We thank Shahbaz et al for their commentary ^{Reference Shahbaz, Corti and Gray1} on our article, ^{Reference Battle, Álvarez-Mon, Lara-Abelenda, Perez-Araluce and Pinto da Costa2} and for emphasising the importance of further research on the negative perceptions of psychiatrists.

Shahbaz et al suggest that alternative findings might have emerged had the search term ‘mental illness’ been included. Because our study focused on ‘mental health professionals’, rather than on specific conditions, this term was not incorporated into our search strategy. Future research could investigate the range of terms used to describe mental illness (including ‘mental health condition’ and ‘mental health disorder’) and examine how these terms are deployed in public discourse, and the associated sentiments.

Their commentary also reflected whether another contributing factor to the increased negative perceptions of psychiatrists, compared with psychologists, could be differences in the therapeutic relationship. Our own review of the responses when this article was shared on X (formerly Twitter) lends support to this interpretation. A substantial proportion of negative responses centred on concerns regarding compulsory treatment and the adverse effects of medication, which may influence the therapeutic relationship and, in turn, lead to negative perceptions of psychiatrists. These perceptions may also be shaped by wider public discourse surrounding psychiatry and severe mental illness, particularly following high-profile incidents that receive substantial attention in the media and on social media, where questions about risk assessment and public safety are frequently raised. Such events can generate intense public discussions and reactions, and may reinforce fear-based or stigmatising narratives about mental illness and psychiatric care. Psychiatrists and psychiatric services may also face further public and media scrutiny following the publication of the forthcoming findings of the Nottingham Inquiry.

Shahbaz et al further highlighted stigma within the medical profession itself as an important factor influencing perceptions of psychiatrists. This is supported by existing evidence. In 2022, following the impact of COVID-19, a review was published investigating psychiatric issues among health professionals, ^{Reference Braquehais and Vargas-Cáceres3} noting that stigma towards mental disorders may be even greater among healthcare professionals than among the general population. ^{Reference Braquehais and Vargas-Cáceres3} Earlier findings point to these persistent concerns. A 2009 study conducted in Birmingham, UK, found that 8% of doctors would not seek treatment for mental illness. ^{Reference Hassan, Ahmed, White and Galbraith4} Similarly, in Australia, data from the National Mental Health Survey of Doctors and Medical Students reported that 25–34% of doctors did not want to seek help for anxiety, depression or substance use. ^{Reference Wijeratne, Johnco, Draper and Earl5} Additionally, 16–19% did not believe that seeking professional assistance would be beneficial ^{Reference Wijeratne, Johnco, Draper and Earl5} and 40% agreed that many physicians perceive colleagues with a history of depression or an anxiety disorder as less competent. ^{Reference Wijeratne, Johnco, Draper and Earl5} These findings underscore the persistence of stigma within the profession, and highlight the importance of continued research to better understand and address these attitudes.

Stigma may also extend beyond individual clinicians to institutional settings, particularly psychiatric hospitals, which have been shown to be subject to negative perceptions and avoidance behaviours, ^{Reference Kamalzadeh, de Filippis, El Hayek, Heidari Mokarar, Jatchavala and Koh6} further reinforcing barriers to engagement with psychiatric care environments.

Our review of responses to our article on X revealed calls for greater self-reflection within psychiatry, and the need to make changes in clinical practice in order to shift public perceptions. Collaborative strategies involving psychiatrists alongside other medical professionals and people with lived experience – particularly at scale – may offer a valuable avenue for fostering such reflection and promoting meaningful change.

Beyond social media, the representation of psychiatrists and other mental health professionals in popular culture, particularly films and television, may also play an important role in shaping public perceptions. It has been argued that achieving more accurate portrayals may require closer engagement between the film industry and mental health professionals, including prior exposure of scriptwriters and directors to mental health settings or the inclusion of multidisciplinary input from clinicians during script development. ^{Reference de Filippis, Kamalzadeh, Adiukwu, Aroui, Ramalho and El Halabi7} This highlights a broader responsibility of the arts and cinema industry in ensuring that portrayals of psychiatrists are balanced, realistic and avoid reinforcing stigma or caricatured depictions that may contribute to negative public attitudes. ^{Reference Halabi, Fish, Boroon, Filippis, Hayek and Larnaout8}

We acknowledge our study limitations, as noted in our article, including the potential underrepresentation of older populations and the restriction to publicly available tweets. Although the exclusion of private content may limit access to certain perspectives, it also reduces the self-selection bias commonly encountered in survey-based research. Over time, patterns of social media use are evolving. For example, Age UK reported that, in 2022, over half (57%) of people aged over 75 years used the internet at least once a month for social media. ⁹

Nonetheless, the reliance on publicly available posts may limit insights from individuals with lived experience who do not engage in open online discourse. Future research should prioritise inclusive approaches that actively involve people with lived experience, in order to deepen understanding and inform efforts to address negative perceptions of psychiatrists.

We thank Shahbaz et al for highlighting the need for further research. In particular, expanding the scope to include older populations, people with lived experience and a broader range of healthcare professionals may be critical to improving public perceptions of psychiatrists on and beyond social media.