What is the difference between public stigma and self-stigma?

Public stigma is the negative attitudes and discriminatory behaviour held by a community toward people with mental illness, whereas self-stigma is the internalisation of those negative stereotypes by the person themselves, which can lower self-esteem and discourage help-seeking.

Do anti-stigma interventions work?

Evidence suggests that interventions based on social contact can reduce stigmatising attitudes in the short to medium term; effects of education are generally smaller, and evidence on lasting behavioural and structural change remains more limited.

Mental Health Stigma and Discrimination

Stigma is the social process by which people with mental illness are labelled, stereotyped, set apart, and devalued, leading to discrimination and loss of status. It operates at the level of public attitudes, internalised self-stigma, and structural arrangements, and it is widely recognised as a major barrier to help-seeking, recovery, and social participation.

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Definition

Mental health stigma is the co-occurrence of labelling, stereotyping, separation, status loss, and discrimination within a context of power that disadvantages people identified with mental illness; discrimination is the resulting unfair treatment they experience.

Scope

This entry covers how stigma is conceptualised, its public, self, and structural forms, the discrimination experienced by people with mental illness, and the evidence on interventions to reduce stigma. It is an educational overview and does not provide individualised clinical guidance.

Core questions

What components make up stigma as a social process?
How do public stigma, self-stigma, and structural stigma differ?
How common is experienced and anticipated discrimination?
What kinds of interventions can reduce stigma and discrimination?

Key concepts

Public stigma
Self-stigma (internalised stigma)
Structural stigma
Labelling and stereotyping
Anticipated vs. experienced discrimination
Social distance
Anti-stigma interventions (education, social contact, protest)

Key theories

Stigma as labelling, stereotyping, separation, status loss and discrimination (Link & Phelan): Link and Phelan conceptualise stigma as the convergence of five interrelated components — labelling, stereotyping, separation into 'us' and 'them', status loss, and discrimination — occurring within a power relationship that allows these components to take hold.

Mechanisms

The Link and Phelan model describes stigma as labelling, stereotyping, separation, status loss, and discrimination operating together within a power context (Link & Phelan 2001). Stigma is commonly distinguished into public stigma (community attitudes and behaviour), self-stigma (internalisation of negative stereotypes, eroding self-esteem and help-seeking), and structural stigma (policies and institutional practices that disadvantage people with mental illness). A broader conceptual literature links stigma to processes of social exclusion and the reproduction of inequality (Parker & Aggleton 2003). Cross-national surveys document that anticipated discrimination is often as widespread as experienced discrimination, itself contributing to withdrawal (Thornicroft 2009-disc).

Clinical relevance

Stigma and discrimination are relevant to mental health nursing because they affect whether people seek help, how they are treated across services and society, and their prospects for recovery and participation. This entry describes the phenomenon and the evidence on reducing it at a population and service level, not interventions for any individual.

Epidemiology

An international survey of people with schizophrenia (the INDIGO study) found that experienced and anticipated discrimination were reported across many countries and life domains, including making and keeping friends, family relationships, and finding or keeping work (Thornicroft 2009-disc).

Evidence & guidelines

Reviews indicate that interventions based on social contact between the public and people with lived experience can reduce stigmatising attitudes in the short to medium term, while education has smaller effects and evidence on changing behaviour and on long-term or structural change is more limited (Thornicroft 2016). Anti-stigma programmes are recommended components of mental health policy.

History

Sociological analysis of stigma was shaped by Erving Goffman's work on spoiled identity in the 1960s. Link and Phelan (2001) later reframed stigma as a multi-component social process embedded in power. From the 1990s onward, national and international anti-stigma campaigns and cross-national studies of discrimination, including the INDIGO survey, brought systematic evidence to bear on the problem (Thornicroft 2009-disc; Thornicroft 2016).

Debates

What reduces stigma most durably?: Social contact interventions show the clearest short- to medium-term effects on attitudes, but there is debate about whether changes persist, whether they translate into behaviour change, and how to tackle structural stigma embedded in policy and institutions.

Key figures

Erving Goffman
Bruce Link
Jo Phelan
Patrick Corrigan
Graham Thornicroft

Seminal works

link-phelan-2001
thornicroft-2009-disc
thornicroft-2016-stigma

Frequently asked questions

What is the difference between public stigma and self-stigma?: Public stigma is the negative attitudes and discriminatory behaviour held by a community toward people with mental illness, whereas self-stigma is the internalisation of those negative stereotypes by the person themselves, which can lower self-esteem and discourage help-seeking.
Do anti-stigma interventions work?: Evidence suggests that interventions based on social contact can reduce stigmatising attitudes in the short to medium term; effects of education are generally smaller, and evidence on lasting behavioural and structural change remains more limited.