Applied and Preventive Psychology 11 (2005) 179190

The stigma of mental illness: Explanatory models and methods for change
Patrick W. Corrigan a, , Amy Kerr b , Lissa Knudsen c
a

Center for Psychiatric Rehabilitation, Evanston Northwestern Healthcare, 1033 University Place,
Suite 440-450, Evanston, IL 60201, USA
b Loyola University of Chicago, USA
c California State University, Northridge, USA

Abstract
For people with mental illness, diminished quality of life and loss of personal goals does not result solely from the symptoms, distress,
and disabilities caused by their psychiatric disorder. Quality of life and personal goals are also hindered by people who embrace the stigma
that accompanies mental illness and mental health care. This paper reviews evidence of the impact of mental illness stigma and strategies for
seeking to ease its impact. To achieve these goals, we (a) describe the ways in which stigma harm people with mental illness, (b) summarize
models that explain the development and maintenance of these stigmatizing effects, and (c) review strategies that have been shown to decrease
the impact of stigma. Concerns about stigma are on the political agendas of many mental health advocacy groups. It has recently also become
the focus of extensive research. Our goal in this paper is to balance the practical concerns raised by mental health advocates against data that
support or contradicts specific assertions.
2005 Elsevier Ltd. All rights reserved.
Keywords: Mental illness; Stigma; Quality of life

1. The impact of mental illness stigma

1.1. Public stigma

Goffman (1963) adopted the term stigma from the Greeks

who used it to represent bodily signs indicating something
bad about the moral character of the person marked with the
stigma. This mark can be obvious (such as skin color) or
subtle (as in gays or people with mental illness). This kind
of moral imputation has egregious affects on at least two
levels, what we have called public stigma and self-stigma
(Corrigan & Watson, 2002). Public stigma is the phenomenon
of large social groups endorsing stereotypes about and acting
against a stigmatized group: in this case, people with mental
illness. Self-stigma is the loss of self-esteem and self-efficacy
that occurs when people internalize the public stigma. The
distinction between public and self-stigma is important for
understanding, explaining, and building strategies to change
stigma.

Public stigma impacts many people beyond those directly

stigmatized. Although our review is limited to the impact
of stigma on people with mental illness, research suggests
public stigma impacts other groups as well. Family members
and friends suffer the impact of public stigma (Lefley,
1987; Phelan, Bromet, & Link, 1998; Thompson & Doll,
1982). Mental health provider groups involved in mental
health services have reported being harmed by public
stigma (Dichter, 1992; Dickstein & Hinz, 1992; Fink, 1986;
Gabbard & Gabbard, 1992; Persaud, 2000).
The stigma of mental illness can rob people labeled mentally ill of important life opportunities that are essential for
achieving life goals. Two goals, in particular, are central to
the concerns of most people, including those with serious
mental illness (Corrigan, in press): (a) obtaining competitive
employment and (b) living independently in a safe and comfortable home. Clearly, housing and work problems can occur
directly because of the disabilities that result from mental
illness (Corrigan, 2001). People with some mental illnesses
frequently lack the social and coping skills needed to meet the

Corresponding author. Tel.: +1 224 364 7200; fax: +1 224 364 7201.
E-mail address: Corrigan@iit.edu (P.W. Corrigan).

0962-1849/$ see front matter 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.appsy.2005.07.001

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P.W. Corrigan et al. / Applied and Preventive Psychology 11 (2005) 179190

demands of a competitive work force and independent living.

