A Randomized Controlled Trial Exploring Stigma, Discrimination and Recovery-Based Perspectives toward Mental Illness and Substance Use Problems among Primary Healthcare Providers in Ribeirão Preto, Brazil: A Randomized Controlled Trial Dr. Carla Ventura Associate Professor PAHO/WHO Collaborating Centre for Nursing Research Development University of São Paulo at Ribeirão Preto College of Nursing (Brazil) Sireesha Bobbili Project Manager WHO/PAHO Collaborating Centre for Addiction & Mental Health Centre for Addiction & Mental Health (Canada)

EARLY STAGES OF THE PROJECT DEFINING THE PROBLEM Stigma towards people with mental illness & substance use issues... is a major source of harm, specifically related to problems finding employment and housing, leading to social isolation can be conveyed by both the general public and health care providers prevents individuals from seeking help and utilizing services1 1Pickenhagen, A., Sartorius, N., 2002 Stigma & Discrimination toward Mental Illness & Substance Use in PHC: An RCT (Brazil)

PROCESS OF STIGMATIZATION EARLY STAGES OF THE PROJECT PROCESS OF STIGMATIZATION EMOTIONAL REACTIONS + IGNORANCE + LABELING STEREOTYPE (BELIEF) PREJUDICE (ATTITUDE) DISCRIMINATION (BEHAVIOUR) Stigma & Discrimination toward Mental Illness & Substance Use in PHC: An RCT (Brazil)

EARLY STAGES OF THE PROJECT OBJECTIVE: To determine the effectiveness of a comprehensive anti-stigma/recovery-oriented intervention in reducing stigmatizing attitudes and behaviours among primary health care providers toward individuals with mental illness and substance use problems in the Brazilian context, using Family Health Units (FHUs) as the point of intervention. Stigma & Discrimination toward Mental Illness & Substance Use in PHC: An RCT (Brazil)

CULTURAL ADAPTATION & VALIDATION OF TOOLS Current Status CULTURAL ADAPTATION & VALIDATION OF TOOLS Stigma measurement tools are undergoing adaptation and validation for the Brazilian context: Opening Minds Scale for health care providers Modified Bogardus Social Distance Scale Mental Illness: Clinicians' Attitudes scale (MICA – 4) TRANSLATION CULTURAL ADAPTATION FACE VALIDITY & CONTENT PRE-TEST WITH TARGET POPULATION VALIDATION FROM ENGLISH TO BRAZILIAN PORTUGUESE CONSTRUCT VALIDITY CRITERION VALIDITY FACTORIAL ANALYSIS RELIABILITY Stigma & Discrimination toward Mental Illness & Substance Use in PHC: An RCT (Brazil)

FHU Vila Albertina, Ribeirão Preto, Brazil Milestones Accomplished ENVIRONMENTAL SCANS Environmental scans of six participating Family Health Units (FHUs) were conducted to better understand: the organizational structure, context & unique culture of each participating FHU challenges & opportunities for adapting & implementing an anti-stigma/recovery-oriented intervention for FHUs Key informants: Administrators, executives, health care professionals provided insight into service provision indivudals with mental illness / substance use problems & their family members discussed experiences while receiving care. FHU Vila Albertina, Ribeirão Preto, Brazil Stigma & Discrimination toward Mental Illness & Substance Use in PHC: An RCT (Brazil)

Symposium for Knowledge Users Oct.17, 2018; Ribeirão Preto, Brazil Milestones Accomplished OCTOBER 2018 SYMPOSIUM Collected information regarding staff and service user’s understandings and experiences of stigma related to mental illness and substance use Presented literature review findings of existing evidence Researchers, clinicians, service users & family members discussed ideas for addressing stigma Symposium for Knowledge Users ‘Mental Health, Stigma and Discrimination: experiences, challenges and lessons learned in primary care’ Oct.17, 2018; Ribeirão Preto, Brazil Stigma & Discrimination toward Mental Illness & Substance Use in PHC: An RCT (Brazil)

OCTOBER 2018 SYMPOSIUM Milestones Accomplished Carla Ventura - project coordinator in Brazil; Opening of the symposium: “Mental health, stigma and discrimination: experiences, challenges and lessons seized in primary care” Health care providers, service users, family members, community members, students and professors at “CAMH’s experience implementing anti-stigma interventions in primary care” presentation Stigma & Discrimination toward Mental Illness & Substance Use in PHC: An RCT (Brazil)

Quote from October 2018 Symposium Milestones Accomplished ENGAGEMENT WITH IMPLEMENTERS “The NBA (National Basketball Association) last year had a very interesting campaign where it showed several professionals with depression. Professionals who are worshipped sometimes suffer individually which shows that it happen can happen to anyone. Use your own experience to help discuss that topic, you know!? I think that's part of it and it takes away the prejudice. We have a lot of prejudice inside us. Society has a lot of prejudice within it and it will only be reduced with exchanges between people. What we need is socialization rather than just education. Sometimes it's a lot simpler than what we think...” Claudimar Rodrigues, Physician, Brazilian Center for Health Studies (CEBES), Ribeirão Preto, Brazil Quote from October 2018 Symposium Stigma & Discrimination toward Mental Illness & Substance Use in PHC: An RCT (Brazil)

WANT TO KNOW MORE? LET’S CHAT! Send us an email! caaventu@eerp.usp.br sireesha.bobbili@camh.ca