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Cited by 432Mental Health Treatment and AccessPsychology and Mental HealthGender Roles and Identity Studies

Stigma and discrimination limit access to mental health care

Open access
Thornicroft, Graham·2008·Epidemiologia e Psichiatria Sociale
DOI 10.1017/s1121189x00002621
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Abstract

This editorial provides an overview of how far access to mental health care is limited by perceptions of stigma and anticipated discrimination. Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff. The rates of non-treatment are far higher in low income countries. Evidence from some descriptive studies and epidemiological surveys suggest that potent factors increasing the likelihood of treatment avoidance, or long delays before presenting for care include: (i) lack of knowledge about the features and treatability of mental illnesses; (ii) ignorance about how to access assessment and treatment; (iii) prejudice against people who have mental illness, and (iv) expectations of discrimination against people who have a diagnosis of mental illness. The associations between low rates of help seeking, and stigma and discrimination are as yet poorly understood and require more careful characterisation and analysis, providing the platform for more effective action to ensure that a greater proportion of people with mental illness are effectively treated in future.

AI snapshot

Written from the paper’s full text.

TL;DR

This editorial argues that stigma and discrimination are major barriers to mental health care, with most people with mental illness untreated worldwide. It synthesizes evidence on treatment gaps, help-seeking delays, and disadvantaged groups, concluding that the links between low help seeking and stigma/discrimination remain poorly understood.

Key findings

  • Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff; in the USA 31% are affected annually but 67% are untreated, in Europe 27% are affected and 74% receive no treatment, and in Nigeria only 1.6% received mental health care over 12 months. A WHO overview of 37 studies found untreated proportions of 32.2% for schizophrenia, 56.3% for depression, 56.0% for dysthymia, 50.2% for bipolar disorder, 55.9% for panic disorder, 57.5% for generalised anxiety disorder, 57.3% for obsessive compulsive disorder, and 78.1% for alcohol abuse and dependence.
  • Help seeking is often delayed: after clear-cut signs of a psychotic disorder, it takes on average over a year to first receive assessment and treatment; in a US survey of almost 10,000 adults, average delays were 8 years for mood disorders and at least 9 years for anxiety disorders. Only 41% of people with mental illness in the previous year had received any treatment, and a quarter first went to a member of the clergy (31% in the 1950s and 24% in the 1990s), more than went first to a psychiatrist (17%) or general medical practitioner (17%).
  • Stigma and anticipated discrimination reduce help seeking: in a survey of over 3000 US military staff after combat duty in Iraq or Afghanistan, 60–77% of unwell soldiers did not seek mental health care, largely related to concerns about stigmatisation. In rural Virginia, over a third of residents had a diagnosed mental disorder but only 6% sought help; African Americans receive mental health care about half as often as white people.
  • Stigma is described as an amalgamation of ignorance/misinformation, prejudice, and discrimination, with rejection and avoidance of people with mental illness appearing universal; no known country, society, or culture considers people with a mental illness diagnosis to have the same value and acceptability as those without.

Methods

  • Design: editorial overview, not primary research; it synthesizes descriptive studies, epidemiological surveys, and prior reviews to examine how stigma and discrimination limit access to mental health care.
  • Data/sample: no primary dataset; evidence includes a WHO overview of 37 studies, a US national survey of almost 10,000 adults, a survey of over 3000 military staff, and other cited studies from multiple countries.
  • Main analysis: narrative synthesis of treatment rates, help-seeking delays, pathways to care, and stigma/discrimination factors, with illustrative quotations and examples.

Limitations

  • The paper states that the associations between low rates of help seeking and stigma/discrimination are “as yet poorly understood and require more careful characterisation and analysis”; it also states that the quality of information is relatively poor, with very few comparative studies between countries or over time, and that rural evidence is patchy.
  • Evident from the text: as an editorial, it does not describe a systematic search strategy, inclusion criteria, or quantitative synthesis, so its conclusions rely on selected cited studies and examples rather than a formal systematic review.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1017/s1121189x00002621

Cites

74 of 74 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 67 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff.

    “Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff.”
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    • cites Kohn et al, 2004a

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    • cites Thornicroft, 2007

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  • Premisecitation

    Under-treatment occurs even in countries with the best resources.

