Cost of implementing the QualityRights programme in public hospitals in Gujarat providing mental healthcare.

Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation. Methods: Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems' perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training. Results: Total costs of implementing the QualityRights intervention varied from Indian Rupees (₹) 0.59 million to ₹ 2.59 million [1United States Dollars (US $) = ₹ 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State. Interpretation & conclusions: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.

Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study.

Background: Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention. Methods: The intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or "cluster"). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects. Discussion: This study represents a new stage of relevant and innovative research in mental health and stigma in Chile that will contribute to improving access and quality of care for people with MISUI. Evaluating the impact of the intervention model and its implementation will provide the necessary tools to scale the intervention up to other CESFAMs across Chile. Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT05578066].

Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India.

BACKGROUND: Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level. AIMS: To describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. METHOD: This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. RESULTS: Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50-0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). CONCLUSIONS: To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services.

Stigma and discrimination related to mental health and substance use issues in primary health care in Toronto, Canada: a qualitative study.

PURPOSE: Community Health Centres (CHCs) are an essential component of primary health care (PHC) in Canada. This article examines health providers' understandings and experiences regarding stigma towards mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario. METHODS: Using a phenomenological approach, we conducted twenty-three interviews with senior staff members and peer workers, and three focus groups with front-line health providers. Ahybrid approach to thematic analysis was employed, entailing a combination of emergent and a priori coding. RESULTS: The findings indicate that PHC settings are sites where multiple forms of stigma create health service barriers. Stigma and discrimination associated with MHSU also cohere around intersecting experiences of gender, race, class, age and other issues including the degree and visibility of distress. Clients may find social norms to be alienating, including behavioural expectations in Canadian PHC settings. CONCLUSIONS: Given the turmoil in clients' lives, systematic efforts to mitigate stigma were inhibited by myriad proximate factors that demanded urgent response. Health providers were enthusiastic about implementing anti-stigma/recovery-based approaches that could be integrated into current CHC services. Their recommendations for interventions centred around communication and education, such as training, CHC-wide meetings, and anti-stigma campaigns in surrounding communities.

Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries.

Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality-most only included evaluations after intervention or short follow-up periods (1-3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.

Evaluation of a Pilot Intervention to Reduce Mental Health and Addiction Stigma in Primary Care Settings.

Healthcare environments are not exempt from the impact of stigma against mental illness and addiction, which contributes to barriers to client access and appropriate treatment. To address this concern, healthcare organizations have a growing interest in mental illness and addiction anti-stigma anti-discrimination programming as part of their staff-wide professional development. Though standard interventions demonstrate effectiveness in the short and mid-term, the evidence for long-term change is inconclusive. A flexible, innovative intervention was developed in collaboration with community health care centres to reduce mental illness and addiction stigma and discrimination at an organizational level. A mixed methods approach was utilized to develop the intervention design and evaluate the effectiveness of the intervention. 137 people participated in the survey component of the study and five senior management staff in interviews. Quantitative results showed that the intervention was effective in changing attitudes toward mental illness (e.g. 5,9% improvement in OMS-HC score, p < 0,05) and substance use problems (e.g. 8.4% reduction in social distance for heroin dependence, p < 0.05). Qualitative findings were positive for indicators of observed improvement in mental health knowledge and behaviour. The implications for future research that allows for the further evaluation of multicomponent anti-stigma interventions in healthcare settings are discussed.

Knowledge of the consequences and use of drugs for CostaRica niversity students / Conhecimento das consequências e do uso de drogas em estudantes universitários costarriquenses / Conocimiento de las consecuencias y uso de drogas en estudiantes universitarios costarricenses

ABSTRACT Objective: to determine the relationship between knowledge of consequences and drug use in undergraduate students of a university in San José, Costa Rica. Method: the cross-sectional study examines the demographic profile of the sample and the relationship between knowledge of consequences, drug use and academic performance. The study focuses on three types of drugs: alcohol, marijuana and cocaine. Three variables will be analyzed: demographic data, knowledge of consequences and use of drugs. Results: the relationship between knowledge of consequences and use of drugs was made using of the T-test. The sample had 272 students, 28.2% (n=77) of them were men and 71.4% were women (n=195). They were selected from the areas of social sciences (n=137, 50.2%), and from the area of health sciences (n=136; 49.8%). Alcohol was the most used drug (n=217, 79.8%), followed by marijuana (n=72, 26.6%) and finally cocaine (n=3, 1.1%) in the last 12 months. Conclusion: the results shown indicate that there is no significant relationship between such variables. The findings are important at the level of drug policies to support the development of new preventive strategies for drug use.

