In conversation with structural stigma researcher Dr. Stephanie Knaak
Stephanie Knaak has been studying structural stigma for the better part of a decade. She’s an expert in the foundational policies, laws, and practices in our health-care system that put people who live with mental illness at a disadvantage.
“But that doesn’t mean I have all the answers,” said Knaak from her home office in Golden, B.C., where she’s been working since the onset of the pandemic. “Sometimes I get overwhelmed. It’s a beast of a challenge to tackle because some people can’t see structural stigma, and others are suffocating under its weight. It all depends on where you’re sitting.”
When asked how something so invisible to some and dead obvious to others can be addressed, she paused. “In health-care settings, if you aren’t measuring it, it just doesn’t matter. We’ve got to show providers and administrators the true cost of these blind spots by giving them tools that can bring them to light. Then, we’ve got to use the evidence of those gaps to make a case to close them.”
Knaak and her colleagues at the Mental Health Commission of Canada (MHCC) are charting new territory. For example, they are mapping out the topography that people living with mental illness must face when seeking basic physical health care.
“A person’s mental health may have nothing to do with the reason for their visit, but it becomes a huge barrier to getting timely and proper diagnosis and treatment — because physical complaints are often dismissed or seen only through the lens of their mental health diagnosis. The system doesn’t have the right checks and balances to make sure these kinds of blind spots get caught,” she explained. “This is the equivalent of a mountain, and we’ve got to identify it on a map so we can point to it and say, ‘How are we going to scale this?’”