    “This under-treatment occurs even in countries with the best resources”
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    • cites Kohn et al, 2004a

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    • cites Thornicroft, 2007

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  • Premisecitation

    Reluctance of many people to seek help for mental illness related problems because of their anticipation of stigma should they be diagnosed contributes to neglect.

    “the reluctance of many people to seek help for mental illness related problems because of their anticipation of stigma should they be diagnosed”
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    • cites Kohn et al, 2004a

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  • Premisecitation

    The combination of lack of knowledge, negative attitudes, and excluding or avoiding behaviours has a powerful force for social exclusion.

    “The combination of these three elements has a powerful force for social exclusion”
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    • cites Thornicroft, 2006b

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  • Premisecitation

    Rates of non-treatment are far higher in low income countries.

    “The rates of non-treatment are far higher in low income countries.”
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    • cites Wang et al, 2007

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    Premisecitation

    Even under better resourced countries, most people with a mental illness in the United States do not seek assistance; an early national survey found that fewer than one third of all mentally ill people received assessment and treatment, although the rate rose to 60% for people with a diagnosis of schizophrenia, and even though two thirds of all adults with a mental illness went untreated, a half

    “Even under better resourced countries, it is known that most people with a mental illness in the United States do not seek assistance.An early national survey found that fewer than one third of all mentally ill people received assessment and treatment, although the rate rose to 60% for people with a diagnosis of schizophrenia”
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    • cites Narrow et al, 1993

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    Premisecitation

    A large national survey in Germany found the general public thought that mental health staff is useful for treating people with schizophrenia, but not for depression; most people felt schizophrenia was caused by biological or uncontrollable influences, while they understood depression to be a consequence of 'social disintegration', so people with depression were more often recommended to seek help

    “Revealingly the general public thought that mental health staff is useful for treating people with schizophrenia, but not for depression.The reason for this is that most people felt that schizophrenia was caused by biological or uncontrollable influences, while they understood depression to be a consequence of 'social disintegration'”
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    • cites Angermeyer et al, 1999

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    Premisecitation

    Mental health specialists provided care that was at least reasonable in about half (48%) of the cases, while in primary care only 13% of people treated received care that was adequate.

    “mental health specialists providing care that was at least reasonable in about half (48%) of the cases they say, while in primary care only 13% of people treated received care that was adequate”
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    • cites Wang et al, 2005b

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    Premisecitation

    In low and medium resource countries, the proportions of people with mental illness who are treated are far less than in better resourced countries; a recent worldwide survey found the proportion receiving mental health care over 12 months was as low as 1.6% in Nigeria, and in most of the 17 countries studied only a minority of people with severe disorder received treatment.

    “The proportions of people with mental illness who are treated in low and medium resource countries (LAMIC) are far less, for example a recent worldwide survey found that the proportion of respondents receiving mental health care over 12 months was as low as 1.6% in Nigeria, and that in most of the 17 countries studied only a minority of people with severe disorder received treatment”
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    • cites Wang et al, 2007

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    Premisecitation

    An international study of depression found that 0% of people with depression in St. Petersburg received evidence-based treatment in primary care, and only 3% were referred on to specialist mental health care at all; the major barrier to care in that Russian site was money, with an inability to afford treatment costs the main barrier for 75% of the depressed Russian patients studied.

    “An international study of depression found that 0% of people with depression in St. Petersburg received evidence-based treatment in primary care, and only 3% were referred on to specialist mental health care at all (Simon et al, 2004a).But the major barrier to care in that Russian site was money: an inability to afford treatment costs was the main barrier to care for 75% of the depressed Russian”
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    • cites Simon et al, 2004a

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    Premisecitation

    Unmet needs were greater for older people, minority ethnic groups, those with low incomes or without insurance, and residents of rural areas.

    “Unmet needs were greater for the poor: older people, minority ethnic groups, those with low incomes or without insurance, and residents of rural areas”
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    • cites Wang et al, 2005b

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    Interpretationcitation

    No single factor is enough to explain complex patterns of help seeking; the weight of evidence suggests that even when there are no major financial barriers to care, many people do not seek help or minimize their contact with services in an attempt to avoid being labeled as mentally ill.