Nevertheless, the problems of many people with psychiatric
disability are further hampered by stigma. Several studies
have documented the publics widespread endorsement
of stigmatizing attitudes. In a survey administered to two
towns, one served by community psychiatry and the other
served by a traditional mental hospital, Brockington, Hall,
and Levings (1993) found that three primary factors arose in
attitudes toward people with mental illnesses: benevolence,
authoritarianism, and fear. Between the two towns, people
from the one served by the traditional mental hospital were
slightly more tolerant than people from the town served by
community psychiatry (1993). Other research has found
similar stigmatizing results (Bhugra, 1989; Hamre, Dahl, &
Malt, 1994; Link, 1987; Madianos, Madianou, Vlachonikolis, & Stefanis, 1987; Rabkin, 1974; Roman & Floyd, 1981).
These attitudes have a deleterious impact on obtaining
and keeping good jobs (Bordieri & Drehmer, 1986; Farina
& Felner, 1973; Farina, Felner, & Boudreau, 1973; Link,
1982; Link, 1987; Olshansky, Grob, & Ekdahl, 1960; Wahl,
1999; Webber & Orcutt, 1984) and leasing safe housing
(Aviram & Segal, 1973; Farina, Thaw, Lovern, & Mangone,
1974; Hogan, 1985a, 1985b; Page, 1977, 1983, 1995; Segal,
Baumohl, & Moyles, 1980; Wahl, 1999). Classic research
by Farina (Farina & Felner, 1973) provides an example of
the employment problem. A male confederate, posing as
an unemployed worker, sought jobs at 32 businesses. The
same work history was reported at each of the job interviews
except 50% of confederates also included information about
a past psychiatric hospitalization. Subsequent analyses
found interviewers were less friendly and less supportive
of hiring the confederate when he added his psychiatric
hospitalization.
Apart from its role in the universal concerns of work
and housing, stigma also impacts people with mental illness
who interact with the criminal justice system. Criminalization of mental illness occurs when people with mental illness
are dealt with by the police, courts and jails, instead of the
mental health system. Inadequate funding for mental health
services and get tough on crime policies have contributed
to the increasing proportion of serious mental illness in jail
(Watson, Corrigan, & Ottati, 2004). Public fear of people with
mental illness has increased over the past 40 years (Martin,
Pescosolido, & Tuch, 2000; Phelan, Link, Moore, & Stueve,
1997; Phelan, Link, Stueve, & Pescosolido, 2000), resulting
in a higher degree of preferred social distance from people
with mental illness. The growing intolerance of offenders in
general has led to harsher laws and hampered effective treatment planning for mentally ill offenders (Jemelka, Trupin, &
Chiles, 1989; Lamb & Weinberger, 1998). As Teplin (1984)
points out, people exhibiting symptoms and signs of serious
mental illness are more likely than others to be arrested by
the police. The selective process continues if the person is
taken to jail. Someone with a mental illness tends to spend
more time incarcerated than people without mental illness
(Steadman, McCarty, & Morrissey, 1989). Treating people

with mental illness like criminals has implications not only

for their life, liberty, and well being, but also for the larger
community such as loss of potential contributions by viable
citizens.
Finally, research seems to indicate that people with
mental illness are less likely to benefit from the American
health care system than people without these illnesses.
Research by Druss and colleagues suggests that people
with mental illness receive fewer medical services than
those not labeled in this manner (Desai, Rosenheck, Druss,
& Perlin, 2002; Druss & Rosenheck, 1997). Moreover,
studies suggest people with mental illness are less likely
to receive the same range of insurance benefits as people
without mental illness (Druss, Allen, & Bruce, 1998; Druss
& Rosenheck, 1998). Previous research has used rates of
procedures for cardiovascular disorders as an index of bias
by race (Ayanian, Udvarhelyi, Gatsonis, Pashos, & Epstein,
1993; Wenneker & Epstein, 1989) and gender (Ayanian &
Epstein, 1991; Krumholz, Douglas, Lauer, & Pasternak,
1992). Druss, Bradford, Rosenheck, Radford, and Krumholz
(2000) examined the likelihood of a range of medical procedures after myocardial infarction in a sample of 113,653.
Compared to the remainder of the sample, Druss et al. found
that people with comorbid psychiatric disorder were significantly less likely to undergo percutaneous transluminal
coronary angioplasty (PTCA), also known as coronary artery
balloon dilation. PTCA is a less expensive, less traumatic
alternative to bypass surgery (American Heart Association,
2004).
1.2. Impact of stigma on the self
Prior to the onset of mental illness, most people are
aware of culturally endorsed stereotypes about mental illness.
Upon diagnosis, awareness of stigma may affect a persons
sense of self in at least two ways. First, people may constrict their social networks in anticipation of rejection, which
leads to isolation, unemployment and lowered income. These
failures result in self-esteem and self-efficacy decrements
(Link, 1987; Markowitz, 1998). Second, people with mental
illness may consider such stigmatizing ideas self-relevant and
believe that they themselves are less valuable because of their
disorder in the same way they are described by others. The net
effect of these processes we define as self-stigma (Corrigan
& Watson, 2002; Crocker & Major, 1989). Research suggests that both perceived- and self-stigma result in losses of
self-esteem and self-efficacy and limit prospects for recovery
Link and colleagues (1980) assessed self-esteem and perceived stigma in 70 people with serious mental illness at
three time points: baseline and 6 and 24 months (2001). After
controlling for baseline self-esteem, depressive symptoms,
diagnosis, and demographic characteristics, results showed
that those with high perceptions of perceived stigma (90th
percentile) were more likely to have low self-esteem than
those with low perceptions of perceived stigma (10th percentile). These findings along with other research in the field

P.W. Corrigan et al. / Applied and Preventive Psychology 11 (2005) 179190

suggest that stigma perceived by people with mental illness

harms their self-esteem (Corrigan, 1998; Holmes & River,
1998; Link, 1987; Link, Cullen, Struening, & Shrout, 1989;
Link, Mirotznik, & Cullen, 1991; Markowitz, 1998; Perlick
et al., 2001; Rosenfield, 1997; Sirey et al., 2001).
Of course not everyone with a mental illness suffers a
loss of self-esteem due to stigma (Crocker & Major, 1989).
Research has found that people with mental illness while
being aware of the negative stereotypes endorsed by the
public do not experience a sharp decline in self-esteem
(Hayward & Bright, 1997). Elsewhere, we detail a model
of personal reactions to stigma in which people may: (1)
self-stigmatize and suffer a loss of self-esteem, (2) remain
relatively indifferent to stigma, or (3) become empowered by
stigma and advocate on behalf of themselves and others with
mental illness (Corrigan & Watson, 2002). Among various
factors, research suggests people who strongly identify with
a stigmatized group i.e., opt to strongly relate with consumer and survivor groups are less likely to fall victim to
self-stigma.

