JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY

2021, VOL. 35, NO. 4, 327–344

https://doi.org/10.1080/87568225.2020.1737853

Reducing Stigma Surrounding Mental Health: Diverse

Undergraduate Students Speak Out
Milushka M. Elbulok-Charcape a, Faigy Mandelbaumb, Rona Milesb,
Rose Bergdollb, David Turbevilleb, and Laura A. Rabinb
a
The Graduate Center, CUNY, Educational Psychology, New York, NY, USA; bPsychology Department,
CUNY, Brooklyn College, Brooklyn, NY, USA

ABSTRACT KEYWORDS
Given the growing rates of psychological disorders in college Stigma; undergraduate;
settings, the current study investigated student perspectives mental health; thematic
about how to end mental health stigma, a hindrance to help analysis; health
seeking. Participants were 1,255 demographically diverse under-
graduate students from a large city university system (Mage
= 22.4, 73.9% non-White). Students completed a questionnaire
that assessed their knowledge and perspectives about mental
health-related issues including an open-ended question that eli-
cited suggestions for how to end mental health stigma.
Responses were coded using qualitative thematic analysis, of
which the top three were: education (n = 325, 20.5% of
responses), awareness (n = 271, 17.1% of responses), and positive
atmosphere (n = 178, 11.2% of responses). Notably, students who
reported having been diagnosed or treated for a mental health
disorder were more likely to suggest curriculum changes and
reconceptualization of mental health themes. We hope that results
will be used to inform targeted interventions for combatting
stigma in diverse college settings and beyond.

Introduction
Mental health disorders are on the rise among the adult population (National
Alliance on Mental Illness, 2016; National Institute of Mental health, 2016;
Watkins, Hunt, & Eisenberg, 2012). Additionally, the American College
Health Association National College Health Assessment (ACHA-NCHA)
reports that approximately one third (34.5%) of undergraduate students received
one or two mental health diagnoses within the last 12 months (ACHA-NCHA,
Fall 2018). These prevalence rates are comparable to international data (Alonso
et al., 2018; Benjet et al., 2019; Bruffaerts et al., 2018, Cía et al., 2018).
Undergraduate students are particularly susceptible to the onset and/or exacer-
bation of mental health disorders as they develop identities separate from their
families, contend with challenging tasks (Pedrelli, Nyer, Yeung, Zulauf, &
Wilens, 2015), and embark upon new experiences, relationships, and living

CONTACT Milushka M. Elbulok-Charcape MCharcape@gc.cuny.edu The Graduate Center, CUNY,

Educational Psychology, 365 5th Avenue, New York, NY 10016, USA
© 2020 Taylor & Francis
328 M. M. ELBULOK-CHARCAPE ET AL.