    “So no single factor is enough to explain complex patterns of help seeking.Nevertheless the weight of evidence does suggest that even when there are no major financial barriers to care, that many people do not seek help or minimize their contact with services in an attempt to avoid being labeled as mentally ill”
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    • cites Corrigan, 2004a

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    Premisecitation

    In the USA, 31% of the population are affected by mental illness every year, but 67% of these individuals are not treated.

    “In the USA, for example, 31% of the population are affected by mental illness every year, but 67% of these individuals are not treated”
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    • cites Kessler et al, 2005a

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    Premisecitation

    People who wait longer than average before receiving care are more likely to be young, old, male, poorly educated, or a member of a racial/ethnic minority.

    “People who wait longer than average before receiving care are more likely to be young, old, male, poorly educated, or a member of a racial/ethnic minority”
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    Premisecitation

    In a study of depressed people in St Petersburg, only 3% were treated, both because of the low level of coverage of services and because of demand limiting factors such as the need for out-of-pocket payments to afford treatment.

    “Indeed one particular study of depressed people in St Petersburg only 3% were treated (Simon et al, 2004b), both because of the low level of coverage of services, and because of demand limiting factors such as the need for out-of-pocket payments to afford treatment.”
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    Premisecitation

    In Europe, mental illness affects 27% of people every year, 74% of whom receive no treatment.

    “in Europe mental illness affects 27% of people every year, 74% of whom receive no treatment”
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    • cites Wittchen & Jacobi, 2005

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    Premisecitation

    A survey of almost 10,000 adults in the USA found that the majority of people with mental disorders eventually contact treatment services, but they often wait a long time before doing so, with average delays before seeking help of 8 years for mood disorders and at least 9 years for anxiety disorders.

    “The results showed that the majority of people with mental disorders eventually contact treatment services, but they often wait a long time before doing so: with average delays before seeking help of 8 years for mood disorders, and at least 9 years for anxiety disorders.”
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    Premisecitation

    Each year approaching 30% of the population worldwide has some form of mental illness.

    “Although each year approaching 30% of the population worldwide has some form of mental illness”
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    • cites Thornicroft, 2007

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    Premisecitation

    Several American studies suggest that African Americans receive mental health care about half as often as white people, even though they have higher rates of some mental disorders.

    “Several American studies suggest that African Americans receive mental health care about half as often as white people (Diala et al, 2000;Snowden, 2001;Snowden, 2003), even though they have higher rates of some mental disorders”
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    • cites Diala et al, 2000

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    • cites Snowden, 2001

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    Premisecitation

    A study in Iowa found people living in the most rural environments were more likely to hold stigmatising attitudes toward mental health care than people in towns, and such views strongly predicted willingness to seek care.

    “Similar findings also emerged from a study in Iowa where people living in the most rural environments were more likely to hold stigmatising attitudes toward mental health care than people in towns, and such views strongly predicted willingness to seek care”
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    • cites Hoyt et al, 1997

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The National Depressive and Manic-Depressive Association concluded that reasons for the continuing gap in depression treatment include patient, provider, and health care system factors; patient-based reasons include failure to recognize symptoms, underestimating severity, limited access, reluctance to see a mental health care specialist due to stigma, noncompliance with treatment, and lack of

    “They concluded that the 'reasons for the continuing gap include patient, provider, and health care system factors.Patient-based reasons include: failure to recognize the symptoms, underestimating the severity, limited access, reluctance to see a mental health care specialist due to stigma, noncompliance with treatment, and lack of health insurance.”
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    • cites Hirschfeld et al, 1997

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    • cites Castiello & Magliano, 2007

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  • May combine two claims.

    Interpretationreasoning

    Stigmatisation against people with mental illness is common wherever it has been studied, and these processes present formidable barriers both to social inclusion and to proper access to mental health care.

