Introduction: Public health systems play a crucial role in providing universal access to mental health services. However, users of these services are often subject to stereotypes and prejudice, which reinforce social stigma and may undermine treatment adherence, psychosocial rehabilitation, and social inclusion. Understanding the psychosocial processes that shape such representations is essential to advancing equitable health care.
Purpose: This study aimed to investigate the presence and content of stereotypes and prejudices associated with public health service users in mental health, analyzing how these representations affect perceptions of legitimacy, competence, and deservingness of care.
Method: A mixed-methods design was adopted. In the quantitative phase, 412 Brazilian adults responded to a survey including implicit association measures and explicit attitude scales regarding mental health service users. In the qualitative phase, 20 semi-structured interviews were conducted with health professionals and family caregivers, focusing on lived experiences and perceived social images. Data were analyzed using thematic content analysis.
Results: Findings indicate the persistence of negative stereotypes (e.g., "dependent," "noncompliant," "burden to society"), combined with ambivalent perceptions that oscillate between compassion and distrust. Prejudices were linked to broader social beliefs about poverty, marginality, and the quality of public services. Interviews revealed that professionals often recognized stigma but reported difficulties in confronting institutional barriers. Family members noted that prejudice reinforced isolation and discrimination in community contexts.
Conclusions: The study highlights that stereotypes and prejudices toward public health service users in mental health are not merely individual biases but are embedded in cultural narratives and institutional practices. Addressing these representations requires strategies of psychoeducation, community dialogue, and structural investment in health systems to reduce inequalities and foster social inclusion.