Hostname: page-component-77c89778f8-7drxs Total loading time: 0 Render date: 2024-07-23T22:42:03.420Z Has data issue: false hasContentIssue false

Stigma and discrimination limit access to mental health care

Published online by Cambridge University Press:  18 May 2011

Rights & Permissions [Opens in a new window]


Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This editorial provides an overview of how far access to mental health care is limited by perceptions of stigma and anticipated discrimination. Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff. The rates of non-treatment are far higher in low income countries. Evidence from some descriptive studies and epidemiological surveys suggest that potent factors increasing the likelihood of treatment avoidance, or long delays before presenting for care include: (i) lack of knowledge about the features and treatability of mental illnesses; (ii) ignorance about how to access assessment and treatment; (iii) prejudice against people who have mental illness, and (iv) expectations of discrimination against people who have a diagnosis of mental illness. The associations between low rates of help seeking, and stigma and discrimination are as yet poorly understood and require more careful characterisation and analysis, providing the platform for more effective action to ensure that a greater proportion of people with mental illness are effectively treated in future.

Copyright © Cambridge University Press 2008



Al-Krenawi, A., Graham, J.R., Dean, Y.Z. & Eltaiba, N. (2004). Cross-national study of attitudes towards seeking professional help: Jordan, United Arab Emirates (UAE) and Arabs in Israel. International Journal of Social Psychiatry 50(2), 102114.CrossRefGoogle ScholarPubMed
Amaddeo, F. & Jones, J. (2007). What is the impact of socio-economic in-equalities on the use of mental health services? Epidemiologia e Psichiatria Sociale 16(1), 1619.CrossRefGoogle Scholar
Angermeyer, M.C., Matschinger, H. & Riedel-Heller, S.G. (1999). Whom to ask for help in case of a mental disorder? Preferences of the lay public. Social Psychiatry and Psychiatric Epidemiology 34(4), 202210.CrossRefGoogle ScholarPubMed
Angold, A., Erkanli, A., Farmer, E.M., Fairbank, J.A., Burns, B.J., Keeler, G. & Costello, E.J. (2002). Psychiatric disorder, impairment, and ser-vice use in rural African American and white youth. Archives of General Psychiatry 59(10), 893901.CrossRefGoogle Scholar
Black, K., Peters, L., Rui, Q., Milliken, H., Whitehorn, D. & Kopala, L.C. (2001). Duration of untreated psychosis predicts treatment outcome in an early psychosis program. Schizophrenia Research 47(2-3), 215222.CrossRefGoogle Scholar
Castiello, G. & Magliano, L. (2007). [Beliefs about psychosocial consequences of schizophrenia and depression: a comparative study in a sample of secondary school students], in Italian. Epidemiologia e Psichiatria Sociale 16(2), 163171.CrossRefGoogle Scholar
Chisholm, D., Flisher, A., Lund, C., Patel, V., Saxena, S., Thomicroft, G. & Tomlinson, M. (2007). Scale up services for mental disorders: a call for action. Lancet 370 (9594), 12411252.Google ScholarPubMed
Compton, M.T., Kaslow, N.J. & Walker, E.F. (2004). Observations on parent/family factors that may influence the duration of untreated psychosis among African American first-episode schizophrenia-spectrum patients. Schizophrenia Research 68(2-3), 373385.CrossRefGoogle ScholarPubMed
Cooper, A.E., Corrigan, P.W. & Watson, A.C. (2003). Mental illness stigma and care seeking. Journal of Nervous and Mental Disease 191(5), 339341.CrossRefGoogle ScholarPubMed
Corrigan, P. (2004a). How stigma interferes with mental health care. American Psychology 59(7), 614625.CrossRefGoogle ScholarPubMed
Corrigan, P.W. (2004b). On the Stigma of Mental Illness: Practical Strategies for Research and Social Change. American Psychological Association: Washington, D.C.Google Scholar