2. Models of mental illness stigma

Most current models that explain the phenomenon of
mental illness stigma have emerged from basic behavioral science. Explanatory models can be divided into
three general groups: those that explain stigma in terms
of naturally occurring cognitive structures; motivational
models that explain why people stigmatize; sociological
models that ground some of the experiences of stigma and
discrimination in social institutions and structures. Each of
these is described more fully in turn.
2.1. Individual cognitive models
Psychologists argue that the way humans come to know
the world is bound by the limits of their cognitive structures
and processes. For example, social cognitive models describe
how stigma-related processes are formed and maintained
at the psychological level. Three components that make up
this model are outlined in Fig. 1: stereotypes, prejudice,
and discrimination. Social psychologists view stereotypes
as knowledge structures that are learned by most members
of a social group (Augoustinos, Ahrens, & Innes, 1994;
Esses, Haddock, & Zanna, 1994; Hilton & von Hippel,
1996; Judd & Park, 1993; Krueger, 1996; Mullen, Rozell, &
Johnson, 1996). Stereotypes are especially efficient means
of categorizing information about social groups. Stereotypes
are considered social because they represent collectively
agreed upon notions about groups of people. They are
efficient because people can quickly generate impressions
and expectations of people who belong to a stereotyped
group (Hamilton & Sherman, 1994). The categorization
functions as a method for people to organize the vast amount
of stimulus encountered in everyday life (Eagly & Chaiken,

181

1993). Common stereotypes about mental illness include

dangerousness, incompetence, and character weakness.
Just because most people have knowledge of a set of
stereotypes does not require that they agree with them
(Jussim, Nelson, Manis, & Soffin, 1995). People who are
prejudiced endorse these negative stereotypes (thats right;
all people with mental illness are violent!) and generate
negative emotional reactions as a result (they all scare me!)
(Devine, 1988, 1989, 1995; Hilton & von Hippel, 1996;
Krueger, 1996). In contrast to stereotypes, prejudicial attitudes involve agreement with an evaluative (generally negative) component (Allport, 1954; Eagly & Chaiken, 1993).
Prejudice, which is fundamentally a cognitive and
affective response, may or may not lead to discrimination,
the behavioral reaction (Crocker, Major, & Steele, 1998).
Prejudice that yields anger can lead to hostile discriminatory behavior (e.g., physically harming a minority group)
(Weiner, 1995). Angry prejudice may lead to withholding
mental health care or replacing mental health care with
services provided by the criminal justice system (Corrigan,
2000). Fear may also lead to discriminatory avoidance, e.g.,
employers do not want people with mental illness nearby
so they do not hire them. As outlined in Fig. 1, stereotype,
prejudice, and discrimination manifest differently depending
on whether the public is considering stigma or the self.
2.1.1. Motivational models
Motivational theories seek to explain why people stigmatize, or the function that stigma serves for the stigmatizer.
Three such motivations have emerged in the literature: egojustification, group-justification, and system-justification
(Jost & Banaji, 1994). Psychoanalysts were among the
first to write about ego-justification, suggesting that the
self is protected when internal conflicts are projected on to
stigmatized groups (Bettelheim & Janowitz, 1964; Freud,
1946). In this way, stigma serves to shield self-esteem
from the effects of personal failings. Social psychologists
expanded the ego-justification idea beyond personal defense
mechanisms to include any function that protects ideas,
images, or behaviors that reflect the self by projecting these
negative conceptualizations and actions on others (Katz
& Braly, 1935). Little empirical evidence has been found
to support ego-justification as an explanation of stigma.
Research has, however, provided support for stigma and
stereotypes serving a self-protective function that does not
have psychodynamic origins. This research suggests that
the function of stigma may be to avoid potential threat
to ones body or psychological self possibly through the
motivation to avoid danger of a socially perceived threat
or by rationalizing negative group-based attitudes and discrimination (Biernat & Dovidio, 2000; Stangor & Crandall,
2000).
Group-justification models purport that stigmatization of
an out-group, such as those with mental illness, emerges
to support the goals of the in-group. From an evolutionary perspective, stigmatizing out-groups who may threaten

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Fig. 1. Cognitive levels that explain the distinction between public stigma and self-stigma.