situations (Liu, Stevens, Wong, Yasui, & Chen, 2019). Because the vast majority
of chronic mental health disorders begin by age 24 (NAMI, 2016), early identi-
fication and targeted treatment during emerging adulthood is critical (Pedrelli
et al., 2015). Failure or resistance to treat mental health disorders is associated
with negative consequences such as academic underperformance (Bruffaerts
et al., 2018), health disparities (Hatzenbuehler, Phelan, & Link, 2013), difficulty
securing employment (Krupa, Kirsh, Cockburn, & Gewurtz, 2009; Stuart, 2006),
criminal justice problems (Watson, Corrigan, & Ottati, 2004), compromised
civil rights (Hemmens, Miller, Burton, & Milner, 2002), and mental health
stigma (Rüsch, Angermeyer, & Corrigan, 2005; Schnyder, Panczak, Groth, &
Schultze-Lutter, 2017).
Mental health stigma can be defined as the devaluation, marginalization,
and stereotyping of individuals living with mental illness (Goffman, 1963;
Link & Phelan, 2001). Generally, mental health stigma contributes to lower
quality of life (Corrigan & Watson, 2002) and interferes with access to
important social and structural supports such as education, income, health-
care, employment, housing (Seroalo, Du Plessis, Koen, & Koen, 2014; Sharac,
Mccrone, Clement, & Thornicroft, 2010), in turn increasing experiences of
marginalization among these individuals. In undergraduate students, mental
health stigma is negatively associated with help-seeking attitudes (Clement
et al., 2015; Masuda & Boone, 2011), and perceived need for medication,
therapy, as well as other sources of support (Eisenberg, Downs, Golberstein,
& Zivin, 2009). Mental health stigma deters students from self-disclosing
mental health problems due to fear that doing so will result in discrimination
at school and limit potential employment opportunities (Martin, 2010).
Moreover, college students who disclose their mental illness history perform
worse on standardized tests (Quinn, Kahng, & Crocker, 2004). Mental health
stigma among college students has also been found to increase psychological
symptom distress (Denenny, Thompson, Pitts, Dixon, & Schiffman, 2015),
and exacerbate stress and depression as well as suicidal behaviors (Hirsch,
Rabon, Reynolds, Barton, & Chang, 2017).
Maintenance and intensification of mental health stigma may be attributed to
numerous variables including low mental health literacy – i.e., knowledge and
beliefs about mental disorders which aid their recognition, management, or
prevention (Jorm et al., 1997), certain cultural factors, and demographic vari-
ables. For example, research has consistently found that individuals with low
levels of mental health literacy have negative mental health attitudes (Beatie,
Stewart, & Walker, 2016; Rafal, Gatto, & DeBate, 2018). Additionally, a host of
cultural factors may contribute to mental health stigma including enculturation
(Hirai, Vernon, Popan, & Clum, 2015), cultural beliefs against mental illness
(Rayan & Fawaz, 2018), cultural mistrust of mental health professionals
(Gulliver, Griffiths, & Christensen, 2010), and values that promote spiritualism,
familism, collectivism, interdependence, and cooperation (Abdullah & Brown,
 JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 329

2011). Also, specific demographic variables such as being male (Brown, Moloney,
& Brown, 2018; Pedersen & Paves, 2014) and being a member of a racial/ethnic
minority group (Pedersen & Paves, 2014; Smith & Applegate, 2018) associate
with higher mental health stigma.
Various interventions (Bingham & O’Brien, 2018; Stanley, Hom, & Joiner,
2018), events (Hankir et al., 2017), programs (Zalar, Strbad, & Svab, 2007),
workshops (Hamann, Mendel, Reichhart, Rummel-Kluge, & Kissling, 2016),
and curricula (Carroll, 2018) have focused on reducing or ending mental
health stigma among undergraduate students. Efforts to combat mental health
stigma, negative associated outcomes, and incidence of mental health disorders
in college students have been documented in the literature. However, under-
graduate student perceptions on how to end mental health stigma, and factors
(including diagnosis or treatment for a mental health disorder) mediating
those perceptions have not been thoroughly investigated. To our knowledge,
only two studies have explored undergraduate perceptions about how to
reduce mental health stigma-related attitudes (Vidourek & Burbage, 2019;
Wada et al., 2019). Vidourek and Burbage (2019) utilized a structured inter-
view and included 23 students at a public, urban university in the U.S. The
researchers found that the majority of participants identified stigma as
a barrier to receiving mental health treatment (Vidourek & Burbage, 2019).
Additionally, participants suggested that education and awareness could
reduce stigma associated with having a mental health problem (Vidourek &
Burbage, 2019). Wada et al. (2019) utilized one or more of the following
approaches with 24 students from a university in Canada: semi-structured
interviews, focus groups, and Photovoice. The most prominent student sugges-
tions for combatting mental health stigma included raising awareness about
mental health including its prevalence (leading to normalization of mental
illness); educating faculty and staff about how to recognize symptoms in
students and direct them to appropriate resources; and promoting existing
mental health resources (Wada et al., 2019). While these studies represent
a strong first step in understanding student views about mental health stigma,
the small sample sizes and homogeneous demographic characteristics (e.g.,
predominantly female greater than 80% for both studies, Caucasian; Vidourek
& Burbage, 2019; Wada et al., 2019) limit transferability.
In the current study, we build upon previous research by directly soliciting
undergraduate student ideas about how to end mental health stigma. We also
consider how these ideas are mediated by four variables that might impact
mental health stigma: gender, race/ethnicity, self-reported prior diagnosis of
a psychological disorder, and self-reported prior treatment for a psychological
disorder. This study is novel and extends the literature by investigating the
suggestions of diverse undergraduate students, including those with history of
mental health diagnosis and/or treatment, for how to end mental health stigma.
330 M. M. ELBULOK-CHARCAPE ET AL.

