Authors’ reply

Not considering the broader context, Evans-Lacko and colleagues' critique of our study ¹ mainly focuses on a part of a sentence (‘target these personal attitudes rather than broad public opinions’) in the conclusion of the abstract and understand this as a general recommendation for anti-stigma campaigns. In this generalisation, they lost sight of our paper's explicit focus on the relationship between stigma and help-seeking, which was also stated in the full sentence: ‘Campaigns promoting help-seeking and fighting mental illness-related stigma should target…’. Unfortunately, when only browsing the abstract, the ‘and’ might indeed be misperceived as a two-fold recommendation, for campaigns promoting help-seeking on the one hand and anti-stigma campaigns on the other. We are sorry for that and have suggested that the BJPsych publish a correction for clarification that reads: ‘Campaigns promoting help-seeking by means of fighting mental illness-related stigma should target these personal attitudes rather than broad public opinions’.

Evans-Lacko and colleagues further argued that we overemphasised help-seeking as the key outcome. In light of the authors' own reviews on this topic ^2,3 this is a surprising statement. Just like our meta-analysis, these reviews start from the observation of the negative consequences of delays in help-seeking for mental illness and highlight the importance of better understanding the reasons for these delays. Of these, ‘stigma associated with mental illness is one such potential influence’. ²

This makes help-seeking one important outcome in stigma research. All the more, as early help-seeking might prevent the development of severe social disability and the need for intensive treatment that were both reported to abet stigmatisation and discrimination. Our principal finding was that the connection between stigma and active help-seeking varies according to type of stigma and that, in particular, a person's own attitudes towards mental health help-seeking and towards persons with mental illness are associated with their help-seeking behaviour. Thus, we suggested that these finding might be considered in planning, evaluating and implementing campaigns with the aim of promoting help-seeking.

We certainly admire the work of Evans-Lacko, Thornicroft and colleagues in stigma research. We especially acknowledge that population-level anti-stigma programmes are helpful in reducing negative and stigmatising attitudes and enhancing the public's knowledge about mental illness. We also acknowledge that different stigma types (such as perceived public attitudes and self-stigma) are interrelated and can influence each other (see the Discussion section of our study ¹ ). It is important to point out that we understand personal attitudes towards persons with a mental illness as a part of the broader term of public stigma (see the introductory section ¹ ).

With this, we hope to have clarified some initial misperceptions of Evans-Lacko and colleagues.