the effective functioning of the in-group is highly adaptive

for group survival and gene transmission (Neuberg, Smith,
& Asher, 2000). Stigmatizing out-groups enhances group
cohesion, protects against contamination, and helps members avoid poor social exchange partners (Kurzban & Leary,
2001). Using group-justification as an explanation for mental illness stigma is a bit problematic, however. What exactly
is the in-group against which people with mental illness are
contrasted? The normal in-group is a default category that
only gains definition in the absence of mental illness. Hence,
there is no readily apparent source of in-group motivation to
drive group-justification.
Jost and Banaji (1994), Jost, Kruglanski, and Simon
(1999) and Stangor and Jost (1997) have identified an even
broader (beyond the self or group) target for justification,
arguing that stereotypes and prejudice develop to confirm
the system. Once a set of events produces specific social
relationships, whether by historical accident, biological
derivation, public policy, or individual intention, the resulting arrangements are explained and justified simply because
they exist. For example, the stereotype that people with
mental illness are violent and need to be controlled may
have arisen from, and to justify, the establishment and
maintenance of institutions that suggest people labeled
with mental illness need to be controlled via state hospitals
and prisons. Although system justification helps people to
make cognitive sense of current differences among groups,
it does not offer any explanation of the origins of the
system.

2.2. Institutional and structural models

Focusing on the individual psychological level of
explanation in terms of cognition and motivation gives an
incomplete picture of the problem of stigma. Stigma and
discrimination may also be understood at societal levels in
terms of the historical, political, and economic forces that
influence institutions and social groups. For example, in better understanding racism in America, civil rights activists
(Carmichael & Hamilton, 1967; US Commission on Civil
Rights, 1981) and sociologists (Friedman, 1975; Hill, 1988;
Merton, 1948; Pincus, 1999, 1996; Wilson, 1990) realized
that discrimination impacts people of color in ways not
explained by the direct effects of other peoples bigoted
behavior. Activists and sociologists made the distinction
between these individual-levels of impact and both institutional and structural causes of prejudice and discrimination.
Institutional discrimination manifests itself as rules, policies,
and procedures of private and public entities in positions
of power that intentionally restrict the rights and opportunities of people with color. Jim Crow Laws were examples of public institutional discrimination. Mississippi, for
example, passed legislation that required separate schools
for whites and colored people. Extending from the end
of the nineteenth to the middle of the twentieth century,
these laws largely enacted by Southern States explicitly
undermined the rights of African Americans in such vital
areas as employment, education, and public accommodation.

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The effects of institutional discrimination are by definition

intentional, perhaps not by the line-level person carrying out
the policy, but by a small group of powerful people at the
top of an institution who explicitly sought to diminish the
opportunities of racial or ethnic groups by passing laws or regulations (Hill, 1988; Mayhew, 1968; Pincus, 1999). Hence,
one might conclude that institutional discrimination is the
direct result of the stigmatizing behaviors and attitudes of a
few powerful people. There is a separate set of public and private sector policies what is called structural discrimination
whose unintended consequences restrict the opportunities
of members of minority groups (Feagin, 1978; Hill, 1988).
For example, many universities and colleges use the SAT or
ACT to restrict admission offers to students who have earned
the highest scores (Pincus, 1999). Given that African American and Hispanic students typically score lower on these
tests, universities that rely on test scores for admissions are
likely to prevent an unequal number of Black and Hispanic
students from being educated at these institutions. Note that
in this example, people at the top of the organization did not
intend to restrict the prospects available to people of color.
College presidents are typically people who seek to better
their community by advancing principles related to social
justice. Nevertheless, the results of these kinds of policies
limit the possibilities for people because of their ethnic
group and the economic and historical forces that have
forged that groups place in society (Merton, 1948, 1957).
2.2.1. Institutional discrimination and mental illness
According to Link and Phelan (2001), there is evidence
of institutional discrimination against people labeled with
mental illness in both public and private sectors. A good
example from the public sector is legislative activity that
restricts the rights and opportunities of people with mental
illness. Results of two comprehensive reviews of laws by
state showed that approximately one-third restrict the rights
of an individual with mental illness to hold elective office,
participate in juries, and vote (Burton, 1990; Hemmens,
Miller, Burton, & Milner, 2002). Even greater limitations
were evident in the family domain. More than 40% of states
limit the rights of people with mental illness to remain
married. Depending on the year of the survey, from 40 to
50% of states limited the child custody rights of parents with
mental illness (Hemmens et al., 2002).
2.2.2. Structural discrimination and mental illness
Institutional discrimination is marked by an explicit
and conscious attempt to distinguish between groups and
withhold from the stigmatized subset some rights and
privileges. Structural discrimination is based more on effect
than intent, and hence it is much more difficult to define
(Pincus, 1996, 1999). Examples from the US Supreme Court
highlight the distinctions between structural and institutional
discrimination. In determining whether state or federal laws
were unconstitutional because they promoted segregation,
Justices frequently distinguished between the laws intent

