Stigma in mental health is defined as a set of negative beliefs and discriminatory behaviors directed toward people who live with mental health conditions.
There is no polite way to say this: The current healthcare system still reinforces stigma around mental health. Sometimes, it does so subtly; other times in painfully obvious ways.
The bare minimum anyone expects from healthcare is empathy and a judgment-free zone. So it is unfair, and frankly unacceptable, for patients to seek help in settings where their very real struggles are minimized.
If stigma is going to be challenged, patients need to recognize it in healthcare systems so they can call it out. In this post, we discuss these uncomfortable realities and offer you practical ways to push for better mental health care.
Founded in 2010, A Mission For Michael (AMFM) offers specialized mental health care across California, Minnesota, and Virginia. Our accredited facilities provide residential and outpatient programs, utilizing evidence-based therapies such as CBT, DBT, and EMDR.
Our dedicated team of licensed professionals ensures every client receives the best care possible, supported by accreditation from The Joint Commission. We are committed to safety and personalized treatment plans.
Mental Health Stigma in Health Care Settings
It is ironic that the very system built to improve mental health outcomes is dealing with inherent issues that contribute to stigma. The following sections discuss some major contributors to stigma in healthcare settings.
Systemic Bias
Systemic bias refers to how institutions themselves, not just individual clinicians, are organized in ways that advantage certain groups over others. It is rooted in the norms, policies, and expectations of society in general.
Decades of research studies document very drastic racial and ethnic disparities in mental health care. For instance, people of color are less likely to receive mental health services even when their symptoms are similar to those of White people.1 The bias affects judgment in mental health assessments and interventions, too.
Similarly, systemic bias is present in the opportunities people receive in terms of getting research attention and being included in clinical trials.
Black participants are included in schizophrenia medication trials at disproportionately high rates and make up a large share of psychiatric drug studies overall.2 In contrast, Asian populations and American Indian and Alaska Native communities are barely present in these trials.
In fact, it was only recently that the FDA urged trial sponsors to enrol participants from racial and ethnic groups in proportions that reflect the U.S. population.3
Insurance-Based Stigma
Many insurance plans make mental health care harder to access than physical care. So it is not uncommon for insurance companies to deny coverage for mental health claims. There are surveys in which half of the people with mental health issues reported that the insurance claims process itself worsened their mental health.
The Mental Health Parity and Addiction Equity Act (MHPAEA) has been in place since 2024.4 It requires insurance providers to cover both mental and physical health equally.
Still, we have a long way to go before all insurance providers follow a universal strategy where they cover mental health and addiction services more loosely. You will still find that some insurance plans put up:
- Higher hurdles for mental health utilization reviews
- Narrow networks of therapists
- Stricter limits on sessions
- More frequent pre-authorizations compared to other forms of care
Provider Assumptions and Implicit Bias
Implicit bias is an attitude you don’t even realize you have. These are thoughts forged by culture, training, expectations, and society that affect your decisions. And like all people, clinicians are prone to falling for them.
Doctors can have ingrained stereotypes about who is “likely to recover,” who is “dangerous,” who is “medically compliant,” what behaviors are evidence of real illness, and so on. It leads some people to be overlooked for the very care that could help them.
A clinician’s unexamined assumptions about a patient’s education, background, presentation style, gender, or race affect their treatment plan decisions.
People from marginalized backgrounds, low socio-economic status in particular, are known to face disproportionate assumptions of incompetence or resistance against treatment.5
Fragmentation Between Physical and Mental Health Services
Too many health systems treat the body and the mind as separate entities. Some large-scale hospitals that treat diseases of almost every organ system do not have an integrated mental health treatment approach. Instead, they’ll have a separate building with records of its own and separate insurance codes.
There’s evidence that when physical and mental health are separated, people with mental health challenges get worse outcomes on both fronts.6 The problem is, the system does not treat them holistically.
Also, doctors who see you for physical symptoms may not be trained to recognize or address your mental distress in the same visit.
Similarly, mental health specialists rarely check in about your physical health risks, even though heart disease and diabetes are common among people living with a serious mental illness.
Sometimes, your physical symptoms may be dismissed as “just anxiety” rather than being given thorough clinical attention. This is known as “diagnostic overshadowing.”7 Unfortunately, the misattribution of physical symptoms to an already existing mental health diagnosis is a cause of higher mortality among people with mental illnesses.
Therapeutic Pessimism
Therapeutic pessimism is defined as the belief held by some health professionals that people with mental illness are difficult to treat.
Naturally, this pessimism has been linked with poorer patient engagement and a sense among providers that “what we do doesn’t matter.”8
It’s in the culture of medicine that change is supposed to equal progress, so admitting the hope for mental health improvement doesn’t come easily to providers. So those who are trained to manage physical symptoms with clear protocols can feel helpless in the case of mental health treatments, where change is slower and less linear.
In a study, therapeutic pessimism was also associated with clinical inertia. This is a failure to offer evidence-based treatments or insist on follow-up because the provider doesn’t believe they’ll help.9
How Healthcare Policies Contribute to Mental Health Stigma
Many healthcare policies create conditions that normalize stigma. In almost every country, the funding for mental health services is a tiny fraction of what is spent on physical health, even though mental disorders contribute massively to disability and suffering worldwide.