Corrigan, P. (2005). On the Stigma of Mental Illness. American Psychological Association: Washington, D.C.Google ScholarPubMed
Corrigan, P.W., Markowitz, F.E. & Watson, A.C. (2004). Structural levels of mental illness stigma and discrimination. Schizophrenia Bulletin 30(3), 481491.CrossRefGoogle ScholarPubMed
Costello, E.J., Keeler, G.P. & Angold, A. (2001). Poverty, race/ethnicity, and psychiatric disorder: a study of rural children. American Journal of Public Health 91(9),14941498.CrossRefGoogle Scholar
Davis, S. & Ford, M. (2004). A conceptual model of barriers to mental health services among African Americans. African American Research Perspectives 10, 4454.Google Scholar
Diala, C., Muntaner, C., Walrath, C., Nickerson, K.J., LaVeist, T.A. & Leaf, P.J. (2000). Racial differences in attitudes toward professional mental health care and in the use of services. American Journal of Orthopsychiatry 70(4), 455464.CrossRefGoogle ScholarPubMed
Falk, G. (2001). Stigma: How We Treat Outsiders. Prometheus Books: New York.Google Scholar
Fox, J.C., Blank, M., Berman, J. & Rovnyak, V.G. (1999). Mental disorders and help seeking in a rural impoverished population. International Journal of.Psychiatry in Medicine 29(2), 181195.CrossRefGoogle Scholar
Gregoire, A. (2002). The mental health of farmers. Occupational Medicine (London) 52(8), 471476.CrossRefGoogle ScholarPubMed
Hawton, K., Fagg, J., Simkin, S., Harriss, L., Malmberg, A. & Smith, D. (1999). The geographical distribution of suicides in farmers in England and Wales. Social Psychiatry and Psychiatric Epidemiology 34(3), 122127.CrossRefGoogle ScholarPubMed
Hines-Martin, V., Brown-Piper, A., Kim, S. & Malone, M. (2003a). Enabling factors of mental health service use among African Americans. Archives of Psychiatric Nursing 17(5), 197204.CrossRefGoogle ScholarPubMed
Hines-Martin, V., Malone, M., Kim, S. & Brown-Piper, A. (2003b). Barriers to mental health care access in an African American population. Issues in Mental Health Nursing 24(3), 237256.CrossRefGoogle Scholar
Hirschfeld, R.M., Keller, M.B., Panico, S., Arons, B.S., Barlow, D., Davidoff, F., Endicott, J., Froom, J., Goldstein, M., Gorman, J.M., Marek, R.G., Maurer, T.A., Meyer, R., Phillips, K., Ross, J., Schwenk, T.L., Sharfstein, S.S., Thase, M.E. & Wyatt, R.J. (1997). The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. Journal of American Medical Association 277(4), 333340.CrossRefGoogle ScholarPubMed
Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I. & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351(1), 1322.CrossRefGoogle ScholarPubMed
Hoyt, D.R., Conger, R.D., Valde, J.G. & Weihs, K. (1997). Psychological distress and help seeking in rural America. American Journal of Community Psychology 25(4), 449470.CrossRefGoogle ScholarPubMed
Jacoby, A., Snape, D. & Baker, G.A. (2005). Epilepsy and social identity: the stigma of a chronic neurological disorder. Lancet Neurology 4(3), 171178.CrossRefGoogle ScholarPubMed
Jamison, K.R. (2006). The many stigmas of mental illness. Lancet 367(9509), 533534.CrossRefGoogle ScholarPubMed
Johannessen, J.O., McGlashan, T.H., Larsen, T.K., Homeland, M., Joa, I., Mardal, S., Kvebaek, R., Friis, S., Melle, I., Opjordsmoen, S., Simonsen, E., Ulrik, H. & Vaglum, P. (2001). Early detection strategies for un-treated first-episode psychosis. Schizophrenia Research 51(1), 3946.CrossRefGoogle Scholar
Keating, F. & Robertson, D. (2004). Fear, black people and mental illness. A vicious circle? Health and Social Care in the Community 12(5), 439447.CrossRefGoogle ScholarPubMed
Kessler, R.C., Berglund, P.A., Bruce, M.L., Koch, J.R., Laska, E.M., Leaf, P.J., Manderscheid, R.W., Rosenheck, R.A., Walters, E.E. & Wang, P.S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research 36(6 Pt 1), 9871007.Google ScholarPubMed
