摘要：Stigma against mental illness is a complex construct with affective, cognitive, and behavioral components. Beyond its symbolic value, federal law can only directly address one component of stigma: discrimination. This article reviews three landmark antidiscrimination laws that expanded protections over time for individuals with mental illness. Despite these legislative advances, protections are still not uniform for all subpopulations with mental illness. Furthermore, multiple components of stigma (e.g., prejudice) are beyond the reach of legislation, as demonstrated by the phenomenon of label avoidance; individuals may not seek protection from discrimination because of fear of the stigma that may ensue after disclosing their mental illness. To yield the greatest improvements, antidiscrimination laws must be coupled with antistigma programs that directly address other components of stigma. INDIVIDUALS WITH MENTAL illness experience disparities in health care, education, and employment outcomes, and the stigma associated with mental illness is a central contributing factor to these disparities. 1–6 Stigma is a complex construct with four social-cognitive processes (i.e., cues, stereotypes, prejudice, and discrimination) that may be directed by others toward those with mental illness (i.e., public stigma) and may occur within an individual with mental illness (i.e., self-stigma). To examine the role of federal policy in improving disparities resulting from the stigma process, we first provide a brief overview of stigma and highlight how federal legislation only directly addresses one of its components—discrimination resulting from public stigma. Next, we provide an overview of three landmark antidiscrimination laws in health care (Mental Health Parity and Addiction Equity Act [MHPAEA] 7 of 2008), education (Education for All Handicapped Children Act [EAHCA] 8 of 1975), and employment (Americans with Disabilities Act [ADA] 9 of 1990) and highlight three common features they share (1) expanded protections over time for persons with mental illness, (2) differential protections for subgroups with mental illness, and (3) implementation challenges resulting from label avoidance that undermine the ability of these laws to yield better outcomes. Finally, we highlight how antidiscrimination legislation must be complemented by approaches that directly target other components of the stigma process (e.g., prejudice) to yield the greatest improvement in outcomes for this population.
