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Mental Illness: Clinician's Attitudes (MICA) Scale


People with mental health problems come into regular contact with a wide range of health care professionals. However, the attitudes of health care professionals are not always positive and encouraging towards people with mental illness and may sometimes be less favourable than members of the general public. Prior to the development of the MICA, there were no published scales to assess the attitudes of students and professionals across a wide range of healthcare disciplines towards people with mental illness. In addition, existing scales had not been used with medical students after a mental illness-related stigma intervention.


To develop a reliable, valid and responsive scale and to assess medical students' attitudes towards people with mental illness and psychiatry. As an extension to the work conducted on the medical student version (MICA version 2), our research group aimed to develop a version suitable for use with students and qualified staff across a range of healthcare professionals (MICA version 4).


The initial item pool generated for the MICA scale was based on separate focus groups with service users, carers, third year medical students and trainee psychiatrists. Thirty two items emerged from the focus groups which were reviewed by an additional group of medical students to assess face and content validity. The scale was then revised into a 28 item scale (MICA version 1) and completed by 77 third year medical school students. Items were eliminated based on ceiling or floor effects resulting in the existing 16 items MICA version 2 scale. Psychometric testing was completed in a number of student samples to assess the reliability, validity, and responsiveness of the MICA 2 scale.

There were minor word changes to the medical student version to make it potentially suitable for students and qualified staff across a range of healthcare professions (MICA version 4). Secondary analyses were carried out to assess the reliability, validity and acceptability of the MICA 4 in a sample of 191 nursing students.


The MICA 2 was found to be reliable, valid and responsive measure to assess medical students' attitudes towards people with mental illness. It can be used in medical education and mental health promotion settings and studies. The MICA 4 was found to be a reliable, valid and acceptable measure of nursing students' attitudes towards mental illness. It may be suitable for use with students and qualified staff across a range of healthcare professions (we recommend initially checking the acceptibility of the scale with the intended groups when the MICA is used with samples other than medical and nursing students).

Full details and psychometric properties can be found in: Kassam et al 2010 for the MICA-2, and in Gabbidon et al 2013 for the MICA-4

Availability of the scales:  

Both versions of the MICA are now available for use.

The Mental Illness Clinicians’ Attitudes scale (MICA-2) was created for use with medical students. It was found to be reliable, valid and responsive to change. An amended version (MICA-4) was validated with a sample of nursing students and may be suitable for staff and students from a wide range of health professions. The MICA has 16 questions and has been widely used around the world.

The scale is freely available for use. For more information on MICA2 and MICA4 scales, how to download them and access the manual, please contact Maria Milenova at or visit the INDIGO Network website at

Key papers:

Kassam A., Glozier N., Leese M., Henderson C., Thornicroft G.  (2010). Development and responsiveness of a scale to measure clinicians attitudes to people with mental illness (medical student version) Acta Psychiatrica Scandinavica. Volume 122,2:153-161 

Gabbidon J., Clement S., Nieuwenhuizen AV., Kassam A., Brohan E., Norman I., Thornicroft G. (2013). Mental illness: clinicians' attitudes (MICA) scale. Psychometric properties of a version for students and professionals in any healthcare discipline. Psychiatry Research 206:81-87

For further information please contact Professor Sir Graham Thornicroft at


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