The Stigma Gap: Why Adults and Young People Aren’t Talking About the Same Thing

Note on terminology. Mental health language varies widely, from clinically diagnosed illness to broader struggles with wellbeing. Here, I use poor mental health as an umbrella term for individuals who self-identify as struggling with their mental health. This framing is especially relevant for adolescents, who often face barriers to diagnosis (O’Connor et al., 2018; Schmeck, 2022). For discussion of terminology debates (largely adult-focused), see Fox et al. (2021) and Lyon & Mortimer-Jones (2020).

We often say we want to “reduce mental health stigma.” Yet adults and young people are not always speaking about the same thing. When it comes to youth mental health, adults are often in the driver’s seat for making decisions, making judgements on ‘seriousness’, and deciding outcomes. One reason for this is the fact that we may not fully understand the impact of our attitudes and actions on young people, because we do not hear from them.  Consider a familiar scene. A pupil asks to leave class to see the pastoral lead. The teacher, under pressure and with good intentions, says, “You’ll be fine, try to focus.” Nothing overtly hostile is said. But the message is clear: the adult decides what counts as “serious,” when support is warranted, and whether the young person’s account is credible. Small statement, large impact. So, what do we know about stigma?

Mental Health Stigma
Mental health stigma is hard to miss in today’s education and public discourse. It is commonly defined as the social process by which people with poor mental health are devalued and discriminated against based on having poor mental health (Corrigan & Watson, 2002; Link & Phelan, 2001). Stigma is inherently social: once marked as “other,” people experience what Goffman called a “spoiled identity” (1963, p. 3), with consequences that include othering, discrimination, and status loss (Link & Phelan, 2001).

Stigma operates at multiple levels (Fox et al., 2018): public stigma (wider attitudes), self-stigma (internalised devaluation), structural stigma (policies, practices, and cultures that systematically disadvantage), and anticipated stigma (expectations of future mistreatment). Across these layers, stigma functions as a powerful social determinant of health: it generates psychosocial stress, restricts opportunities, and reduces help-seeking (Clement et al., 2015; Ferrie et al., 2020; Hatzenbuehler et al., 2016; Link & Phelan, 2006; Major et al., 2018; Link, 2023). Put simply: stigma reshapes lives long before anyone actually reaches the point of help-seeking.

The Stigma Gap
However, when we consider young people’s experience, we identify a problem - the stigma literature is overwhelmingly adult-centric. Definitions, theories, and measures are largely built from adult experiences (Deluca, 2020). As a result, young peoples lived experiences are under-represented (Deluca, 2020; Kaushik et al., 2021; Woodgate et al., 2020). When youth experiences are studied, researchers often translate adult concepts to adolescent contexts, known as the “translational” approach. While some experiences overlap (Kranke et al., 2010), adolescents differ from adults in crucial ways: they hold less social power and status; have less experiential knowledge to contest stigma; move through unique contexts (schools, youth services, family settings); and are in distinct developmental stages.

These differences matter. Emerging work identifies components of youth stigma that are easy to miss when we default to adult frames (Ansell et al., 2025; Austin et al., 2025; Johnson, 2025; Woodgate et al., 2020). Compounding this, youth voice is often absent from study design and interpretation (Swords et al., 2021). Which means that many adults working with young people may be relying on incomplete or adult-centric models, leaving them unequipped and unintentionally reinforcing stigma.

A further gap lies in measurement. Many widely used stigma scales were validated in adult populations. When applied to adolescents, they can miss context: avoiding a school counsellor after repeated minimisation may be scored as a lack of help-seeking rather than a rational response to anticipated stigma. Language matters, too. Terms that feel neutral to adults (e.g., ‘resilience’, ‘thresholds’, ‘compliance’) often carry power signals for young people about who must adapt, who decides what ‘counts’, and whose perspective sets the terms of care. If we mismeasure, we misdiagnose the problem and mistarget our solutions.

Youth Experiences: Power Imbalance
When research centres youth voices, a different picture emerges. The most consistent finding is stark: adults are central to many youth stigma experiences (Ansell et al., 2024; Austin et al., 2025; Johnson et al., 2025). Teachers, clinicians, parents, and other adults occupy positions of authority over young people and that asymmetry shapes how stigma is felt and managed. Adolescents describe gatekeeping, such as adults controlling access to support, opportunities, and resources. They describe minimisation, including not being believed, being told they are “overreacting,” or seeing concerns downplayed. Finally, they describe inaction and opacity through delays, lack of follow-through, and limited transparency that leave them in a limbo of adult decisions.

