External perceptions contribute to self-stigma 

Many clients living with serious mental illness (SMI) walk into care already minimizing what and how they think about themselves. Absorbing what the world tells them about mental illness, they see themselves through that lens. Those messages become internalized, leading to beliefs that they don’t belong, they’re broken or their goals aren’t achievable. 

While self-stigma may appear to be an internally driven experience, it doesn’t form in isolation. Self-perception is shaped by the systems people encounter, including the language used in clinical settings and the design of care models, making self-stigma not just a personal struggle, but also a systemic issue.

Healthcare systems are part of that narrative

Every healthcare environment communicates unspoken messages about identity, value and belonging. Using labels like “patient” can subtly establish a dynamic that says, “I’m sick and you’re taking care of me.” That characterization alone can reinforce people seeing themselves as defined by illness rather than as capable partners in their own care.

Whether it’s a provider interacting directly with a client or a staff member handling scheduling or billing questions, every touchpoint with the healthcare system sends a message to those living with SMI about who they are and how much their voice matters. When appointments are structured around compliance instead of collaboration, that can quietly suggest the expectation is to follow orders, not to participate. Rushed visits or fragmented care can leave people feeling like their story doesn’t fit or that there isn’t time or space for all that they’re carrying.

These often unintentional signals teach clients who they are within the healthcare setting. Over time, these small moments can reinforce the very self-stigma many clients already bring into the room.

How language shapes self-perception

One of the most immediate ways organizations can counteract self-stigma is through intentional language. Reframing common terms to promote dignity and partnership plays a powerful role in shaping how individuals experience care. For example, using the word “client” instead of “patient” communicates that a person is coming for a service, not to be defined by an illness. Another example includes taking words like “non-compliant,” which imply blame, and replacing them with phrases such as “facing barriers.” Even describing something as a “challenge” rather than a “problem” conveys that growth and progress are possible.

Practically speaking, adopting this approach in care delivery systems and settings can begin with straightforward changes such as revising electronic health record templates, retraining staff and updating policies to reflect person-centered, recovery-oriented language.

Care models to build confidence

In addition to chosen language, the structure of care drastically shapes self-stigma. If treatment isn’t built on shared decision-making, self-stigma grows. In my experience, when clients are included in their treatment plans, they feel empowered to do better. When decisions are made for them, they often withdraw. Care models that emphasize collaboration and transparency, including shared goal-setting and motivational interviewing, help clients recognize their own agency and strengths, rather than feeling like treatment is something happening to them.

For example, when discussing treatment options, the approach should center on aligning care with the client’s goals. Consider the experience of introducing a long-acting injectable treatment, such as ARISTADA®, to a person who has previously only received oral medications. Rather than framing missed doses as a failure, shifting the conversation toward understanding what’s getting in the way and offering support creates space for problem-solving and partnership. This approach allows providers to explore options that fit a person’s lifestyle and strengthen consistency in care. By focusing on solutions rather than implying shortcomings, care teams can reinforce autonomy and self-worth. Presenting treatment in this way moves the conversation from correction to collaboration and helps clients view both the medication and themselves with greater confidence.

Creating a culture of safety and belonging

Feeling psychologically safe within healthcare environments is imperative. For those living with SMI, psychological safety is contingent on feeling seen, heard, validated and wanted. 

Creating a supportive environment extends beyond the exam room. Every person a client interacts with, from the front desk to the clinical team, shapes the experience of care. When staff are trained in trauma-informed approaches, when peer support specialists are part of the team, and when clients are invited to share feedback in ways that feel genuine, it builds a culture where dignity and respect are felt at every step.

This culture is strengthened when healthcare leaders view the complex realities of living with an SMI through a brain-based filter. As people—even as experts in psychiatry—we all behave in response to experiences and feelings. Understanding that our clients react similarly, and viewing their actions as natural extensions of their experiences and not as a sign of failure or misbehavior, helps shift the focus from judgment to partnership. That change in perspective helps transform systems from unintentionally reinforcing stigma to actively reducing it, fostering an environment where clients feel safe, capable, and valued.

When organizations model inclusion, respect and curiosity, they are improving care delivery while actively dismantling the self-stigma many clients have carried for years.

Rebuilding healthcare systems to reflect dignity

Self-stigma is a reflection of the environments people move through. By examining the messages embedded in care delivery, communication and culture, healthcare leaders can design systems that build confidence rather than diminish it.

Language and relationships are central to this shift. Including clients in their care and listening without judgment chips away at often deeply encoded self-stigma.

When every part of the system reinforces dignity, it becomes easier for clients to believe in their own value and potential, and see themselves through a more compassionate and empowering lens.