September 07, 2023
Stigma has long been a barrier to access to mental health treatment. These FAQs explain the role employers can play in eliminating it, opening doors to employees in need of mental health services.
What is mental health stigma?
Mental health stigma is defined as negative attitudes among groups of people or the general public toward people with mental illnesses or substance use disorders (SUD). Mental health stigma contributes to the silence, shame and suffering that a person with a mental health condition or SUD may feel. Stigma is one of the reasons why people with mental illness or SUD do not seek and/or sustain participation in treatment, especially when they develop self-stigma about themselves.
Self-stigma develops when people “internalize perceived prejudices and develop negative feelings about themselves.”
Is mental health stigma still a problem?
While there is evidence to show that stigma related to people with mental health conditions, particularly depression, has decreased in recent years, negative attitudes toward people with mental health conditions and SUD remain.1 This stigma may vary across demographics, regions, and countries across the globe. For example, Gen Z tends to report lower levels of stigma toward mental health, and there is some hope that a silver lining of the Covid pandemic is a more supportive public attitude toward people with mental illness or SUD, though long-term impacts are yet to come.
Unfortunately, the workplace isn’t immune to these negative attitudes and feelings. For example, one survey of employees and employers conducted in late 2020 found that 80% of employees said there was mental health stigma in their workplace, with the majority of employers reporting the same.2
For additional information and considerations related to mental health training, see Engineering Mental Health: Building a Strategy from the Ground Up.
Are employers focused on reducing mental health stigma?
According to Business Group on Health’s 2024 Large Employer Health Care Strategy Survey, 40% of employers report that stigma is a mental health focus area.3 This number may decrease in 2024, with just 28% of employers reporting that stigma will be a focus area, potentially indicating that employers have made inroads in improving their organizational culture around mental health.3
Eliminating stigma is important to employers because research shows that stigma can prevent people with mental health conditions from obtaining treatment and may be detrimental to recovery even when they do access care.4 Reducing negative attitudes among employees about mental health and creating a culture where it feels safe for employees to discuss their condition and seek care has the potential to increase positive health outcomes and work/life satisfaction.
Is stigma the main barrier to employees getting treatment for mental health conditions?
As described above, stigma is one reason why people do not seek care for mental health conditions or engage in employer-sponsored mental health programs and benefits. To illustrate, according to a survey of employees, 37% of those with mental health conditions said they avoided treatment to avoid others from finding out about their condition, and this number increased to 52% among those with substance use disorders.5 Other barriers to care include access challenges such as cost, limited providers or networks, availability of quality care, and difficulty getting time off work.
How common are anti-stigma campaigns?
Fifty-four percent of the large employers surveyed by Business Group on Health reported that they have an anti-stigma campaign in place in 2023, with 51% reporting that they’ll have one in 2024.3 Beyond these campaigns, employers have a number of other initiatives to improve company culture, including manager and peer training, along with the appointment of mental health champion/allies.3 Taken together, there is a clear employer desire to ensure that employees are comfortable expressing their mental health needs and seeking appropriate treatment.
What are employers doing to reduce stigma?
Employers are seeking to reduce mental health stigma using several tactics, including:
- Communication campaigns, including those that leverage health observances such as World Mental Health Day;
- Storytelling through leader and employee testimonials;
- Executive leadership buy-in and endorsement of anti-stigma initiatives;
- Manager and peer training;
- Mental health resource toolkits for managers or site leaders;
- Anti-stigma pledges, including those that leverage national campaigns;
- Mental health champions/allies;
- Mental health awareness events;
- Partnerships with local advocacy groups to host events and trainings;
- Partnerships with the employee assistance program (EAP), health plans, engagement and concierge platforms and other health and well-being vendors to cross-promote resources; and
- Promotion of mental health benefits and resources.
How many employers offer mental health trainings and what type are they?
In 2023, 73% of employers offer mental health training for managers and 44% have trainings in place for peers.3 These trainings are intended to help managers or peers recognize the signs of mental health issues and how respond appropriately, including directing them to available resources or services.
Some employers work with their EAP, mental health vendor(s) or mental health organizations (e.g., National Alliance on Mental Illness) to provide training. Examples of trainings and commercial products include Mental Health First Aid, the ICU Program, R U OK?, Mind Forward, QPR and Living Works. There are several local organizations around the world that also provide mental health training services tailored to local customs and culture. Additionally, some employers have created their own mental health trainings using internal staff and resources, while others have developed custom programs with third-party vendors.
What type of employees participate in mental health trainings?
As indicated above, some employers focus on training managers or site leaders, likely because research indicates that supervisors are more comfortable having conversations about mental health after undergoing training.6 Indeed, according to a research analysis by the World Health Organization (WHO), there is moderate evidence that mental health training has a strong beneficial effect on managers’ knowledge of mental health issues.7 Some employers make manager training mandatory, while others make it voluntary and promote it heavily.
Other employers permit any employee who express an interest in training to participate. And still others target both populations – managers and other employees – with distinct training programs or modules for each group.
Are mental health trainings effective at reducing stigma?
According to the aforementioned research analysis by the WHO, in addition to increasing manager knowledge of mental health, training may reduce stigma in the workplace.7 Manager training can also play a role in transforming work culture; research indicates that it may positively impact managers’ supportive skills or behaviors, leading to increased likelihood that they encourage employees to seek help for mental health challenges.7 For these reasons, the WHO recommends mental health training for managers as a part of their guidelines on mental health at work.
