Stigma toward persons with mental illnesses in prison

The healthcare provision for mentally ill offenders in Germany remains inadequate, despite higher prevalence rates compared to the general population. We examined whether stigma-based discrimination is greater toward this group compared to individuals with somatic illnesses and/or non-incarcerated individuals.

In February 2025, we conducted a quota-based online survey among adults living in Germany (aged 18 years or older; n = 1,609), in which respondents were randomly assigned to one of eight case vignettes varying by illness (schizophrenia vs. diabetes), incarceration status, and gender. Indicators for discrimination included desire for social distance and public rejection of healthcare provision.

The incarceration status and mental illness of the vignette person significantly predicted greater social distance, whereas the respondent's personal experience with mental illness predicted lower social distance. Public rejection of healthcare provision was lower among older and female respondents, respondents with high compared to low education, and those with experience of mental illness in their social environment. Rejection was also lower for vignette persons with mental rather than somatic illness, but significantly higher for incarcerated vignette persons and among respondents with personal experience of incarceration.

These findings highlight the role of stigma-related processes in shaping attitudes toward healthcare provision, particularly for socially marginalized groups. They underscore the importance of reducing perceived boundaries between social groups and suggest that targeted educational and contact-based interventions may improve healthcare provision, particularly for incarcerated individuals.