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Authors’ reply

Published online by Cambridge University Press:  02 January 2018

Nina Schnyder
Affiliation:
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern
Radoslaw Panczak
Affiliation:
Institute of Social and Preventive Medicine, University of Bern
Nicola Groth
Affiliation:
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland. Email: nina.schnyder@kjp.unibe.ch
Frauke Schultze-Lutter
Affiliation:
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland. Email: nina.schnyder@kjp.unibe.ch
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Abstract

Type
Columns
Copyright
Copyright © The Royal College of Psychiatrists 2017 

Not considering the broader context, Evans-Lacko and colleagues' critique of our study Reference Schnyder, Panczak, Groth and Schultze-Lutter1 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 Reference Gronholm, Thornicroft, Laurens and Evans-Lacko2,Reference Clement, Schauman, Graham, Maggioni, Evans-Lacko and Bezborodovs3 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’. Reference Gronholm, Thornicroft, Laurens and Evans-Lacko2

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 Reference Schnyder, Panczak, Groth and Schultze-Lutter1 ). 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 Reference Schnyder, Panczak, Groth and Schultze-Lutter1 ).

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

References

1 Schnyder, N, Panczak, R, Groth, N, Schultze-Lutter, F. Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis. Br J Psychiatry 2017; 210: 261–8.CrossRefGoogle ScholarPubMed
2 Gronholm, PC, Thornicroft, G, Laurens, KR, Evans-Lacko, S. Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review. Psychol Med 2017; 15: 113.Google Scholar
3 Clement, S, Schauman, O, Graham, T, Maggioni, F, Evans-Lacko, S, Bezborodovs, N, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med 2015; 45: 1127.Google Scholar
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