Mental Illness Stigma: Problem of Public Health Or Social Justice?(Column)

The U.S. Surgeon General's report on mental health,(1999) and the report of President Bush s New Freedom Commission on Mental Health (2003) highlighted the public health impact of mental illness stigma. Using a medical model, several education programs have sought to diminish stigma's effect on public health by describing mental illness as a disease of the brain that can be treated successfully. This approach has been shown to be useful for reducing blame related to mental illness. Unfortunately, such public health messages may also exacerbate stigma by reinforcing notions of individual difference and defect. Alternatively, framing mental illness stigma as a social justice issue reminds us that people with mental illness are just that--people. The social justice perspective proposes that all people are fundamentally equal and share the right to respect and dignity. Applying this perspective to mental illness stigma allows us to increase our understanding of the problem and expands the means and targets of efforts to eliminate stigma. In this Commentary, we review the assertions of the public health perspective, highlighting some of the limitations that emerge from this approach. We then review stigma as social injustice and feature ways in which this paradigm advances understanding and changing stigma. THE PUBLIC HEALTH MODEL OF STIGMA AND STIGMA CHANGE