Overcoming Mental Health Stigma For Nurses
What’s the first thought that comes to mind when you think about mental illness? Is it something negative?
If so, it probably comes from the stigma associated with mental health. A stigma is defined as “a mark of disgrace associated with a particular circumstance, quality, or person.” And despite more conversations happening around conditions like depression and anxiety, mental health disorders are still often viewed in a negative light.
The stigma around mental health affects nurses in two ways: It can subconsciously influence how nurses perceive and treat patients, and it can prevent nurses from seeking care when they themselves need it.
Nurses are the most trusted profession. Many people in the public view nurses as superheroes. Yet, nurses are human, too.
“Nurses are expected to fulfill their roles as superheroes,” said Dawn Webb, MSN, RN, PMH-BC, Director of Nursing Practice and Professional Development at Texas Nurses Association. “Having anything wrong isn’t permitted. They’re supposed to be strong, resilient, and not experience the same issues that other people in society experience — including mental illness.”
But nurses do experience the same mental health issues that the rest of the world faces. Some would argue they’re even more susceptible to conditions like burnout, depression, anxiety, and post-traumatic stress disorder (PTSD) than the average person because of the intense nature of their work. During the COVID-19 pandemic, at least 20% of nurses experienced depression and anxiety, and nearly 40% had difficulty sleeping.
The public stigma against nurses with mental health conditions comes from the fixed notion that nurses are supposed to be strong, perfect examples of good health.
What Nurses Need to Know When Seeking Mental Health Help
Seeking help can be challenging for many nurses. Nurses witness stigma and discrimination in the workplace every day, and this creates fear. Whether that stigma comes from a fellow nurse, leadership, or the institution, nurses may worry about:
- Physical violence
- Fewer opportunities
- Loss of employment
Fear of retribution and job loss for having mental health disorders, especially if they involve substance abuse, are common concerns. A 2019 national poll found that half of workers surveyed were worried about sharing their mental health issues at their jobs. More than 1 in 3 workers were concerned about retaliation or being fired if they sought help for mental health.
While retribution and job loss because of mental health issues sometimes happens, if it happens when you’re seeking treatment, it’s discrimination. Mental health conditions and substance use disorders are considered a disability and are protected by the Americans with Disabilities Act (ADA). It’s illegal for an employer to discriminate against you if you are seeking treatment or recovered from a mental health condition (including eating disorders) or a substance use disorder. If you are seeking help for one of these conditions, they cannot:
- Fire you
- Reject you for a job or promotion
- Force you to take leave
IMPORTANT: Current drug or alcohol use that affects work performance is not protected by the ADA.
Someone who is scared to speak up due to any of these consequences is less likely to seek help. And when they’re less likely to seek help, their mental health issues are more likely to impact job performance and patient care, leading to retribution and job loss.
How to Help Eliminate the Mental Health Stigma in Nursing
Ending the stigma requires changing the way we think and talk about mental health. Stigmas don’t go away overnight. It requires a cultural shift. And while it takes time, it starts with one person.
“We’re missing some key things when it comes to our Code of Ethics, and that’s supporting one another,” says Dawn. “We forget that, and we need to be reminded that we are nothing by ourselves.” For example, Provision 1 of the Code of Ethics states that, “The nurse practices with compassion and respect for the inherent dignity, work, and unique attributes of every person.” Furthermore, this provision reminds nurses to have respect for all those with whom they interact by maintaining “professional, respectful, and caring relationships with colleagues” and being “committed to fair treatment.”
Whether you’re a nurse leader or a staff nurse, you can set an example for the rest of your unit. One person having the courage to fight the stigma can spark a chain reaction and encourage others to do the same. Here are some ways to move the needle toward 3 separate goals:
To Better Serve Patients:
- Educate yourself: Learn more about mental health in general. Replace your preconceived notions with the truth. NAMI is a fantastic resource for learning more about mental health disorders and their impact on overall health.
- Check for unconscious bias: Unconscious bias is the automatic and unintentional feelings against groups of people. We all have some inherent biases that we may not even realize. Learning about these types of biases can help bring awareness to them. Take this quiz to understand if you may have unintentionally disrespected another because of mental health, race, or other stereotypes.
- Use person-first language: People-first language avoids defining people by their disability. It places the reference to the disability after the reference to a person. This helps you avoid stigmatizing language that labels people, like calling someone with schizophrenia a “schizophrenic.” Instead, use person-centered language by referring to them as a “person who has schizophrenia.”
To Better Support Coworkers:
- Talk about mental health positively and openly, with acceptance: When others know you don’t judge those with mental illness, they’re more likely to feel comfortable opening up to you. Be a non-judgmental colleague. Let others see they can talk to you without fear of judgement.
- Avoid stigmatizing conversations: If you hear other nurses using derogatory language about patients or fellow employees with mental health conditions, don’t join in. Leave the conversation or speak up to discourage this kind of behavior. This is especially important for nurse leaders — don’t let this negativity spread within your unit. Teach your staff that this behavior is unacceptable.
- Join the National Alliance on Mental Illness (NAMI): Get involved by donating to the cause, joining a local NAMI walk, or exploring resources to help you become a mental health advocate.
- Pledge to be stigma-free: NAMI’s StigmaFree campaign is helping to end stigma and create hope for those affected by mental illness.
To Seek Help and Protect Yourself From Retribution:
- Use the resources at your disposal: Explore this list of mental health resources specifically curated for nurses. NAMI also offers an array of resources for those with a mental health issue, including an entire section devoted to frontline professionals. Especially for those with substance use or eating disorders, check to see if your organization offers an Employee Assistance Program (EAP), Peer Assistance Program (PAP), or Alternative-to-Discipline Program (ADP). The Family and Medical Leave Act (FMLA) can also help get you time off to recover or provide other accommodations. The Well-Being Initiative provides free tools and apps to support the mental health of all nurses. And the ANA website has many nurse suicide prevention/resilience resources.
- Tell your employer about your mental health diagnosis: The ADA protects you from discrimination or retribution based on a disability if you are seeking treatment and the employer is aware of the disability. It’s OK if you don’t feel comfortable disclosing this information to your employer, but they can’t be held accountable for what they don’t know.
- Get help: Participate in mental health screening if offered by your employer and seek support as needed. Explore tele-mental health options through your insurance and contact your healthcare provider for options.
If you have thoughts of suicide or self-harm, call or text 988, the National Suicide Prevention Lifeline.
A chat is also available at 988lifeline.org. You are not alone. Please reach out.
Read more mental health blogs here.
DISCLAIMER: The content provided on this webpage is general in nature and does not constitute legal or medical advice. This webpage is for reference only. Always consult with a qualified health care provider for any questions you may have regarding thoughts of suicide. If you believe someone is at imminent risk of harming themselves and is refusing help or you have reason to believe someone has harmed themselves, call 911. Laws vary by jurisdiction, locality, state, or country; please follow the laws of your specific jurisdiction and consult with an attorney if you have any questions regarding the laws of your jurisdiction.
ADDITIONAL DISCLAIMER: Programs, resources, or information mentioned or referred to on any webpage are for illustrative purposes only. ANA does not endorse any program, resource or information mentioned or referred to on any webpage.