Cross-National Public Support for Mental Health Policies: The Influence of Stigma, National Culture and Political Landscape

Health inequalities are created and sustained in various ways. While individual advantages or disadvantages play a role in determining health outcomes, the social policies of welfare states have received increased attention as a mechanism that creates health inequalities. Multiple factors impact the design of programs, the provision of services and financing mechanisms for a nation’s health care system, but it is clear that public support is a major determinant for ongoing and transformations in health care policies. We know that the public is generally supportive of health policies, but government responsibility for mental health and behavioral health care has received significantly less public support than for comparable health policies cross-nationally. The current study uses nationally representative data for Belgium, Germany, Hungary, Iceland, Spain, Great Britain and the United States drawn from the Stigma in Global Context-Mental Health Study (SGC-MHS). Although prevalent cultural stereotypes are associated with policies and practices that disadvantage persons with mental illnesses, no methodologically coordinated study has demonstrated the extent to which mental illness is stigmatized and results in inequalities in policies cross-nationally. Our results show cross-national variation in public support for government responsibility for mental health policies ranging from 39% in the United States to 86% in Iceland. Variable dimensions of stigma capture multifold expressions of the public’s view about mental illness that impact governments’ assuming responsibility for mental health care along with other influences including literacy about mental illness, shame associated with receiving public support, political affiliation and support shown for minority racial/ethnic groups with a mental illness. The results provide insights into the public pressures policymakers face when making decisions about mental health policies that ultimately have consequences for how vulnerable groups with mental illness are treated and the inequalities likely to exist within and across societies.