Stigma and anti-stigma campaigns

On this plate (5 sections)

Stigma around mental health is older than any campaign against it, and it affects everyday decisions about work, relationships and care. This page defines the term as researchers and the World Health Organization use it, separates public, self and structural stigma, describes four anti-stigma programs from England, Canada, New Zealand and the World Psychiatric Association as the sources describe them, and reports what reviews say about contact with people who have lived experience. It does not evaluate any one organization.

What stigma is

WHO/Europe says stigma is "far from just negative attitudes." Prejudice and misinformation lead to discrimination, both between individuals (public stigma) and in laws and policies (structural stigma). A third form, self-stigma, occurs when people take on stigmatizing beliefs about themselves, which can harm self-esteem. WHO/Europe gives an example it calls "why-try syndrome," where a person avoids applying to university because they expect to fail, and an example of diagnostic overshadowing, where a physical symptom is dismissed as being "all in your mind."

Scholarly ideas about stigma have their own history. A 2008 review in World Psychiatry traces contemporary notions to sociological and psychological traditions, including Erving Goffman's work in the early 1960s (see Asylum reform and its critics). It describes a move from viewing stigma as a by-product of psychiatry to a broader view that sees social-structural, interpersonal and psychological factors interacting.

Four programs, described neutrally

World Psychiatric Association: Open the Doors

The WPA started a global anti-stigma program in 1996, in recognition of what it called the especially harsh burden of stigma attached to schizophrenia. By 2008 more than 20 countries had joined its network. Three core principles guided it: goals drawn from the priorities of people living with schizophrenia, broad community participation beyond the mental health sector, and a commitment to long-term sustainability.

Time to Change, England

Time to Change was delivered by the charities Mind and Rethink Mental Illness. A peer-reviewed evaluation says its first phase ran from 2007 to 2011, with a social marketing campaign launched in January 2009 aimed at adults aged 25 to 44 in middle-income groups. A second phase was funded for 2011 to 2015 with an extension to 2016, and a third ran from 2016 to 2021, with a later focus on men's mental health.

Opening Minds, Canada

The Mental Health Commission of Canada's interim report says the initiative's media component began with a small public education campaign in 2009. The campaign's results were described as "disappointing," with no sign of positive effects, and the initiative judged a larger campaign not cost-effective. It then shifted toward evaluating existing grassroots programs aimed at youth, health care providers and the workforce, using before-and-after testing and, in some cases, follow-up a few months later.

Like Minds, Like Mine, New Zealand

News reports describe the program as established in 1997 and, in July 2021, relaunched as Nōku te Ao: Like Minds, with NZ$8 million over five years. Its stated aims include challenging stigma, prejudice and discrimination, improving social inclusion with particular emphasis on Māori and Pacific communities, and funding education campaigns, social action grants, and research and evaluation. The reports are news coverage rather than program evaluations, and they name 1997 as the start without detailing the original design.

What the evidence says about contact

WHO/Europe's summary of the 2022 Lancet Commission says the best way to reduce stigma is through social contact between people with and without mental health conditions, and that awareness-raising alone has "extremely weak" evidence. The 2008 World Psychiatry review reached a similar view earlier, finding that approaches combining active learning with positive contact did best, and that fact-based and protest-based approaches did less well.

A 2017 National Academies workshop report adds detail. A presenter reviewing 79 studies reported that contact had effects on attitudes and behavioral intentions two to three times larger than education at immediate testing, that attitude effects stayed greater for contact at follow-up, and that in-person contact beat media-based contact. Education worked better than contact for children, mostly adolescents. A school-based study of 722 sixth-graders found effect sizes between .25 and .50, described by its author as "not enormous but still positive," and whether attitude change leads to help-seeking was unresolved.

What is still uncertain

For England, the evaluation reported significant improvements in knowledge, attitudes and desire for social distance between 2009 and 2015, and a reduction in service users' direct experiences of discrimination from 2008 to 2014, particularly in informal relationships. Its authors conclude that the positive changes support effectiveness but cannot be definitively attributed to Time to Change, because a controlled study was impossible. They also found no evidence that differences by income, gender or ethnicity had narrowed.

The wider caveats are plain. The workshop report cautions that norms change slowly, and whether attitude change leads to help-seeking was left unresolved. Service users' own organizing against stigma is told in The consumer/survivor movement, and the practical side of speaking up is covered in How to advocate for your own mental health care. Related legal and policy history appears in The UN Convention on the Rights of Persons with Disabilities, and dates are collected on the timeline. A clinician or a qualified adviser is the right contact for questions about a person's own care.

The short version

Stigma operates between people, inside people and in laws and institutions, so single-channel campaigns have limits. Reviews favor structured contact with people who have lived experience over information alone, and England's evaluation reported attitude gains, though attributing them to a campaign is difficult. Whether attitude gains lead to changed behavior is less settled.