Structural Stigma and Health for Persons with Mental Illness

Adults with serious mental illness bear a disproportionate burden of physical health conditions and die earlier than persons in the general population. The causes of health disparities among persons with serious mental illness are multiple and complex. However, it is theorized that differences in health between different groups are caused, at the root, by differences in social and structural factors. Structural stigma, or “societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources and well-being of the stigmatized” (Hatzenbuehler & Link, 2014, p.2) have been found to be an important determinant of health among sexual minority populations, but there is a dearth of research examining the relationship between structural stigma and the physical health of persons with mental illness. This study explored the relationship between structural stigma and differential, health-related outcomes for persons with and without serious mental illness. This was examined through a cross-sectional, multilevel analysis of the association of state-level structural stigma measures (e.g., number of U.S. Equal Opportunity Employment Commission charges with a mental health basis per capita, State Mental Health Agency expenditures per capita) in three domains (investment in mental health, availability and receipt of mental health services, and unfair treatment) and diabetes, obesity, and self-rated health. Controlling for state-level poverty and individual risk factors, significant relationships between structural stigma and health were found in two domains, investment and mental health and availability and receipt of mental health services. Few of the relationships had a differential impact on persons with serious mental illness, suggesting that structural stigma also limits the opportunities, resources, and well-being of persons that don’t have serious mental illness. Implications for research, practice, policy and advocacy, and education are discussed.