental disorders has a drastic impact on
the individuals overall health and wellbeing (Stacin & Perrin, 2014). Mental health stigma
cannot be decreased until a systematic changes are made in regards to the United States
healthcare system. When these changes occur, the US health care system could see a drastic
decline in the way individuals with mental disorders are treated and while increasing the
individual’s self-efficacy.

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