Overcoming stigma: 3 strategies toward better mental health in the workplace

The COVID-19 pandemic has taken a heavy toll on the global psyche. Today, as the world moves toward the end of the pandemic, almost one billion people have a mental-health or substance-use disorder —collectively referred to as behavioral-health conditions. As companies prepare for a postpandemic return to the workplace, identifying behavioral-health conditions and offering the necessary support for employees affected by them should be a top C-suite priority.

While most employers report that they are serious about employees’ mental health, many haven’t confronted one critical challenge: stigma. Using data from two recent US surveys conducted by McKinsey’s Center for Societal Benefit through Healthcare, this article takes a deep look at stigma in the workplace and its role in exacerbating behavioral-health conditions and driving down an employee’s self-worth and productivity. This is a widespread problem with serious implications. The good news is that employers are in a unique position to address stigma—especially during the short postpandemic window when many organizations are evolving their operations for the new reality of hybrid work.

In behavioral health, “stigma” is defined as a level of shame, prejudice, or discrimination toward people with mental-health or substance-use conditions. Because of stigma, such conditions are often viewed and treated differently from other chronic conditions, despite being largely rooted in genetics and biology. Stigma affects everything from interpersonal interactions to social norms to organizational structures, including access to treatment and reimbursement for costs.

The National Academy of Medicine defines three primary forms of stigma, each of which can have far-reaching and harmful effects:

The impact of stigma can be profound. At a time when people are at their most vulnerable and most in need of help, stigma prevents them from reaching out. This terrible paradox can deepen an illness that is often invisible to others. Evidence-based, effective treatments that allow people with behavioral-health conditions to live productive and fulfilling lives exist. Stigma creates a cloud of shame and uncertainty that obscures what could be a clear path to recovery.

Our analysis of our two surveys substantiates that impact. For example, many employees with a behavioral-health condition indicated that they would avoid treatment because they didn’t want people finding out about their mental illness (37 percent) or substance-use disorder (52 percent). Stigma was also associated with lower workforce productivity. Close to seven in ten respondents with high self-stigma levels reported missing at least a day of work because of burnout or stress.

There is a pronounced disconnect between employer and employee perspectives on stigma in the workplace. While some 80 percent of the full-time-employed individuals we queried indicated that they believed that an antistigma or awareness campaign would be useful, only 23 percent of employers reported having implemented such a program. Further, when employers were asked to prioritize 11 potential behavioral-health-focused initiatives, they ranked stigma reduction last (Exhibit 1).

Yet 75 percent of the same employers acknowledged the presence of stigma in their workplaces. They know that their employees are afraid to speak up about behavioral-health needs. In fact, many leaders admit that they themselves may not be comfortable asking for help. So why aren’t they acting on what they know?

While companies may shy away from stigma because they imagine that it is too abstract to address, they are, in fact, missing an enormous opportunity. Employers can’t solve every aspect of substance-use disorders and mental illnesses in their workplaces. But stigma is something that they actually can change. Taking the right kind of actions can shift the dialogue from stigma to support.

The short window of time when organizations are evolving their operations for post-pandemic life is the perfect moment to act. Understanding, prioritizing, and planning for employees’ postpandemic mental health should be part of every company’s strategy for returning to the workplace. An inclusive culture and equitable benefits can lead to earlier, more effective intervention and support for people with behavioral-health conditions. Addressing stigma as a collective responsibility across three levels—organizational systems, leaders, and peers and teammates7 —will make those plans far more effective and help ensure the long-term health and commitment of the workforce.

We understand that stigma can seem like a vague concept and an insurmountable challenge for employers. We also know that attitudes toward stigma can vary by demographics and other factors, making it harder to address effectively without a tailored approach. Nevertheless, those employers that have addressed stigma have modeled approaches that can work across a variety of populations. Blending their experiences and the lessons from our research, here are three overarching strategies that can help dismantle the stigma associated with behavioral-health conditions in the workplace.

For starters, employers can change the misperception that a behavioral-health condition is a moral failing. These conditions are treatable diseases like other medical conditions. In our survey, a significant percentage of employees with behavioral-health conditions reported feeling “ashamed” or “out of place in the world” because of their conditions. Many respondents expressed worry that people would think they were worthless, or had serious character flaws, if their behavioral-health condition was known (Exhibit 2). As one employee told us, “I had a strong sense of shame, and upper management did not talk to me at all. They acted as if nothing had happened, even though the reason I had to take a leave from work was because of work-driven anxiety.” Many respondents were also concerned that colleagues who knew about their illness would doubt their talents or skills.

Companies can’t shift perceptions of mental illness by fiat. Instead, they need targeted programs that educate people and promote supportive teams. These direct actions can mitigate harmful sentiments across the company:

Not surprisingly, most employers agree that behavioral-health conditions should be treated with the same urgency, skill, and compassion as other medical conditions (for example, diabetes) are. Yet many employees still face prejudice in the workplace. “At my employer, there is a stigma associated with seeking out help and speaking about mental illness,” said one employee. “Maybe that’s because many workplace practices here are the reason many people feel anxious, stressed, and depressed.” Among our survey respondents, the great majority with mental illness (65 percent) or substance-use disorders (85 percent) perceive stigma in the workplace—and for good reason. Respondents who had little experience with behavioral-health conditions were far less likely to be strongly willing to work with a person in recovery compared with individuals with a mental or substance-use disorder (Exhibit 3). However, over a third of respondents who had little experience with behavioral-health conditions reported being somewhat willing, indicating a potential opportunity to reduce stigma among a substantial part of the workforce.

Policies and practices to create a culture free from discrimination are now considered “table stakes.” Employers should look closely at their workplace cultures, and many may well need to take concrete steps to ensure that their workplaces are inclusive and supportive environments as they commit to treating people with mental-health and substance-use disorders with dignity and respect. Here are some potential actions they can take to curtail discriminatory behavior:

The majority of employees want their employers to ensure parity in the health plans, employee-assistance programs, and other support programs offered (Exhibit 4). Making it happen wouldn’t just be a symbolic move by employers. It would be, in fact, one of the most tangible things they could do for their workforces. As one employee reported, “Getting behavioral-health services can be incredibly challenging. It leaves me feeling very alone.”

Offering true parity in employee-support programs takes work. Companies have to check regularly to make sure that they are actually offering what they say they offer. Stigma makes the issue even more important. It takes a lot of confidence for a person to be willing to even ask for help in the first place. If they come across barriers to access, their perceptions of stigma may drive them to simply give up rather than press harder for help. One employee told us, “I got a referral for my mental illness through my employee-assistance program back in February, but the provider they referred me to was not accepting new clients. It took a lot to seek that referral, and I haven’t taken the time to request another one.”

Here are some potential actions employers can take to drive the parity of mental- and physical-health benefits they offer:

Fewer than one in ten employees describe their workplace as free of stigma on mental or substance-use disorders. As anxious employees return to the workplace and organizations adjust to new realities after the COVID-19 pandemic, organizational systems and behaviors of leaders and employees need to change. Companies have a unique opportunity to replace negative attitudes and discriminatory policies with healthier attitudes and policies that can improve the well-being of their people.

Promoting behavioral-health literacy, creating an inclusive culture, and making mental health a clear organizational priority are no-regret moves, especially at a time when the battle for talent is getting tougher. By reducing stigma and increasing support, employers can mitigate the human, organizational, and economic costs of the pandemic-driven rise in mental illnesses and substance-use disorders.