183

and its effect. For example, the Court has refused to declare
school segregation unlawful unless direct evidence of
discriminatory intent on the part of the school district could
be found, regardless of segregations effect on minority
children (Graglia, 1980; Hill, 1988).
According to a structural view, group-neutral goals are
frequently not accomplished because they seem to clash
with dominant ideologies that unintentionally maintain the
unequal status quo (Hill, 1988; Jackman & Muha, 1984).
Two dominant viewpoints are a democratic belief in meritocracy and a capitalist value in cost-effectiveness (Pincus,
1999). Note that although they are not malicious in intent,
both ideologies yield unintended negative consequences.
Meritocracy, for example, is the value that drives standardized test scores; i.e., decisions about college admissions,
and the opportunities that those decisions entail, should be
based on the candidates intellectual merit (e.g., abilities and
achievements). Societal concerns about cost-effectiveness,
and decisions representing good business, also seem to yield
structural discrimination and may be especially relevant to
mental illness. Link and Phelan (2001) expound upon the
business value in listing examples of structural discrimination related to mental illness. Less money is allocated
to research and treatment on psychiatric illness than other
health disorders because illnesses like cancer and heart
disease have dominated the American public health agenda.
Many psychiatrists and other mental health professionals
opt out of the treatment system serving people with the most
serious psychiatric and substance abuse disorders. Salaries
and benefits are better in the private health sector that is more
likely to treat relatively benign illnesses like adjustment
disorders, relational problems, and phase of life problems
so providers opt for those kinds of jobs. Hence, the quality
of services for people with more serious mental disorders is
inferior to many other less serious conditions.
Problems with mental health insurance parity (i.e.,
insurance benefits for mental health problems equaling those
provided for general health) are an especially prominent
example of structural stigma related to mental illness. Strong
opposition to mental health parity legislation was heard from
the business community, citing the kind of cost concerns
frequently used to justify other forms of structural discriminations. Lobbyists for the business sector argued that parity
requirements could bankrupt small businesses by raising
health care costs (Levinson & Druss, 2000). The history and
subsequent impact of parity reveals key elements of structural
discrimination. First, the resulting act leads to fewer financial
resources for psychiatric disorders, compared to medical
illness, thereby yielding diminished opportunity for people
with mental illness. Second, this disparity does not seem to
reflect conscious prejudice on the part of Congress or the
public. Most members of both houses, regardless of political
affiliation, support equal care for mental health disorders, as
does the American public (Hanson, 1998). Lack of support
for many of the provisions of parity stems from financial
concerns that are frequently at the root of other structural

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discriminations: parity makes for bad business. The seemingly contradictory tension between wanting to support
treatment equity but not wanting to make a bad business move
is evident in public attitude. One review found that participants of national surveys on parity supported equal resources
for mental health and medical diagnoses, on the one hand,
but, on the other hand, did not support paying higher premiums or redistributing funds from medical/surgical services
to mental health services to accomplish this goal (Hanson,
1998).

3. Changing stigma
Given that processes giving rise to and producing differential effects of stigma vary by level of analysis, it seems
reasonable to suggest that stigma change methods vary by
conceptual level. Hence, we summarize the stigma-change
literature in terms of its impact on public stigma, self-stigma,
or institutions and structures that maintain stigma.
3.1. Erasing public stigma
In recent years, advocacy groups have made reducing
stigma a priority, implementing campaigns aimed at the
public and the media. These efforts have targeted various
components of mental stigma with a variety of strategies,
few of which have been formally evaluated. However, social
psychological research on ethnic minority and other group
stereotypes provides important insight on the effectiveness of
these strategies for reducing mental illness stigma (Corrigan
& Penn, 1999). Based on this literature, we have grouped
the various approaches to changing public stigma into three
processes: protest, education, and contact (Corrigan & Penn,
1999).
Protest strategies highlight the injustices of various forms
of stigma chastising the offenders for their attitudes and
behaviors. Anecdotal evidence suggests that protest can
change some behaviors significantly (Wahl, 1995). For
example, in 2000 NAMI StigmaBusters played a prominent
role in getting ABC to cancel the program Wonderland,
which portrayed people with mental illness as dangerous and
unpredictable. StigmaBusters efforts not only targeted the
shows producers and several management levels of ABC,
they encouraged communication with commercial sponsors
including the CEOs of Mitsubishi, Sears, and the Scott Company. Hence, research might show protest to be effective as a
punishing consequence to discriminatory behavior decreasing the likelihood that people will repeat this behavior. The
punishing consequences of protest are especially relevant
for examining the effects of legal penalties prescribed by
the Americans with Disabilities Act and the Fair Housing
Act. In like manner, research might identify reinforcing
consequences to affirmative actions that undermine stigma
and encourage more public opportunities for people with
mental illness, e.g., government tax credits for employers

