In recent years we have seen a welcome improvement in mental-health awareness. Driven by the high prevalence of mentalhealth issues worldwide and its vast impact on public health, stakeholders are organizing to eliminate the stigma surrounding mental-health services so that people can access the help they need. Social campaigns have been launched in many parts of the world, and public figures openly talk about their mentalhealth struggles as a reminder that it can happen to anyone.

However, one year into my psychiatric residency training, I realize we still have much work to do. Combating stigma so people can reach out for help is one thing, but educating the public about mental health is quite another story.

One of the most persistent stigmas is that people struggling with mental illnesses are “lost causes” who will not improve much despite the best efforts. This stigma can be partly traced to the chronic and deteriorating course of mental illness, especially serious mental illnesses such as schizophrenia or bipolar disorder. Furthermore, the stigma can rear its ugly head in many ways.

Most of us are familiar with “social stigma,” where community members, including family and friends, retain negative stereotypes about people with mental illness and act accordingly. When family members view a patient as “permanently defective”, they think the mental condition will only worsen, so they make little, if any, effort in supporting the patient. Reports of people with mental illnesses being shackled and denied basic needs are not uncommon here.

When institutionalized in public policy, stigma perpetuates social exclusion and discrimination against people with mental-health problems. For example, mentalhealth care is generally underfunded compared to other types of health care, and rehabilitation services to help patients get back on their feet are scarce. Also, people with a history of mental illness are still discriminated against when seeking employment.

Less discussed but just as dangerous is self-stigma. As people struggling with mental illness become aware of how they are considered “lost causes,” they may unconsciously absorb those stereotypes, eventually influencing their thoughts and behavior.

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