Kessler, R.C., Dernier, O., Frank, R.G., Olfson, M., Pincus, H.A., Walters, E.E., Wang, P., Wells, K.B. & Zaslavsky, A.M. (2005a). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352(24), 25152523.CrossRefGoogle ScholarPubMed
Kessler, R.C., Dernier, O., Frank, R.G., Olfson, M., Pincus, H.A., Walters, E.E., Wang, P., Wells, K.B. & Zaslavsky, A.M. (2005b). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352(24), 25152523.CrossRefGoogle ScholarPubMed
Keusch, G.T., Wilentz, J. & Kleinman, A. (2006). Stigma and global health: developing a research agenda. Lancet 367(9509), 525527.CrossRefGoogle ScholarPubMed
Kohn, R., Saxena, S., Levav, I. & Saraceno, B. (2004a). Treatment gap in mental health care. Bulletin of the World Health Organization 82, 858866.Google ScholarPubMed
Kohn, R., Saxena, S., Levav, I. & Saraceno, B. (2004b). The treatment gap in mental health care. Bulletin of the World Health Organization 82(11), 858866.Google ScholarPubMed
Lai, Y.M., Hong, C.P. & Chee, C.Y. (2001). Stigma of mental illness. Singapore Medical Journal 42(3), 111114.Google ScholarPubMed
Lee, S., Lee, M.T., Chiu, M.Y. & Kleinman, A. (2005). Experience of social stigma by people with schizophrenia in Hong Kong. British Journal of Psychiatry 186, 153157.CrossRefGoogle ScholarPubMed
Li, Z.J., Chen, S.Y., Zhou, J. & Wu, Y.Q. (2004). [The study of poisoning-suicide-attempted patients in emergency departments of 25 hospitals in China]. Zhonghua Liu Xing.Bing.Xue.Za Zhi. 25(4), 285287.Google Scholar
Link, B.G. & Phelan, J.C. (2006). Stigma and its public health implications. Lancet 367(9509), 528529.CrossRefGoogle ScholarPubMed
Link, B.G., Cullen, F.T., Struening, E.L., Shrout, P.E. & Dohrenwend, B.P. (1989). A modified labeling theory approach in the area of mental disorders: An empirical assessment. American Sociological Review 54, 100123.CrossRefGoogle Scholar
Littlewood, R. (1998). Cultural variation in the stigmatisation of mental illness. Lancet 352(9133), 10561057.CrossRefGoogle ScholarPubMed
Mann, C.E. & Himelein, M.J. (2004). Factors associated with stigmatization of persons with mental illness. Psychiatric Services 55(2), 185187.CrossRefGoogle ScholarPubMed
Morgan, C. & Fearon, P. (2007). Social experience and psychosis insights from studies of migrant and ethnic minority groups. Epidemiologia e Psichiatria Sociale 16(2), 118123.CrossRefGoogle ScholarPubMed
Narrow, W.E., Regier, D.A., Rae, D.S., Manderscheid, R.W. & Locke, B.Z. (1993). Use of services by persons with mental and addictive disorders. Findings from the National Institute of Mental Health Epidemiologic Catchment Area Program. Archives of General Psychiatry 50(2), 95107.CrossRefGoogle ScholarPubMed
National Institute for Mental Health in England (2003). Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England. Department of Health: London.Google Scholar
Notkola, V.J., Martikainen, P. & Leino, P.I. (1993). Time trends in mortality in forestry and construction workers in Finland 1970-85 and impact of adjustment for socioeconomic variables. Journal of Epidemiology and Community Health 47(3), 186191.CrossRefGoogle ScholarPubMed
Page, A.N. & Fragar, L.J. (2002). Suicide in Australian farming, 1988-1997. Australian and New Zealand Journal of Psychiatry 36(1), 8185.CrossRefGoogle ScholarPubMed
Regier, D.A., Narrow, W.E., Rae, D.S., Manderscheid, R.W., Locke, B.Z. & Goodwin, F.K. (1993). The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50(2), 8594.CrossRefGoogle Scholar
Rose, D., Thornicroft, G., Pinfold, V. & Kassam, A. (2007). 250 ways to label people with mental illness. BMC Health Services Research 7, 97.CrossRefGoogle Scholar
Rost, K., Smith, G.R. & Taylor, J.L. (1993). Rural-urban differences in stigma and the use of care for depressive disorders. Journal of Rural Health 9(1), 5762.CrossRefGoogle ScholarPubMed
Sartorius, N. & Schulze, H. (2005). Reducing the Stigma of Mental Illness. A Report from a Global Programme of the World Psychiatric Association. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370(9590), 878889.CrossRefGoogle ScholarPubMed