who hire and provide reasonable accommodations to people

with psychiatric disabilities.
Although organized protest can be a useful tool for
convincing television networks to stop running stigmatizing
programs, protest may produce an unintended rebound
effect in which prejudices about a group remain unchanged
or actually become worse. Protest programs asking people
to suppress their prejudice about a group can promote
psychological reactance (do not tell me what to think)
and worsen attitudes as a result (Corrigan et al., 2001;
Macrae, Bodenhausen, Milne, & Jetten, 1994; Penn &
Corrigan, 2002). Hence, while protest may be a useful tool
for changing the behavior, it may have little or negative
impact on public attitudes about people with mental illness.
Educational approaches to stigma change attempt to
challenge inaccurate stereotypes about mental illness and
replace these stereotypes with factual information. Evidence
about educational strategies targeting race and other minority group stereotypes is mixed and suggests that effects of
educational interventions may be limited (Devine, 1995;
Pruegger & Rogers, 1994). Educational strategies aimed
at reducing mental illness stigma have used public service
announcements, books, flyers, movies, videos, and other
audio visual aids to dispel myths about mental illness and
replace them with facts (Bookbinder, 1978; National Mental
Health Campaign, 2002; Pate, 1988; Smith, 1990). Some
benefits of educational interventions include lower cost and
broad reach. It is important to note, however, that though
education produces short-term improvements in attitudes
(Corrigan et al., 2001, 2002; Keane, 1991; Morrison & Teta,
1980; Penn, Guynan, Daily, & Spaulding, 1994; Penn,
Kommana, Mansfield, & Link, 1999); In a study by Holmes,
Corrigan, Williams, Canar, and Kubiak (1999), for example, participants either took either a semester-long course on
serious mental illness or a general psychology course. Subjects were administered a pre- and post-test on knowledge of
mental illness and opinions of mental illness questionnaire.
Results showed that the education group interacted with preeducation depending on the attitude about mental illness.
Those with greater prejudice were less likely to benefit from
an education group like the semester long, stigma course.
The third strategy for reducing stigma is interpersonal contact with members of the stigmatized group. Contact has long
been considered an effective means for reducing intergroup
prejudice (Allport, 1954; Pettigrew & Tropp, 2000). Several
studies specifically focusing on contacts effect on mental
illness stigma have produced promising findings. Corrigan et
al. (2001) found that contact with a person with mental illness
produced greater improvements in attitudes than protest, education, and control conditions. In a subsequent study, contact
again produced the greatest improvements in attitudes and
participant willingness to donate money to a mental health
advocacy group (Corrigan et al., 2002). Improvements in
attitudes seem to be most pronounced when contact is with
a person who moderately disconfirms prevailing stereotypes
(Reinke, Corrigan, Leonhard, Lundin, & Kubiak, 2004).

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185

Table 1
Understanding targets of anti-stigma programs
Targets

Discriminatory behavior

Landlords

Fail to lease
No reasonable accommodation

Employers

Fail to hire
No reasonable accommodation

Health care providers

Withhold some services

Unnecessarily coercive treatment

Criminal justice professionals

Unnecessarily coercive
Fail to use mental health services

Policy makers

Insufficient resource allocation

Unfriendly interpretation of regulations

The media

Perpetuation and dissemination of stigmatizing images

3.1.1. Targeted stigma change

Anti-stigma programs are more successful when they
target specific groups of people instead of the general public.
Target has a double meaning here. It is first defined in
terms of specific social groups who are powerful vis-`a-vis
people with mental illness. Examples of these groups
are listed in the first column of Table 1. Power is based
on functional relationships (Fiske, 1993); the groups in
Table 1 are frequently in positions of control and authority
relative to people with mental illness. In particular, they can
exercise discriminatory behavioral options that curtail the
life opportunities of people with mental illness. These are
the second set of targets for anti-stigma programs, which are
highlighted in Table 1 as specific discriminatory behaviors.
Table 1 is meant to be an example of the elements in targeted
stigma change. As an example, Table 1 illustrates parts of
the table: targets, discriminatory behavior, corresponding
attitudes, social context, and change strategies. The table
is not to be a comprehensive treatment of targeted stigma.
Let us more fully consider how certain power groups may
specifically harm people with mental illness.
By virtue of their social position, landlords and employers
are in the position to influence two important life goals
for people with mental illness: living independently and
obtaining good jobs (Corrigan et al., 2002). Landlords and
employers who believe stereotypes about mental illness may
respond in a discriminatory manner. Landlords may be afraid
of people with mental illness and decide not to rent property
to them (Farina et al., 1974; Hogan, 1985; Page, 1995;
Segal et al., 1980; Wahl, 1999). Employers might believe
people with mental illness are incapable of competent
work, and therefore, not hire them (Bordieri & Drehmer,
1986; Farina & Felner, 1973; Farina et al., 1973; Link,
1982, 1987; Wahl, 1999). Hence, stigma programs need to
generate change strategies that target the specific prejudicial
attitudes and discriminatory behaviors of these two power
groups to advance the empowerment and life opportunities
of people with mental illness. (behaviors or attitudes?
Discrimination cannot be an attititude can it? I inserted
prejudicial attitudes and before discriminatory behavior).