Methods
This project was part of a larger study on mental health issues, knowledge
about mental health disorders and related topics, and mental health help-
seeking behaviors among diverse undergraduates. For the current study, we
analyzed responses to the open-ended question “How we can end stigma
associated with mental health issues?” We subsequently examined responses
to that item in relation to four relevant variables: sex/gender, race/ethnicity,
disclosure of mental health diagnosis (“Yes” or “No” response to the question
“Have you ever been diagnosed with a psychological disorder?”), and prior
psychological treatment (“Yes” or “No” response to the question “Have you
ever been treated for a psychological disorder?”).

Participant recruitment
Institutional Review Board (IRB) approval was obtained prior to participant
recruitment. Participants were undergraduate students from a large, urban
university system in the Northeast United States. Classroom instructors across
many academic departments were contacted in-person or through e-mail to
obtain permission for the administration of the survey during class time. Other
recruitment methods included scheduled open administration sessions, subject
pool listings, and requests to participate at densely populated campus locations
(e.g., cafeterias, libraries, student lounges). Only undergraduate students who
were actively enrolled and over age 18 were eligible to participate. The research
team read IRB-approved scripts informing participants about the study, survey
overview, steps to ensure confidentiality, voluntary participation, and partici-
pants’ right to withdraw. The duration of the survey was approximately
30–40 minutes. Participants recruited from subject pool listings received course
credit, while those recruited through other methods were offered 5 USD as
a token of appreciation.

Thematic analysis
Responses to the open-ended question, “How we can end stigma associated with
mental health issues?” were coded using thematic analysis, which refers to
qualitative analytic approaches used by researchers in diverse fields (e.g.,
Braun, Clarke, Hayfield, & Terry, 2019; Clarke & Braun, 2013; Gagnon &
Roberge, 2012; Karlsen, Gabrielsen, Falch, & Stubberud, 2017; Lehtomäki,
Moate, & Posti-Ahokas, 2016). We followed Braun and Clarke’s framework
(2006), which allows researchers to identify semantic and latent themes within
qualitative data through a six-step approach that includes: 1) familiarizing
oneself with the data; 2) generating initial codes (through the process of devel-
oping and modifying themes); 3) searching for themes; 4) reviewing themes; 5)
 JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 331

defining themes; and 6) reporting the thematic analysis. Two research assistants
independently analyzed responses using this method of analysis. First, each
research assistant reviewed student responses to familiarize himself/herself
with the data. Next, each research assistant independently generated a list of
initial codes. Subsequently, they compared these initial codes and agreed upon
a final list. Individual participant responses were then categorized indepen-
dently; categorizations were compared and when required, reconciled. Finally,
definitions of the final themes were refined and results were reported.

Quantitative analysis
Descriptive statistics of frequency and percentage were conducted to describe
the categorical variables. The focus of the study was participants’ coded
responses on how to end stigma and the distribution of these responses in
relation to: 1) sex/gender 2) race/ethnicity 3) disclosure of mental health diag-
nosis and 4) prior psychological treatment categorical; all data were categorical.
As such, we used either Pearson chi-square tests or Fisher’s exact test (when cell
size had fewer than five cases for each of the four variables). IBM SPSS Statistics
version 22 was used for analyses. All reported p-values are two-sided.

