1. 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)

2. 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)

3. 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)

4. 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)

5. 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)

6. 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)

7. 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)

8. 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)

9. 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)

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