This blog post was written in conjunction with Emma Beth McGinty, PhD, Associate Professor, Johns Hopkins Bloomberg School of Public Health, as a follow-up to Business Group on Health’s Virtual Summit, Tackling Mental Health Stigma: Guiding Principles for Impactful Strategies.

Author’s note: Anti-stigma campaigns are more important than ever. The COVID-19 pandemic has negatively affected the mental health of people around the world. What’s more, experts warn that the stress and loneliness caused by the coronavirus may trigger or worsen symptoms among those with mental illness or substance use disorder. At a time when the need for care is so great, employers should ensure they’re doing everything possible to reduce stigma as a barrier to treatment.

It’s no secret that stigma is a barrier to employee engagement in benefits and programs to treat mental health conditions and substance use disorders since nearly half of companies surveyed by Business Group on Health have an anti-stigma campaign in place. Many of these campaigns seek to reach employees with mental health conditions or substance use disorders and encourage them to seek help. But to truly change organizational culture around these conditions, employers must expand the target audience of their campaigns to the entire workforce and address “public stigma”, the root cause of fear and shame that may keep some employees from accessing treatment.

Public stigma, meaning negative attitudes among the general public toward people with mental illness or substance use disorder, is pervasive. One national survey, for example, found that 38% of respondents would be unwilling to work closely with someone who had a mental illness and 59% would be unwilling to marry into family with mental illness. The percentages increased to 78% and 90% respectively when respondents were asked the same questions about working closely with or marrying into a family with addiction. Public stigma is harmful because it can lead to self-stigma, characterized as shame and the expectation of discrimination among individuals with those conditions. Research shows that self-stigma can prevent people with mental health conditions or substance use disorders from obtaining treatment and can be detrimental to recovery even when they do seek care. In addition to contributing to self-stigma, public stigma can lead to suboptimal medical care and discrimination in areas such as employment and housing.

Fortunately, there are evidence-based guiding principles for message development that employers can use to reduce public stigma within their workforce. And as history has taught us, using evidence is important because even the most well-intentioned but untested messages can be ineffective or even backfire. The “A Disease Like Any Other” campaign, for example, which sought to equate mental health and physical health conditions by underscoring the neurobiological causes of mental illness, did not reduce public mental health stigma as intended and by some measures even increased negative attitudes. To increase the likelihood of campaign success, employers should consider the following guidance, all gleaned from research conducted by the Johns Hopkins Bloomberg School of Public Health’s Stigma Lab.¹ These principles apply to messaging about mental health conditions and substance use disorders:

• Develop a sympathetic narrative. Personal stories can be a highly engaging way to capture employees’ attention. But for these stories to reduce public stigma in the workforce, contextual information is essential, including systemic causes of the issue (e.g. overprescribing of opioids), barriers to care (e.g. provider shortages) and successful treatment. Without context, audiences are more likely to the blame the person with mental illness or substance use disorder for their condition or feel that nothing can be done.
• Discuss barriers to care and successful treatment. Incorporating messaging about barriers to care is important for two reasons. Not only can it reduce the feelings of blame described above, it can increase the audience’s support for improving access to care. Equally important is discussing successful treatment, which can help audiences understand that treatment exists and there is hope for condition management or recovery. On that note, discussing successful treatment is also essential for any messages that touch on the biological basis of mental health conditions or substance use disorders, as this information on its own can leave audiences feeling hopeless.
• Avoid messages that include violence or imply blame. Unfortunately, messages about mental illness (especially serious mental illness) disseminated in the news media often focus on violence, which can increase public stigma. Similarly, messages implying that a person’s poor choices are the reason for their condition can also increase stigma.

For an example illustrating how these guiding principles can be woven together into a short, compelling narrative, refer to the Tackling Mental Health Stigma: Guiding Principles for Impactful Strategies presentation.

Although the tips above may put employers’ anti-stigma campaigns on a path to success, employers should also consider testing messages for their effectiveness using employee focus groups or surveys. Employers can evaluate the overall success of their campaigns by assessing baseline prevalence of public stigma and conducting a follow-up assessment using the Bogardus Social Distance Scale, one of the most commonly used measures of public stigma. For more information on mental health stigma research, visit the Johns Hopkins Bloomberg School of Public Health’s Stigma Lab. Employers can also find practical strategies to support all stages of employees’ mental health journey on the Business Group on Health website.