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Commentary on Letter to the Editor by Nitasha Sharma

The Editor of International Journal of Social Psychiatry Authors’ reply to the letter to the editor concerning our article on mental health professionals’ attitudes towards people with mental illness Thank you for interesting and important comments to our article. Our results indicate that there on a group level is an association between the professionals ́ and patients ́ attitudes. Another intriguing question is whether there is a causal relationship, which the design of our study did not permit to investigate since this would require linking information from patients to their specific therapists or key workers, which was not possible in our study. A review by Schulze et al. (2007) on mental health professionals has also revealed that negative beliefs and attitudes are common and sometimes worse than attitudes of the general public. In our view it would be hard to perform a study investigating the causal relationships between staff and professionals, since there would be numerous confounders hard to control. We think that the clinical importance of professionals’ negative attitudes is mainly that it may induce treatment pessimism and that patients due to this will not get best possible treatment. Therefore interventions changing professionals attitudes and corresponding behavior would be of importance. It is also of importance to bear in mind the cultural context of these attitudes implying that mental health professionals are part of a society where negative attitudes and discrimination against people with mental illness still is widespread, and possibly has not decreased during the last decades (Schomerus et al., 2012). Interventions targeting mental health professionals, and other professionals in contact with people with mental illness should therefore be made in conjunction with macro level anti stigma campaigns and interventions, an issue which has been raised in a discussion of the evaluation of the ongoing campaign in the UK, Time to Change (Link, 2013).