In response to our editorial in the BJPsych, ^{Reference Corrigan, Schomerus and Smelson1} Ginn & Clark note that medical professionals add to the stigma of substance use disorders. Sadly, their insights parallel the larger research on the stigma of mental illness and psychiatry: namely, psychiatric service providers tend to be among the most stigmatising of professions. This can be surprising because most providers would seem to pursue advanced degrees for reasons of altruism: to help people with behavioural health challenges. Research suggests, however, that patients and their families often describe mental health professionals as the source of stigma, with specific providers frequently focusing on the disease and ignoring the person. ^{Reference Angermeyer and Dietrich3} As many as half of providers fail to endorse recovery as an outcome for serious mental illness. Psychiatrists, in particular, are often found to be more pessimistic about mental illness compared with other provider groups. Mental healthcare providers endorse stereotypes about mental illness, including perceptions of dangerousness, unpredictability and blame. Stigma undermines the provision of care. ^{Reference Angermeyer and Dietrich3} Studies have shown that up to half of participating psychiatrists did not share a diagnosis of schizophrenia with the patient unless specifically asked or failed to engage patients in such real-life matters as finance, accommodation and leisure.

Unfortunately, the stigma shown by mental healthcare providers extends to healthcare providers in general, perhaps in even more sobering ways. Studies comparing patients with and without identified mental illness have shown that healthcare providers are less likely to refer patients with mental illness for mammography, hospital admission after diabetic crisis, or cardiac catheterisation. ^{Reference Corrigan, Druss and Perlick2} To make sense of the direct relationship between stigma and healthcare decisions, one study examined views of primary care and psychiatric physicians and nurses towards people with mental illness. ^{Reference Corrigan, Mittal, Reaves, Haynes, Han and Morris4} Results showed that providers who endorsed stigmatising ideas about a patient with mental illness presenting for arthritic pain were less likely to refer the person for a consultation and less likely to refill their analgesic prescription. This relationship was demonstrated equally across primary care and mental healthcare providers. People with mental illness cannot obtain services when providers fail to offer them or do so contrary to practice standards.

Things seem to be getting better, with newly trained providers endorsing stigma less than more senior professionals. In part, this reflects the growing awareness that people with mental illness (and substance use disorders) recover and therefore should be hopeful about life goals. This corresponds to the degree to which people with mental illness and substance use disorders are provider platforms for sharing their stories of recovery.