The Lancet Commission on ending stigma and discrimination in mental health

The Lancet Commission on Ending Stigma and Discrimination in Mental Health is a major international consensus review published in The Lancet. The Commission brought together more than 50 global experts, including people with lived experience, researchers, clinicians, policymakers, and advocates, and reviewed evidence from over 45 countries.

Its purpose was to synthesise the global evidence base on what drives mental health stigma and what works to reduce it, and to provide authoritative guidance for governments, health systems, and communities worldwide.

The Lancet Commission on ending stigma and discrimination in mental health states clearly that many people describe stigma as worse than the mental health condition itself. Stigma and discrimination restrict access to care, reduce opportunities in employment and housing, and lead to avoidable morbidity and early mortality. Stigma operates at multiple levels — internalised, interpersonal, and structural — and each reinforces the others.

What we can learn:

• Lived experience leadership is non-negotiable. People with lived experience are key change agents in stigma reduction

• Change must target systems, not just attitudes. Policies, service design, funding structures, and language practices all shape whether care is safe or stigmatising

• Contact-based and co-produced approaches work. Empowerment, shared decision-making, and meaningful participation improve engagement and outcomes

• National anti-stigma efforts are more effective when tied to service reform. Campaigns alone are insufficient — they must be linked to community-based care, legal protections, and improved access pathways