Results
Participants were 1,255 undergraduate students with a mean age of 22.4
(SD = 4.97) and median age of 21.0 (the average age of an undergraduate student
is 24 at the university where data collection occurred; CUNY Office of
Institutional Research and Assessment, 2019). Most participants self-identified
as female (61.6%), followed by male (38.0%) and “Other” (0.5%). For ethnicity,
27.1% of participants self-identified as Black/African American, 26.1% as White/
Caucasian, 18.7% as Hispanic/Latino, 19.6% as Asian American, 0.3% as Native
American, 2.2% as “Other,” and 6.0% as more than one race/ethnicity. Of the
entire sample, 166 (13.4%) reported having been diagnosed with a psychological
disorder, and 147 (11.9%) reported having been treated for a psychological
disorder. The thematic analysis led to the identification of 18 themes. Table 1
contains the list of themes, definitions, and exemplars. Table 2 contains fre-
quency and percentages corresponding to themes endorsed by participants.
While most participant responses fell under one theme (n = 969; 77.21%),
a smaller percentage of responses fit within two themes (n = 240; 19.12%), and
few responses fit within three themes (n = 46; 3.67%). As such, the total number
of responses (1,586) exceeded the total number of participants (1,255). The top
four themes were: education (n = 325; 20.49% of responses), awareness (n = 271;
17.09% of responses), positive atmosphere (n = 178; 11.22% of responses), and
open discussion (n = 163; 10.28% of responses). There were 83 missing responses
(subsumed under the theme “Response cannot be Coded,” n = 136). The
332 M. M. ELBULOK-CHARCAPE ET AL.

Table 1. Identified themes for how to end mental health stigma.

Theme Definition Exemplar
Awareness Making the public aware of mental health “Bringing more recognition about mental
disorders and people living with them health in different platforms like social
through typical mediums (television, media”
social media, e-mails, etc.), formal
campaigns, advocacy, advertisement.
Education Educating the public about mental health, “Educate more students not familiar with
explaining symptoms, causes, prognosis, mental illness (other than psych
and other statistics. students)”
Open discussion Addressing the topic of mental health “Talking about it more often, being honest
openly and directly through conversation. about it”
Modification of Avoiding labels; not using language that “Discontinue the term ‘crazy’”
language further casts people living with mental
health disorders in a negative light.
Challenging Challenging negative representations, “We can end it by not portraying people
stereotypes misconceptions, judgments, with mental health issues as psychopaths,
misinformation, stereotypes of people but rather people”
with mental health disorders.
Promoting (the Promoting mental health resources, “Promoting available counseling that’s
use of) counseling. Encouraging help-seeking free”
resources attitudes and behaviors.
Positive Expressing the need for empathy, “Provide people with a warm, supporting
atmosphere compassion, acceptance, comfort, & non-judgmental environment”
assurance, and inclusivity when
interacting with people living with mental
health disorders.
Utilizing informal Addressing the topic of mental health “Have fairs and rallies”
settings through an informal setting (e.g.,
carnivals, fairs, clubs, safe spaces, etc.).
Conducting Conducting further psychological research “More research on mental health”
research into mental health disorders.
Reconceptualizing Reconceptualizing mental illness. Not “By not treating mental health like
mental illness viewing mental illness as a deficiency, a taboo illness or topic”
fault, or as a negative but rather as
normal.
Ensuring privacy/ Assuring those seeking/receiving “Tell people (ensure them) that these
confidentiality psychological services that their services are completely anonymous
information will remain private and/or (confidential)”
confidential.
Insensitive Response showing insensitivity to mental “Stop being softies”
health stigma.
Changing Changing the educational curriculum to “Professors shouldn’t give presentations as
educational accommodate people with diverse part of a pass/fail the class grading
curriculum psychological diagnoses. system. I have social anxiety and I’ve
failed classes in college because of that.
I think it’s unfair”
Unsure/Do not Being unsure or being unable to generate “I’m not sure”
know a response.
Elimination of Responses expressed that eliminating or “Stigmas will always exist”
stigma is reducing mental health stigma is unlikely
unlikely or or impossible.
impossible
Response cannot Blank responses; illegible or unintelligible “Nobody’s perfect. All humans are created
be coded responses; responses that defied equal”
classification.
Protest Shaming or punishing those who engage “Punish those who humiliate people with
in mental health stigma. mental health issues”
Contact-based Having contact with people living with “Continue to talk about it more openly,
methods mental illness to diminish prejudice. invite people affected by it to come speak”
 JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 333

Table 2. Stigma themes by frequency of responses.

