Here's How Employee Mental Health Strategies Can Perpetuate Stigma

Well-meaning employee mental health advocates, including wellness leaders, may — in our zeal to address mental health — inadvertently reinforce or perpetuate mental health stigma. Here's how: 1) Viewing stigma too narrowly, especially seeing it only as failure to seek treatment. Mental health stigma includes public stigma, characterized by lack of information (and stereotyping), prejudice, and discrimination, and self stigma, which includes internalization of social stigma stereotypes, reduced self-esteem, and reduced self-efficacy. Reluctance to seek treatment (or not being aware of treatment opportunities) is a critical consequence of stigma. But people who receive treatment, and people who don't need treatment, experience stigma, too.

2) Not understanding how to address stigma. Anti-stigma campaigns are based on protest (e.g. speaking up against stereotyping); education (like the communication tactics employers commonly implement); and contact (interacting with people who have "lived experience" with mental health problems). Research shows that contact is the most effective approach. That’s why we encourage people to tell their story, but…

3) ...People own their story, and are entitled to tell it or not tell it. Making people feel like they're obligated to open their heart publicly about their mental health challenges can be another way of shaming them.

4) Dissing treatment. We hear it all the time: “Folks shouldn't have to take a pill to make them happy.” This oozes stereotype and blame, belittles people’s distress, and implies false information about treatment efficacy.

5) Emphasizing the universality of mental health issues at the expense of affording proper attention to those with mental illness. Mental health is an issue for everyone, and everyone deserves attention and freedom from stigma. But we must be careful not to appropriate the distinct concerns of people with mental illness. “Everyone suffers from mental health problems” may be mental health’s “all lives matter” moment.

6) Simplifying. Telling people that eating vegetables, listing gratitudes, hiking, making a new friend, and meditating will cure their depression or anxiety are tantamount to blaming: “You’re just not doing what you need to.” Activating healthy behaviors can be helpful for some mental health issues, but if someone is in distress or suffering, better not to tell them how to solve their problem. Instead, encourage them to seek appropriate care.

7) Buying into "Big Happy." Scroll down your LinkedIn feed, and you’ll find an unrelenting stream of extroverted glee, including the trending meme "Happiness Is a Choice," a passive-aggressive application of stigma-perpetuating blame if ever there was one. The belief that everyone should be positive all the time and that "negative" emotions must be vanquished is marketed to us (aggressively, but not passively) by a self-improvement industry dependent on stoking feelings of inadequacy. Susan David eloquently connects the dots from toxic positivity to stigma:

When people default to bypassing difficult emotions in the service of fake positivity is when "toxic positivity" takes root…

Telling people to "Just Be Positive" can be done with great intentions, yet the impact is one of silencing—of making it feel unsafe to speak up lest one be labeled as "negative.”…This "Just Be Positive" approach undermines wellbeing.

So, before you decorate the walls of your workplace with an 8-foot-tall pastel mural blaring “SMILE!!” or lead workshops on how to deal with "negative people" (yuck!), consider how they feel to your co-worker who's bravely done all they can just to get out of bed and put one foot in front of the other to get to work.

8) Overlooking the scope of mental illness. Anxiety and depression are common, but when we focus exclusively on them, we box out a significant population: people with substance use disorders, post-traumatic stress disorder, bi-polar disorder, obsessive-compulsive disorder, and many more. Anorexia nervosa, for example, has been identified as the mental health disorder with the second highest rate of mortality and suicide, yet it’s rarely acknowledged in workplace mental health campaigns.

9) Getting the message wrong. There's evidence that some anti-stigma education messaging resonates with people that identify as mentally healthy but alienates subjects who report experiencing mental health problems. As always, test your messaging whenever possible.

The increased attention on mental health — accelerated, like many things, by the COVID-19 pandemic — is a meaningful development in HR, employee benefits, and wellness, and we're better off getting it a little bit wrong rather than doing nothing at all. Improvement of our mental health/anti-stigma strategies will depend on continuing to learn, be open-minded, and exchange in civil dialog.

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