What is the issue?

In a health-care context, structural stigma occurs through the activities its organizations amass over time, which deliberately or inadvertently create and maintain social inequalities.

Structural stigma is especially damaging ꟷ and dangerous ꟷ for persons with lived and living experience of mental health problems and illnesses and/or substance use. Why? Because structural stigma is often enacted unknowingly, through implicit cognitive biases. Such stigma represents the unfairness and inequity embedded into the very fabric of our social institutions, organizations, and our shared ways of thinking and acting toward people facing these challenges.

What are we doing?

In 2019, we launched a multi-year project to better understand the problem of mental health- and substance use-related structural stigma in health-care contexts. Its overarching objective: to identify gaps and reduce stigma, both at policy, practice, and system levels and within the organizational culture of health care.

Our first year involved three main research activities:

  • A comprehensive literature review, with key recommendations and suggested approaches;
  • A qualitative research project using focus groups consisting of people with lived and living experience of mental health and/or substance use problems, to identify key priorities and areas for structural change within the health-care system (forthcoming);
  • An environmental scan to help guide the development of new measurement and audit tools for structural stigma.

The findings across these three projects were overlapping and reinforcing. As a result, a comprehensive picture of structural stigma emerged: how it is experienced, how it impacts health and quality-of-life outcomes, and what are the most important strategies for reshaping the way health services are provided to persons with lived and living experience of mental health problems and illnesses and/or substance use.

Read the summary of our main findings on structural stigma in our Framework for Action.


Health-care leaders at many levels are making important decisions about how to redeploy resources, what to consider an essential service, and how to ensure the best ethical judgment is used for difficult decisions. While COVID-19 is unquestionably bringing out some of the best of health-care provision, such a crisis also exposes the weak spots in our systems.

To assist those working in policy, ethical decision making, resource allocation, planning, and direct care in making the best quality decisions, Dr. Stephanie Knaak and Dr. Thomas Ungar have highlighted some key areas of potential risk in Catching Blind Spots in COVID-19 Health-Care Planning.

Our structural stigma brochure has more on this project. Feel free to share it with colleagues and other stakeholders.