Theme Frequency Percentage
Education 325 20.49%
Awareness 271 17.09%
Positive atmosphere 178 11.22%
Open discussion 163 10.28%
Response cannot be coded 136 8.58%
Promoting (the use of) resources 136 8.58%
Unsure/Do not know 114 7.19%
Challenging stereotypes 66 4.16%
Re-conceptualizing mental illness 48 3.03%
Utilizing informal settings 40 2.52%
Modification of language 23 1.45%
Elimination of stigma is unlikely or impossible 21 1.32%
Ensuring privacy/confidentiality 17 1.07%
Changing educational curriculum 16 1.01%
Insensitive 11 0.69%
Contact-based methods 11 0.69%
Conducting research 7 0.44%
Protest 3 0.19%
Total 1,586 100.0%
Note: Total number exceeds total number of participants as participant responses could fit
within more than one theme.

majority of these responses belonged to female participants (55.4%). For ethni-

city, 28.9% of participants self-identified as Black/African American, 28.1% as
White/Caucasian, 15.7% as Hispanic/Latino, 15.7% as Asian American, 0.0% as
Native American, 2.4% as “Other,” and 8.4% as more than one race/ethnicity.
The overwhelming majority of participants with missing responses selected “no”
to the questions asking whether they had been diagnosed with a mental health
disorder (93.8%) or whether they had received mental health treatment (93.8%).
Next, Pearson chi-square tests or Fisher’s exact tests were performed to
determine the relation between student responses pertaining how to end mental
health stigma and sex/gender, race/ethnicity, disclosure of mental health diag-
nosis, and prior psychological treatment. Results are reported in Table 3. The
categorical variable of ethnicity/race was dichotomized (White and non-White).
For sex/gender, because only six participants self-identified as “Other” when
asked to report their sex/gender (these responses were excluded in the quanti-
tative comparisons, as cell sizes were too small for analyses).
Six category responses on how to end stigma differed by sex/gender. The
relation between the theme awareness and sex/gender was significant, X2 (1,
n = 1248) = 6.684, p = .010. Males were less likely, compared to females, to
endorse awareness as a method for reducing or eliminating mental health
stigma. The relation between the theme education and sex/gender was also
significant, X2 (1, n = 1248) = 8.442, p = .004. A lower proportion of males
selected education as a method to reduce mental health stigma. The relation
between the theme research and sex/gender was also significant, (1, n = 1248)
p = .014. A greater proportion of males endorsed conducting research when
334 M. M. ELBULOK-CHARCAPE ET AL.

Table 3. Significant and non-significant (N.S.) results of non-parametric tests by themes.

Themes Males Non-White Self-reported Diagnosis Self-reported Treatment
Education Negative N.S. Positive Positive
Awareness Negative N.S. N.S. N.S.
Positive atmosphere N.S. N.S. N.S. Negative
Open discussion N.S. N.S. N.S. N.S.
Protest N.S. N.S. N.S. N.S.
Conducting research N.S. N.S. N.S. N.S.
Cannot eliminate Positive N.S. N.S. N.S.
Curriculum Negative N.S. Positive Positive
Reconceptualization N.S. Positive Positive Positive
Cannot be coded N.S. N.S. Negative N.S.
Research Positive N.S. N.S. N.S.
Cannot eliminate Positive Positive N.S. N.S.

asked how mental health stigma could be ended. The relation between the
theme changing the educational curriculum and sex/gender was significant,
X2 (1, n = 1248) = 6.375, p = .013. Males were less likely than females to
suggest that the curriculum should be changed to accommodate students
with psychological issues. The relation between the theme unlikelihood of
eliminating mental health stigma and sex/gender was significant, X2 (1, n
= 1248) = 7.367, p = .007. Males were more likely to state that eliminating
mental health stigma was unlikely or impossible. Finally, the relation between
responses that could not be coded and sex/gender was significant, X2 (1, n
= 1248) = 5.145, p = .023. Males were more likely than females to leave
a blank response or a response that could not be coded.
Only two category responses on how to end stigma differed according to
race/ethnicity. The relation between the theme mental health reconceptuali-
zation and race/ethnicity was significant X2 (1, n = 1255) = 6.313, p = .012.
A smaller proportion of White (compared to non-Whites) stated that mental
health should be reconceptualized. The relation between the theme unlikeli-
hood of eliminating mental health stigma and race/ethnicity was significant,
X2 (1, n = 1255) = 5.154, p = .023. White participants were less likely to
suggest that eliminating mental health stigma was unlikely or impossible.
Four responses on how to end stigma differed according to self-reported
mental health diagnosis. The relation between the theme education and
disclosure of a mental health diagnosis was significant X2 (1, n
= 1237) = 4.206, p = .040. Participants who reported having received a mental
health diagnosis were more likely to endorse education to end mental health
stigma. The relation between the theme reconceptualization and disclosure of
a mental health diagnosis was also significant X2 (1, n = 1237) = 5.764,
p = .016. Students who reported having received a mental health diagnosis
were more likely to suggest that mental health should be reconceptualized.
The relation between the theme changing the educational curriculum and
disclosure of a mental health diagnosis was significant X2 (1, n
 JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 335