Policies that fail to recognize mental health as a priority leave people battling with stigma. For example, insurance mandates and parity laws can require coverage for mental health, but there are still many ways in which a patient has to pay out-of-pocket costs for the type of care they want.
Many national and state-level mental health policies are introduced with goodwill. However, the system does not set measurable goals or timelines. Without metrics required by law, insurance agencies can ignore implementation.
The fact that mental health is separated from primary care and not embedded in universal health coverage schemes is also a policy-level stigmatization.
Effects of Stigma on Treatment Outcomes
If we don’t call out stigma for what it does to people, it will continue to sabotage mental health treatment outcomes.
Stigma in the healthcare setting can delay people from walking into a clinic or picking up the phone to book a therapy session. Once someone does begin treatment, it might make them skip sessions in between because they are too ashamed. In fact, systematic reviews of studies looking at stigmatization and treatment find a strong link between stigma and poor treatment adherence.10
Stigma also erodes confidence in your own ability to cope. This is called “diminished self-efficacy.” The best mental health treatment outcomes follow your belief in your own capacity to follow through with treatment. Internalizing stigma causes lower self-esteem, social withdrawal, and a worse quality of life.
How to Deal With Stigma in Health Care Systems
Although you may not be able to change the healthcare policies that feed into stigma, you should do whatever is in your capacity to reduce the stigma around mental health.
For your clinic visits, come with questions written down so that you know what outcomes you want from the treatment. This assertive communication will make sure that the clinician knows you are engaged with your treatment. It can also counteract the assumptions around mental health conditions that are supposedly less likely to improve.
You could also educate yourself about mental health and the mechanisms of stigma around it in healthcare settings. Doing so can help you challenge any misconceptions you hear in the clinic room or in waiting areas. Understanding stigma strengthens your ability to advocate for yourself without getting derailed by shame.
And if you encounter any negative experience, speak about it with trusted providers. Social contact and candid conversation about it help others see you as a full person with a lived life. Further, direct contact between people with lived experience and others reduces bias.
Finally, participate in public or personal advocacy however you can. Share your story on social media, write to clinic leadership about your experiences with stigma, talk at local events, and support campaigns that push for stigma-aware policies.
Stigma-Free Mental Health Treatment at AMFM Healthcare
No person should be expected to tolerate stigma in mental health care. It is a systems problem that demands a systems response.
AMFM Healthcare is actively building a stigma-free environment with licensed mental health professionals who are trained to see the person before the diagnosis. Our supporting staff centers on empathy for everyone.
We work in-network with major insurance providers and verify your benefits for you so you are not left fighting paperwork for your very real struggles.
We also refine our practices to reduce stigma in our facility every day. Contact us today for judgment-free mental health treatment.
References
- KFF. (2024, May 23). Racial and ethnic disparities in mental health care: Findings from the KFF survey of racism, discrimination and health. https://www.kff.org/racial-equity-and-health-policy/racial-and-ethnic-disparities-in-mental-health-care-findings-from-the-kff-survey-of-racism-discrimination-and-health/
- Schwartz, R. C., & Blankenship, D. M. (2014). Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry, 4(4), 133–136. https://doi.org/10.5498/wjp.v4.i4.133
- Ruiz-White, I., Kramer, L., Philips, L., Wong, B., Lonergan, K., & Moreno, F. (2023). Racial and ethnic disparities in physical and mental health care and clinical trials. The Journal of Clinical Psychiatry, 84(4), Article 47461. https://doi.org/10.4088/JCP.23ah14887
- Federal Register. (2024, September 23). Requirements related to the Mental Health Parity and Addiction Equity Act. https://www.federalregister.gov/documents/2024/09/23/2024-20612/requirements-related-to-the-mental-health-parity-and-addiction-equity-act
- Job, C., Adenipekun, B., Cleves, A., Gill, P., & Samuriwo, R. (2024). Health professionals’ implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: A scoping review. BMJ Open, 14(7), e081723. https://doi.org/10.1136/bmjopen-2023-081723
- Association of American Medical Colleges. (2025). Mental health is part of physical health. Why isn’t it treated as such? https://www.aamc.org/news/mental-health-part-physical-health-why-isn-t-it-treated-such
- Hallyburton, A. (2022). Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses. International Journal of Mental Health Nursing, 31(6). https://doi.org/10.1111/inm.13034
- Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2), 111–116. https://doi.org/10.1177/0840470416679413
- Al-Hashemi, T., Al-Mahrouqi, T., Al-Huseini, S., Salmi, M. A., Al Nuumani, R., Al Balushi, F., Khatib, A., AlKalbani, M., Jose, S., & Al-Adawi, S. (2025). Mental health stigma and help-seeking behaviors among primary healthcare physicians in Oman. International Journal of Environmental Research and Public Health, 22(7), 983. https://doi.org/10.3390/ijerph22070983
- Strickland, K. D. (2025). The effects of stigma on mental health treatment engagement [Master’s thesis, University of Montana]. ScholarWorks at University of Montana. https://scholarworks.umt.edu/etd/12547/
