Solving for stigma in mental health care.

When we face an equation with an unknown variable, we 'solve for x', using methods that allow us to isolate and identify the unknown. Stigma is a known variable in health care equations, but remains impactful in a variety of ways that are not fully mapped or understood. In other words, stigma is a known unknown: it presents potential obstacles to the delivery of effective health care, but what kind of obstacles, of what size and significance, and for whom is often unclear. This paper investigates what Erving Goffman called the 'stigma situation': 'the situation of the individual who is disqualified from full social acceptance.' The core argument is that to successfully incorporate the experiential knowledge of mental health care service users, we must first solve for stigma-that is, we must determine the nature and scope of its significance, and then mitigate its effects. The present paper begins by demonstrating that stigma in mental health care remains an obstacle worthy of sustained attention. It then discusses typical methods taken in efforts to destigmatize mental illness, and suggests that additional work is needed in the clinical context of mental health care. The pervasiveness and complexity of stigma requires diligence in clinical settings to integrate the experience of mental health care service users and work towards an adequate model of recovery.