Simon, G.E., Fleck, M., Lucas, R. & Bushnell, D.M. (2004a). Prevalence and predictors of depression treatment in an international primary care study. American Journal of Psychiatry 161(9), 16261634.CrossRefGoogle Scholar
Simon, G.E., Heck, M., Lucas, R. & Bushnell, D.M. (2004b). Prevalence and predictors of depression treatment in an international primary care study. American Journal of Psychiatry 161(9), 16261634.CrossRefGoogle Scholar
Smith, L.D., McGovern, R.J. & Peck, P.L. (2004). Factors contributing to the utilization of mental health services in a rural setting. Psychological Reports 95(2):435442.CrossRefGoogle Scholar
Snowden, L.R. (2001). Barriers to effective mental health services for African Americans. Mental.Health Services Research 3(4), 181187.CrossRefGoogle ScholarPubMed
Snowden, L.R. (2003). Bias in mental health assessment and intervention: theory and evidence. American Journal of Public Health 93(2), 239243.CrossRefGoogle ScholarPubMed
Sundar, M. (1999). Suicide in farmers in India. British Journal of Psychiatry 175, 585586.CrossRefGoogle ScholarPubMed
Swanson, G.M. & Ward, A.J. (1995). Recruiting minorities into clinical trials: toward a participant-friendly system. Journal of the National Cancer Institute 87(23), 17471759.CrossRefGoogle Scholar
Thomas, H.V., Lewis, G., Thomas, D.R., Salmon, R.L., Chalmers, R.M., Coleman, T.J., Kench, S.M., Morgan-Capner, P., Meadows, D., Sillis, M. & Softley, P. (2003). Mental health of British farmers. Occupational and Environmental Medicine 60(3), 181185.CrossRefGoogle ScholarPubMed
Thornicroft, G. (2006a). Actions Speak Louder: Tackling Discrimination against People with Mental Illness. Mental Health Foundation: London.Google Scholar
Thornicroft, G. (2006b). Shunned: Discrimination against People with Mental Illness. Oxford University Press: Oxford.Google Scholar
Thornicroft, G. (2007). Most people with mental illness are not treated. Lancet 370(9590), 807808.CrossRefGoogle Scholar
Thornicroft, G., Davies, S. & Leese, M. (1999). Health service research and forensic psychiatry: a black and white case. International Review of Psychiatry 11, 250257.CrossRefGoogle Scholar
Thornicroft, G., Rose, D., Kassam, A. & Sartorius, N. (2007). Stigma: ignorance, prejudice or discrimination? British Journal of Psychiatry 190, 192193.CrossRefGoogle ScholarPubMed
Voracek, M., Fisher, M.L. & Marusic, A. (2003). The Finno-Ugrian suicide hypothesis: variation in European suicide rates by latitude and longitude. Perception and Motor Skills 97(2), 401406.CrossRefGoogle ScholarPubMed
Wang, P.S., Berglund, P.A. & Kessler, R.C. (2003). Patterns and correlates of contacting clergy for mental disorders in the United States. Health Services Research 38(2), 647673.CrossRefGoogle ScholarPubMed
Wang, P.S., Berglund, P., Olfson, M., Pincus, H.A., Wells, K.B. & Kessler, R.C. (2005a). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62(6), 603613.CrossRefGoogle ScholarPubMed
Wang, P.S., Lane, M., Olfson, M., Pincus, H.A., Wells, K.B. & Kessler, R.C. (2005b). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62(6), 629640.CrossRefGoogle ScholarPubMed
Wang, P.S., Guilar-Gaxiola, S., Alonso, J., Angermeyer, M.C., Borges, G., Bromet, E.J., Bruffaerts, R., de Girolamo, G., de Graaf, R., Gureje, O., Haro, J.M., Karam, E.G., Kessler, R.C, Kovess, V., Lane, M.C., Lee, S., Levinson, D., Ono, Y., Petukhova, M., Posada-Villa, J., Seedat, S. & Wells, J.E. (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841850.CrossRefGoogle ScholarPubMed
Wittchen, H.U. & Jacobi, F. (2005). Size and burden of mental disorders in Europe–a critical review and appraisal of 27 studies. European Neuropsychopharmacology 15(4), 357376.CrossRefGoogle ScholarPubMed
World Health Organisation (2005). Mental Health Atlas 2005. World Health Organisation: Geneva.Google Scholar