Stigma Research of the Month: Real-World Effectiveness of the Peer-Led Honest, Open, Proud Programme for Self-Stigma Among Adults With Mental Illness

(By Nicolas Rüsch and colleagues, The Lancet Regional Health – Europe, 2026)

Should people disclose a mental illness at work? To family? Friends? Healthcare professionals? For many people, there isn't a simple answer.

Honest, Open, Proud (HOP) isn't a new intervention. It began as a chapter on disclosure in Patrick Corrigan and Robert Lundin's 2001 book Don't Call Me Nuts: Coping with the Stigma of Mental Illness. In 2011, that work evolved into the peer-led Honest, Open, Proud programme, designed to help people navigate one of the most difficult questions many people with mental illness face: Should I tell people?

Delivered over four group sessions by trained peer facilitators with lived experience, HOP helps participants explore the pros and cons of disclosure, think about different levels of disclosure, decide who they may want to tell, and, if they choose to disclose, how to share their story. Importantly, the programme does not encourage people to disclose, or to keep their mental illness secret. Instead, it supports people to make informed decisions that are right for their own circumstances.

The largest evaluation of HOP to date

This month's featured research provides what the authors believe to be the largest and most rigorous evaluation of the programme to date.

Researchers evaluated HOP in a real-world randomised controlled trial involving 457 adults across nine sites in Germany. Participants included people living with depression, anxiety, PTSD, psychosis, bipolar disorder and other mental health conditions who were recruited from hospitals, outpatient services and community settings. Unlike some earlier studies, the programme was evaluated under routine real-world conditions rather than research environments.

Participants who completed HOP experienced lower self-stigma both immediately after the programme and six months later. They also reported less stigma-related stress, fewer depressive symptoms, greater recovery, improved quality of life, stronger intentions to seek help and greater social inclusion. The programme was delivered by trained peer facilitators with lived experience, was highly rated by participants, and was found to be cost-effective, suggesting it could be implemented widely alongside usual mental healthcare.

Beyond the individual

A commentary published in the same issue of The Lancet Regional Health – Europe (Reducing self-stigma and supporting disclosure in adults with mental illness, Nicola J. Reavley, Amy J. Morgan) argues that programmes such as Honest, Open, Proud are an important part of stigma reduction, but they are only one piece of the puzzle.

Helping people reduce self-stigma and make informed disclosure decisions matters. Equally important is ensuring that the people, organisations and systems they disclose to are prepared to respond well. The authors highlight evidence that supportive responses from friends and family are linked to better mental health, stronger relationships, increased help-seeking and reductions in self-stigma over time. They also argue that workplaces, healthcare organisations, education providers and other institutions need policies, resources and cultures that support people when they choose to disclose.

In other words, reducing stigma requires action both within people and around people. Peer-led programmes can help individuals navigate disclosure, but lasting change also depends on creating environments where disclosure is met with understanding, support and respect.

Why this matters

This study provides strong evidence that peer-led stigma interventions can reduce self-stigma under real-world conditions. But it also reinforces an important principle: that disclosure should always remain a personal choice. While this research focuses on mental illness, the same challenge exists across many forms of stigma, where people must weigh the risks and benefits of disclosing a stigmatised identity or health condition.

The accompanying commentary reminds us that lasting stigma reduction requires action at multiple levels. Supporting individuals to navigate disclosure is important, but so is creating healthcare services, workplaces and communities where disclosure can be made safely.

Published shortly after the death of HOP founder Professor Patrick Corrigan, this study represents the culmination of more than two decades of work to better understand and reduce the impact of mental health stigma.

Action to take

Recognise that disclosure is a personal decision. There is no universally ‘right’ choice and decisions might vary across settings

Invest in peer-led interventions that build confidence, reduce self-stigma and support recovery

Involve people with lived experience in designing and delivering stigma reduction programmes

Address structural and interpersonal stigma alongside self-stigma

Review organisational policies, workplace culture and support systems to ensure people can disclose safely if they choose

Educate managers, clinicians, families and colleagues on how to respond supportively when someone discloses a mental illness

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