Stigma is the system

Until we call it out, nothing changes

I work in wellbeing at Queensland Health. I moved into this role from mental health and alcohol and other drugs, but I have brought that lens with me. I cannot separate workforce wellbeing from mental health. They are the same conversation.

The work I am focused on is simple to describe and difficult to implement.

We have to shatter stigma.

Not reduce it slowly. Not manage it. Shatter it.

Stigma is not an abstract concept. I see it playing out every day.

People do not present to emergency departments because they expect to be judged if they say they are there for mental health. Staff do not say they are not coping. They call in sick and say they have a headache or that they are not feeling well, when what they are actually dealing with is mental health.

We hide it across the board.

We also reinforce it in how we label people. We identify some people as having lived experience, as if that is a distinct group. The reality is different. One in five people will experience significant mental health challenges. That means it is not just the peer worker. It is the nurse, the social worker, the cleaner, the person sitting next to you.

If we only protect the visible group, we fail everyone else.This is why stigma is not just a cultural issue. It is a systems issue.

It affects staff. It affects consumers. It shapes behaviour before anyone even enters a service. It determines whether someone asks for help or stays silent. In many cases, the impact of stigma is worse than the mental health issue itself

The response has to be practical.

Through the Shadow the Stigma programme, we are trying to create environments where people can have open conversations and where stigma is actively challenged. That can start with something as simple as a shirt that sparks a conversation, but it cannot end there.

We have to create spaces where people feel able to say, “That language is not acceptable.” Where calling out stigma is normal. This is not optional. It is necessary.

In the workplace, this means building psychological safety.

I want a system where someone can call in and say, “I am having a mental health day,” and that is understood and respected in the same way as a physical illness.

We already make reasonable adjustments for physical conditions. If someone has asthma, we accommodate that without question. We struggle to do the same for mental health, and the reason is stigma.

Change is happening

We are developing training that is being rolled out across Queensland Health. It is not limited to mental health staff. It is for everyone, because everyone interacts with people experiencing mental health challenges, whether they realise it or not.

We are also introducing practical tools.

Wellbeing plans that allow staff to outline what support looks like for them.
Clear guidance on language.
Resources brought into one place so people do not have to search for them.

These are not complex solutions. They are basic changes that make a difference.

Language matters more than we admit.

We are developing guidance on what not to say, because the words we use shape how people feel and how they are treated. This became clear in areas like infrastructure and design, where people with lived experience were in the room and hearing how they were being described. If we get the language wrong, we reinforce stigma before we even begin.

Design also matters.

We have seen this in practice. In Wide Bay, redesigning facilities with stigma in mind has led to a reduction in seclusion. That is not a small outcome.

If you treat someone like a human from the moment they walk in, they are more likely to respond as a human. If you introduce barriers, you send a different message. You signal fear. You reinforce the idea that the person is a problem.

When that happens, behaviour changes. An aggressive interaction is not just about the individual. It is about the environment they are placed in.

This extends to how we respond to people in crisis.

There is a difference between what we might call “mad” and “bad.” If someone is a risk in a criminal sense, there are appropriate responses. But when someone is experiencing mental health distress, the response has to be grounded in compassion.

If we treat people well, we change outcomes.

Even conversations within teams reflect this shift. I have had security staff approach me asking how they can do better, how they can respond differently, how they can avoid unnecessary force.

That is what change looks like. So what do we actually do?

We start with the basics.

Have the conversation. Be upfront. Call out stigma when you see it. Get informed. Make changes. Educate others. Be compassionate. These are not complex instructions. They are actions we can take immediately.

If I had to leave one message, it is this.

Treat people like humans.

It sounds obvious, but it is not how systems are currently designed or how they consistently operate. If you treat someone like a human, you are more likely to get a human response. If you recognise that everyone has some level of vulnerability, you start to break down the barriers that stigma creates.

At the end of the day, that is what this comes back to. Everyone is human.

Until we build systems that reflect that, stigma will continue to shape outcomes more than care itself.

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