Corresponding attitudes

Social context

Change strategies

Dangerousness
Incompetence

Economy
Hiring pool

ADA
Erasing the stigma

This kind of convergence between discriminatory behavior and attitude change strategies echoes what is generally
known about attitude change in basic behavioral research,
namely, behaviors are more likely to change when strategies
target attitudes that correspond with the behavior (Ajzen &
Fishbein, 1977; Cacioppo, Petty, Feinstein, Jarvis, & Blair,
1996). Correspondence is a function of several elements
including participating actors and the context in which
a specific event is likely to occur. Hence, changing the
prejudice and discrimination of mental illness is likely to be
more successful when specific power groups are targeted in
the settings in which they might discriminate.
Consider some of the other important targets for stigma
change listed in Table 1. Health care providers and administrators may endorse stigma about mental illness. As
a result, general medical providers may fail to provide
necessary treatments that would otherwise be prescribed to
people (Felker, Yazel, & Short, 1996). As discussed earlier,
research has shown that people with mental illness are less
likely to receive appropriate cardiovascular procedures after
myocardial infarct compared to a demographically matched
group that is not labeled mentally ill (Druss et al., 2000;
Druss, Bradford, Rosenheck, Radford, & Krumholz, 2001).
Alternatively, mental health providers may endorse coercive
or other mandatory treatments (e.g., being committed to
a psychiatric hospital) when the persons current profile
of needs fails to show these kinds of interventions are
warranted. Several levels of the criminal justice system may
also be impacted by stigma (Watson, Hanrahan, Luchins, &
Lurigio, 2001). Police, overestimating the risk of violence,
may respond with undue force to people labeled mentally
ill. The judiciary, holding people with mental illness
responsible for their symptoms, may fail to divert offenders
to appropriate services in the mental health system.
Two sets of discriminatory behaviors seem to be relevant
to legislators and policy makers. First, members of this group
seem to be unwilling to allocate sufficient resources to mental
health services. This is evidenced by 1990s levels of funding
having dropped more than 8% from the preceding decade
even though service needs did not change (Willis, Willis,

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P.W. Corrigan et al. / Applied and Preventive Psychology 11 (2005) 179190

& Male, 1998). Also, legislators have been unwilling to

pass a parity bill that equalizes insurance benefits for mental
and physical health (Gitterman, Strum, Pacula, & Sceffler,
2001). Second, policy makers and legislators seem unwilling
to interpret existing legislation in a manner that is friendly to
mental health. Note that it took more than 5 years for the Equal
Employment Opportunity Commission to issue an interpretation of the Americans with Disabilities Act (ADA) that is
sensitive to the needs of people with psychiatric disabilities.
Two additional elements in Table 1 influence the relationship between discriminatory behavior and change strategies:
corresponding attitudes and social context. As an example,
consider the relevance of these factors to the possible set of
discriminatory behaviors of employers. According to a social
cognitive perspective, stigmatizing attitudes precede discriminatory behaviors (Corrigan, 2000). Path analytic research has
shown that believing people with mental illness are dangerous leads to socially avoidant behavior, such as unwillingness
to work alongside of people labeled mentally ill (Corrigan et
al., 2002). Perceived incompetence may be an additional attitude that will influence discriminatory behaviors. This is the
belief that people with mental illness are not able to work
effectively so employers may refuse to hire them or to provide reasonable accommodations when they do.
The context in which targets behave may also influence
the form of discriminatory behaviors (Liska, 1990; Newman,
2001). In particular, the social-economic context in which
employers operate may affect the likelihood of hiring people
with mental illness beyond the stereotypes of those doing
the hiring. Some studies suggest that people discharged from
psychiatric hospitals often find employment in less desirable
parts of cities, sometimes called socially disorganized
neighborhoods (Silver, 1999, 2000). The likelihood of
employers hiring people with mental illness may depend
on the economic context of the neighborhood in which the
job site is located. Employers in more desirable parts of the
city may conform to norms regarding the appropriateness
of employees. However, employers in more economically
disadvantaged and less desirable parts of the city may not be
under community pressure to restrict their hiring practices,
and therefore, less likely to be as greatly influenced by stigma.
3.2. Coping with self-stigma
While the responsibility for eliminating mental illness
public stigma rightfully falls on the shoulders of society,
change will be slow. In the meantime, there are several
approaches to diminish self-stigma including cognitive
reframe of stigmatizing self-statements and enhancing ones
sense of personal empowerment. Recent developments in
the area of cognitive therapy suggest that self-stigma may
be understood as resulting from maladaptive self-statements
or cognitive schemata of mental illness developed largely as
a result of socialization. Cognitive therapy has been shown
to be an effective strategy for helping people change the
cognitive schemata that lead to anxiety, depression, and

the consequences of self-stigma (Chadwick & Lowe, 1990;

