Stigma is usually pictured as open prejudice, and open prejudice has become less socially acceptable. The costs that remain operate through quieter mechanisms that awareness campaigns address only partially.
Delay is the largest measurable cost
The interval between symptoms beginning and help being sought is measured in years for many conditions, and anticipated judgement is among the reasons people give.
Delay matters because conditions treated later are generally harder to treat, and because the intervening period contains its own losses in work and relationships.
Reducing that interval is therefore the outcome most anti-stigma work is ultimately trying to move, whatever its immediate messaging.
Structural stigma sits in systems, not attitudes
Insurance terms, employment screening, professional licensing and immigration processes have all historically treated mental health history differently from physical health history.
These operate regardless of individual attitudes, and a person may face them from staff who hold no prejudicial views at all.
Which is why disclosure decisions are frequently rational rather than fearful, and why advising openness without acknowledging the consequences is poor advice.
Internalised expectation changes behaviour
People absorb prevailing assumptions about a condition and apply them to themselves, adjusting expectations about work, study and relationships downward.
This self-limitation occurs without anyone saying anything, and it can persist after the condition itself has responded to treatment.
It is measured separately from public attitudes in stigma research, precisely because the two move somewhat independently.
Diagnoses are not treated equally
Public attitudes toward anxiety and depression have shifted considerably, while conditions involving psychosis, personality disorder diagnoses and substance dependence have moved much less.
Campaigns emphasising the commonness of mental health difficulty tend to help the conditions already best understood, since relatability is the mechanism they use.
The result can be a widening gap, where openness increases around some conditions while others become comparatively more isolating.
Contact changes attitudes more than information
Research on prejudice reduction generally finds that direct contact with people who have the relevant experience outperforms information campaigns.
Which is why programmes built around people speaking about their own history, particularly in workplaces and schools, have better evidence behind them than poster campaigns.
It also means the burden of changing attitudes falls disproportionately on those affected, which is a cost of the most effective approach rather than an argument against it.