= 1237) = 9.233, p = .002. Students who reported having received a mental

health diagnosis were more likely to suggest that to end mental health stigma,
the educational curriculum should be modified to accommodate people
living with mental health diagnoses. Lastly, the relation between responses
that could not be coded and disclosure of a mental health diagnosis was
significant X2 (1, n = 1237) = 4.222, p = .040. In other words, participants
who reported having received a mental health diagnosis were less likely than
those without a diagnosis to leave a blank response or a response that could
not be coded.
There were four responses on how to end stigma that differed according to
self-reported prior psychological treatment. The relation between the theme
education and prior psychological treatment was significant X2 (1, n
= 1237) = 4.733, p = .030. A higher proportion of students who reported having
been treated for psychological treatment endorsed education as a way to end
mental health stigma. The relation between the theme positive atmosphere and
prior psychological treatment was significant X2 (1, n = 1237) = 3.863, p = .049.
Participants who reported having received prior psychological treatment were
less likely to endorse suggesting a positive atmosphere to reduce mental health
stigma. The relation between the theme reconceptualization and prior psycho-
logical treatment was significant X2 (1, n = 1237) = 5.805, p = .016. Participants
who reported having received prior psychological treatment were more likely to
state that mental illness should be reconceptualized to end mental health stigma.
Finally, the relation between the theme changing the educational curriculum and
prior psychological treatment was significant (1, n = 1237) p = .005. Participants
who reported having received prior psychological treatment were more likely to
state that to end stigma, the educational curriculum should be modified to
accommodate people living with mental health diagnoses.

Discussion
In our sample of over 1,200 demographically-diverse students, the most com-
mon ideas for how we can “end mental health stigma” were education, aware-
ness, a positive atmosphere, and open discussion; these themes accounted for
roughly 60% of all responses. Our results are generally consistent with the two
previous qualitative research studies (conducted on small student samples),
which identified stigma-reducing strategies such as education, awareness
(Wada et al., 2019), and being compassionate (Vidourek & Burbage, 2019).
In terms of educational efforts, a common suggestion was for such efforts
not to be limited only to psychology students and to be offered from an early
age. In terms of awareness, a common suggestion was hearing stories about
mental health stigma. This idea is consistent with Corrigan’s strategic stigma
change model, which suggests that sharing stories impacts others (2016), and
Wada et al. (2019) idea about normalizing mental illness by becoming aware
336 M. M. ELBULOK-CHARCAPE ET AL.