Drury, Birchwood, Cochrane, & MacMillan, 1996; Kuipers
et al., 1997; Tarrier, Beckett, Harwood, & Baker, 1993).
Kingdon and Turkington (1991) specifically used a cognitive
behavioral approach to help people reframe stigma as a normal event. While this study was not a randomized-controlled
trial, the interventions were well received by consumers and
seemed to lead to greater illness acceptance. Subsequent
studies have more carefully examined the impact of similar
cognitive therapies on psychotic symptoms, self-statements,
and service utilization (Beck & Rector, 2000; Gould, Mueser,
Bolton, Mays, & Goff, 2001; Turkington & Kingdon, 2000).
Another approach to changing self-stigma is facilitating
personal empowerment, which has been argued as the opposite of self-stigma. Being empowered means having control
over ones treatment and ones life (Rappaport, 1987).
People who have a strong sense of personal empowerment
can be expected to have high self-efficacy and self-esteem.
Communities and health service providers can foster
personal empowerment among mental health consumers by
giving consumers greater control over their own treatment
and reintegration into the community. Empowering services
involve the consumer as a partner in treatment planning
and promote the self-determination of consumers in relation
to employment opportunities, housing, and other areas
of social life. Research findings indicate that programs
that include the person with disabilities in all facets of
intervention are conducive to the attainment of vocational
and independent living goals (Corrigan, Faber, Rashid, &
Leary, 1999; Corrigan & Garman, 1997; Rappaport, 1990;
Rogers, Chamberlin, Ellison, & Crean, 1997).
Many consumers have empowered themselves and
become staff members of traditional treatment programs
(Mowbray et al., 1997), while others have developed
consumer-operated alternatives to the traditional service
system, such as lodges, clubhouses, and self-help/mutual
assistance groups. The Fountain House clubhouse in New
York is a paradigmatic example of consumer empowerment
through mutual help (Corrigan & Calabrese, in press). It
destigmatized the recovering person by focusing on his or
her strengths rather than weaknesses, and by developing
social competence through involvement in the very activities that constitute community integration (employment,
housing, education, etc.). Services like these greatly increase
the consumers sense of power, thereby challenging any
self-stigma with which they might be struggling.
3.3. Changing structures and institutions
Social scientists who have developed ideas related to
institutional and structural factors conclude that individuallevel strategies for stigma change are probably not sufficient
for remediating prejudice and discrimination that are largely
caused by collective variables (Hill, 1988; Pincus, 1999).
Education of key power groups might have some limited
impact on the kinds of intentional biases represented by

P.W. Corrigan et al. / Applied and Preventive Psychology 11 (2005) 179190

institutional discrimination. For example, one way to diminish legislative actions that unjustly restrict the opportunities
of people with mental illness is to educate House and
Senate members about how their actions are impinging
on an important part of their constituency. More difficult,
however, is altering the course of structural discrimination.
Because its impact is unintentional, educational and other
individual-level strategies should have no effect on structural
factors. Instead, various social change strategies that fall
under the rubric of affirmative action may be relevant for
stopping the harm caused by structural discrimination.
Affirmative actions are a collection of governmentapproved activities, which are meant to redress the disparities
that have arisen from historical trends in prejudice and discrimination. According to affirmative models, membership in
a stigmatized group is added to considerations of an individuals skills and achievements for access to specific limited
opportunities. The American with Disabilities Act seems
to be a Federal Policy that mirrors affirmative goals. ADA
clauses that prohibit discrimination by employers because
of a persons psychiatric disability are effective for barring
individual and institutional levels of discrimination. It is the
ADA clause on reasonable accommodation, however, that is
an affirmative action, which decreases structural discrimination. Reasonable accommodations are changes to the work
environment that assist the person in working. Reasonable
accommodation gives people with psychiatric disabilities an
edge towards keeping their job. The 1988 amendments to the
Fair Housing Act provide similar guarantees to reasonable
accommodations for people with psychiatric disabilities in
the housing sector. Affirmative actions like these are needed
to offset the injustices that continue because of structural discrimination against people with mental illness.

4. Final thoughts
Psychiatric disability is defined as an inability to achieve
significant life goals e.g., a vocation that yields a reasonable income and living in a home with ones family that
results from serious mental illness. Our thesis in this paper
was that achievement of life opportunities like these is also
hampered by public and personal reaction to mental illness:
stigma. We summarized cognitive, motivational, and institutional/structural models that explain from whence comes
mental illness stigma. We used these models to describe ways
to diminish stigma at the public and self-levels. With this kind
of information, researchers can join advocates in understanding and diminishing this major barrier to a quality life.

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