Evidence is more mixed on the benefits of peer mental health training than it is for manager training. Peer mental health training may have some impact on improving mental health knowledge and reducing stigma among those who are trained.7 However, this knowledge does not necessarily translate into helping behaviors.7
Anecdotal feedback from employers about mental health training programs is mixed. Numerous employers have reported positive experiences with training programs, while others have expressed concerns that they may cause “more harm than good” due to trained employees overstepping their role and attempting to act as a counselor.
What are some common considerations associated with implementing a mental health training program?
Employers have reported the following considerations associated with choosing and implementing a mental health training program:
- The ability to scale the training to the desired number of employees, as some trainings may only be offered in-person (methods of training vary by program), may be time- or resource- intensive, or may limit the number of participants per class.
- The ability to adapt trainings to a global audience, ensuring that regional and local nuances are taken into account, as well as language capabilities.
- The concern that trained employees may exceed their role and attempt to act as a counselor, creating liability issues.
- The need for or ability to provide oversight of trained employees to promote adherence to the intent of the training program.
- The ease of working with other business units to gain buy-in for the training program, as well as communicate about it.
- The ability for employees to easily access mental health benefits, services and treatment once they have been encouraged to utilize resources.
What role do mental health champions/advocates play in reducing stigma?
In 2023, 36% of employers have mental health champions/advocates, a network of employees who have agreed (and in some cases have been trained) to be there for colleagues who have mental health needs/concerns and direct them to company-provided resources.3 At one company, for example, employees sign up to be an ally be taking a pledge and identifying themselves through their email signature and badge. They also learn about available mental health programs and benefits to be able to discuss them in more detail with coworkers.
What names or slogans are other employers using for their anti-stigma campaigns?
Examples of names and slogans from Business Group member companies include:
- “I’ll Listen”
- “Program #cooltocall”
- “Take Action – Make Traction”
- “Mental Health: Let’s Talk About It”
- “This is Me” – based on a U.K. national campaign
Is there research on how to develop messages effectively for anti-stigma communication campaigns?
There are research-based guiding principles for message development that employers can use to reduce public stigma within their workforce. These guiding principles include:
- Developing a sympathetic narrative;
- Discussing barriers to care and successful treatment;
- Avoiding messages that include violence or imply blame; and
- Featuring a diverse group of speakers whom employees respect or look up to.
Using research in message design is important because even the most well-intentioned but untested communication campaigns can be ineffective or even backfire. For more information on designing effective anti-stigma messaging, see: Is Your Anti-Stigma Campaign Designed for Impact? Increase Efficacy Using Evidence.
How does culture and location impact stigma?
Mental health stigma is a barrier everywhere. However, how stigma manifests itself is influenced significantly by a country’s culture and local environment, including the policy and legal framework. For example, in some countries, mental health issues are criminalized, and seeking care for suicide attempts can risk imprisonment. In other cultures, an individual can risk being ostracized or labeled as “possessed”. As a result, multinational employers have developed locally relevant anti-stigma campaigns, designed to resonate with the in-country needs of employees and their families. Confidentiality is often a concern as well for those facing severe stigma. Employers can help by reinforcing confidentiality measures for those who seek help and engage in programs. For examples of tools and ideas that global employers are implementing in geographies around the world to address stigma, see Addressing Mental Health From a Global and Local Perspective.
How are employers measuring the impact of their anti-stigma campaigns?
Employers are assessing the impact of anti-stigma campaigns through:
- Participation in trainings, webinars, events, etc.;
- Pulse surveys;
- Employee engagement metrics;
- Employee sentiment and morale, including sense of community; and
- Program or benefit utilization.
Employers can also evaluate the overall success of their anti-stigma campaigns by assessing baseline prevalence of public stigma in their employee populations and conducting a follow-up assessment using the Bogardus Social Distance Scale, one of the most commonly used measures of public stigma.
More TopicsArticles & Guides Mental and Emotional Well-being
- 1 | Health Partners. Stigma of mental illnesses decreasing, survey shows. February 24, 2020. https://www.healthpartners.com/hp/about/press-releases/stigma-of-mental-illnesses-decreasing.html. Accessed April 25, 2023.
- 2 | Coe E, Cordina J, Enomoto K, Mandel A, Stueland J. National surveys reveal disconnect between employees and employers around mental health need. McKinsey. https://www.mckinsey.com/industries/healthcare/our-insights/national-surveys-reveal-disconnect-between-employees-and-employers-around-mental-health-need. Accessed March 8, 2023.
- 3 | Business Group on Health. 2024 Large Employer Health Care Strategy Survey. August 2023. https://www.businessgrouphealth.org/resources/2024-large-employerhealth-care-strategy-survey-intro. Accessed August 22, 2023.
- 4 | Hanisch SE, Twomey CD, Szeto AC, Birner UW, Nowak D, Sabariego C. The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry. Jan 6 2016;16:1. doi:10.1186/s12888-015-0706-4
- 5 | McKinsey. Overcoming stigma: Three strategies toward better mental health in the workplace. McKinsey Quarterly. July 23, 2021. https://www.mckinsey.com/industries/healthcare/our-insights/overcoming-stigma-three-strategies-toward-better-mental-health-in-the-workplace. Accessed March 8, 2023.
- 6 | Gayed A, LaMontagne AD, Milner A, et al. A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness. JMIR Ment Health. Jul 3 2018;5(3):e10517. doi:10.2196/10517
- 7 | World Health Organization. WHO guidelines on mental health at work. September 28, 2022. https://www.who.int/publications/i/item/9789240053052. Accessed June 28, 2023.