This extends beyond the familiar clinician-client dynamic. It reflects the ever-present hierarchy embedded in childhood and adolescence. At every stage, adults can make decisions for and about young people. Unlike many adults, young people cannot simply leave school, switch providers with ease, or “go to HR.” They are structurally dependent. In that context, stigma is often something to be endured rather than challenged, especially where questioning elders or authority figures is discouraged.

Youth Experiences: Structural Context
The power imbalance is most keenly felt in hierarchical settings - schools, healthcare, and the home. Early insights from participatory doctoral research suggest three features that make contexts feel stigmatising and unsafe for young people (Johnson, 2025):
• Lack of focus on youth-specific needs. Settings may show a general awareness of mental health yet remain organised around adult perspectives, failing to meet developmental needs or adolescent realities.
• Negative cultures that normalise belittlement. Adultism reappears here and young people’s accounts are dismissed as attention-seeking or naivety; adults assume they know best, with limited consideration of the young person’s perspective.
• Tokenistic action. On the surface, initiatives exist. In practice, they tick boxes without care. Young people commonly say they would prefer no intervention to inauthentic gestures. They can tell when actions lack care and continuity.
These structural features do not simply “set the scene”; they produce stigma by signalling to young people who is credible, who is heard, and who must wait. In such systems, even supportive adults can be constrained by processes that ration time, narrow thresholds, or fragment responsibility.

Practical Steps
What can adults do now to close the stigma gap and create safer, more just contexts for adolescents?
1. Acknowledge and rebalance power. Recognise the asymmetry between adults and young people and how it shapes decisions and interactions. Audit where you hold formal or informal power (policies, schedules, thresholds, language), make those processes transparent, and invite collaboration. Trust is built through honesty and clarity about what can, and cannot, be decided together.
2. Challenge adult power on behalf of young people. Stigma rarely comes from a single source. If you hear dismissive language or see gatekeeping behaviours from colleagues, services, or family members, name and challenge them. Use your standing to advocate: escalate when necessary, document delays, and amplify the young person’s account.
3. Teach the difference between stigma and support. Especially during help-seeking, adolescents benefit from a shared language to recognise supportive versus stigmatising responses. Research suggests that, over time, stigma can feel omnipresent to young people (Ansell et al., 2024), and many come to expect it from adults, internalising the notion that their needs are trivial. Counter this by explicitly validating their interpretation of events, modelling supportive responses, and signposting what good care looks like.
4. Avoid defaulting to adult frameworks. Much of what we “know” about stigma is adult-derived. Check that the evidence and programmes informing your practice include youth voices and youth-generated insights. Better still, co-produce with young people: involve them in defining problems, designing solutions, and evaluating impact.

Practical change need not be grand to be meaningful. Small, repeated, authentic actions such as clear timelines, consistent follow-through, asking “what would help most right now?” accumulate into safer cultures.

Future Directions
Contemporary research is clear: peer-to-peer approaches are necessary but insufficient. Adults play a distinct and powerful role in the stigmatisation of young people. We can no longer focus solely on changing peer norms while leaving adult-run systems untouched. At present, there are no dedicated interventions that target adult stigmatisation of youth, no campaigns, no training packages, no sector-wide efforts (Austin et al., 2025). That is a gap we can fix.

Future research must consider the development and implementation of initiatives to address the stigmatisation youth experience from adults in their lives. This future research should consider the meaningful inclusion of young people, to ensure that interventions tackle the key components of youth experiences. Finally, we need to see a greater involvement of young people in the implementation of initiatives across schools and various settings, to ensure our progress towards changes avoids tokenistic action.
If you work with young people, the invitation is straightforward and challenging: listen to what adolescents are telling us, reflect on how power and adultism shape your practice, and act with care, consistency, and accountability. Adults, we have work to do. That work begins with us, today, in every classroom, clinic, and conversation.

Dr Rebecca Johnson is an academic psychologist and Lecturer in Applied Psychology at Glasgow Caledonian University, as well as a member of the Child and Adolescent Health Research Group. Her research focuses on youth mental health, stigma, and participatory methodologies, with a particular emphasis on amplifying the voices of young people. With a background in youth work spanning over seven years, she brings extensive experience in advocacy, co-production, and youth inclusion. Her doctoral research explored young people’s experiences of mental health stigma using participatory mixed methods and led to the co-creation of a novel youth-centred measurement tool and theoretical model. Her work seeks to challenge epistemic injustice in mental health research and education - balancing rigour with relationality and championing the view knowledge creation belongs within communities. She teaches across undergraduate and doctoral programmes, underpinned by playful pedagogy and a commitment to fostering equitable, inclusive learning environments. Passionate about bridging the gap between research and real-world impact, her work aims to shift the dial in how youth mental health is understood, measured, and supported.

Pure Profile: https://researchonline.gcu.ac.uk/en/persons/rebecca-johnson/

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