    “In summary, this paper shows that stigmatisation against people with mental illness is common wherever it has been studied, and that these processes present formidable barriers both to social inclusion and to proper access to mental health care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the USA, black people with a mental illness are more likely to seek help if their families are supportive, and if a family member has had a positive personal experience of mental health care; in one study they did not view mental health on a continuum of wellbeing, but tended to think of themselves as either mentally healthy or mentally ill, and many interviewees said they did not think they

    “Black people with a mental illness are more likely to seek help if their families are supportive, and if a family member has had a positive personal experience of mental health care.In one study they did not view mental health on a continuum of wellbeing, but tended to think of themselves as either mentally healthy or mentally ill.Many interviewees said they did not think they were 'crazy',”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Hines-Martin et al, 2003a

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    • cites Davis & Ford, 2004

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    Premisecitation

    Rural residents with a history of depression labeled people who sought professional help more negatively than their urban counterparts, and those who labeled depression more negatively were less likely to have sought professional help.

    “The rural residents with a history of depression labeled people who sought professional help more negatively than their urban counterparts.By the same token, those who labeled depression more negatively were less likely to have sought professional help”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Rost et al, 1993

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    Premisecitation

    A study of parents in rural areas of North Carolina concluded that although as many as 20% of children had some type of treatable mental illness, only about one-third of them received help from the mental health system, and one of the main barriers to care was stigma toward the use of the mental health care.

    “A study of parents in rural areas of North Carolina concluded that although as many as 20% of children had some type of treatable mental illness, only about one-third of them received help from the mental health system (Costello et ai, 2001;Angold et ai, 2002).The researchers found that one of the main barriers to care was stigma toward the use of the mental health care.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Costello et al, 2001

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    • cites Angold et al, 2002

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  • May combine two claims.

    Interpretationreasoning

    Stigma about mental illness is no less in many rural areas, and may be even stronger than in towns and cities; in part this may be based upon fears that a rural community will learn details about a period of mental illness, while it is easier in cities to remain anonymous.

    “So it seems to be true that stigma about mental illness is no less in many rural areas, and may be even stronger than in towns and cities.In part this may be based upon fears that a rural community will learn details about a period of mental illness, while it is easier in cities to remain anonymous.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Most of the unwell soldiers (60-77%) did not seek mental health care, largely related to concerns about possible stigmatisation.

    “Most of the unwell soldiers (60-77%) did not seek mental health care, largely related to concerns about possible stigmatisation”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hoge et al., 2004

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    Premisecitation

    Several important barriers to care can increase the impact of mental illnesses among black communities in Britain and the USA: socio-cultural (health beliefs and mistrust of services), systemic (lack of culturally competent practices in mental health services), economic (lack of health insurance), or individual barriers (denial of mental health problems).

    “These factors have been described as: socio-cultural (health beliefs and mistrust of services), systemic (lack of culturally competent practices in mental health services) (Corrigan et al, 2004), economic (lack of health insurance), or individual barriers (denial of mental health problems)”
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    • cites Corrigan et al, 2004

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    • cites Swanson & Ward, 1995

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    Premisecitation

    A survey of rural residents in Virginia found that over a third of the population had a diagnosed mental disorder, but only 6% subsequently sought help, and those who did not go for treatment said that they 'felt there was no need'.

    “a survey of rural residents in Virginia found that over a third of the population had a diagnosed mental disorder, but only 6% subsequently sought help, and those who did not go for treatment said that they 'felt there was no need'”
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    • cites Fox et al, 1999

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  • May combine two claims.

    Premisecitation

    The interplay of these factors produces the contradictory situation in which black groups may have higher rates of many mental illnesses, lower rates of general referral and treatment, but higher rates of compulsory treatment and forensic service contact.

    “The interplay of these factors produces the contradictory situation in which black groups may have higher rates of many mental illnesses, lower rates of general referral and treatment, but higher rates of compulsory treatment and forensic service contact”
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    • cites Keating & Robertson, 2004

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    • cites National Institute for Mental Health in England, 2003

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    Premisecitation

    Common beliefs likely to reduce likelihood of seeking help include: that psychiatric treatments are ineffective; that others would react with avoidance; or that a person should solve their own problems.

    “The following common beliefs are likely to reduce their likelihood of seeking help: that psychiatric treatments are ineffective (Corrigan, 2004b); that others would react with avoidance; or that a person should solve their own problems”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Corrigan, 2004b

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    • cites Kessler et al, 2001

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  • May combine two claims.