of its prevalence and the ability to succeed despite struggling with psycholo-
gical issues. Participant responses also raised the importance of considering
the emotional components of mental health stigma. For example, many
students who endorsed the positive atmosphere theme, recommended the
need for empathy, compassion, and acceptance when dealing with people
living with mental health disorders. One student suggested that “students
[should …] consider opening up to professionals with ‘a ‘gentle embrace’ ex:
motivation with charisma rather that [being] too straight forward.” Such
suggestions, however, may be difficult to enact and measure. For open
discussion, the fourth most highly endorsed theme, students suggested having
“more […] frequent, open, normative conversation on mental health issues.”
A theme that accounted for approximately 10% of responses was promoting
the use of resources. This is particularly important, as a number of students
(8.63%, n = 136) suggested that mental health stigma could be eliminated “by
keeping students informed of resources.” Unfortunately, the majority of stu-
dents in our study reported being unaware of campus initiatives promoting
mental health awareness; these initiatives may be key to directing students to
suitable and cost-effective treatments.
Our findings are in contrast to some other work that has identified
protest (Casados, 2017; Corrigan & Penn, 1999; Corrigan et al., 2001) as
a common method to combat mental health stigma. Protest refers to an
explicit denouncement of people who offend or mistreat those living with
mental illness (Corrigan, Kerr, & Knudsen, 2005), while contact-based
methods refer to having direct interactions with people living with mental
illness as a way to diminish prejudice (Corrigan, Larson, Sells, Niessen, &
Watson, 2007; Corrigan, Morris, Michaels, Rafacz, Rüsch, 2012; Corrigan
et al., 2001; Gronholm, Henderson, Deb, & Thornicroft, 2017; Wong,
Collins, Cerully, Jennifer, & Seelam, 2018). In the current study, protest
was one of the least endorsed themes (0.69%, a total of three times), while
contact-based methods were endorsed less than 1% (0.19%, a total of 11
responses). Students instead opted for more restrained methods (e.g., open
discussion, education, positive atmosphere) to end stigma, which suggests
that some students find more forceful methods less effective or possibly,
counterproductive. It is important to note that we made a distinction
between the themes of contact-based methods and awareness. While some
researchers define the contact model as both interactions with individuals
and presentations of their stories (Corrigan, 2016), we decided to separate
this general idea into explicit, direct contact with people living with mental
illness (contact-based methods) versus making the public aware of mental
health disorders and the stories of people who live with them (awareness).
We felt that distinguishing these types of approaches more accurately
captured the ideas put forth by our participants regarding the restrained
approaches to end stigma.
 JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 337

We next considered potential moderators of coded responses for how to end

stigma. Racial/ethnic groups were dichotomized into White and non-White
groups. Non-White students were more likely to endorse the reconceptualiza-
tion of mental health above and beyond other themes. In other words, they
suggested that mental illness should not be viewed negatively and that the
concept of mental health/illness should be considered normal. Non-White
participants also were more likely to report that the elimination of mental health
stigma was unlikely or impossible. This finding is particularly troubling, as
students who belong to stigmatized racial/ethnic groups have been found to
have higher levels of stigma (Guarneri, Oberleitner, & Connolly, 2019).
However, generalizations across different racial/ethnic minority groups and
mental health stigma cannot be made (Rao, Feinglass, & Corrigan, 2007) as
considerable variability exists (Lipson, Kern, Eisenberg, & Breland-Noble, 2018;
Masuda & Boone, 2011). Additionally, the question of whether unmeasured
cultural and contextual factors account for differences, not race/ethnicity,
remains (American Psychological Association, 2003a).
Male students, compared to female students, were less likely to endorse
awareness, education, and curriculum changes as methods to end mental health
stigma. In addition, male students were more likely to provide responses that
could not be coded and express that eliminating mental health stigma was
unlikely or impossible. These findings are interesting considering previous
research. While earlier studies have documented that the stigmatization of
mental illness is different for males and females (Chandra & Minkovitz, 2006;
Leong & Zachar, 1999; Wirth & Bodenhausen, 2009), recent work has found that
related factors (e.g., stereotypical gender) may also contribute to mental health
stigma (Boysen & Logan, 2017). Studies also reveal that when disclosing mental
illness, both public stigma, a population’s negative appraisal of ostracized groups
(Hamilton & Sherman, 1994) and perceived burden of stress, may be higher for
male college students with mental illness compared to their female counterparts
(Brown et al., 2018). This may partially explain why males were less likely to
suggest certain methods to end mental health stigma and express skepticism
about the possibility of eradicating such stigma. It is encouraging, however, that
males were more likely to endorse research into the topic of mental health as
a potential solution.
Participants who self-disclosed having been diagnosed with or treated for
a mental health disorder had comparable suggestions for how to end mental
health stigma. Both groups suggested that education, reconceptualization of
mental health, and changes in the educational curriculum could help eliminate
mental health stigma. While education was suggested by the overall sample,
reconceptualization of mental health, and changes in the educational curriculum
was not. For reconceptualization of mental health, several participants suggested
for mental health to be normalized, and for people to “talk and treat mental
health checkups like normal medical checkups.” A substantial number of
338 M. M. ELBULOK-CHARCAPE ET AL.

respondents who suggested curriculum changes to accommodate their mental

health diagnoses expressed disappointment, anger, and dismay when faculty
members ignored or misunderstood their mental health condition. To illustrate,
a participant stated that his “attendance is affected by my mental health and
attendance policies are not sensitive to this.” Another shared that after disclosure
of a mental health disorder, she “provided a letter from my psychiatrist, but [the
instructor] treated me as if I made it up and should snap out of it.” While studies
have investigated college students’ attitudes toward mental health and mental
health stigma (Feeg, Prager, Morgan, Smith, Maurer, & Cullinan, 2014; Zolezzi,
Bensmail, Zahrah, Khaled, & El-Gaili, 2017), mental health stigma-related
research rarely inquires about the experiences of individuals with mental illness
(Casados, 2017) and few studies have investigated stigmatized groups in uni-
versity settings (Guarneri et al., 2019). Paradoxically, in our study, participants
who self-reported having been treated for a mental health disorder were overall
less likely to suggest maintaining a positive atmosphere as a way to end mental
health stigma. Future research should confirm and determine an underlying
reason for this finding.
The current study has some limitations. The study was conducted in
a limited geographic area and requires replication among college students
in other parts of the U.S. In terms of content, the two questions that asked
students to disclose whether they had been diagnosed with a mental health
disorder or whether they had received mental health treatment were optional.
This might have discouraged some students who fall into these categories
from providing a response to these questions. Moreover, information per-
taining to specific mental health diagnoses and type of treatment was not
collected but could be instructive, as previous research has found that type of
disorder may moderate the relationship between mental health stigma and
demographic variables (Grant, Bruce, & Batterham, 2016). Furthermore, we
were unable to consider other potentially relevant moderator variables, such
as a predisposition to anxiety symptoms (Pedersen & Paves, 2014), self-
reliance (Jennings et al., 2015), perfectionism (Shannon, Goldberg, Flett, &
Hewitt, 2018), limited experience with mental health issues and systems, and
low recognition of need for psychotherapeutic help (Mendoza, Masuda, &
Swartout, 2015). Finally, 136 of our responses could not be coded and 114
respondents reported that they were unsure/did not know how to end mental
health stigma. It is possible that the phrasing of our question contributed to
these unusable responses. For example, we could have asked how to “reduce”
instead of “end” mental health stigma, as it may be impossible to end some-
thing so pervasive in our society.
Based on our results, future research should investigate undergraduate stu-
dent perceptions about specific interventions intended to combat mental health
stigma. Special attention should be granted to ideas identified in the current
study and to student groups that are prone to greater mental health stigma (e.g.,
 JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 339

men, those with a mental health diagnosis, racial/ethnic minorities, those receiv-
ing mental health treatment). Research exploring within-group variation in
mental health stigma in relation to culture is sparse (Abdullah & Brown, 2011)
and may inform knowledge about vulnerable groups and targeted interventions
that might be maximally effective for or accepted by specific student subgroups.

Conclusions
Much time, money, and effort have been spent on initiatives to combat mental
health stigma (Angermeyer & Dietrich, 2006; Sartorius & Schulze, 2005). Yet,
data on the methods to combat and possibly end stigma have been inconsistent
as there is no established intervention protocol (Mittal, Sullivan, Chekuri,
Allee, & Corrigan, 2012; Stanley et al., 2018). Moreover, existing interventions
are not based on students’ direct suggestions, and rarely have long-term effects
(Casados, 2017). Approaching students for implementation guidance is novel
and could provide a fresh perspective on the issue. We found that education,
awareness, and a positive atmosphere were the top student suggestions for
ending mental health stigma. These findings can guide mental health profes-
sionals as they create targeted interventions informed by undergraduates for
undergraduates. To our knowledge, such an intervention would be the first of
its kind and could be the key to combatting mental health stigma in college
settings and beyond.

Disclosure Statement
The authors report no conflict of interest.

Funding
This work was supported by the JCK Foundation.

ORCID
Milushka M. Elbulok-Charcape http://orcid.org/0000-0003-0674-8557

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