    Premisecitation

    Evidence from Tennessee showed that among people who were mentally unwell, those more likely to seek help were women, younger people and those who had been treated for a mental illness previously.

    “Evidence from Tennessee also showed that among people who were mentally unwell, those more likely to seek help were women, younger people and those who had been treated for a mental illness previously”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Smith et al, 2004

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27 of 27

  • The paper relies on this without support.

    There is no known country, society or culture in which people with mental illness with a diagnosis are considered to have the same value and to be as acceptable as people who do not have mental illness.

    “Indeed there is no known country, society or culture in which people with mental illness with a diagnosis are considered to have the same value and to be as acceptable as people who do not have mental illness.”

  • The paper relies on this without support.

    The core experiences of shame and blame are common everywhere stigma has been studied, but to differing extents.

    “The core experiences of shame (to oneself and one's family) and blame (from others) are common everywhere stigma has been studied, but to differing extents.”

  • The paper relies on this without support.

    Rejection and avoidance of people with a diagnosis of mental illness appear to be a universal phenomenon.

    “Finally, rejection and avoidance of people with a diagnosis of mental illness appear to be universal phenomenon”

  • The paper relies on this without support.

    A strong reluctance to be seen as mentally ill appears to be a universal phenomenon.

    “A strong reluctance to be seen as mentally ill appears to be a universal phenomenon.”

  • The paper relies on this without support.

    Most people of all cultures have relatively little accurate and useful knowledge about mental illness.

    “There is an important general point here: that most people of all cultures have relatively little accurate and useful knowledge about mental illness.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Discrimination, prejudice, and stereotypes in society severely impact recovery, quality of life, and well-being of people with mental illnesses and their families, and represent the main gap in accessing specialized mental health services by the general population.

    “Thus, discrimination, prejudice, and stereotypes present in society not only severely impact the recovery process, quality of life, and well-being of people with mental illnesses and their families, but also represent the main gap in accessing specialized mental health services by the general population [4,5].”

    From Innovative Technology–Based Interventions to Reduce Stigma Toward People With Mental Illness: Systematic Review and Meta-analysis (2022) · cites this paper as [4]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Treatment rate described as one-third but reported as 41%

    Minor

    The sentence describes the treatment rate as about one-third, but its parenthetical figure is 41%, which is closer to two-fifths.

1 of 1

Cites

Flagged first, then by citations

1 of the 75 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. 2003, Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England
  2. Thornicroft, 2006, Actions Speak Louder: Tackling Discrimination against People with Mental Illness
  3. 10.1176/appi.ajp.161.9.1626 · DOI
  4. 10.1056/nejmsa043266 · DOI · Paper page
  5. Davis, 2004, A conceptual model of barriers to mental health services among African Americans, African American Research Perspectives, 10, 44

Cited by

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Related

Authors
Thornicroft, G.
Affiliations
King's College London (GB)
Corresponding author
Thornicroft, Graham
ORCID
Thornicroft, Graham
Venue
Epidemiologia e Psichiatria Sociale
Publisher
Cambridge University Press (CUP)
Published
2008-03
Volume
17
Issue
1
Pages
14-19
ISSN
  • 1121-189X (ISSN-L)
  • 2038-1816
DOI
10.1017/s1121189x00002621
OpenAlex
W1986958797
Semantic Scholar
5bb0083275295c578ac3d6f3bd59044e951f9554
Cited by
432
References
75
Citations by year
2026: 18 · 2025: 34 · 2024: 40 · 2023: 34 · 2022: 41 · 2021: 41 · 2020: 31 · 2019: 38 · 2018: 22 · 2017: 25 · 2016: 21 · 2015: 14 · 2014: 18 · 2013: 20 · 2012: 10
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 1173 d)
Locations
  • Epidemiologia e Psichiatria Sociale (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0611-10053)
  • University of Oxford
  • H. Lundbeck A/S
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
  • Social Sciences › Gender Studies › Gender Roles and Identity Studies
Keywords
mental health stigma, discrimination, access to mental health care, help-seeking, treatment avoidance, low-income countries, mental health service utilization, prejudice
MeSH terms
Mental Disorders, Health Services Accessibility, Humans, Mental Health Services, Stereotyping

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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