RESUMO Objetivo: determinar a relação entre o conhecimento das consequências e o uso de drogas em estudantes de graduação de uma universidade em San José, Costa Rica. Método: este estudo, de corte transversal, examina o perfil demográfico da amostra e a relação entre o conhecimento das consequências, o uso de drogas e o desempenho acadêmico. A pesquisa centra-se em três tipos de drogas: álcool, maconha e cocaína. Três variáveis foram analisadas: os dados demográficos, o conhecimento das consequências e o uso de drogas. Resultados: a relação entre o conhecimento das consequências e o uso de drogas foi realizada através do uso do T-test. A amostra foi composta por 272 estudantes, sendo 28,2% (n=77) homens e 71,4% mulheres (n=195); selecionados da área de ciências sociais (n=137; 50,2%), e da área de ciências da saúde (n=136; 49,8%). O álcool foi a droga mais utilizada (n=217; 79,8%), seguida da maconha (n=72; 26,6%) e, finalmente, a cocaína (n=3; 1.1%) nos últimos 12 meses. Conclusão: os resultados demostram que não existe relação significativa entre tais variáveis, e são importantes no nível das políticas de drogas para apoiar o desenvolvimento de novas estratégias preventivas para o uso de drogas.

RESUMEN Objetivo: determinar la relación entre conocimiento de consecuencias y uso de drogas en estudiantes de pregrado de una universidad en San José, Costa Rica. Método: el estudio, de corte transversal, examina el perfil demográfico de la muestra y la relación entre conocimiento de consecuencias, uso de drogas y rendimiento académico. El estudio se enfoca en tres tipos de droga: alcohol, marihuana y cocaína. Se analizarán tres variables: datos demográficos, conocimiento de consecuencias y uso de drogas. Resultados: la relación entre conocimiento de consecuencias y uso de drogas se realizó mediante el uso de la prueba T-test. La muestra fue de 272 estudiantes, con un 28.2% (n=77) de hombres y 71.4% de mujeres (n=195); seleccionados de las áreas de ciencias sociales (n=137; 50.2%), y del área de ciencias de la salud (n=136; 49.8%). El alcohol fue la droga más utilizada (n=217; 79.8%), seguida por marihuana (n=72; 26.6%) y finalmente la cocaína (n=3; 1.1%) en los últimos 12 meses. Conclusion: los resultados mostrados indican que no hay una relación significativa entre tales variables. Los hallazgos son importantes a nivel de políticas de drogas para apoyar el desarrollar de nuevas estrategias preventivas de uso de drogas.

Perception of damage and benefits associated to the use of marijuana in adolescents, Viña del Mar, Chile / Percepção de danos e benefícios associados ao uso de maconha em adolescentes, Viña del Mar, Chile / Percepción de daño y beneficios asociados al uso de marihuana en adolescentes, Viña del Mar, Chile

ABSTRACT Objective: analyze the perception of harm and benefits, and its association with the use of marijuana in high school students, as well as the intention to use it in a context of regulatory changes. Method: a quantitative, exploratory, cross-sectional study was designed, applying a self-administered questionnaire to 268 high school students. Results: The results showed that the declared consumption in the sample is higher than that obtained in previous studies in Chile, which had already warned of the increase in prevalence, compared to previous measurements. There is a low perception of risk associated with consumption and insecurity regarding benefits. In the framework of regulatory changes, no change was observed in the intention of use. Adolescent consumers would continue to do so as before, while those who have not consumed it, 25% would try it, and 60% would still not use it. Conclusions: The current discussion in the country has focused on the effect that the change in the law would have, by itself, on adolescent consumption, however, it is relevant to direct efforts towards the perceptions of risk and benefits that they have, in order to stop the observed increasing in consumption in the country, in the latest studies.

RESUMO Objetivo: analisar a percepção de danos e benefícios, e sua associação com o uso de maconha em estudantes do ensino médio, bem como a intenção de uso em um contexto de mudanças regulatórias. Método: realizou-se pesquisa quantitativa, exploratória e transversal, aplicando-se questionário autoadministrado a 268 estudantes do ensino médio. Resultados: os resultados mostraram que o consumo declarado na pesquisa é superior ao obtido em estudos prévios no Chile, que tinham alertado sobre o aumento da prevalência, em relação às medições anteriores. Há uma baixa percepção de risco associada ao consumo e à insegurança em relação aos benefícios. No âmbito das mudanças regulatórias, nenhuma mudança na intenção de uso foi observada. Consumidores adolescentes continuariam a fazê-lo como antes, enquanto aqueles que não o consumiram, 25% tentariam, e 60% ainda não o usariam. Conclusões: A discussão atual no país enfocou-se no efeito que a mudança da lei teria, por si só, sobre o uso feito pelos adolescentes. No entanto, é relevante direcionar esforços para as percepções de risco e benefícios que eles têm, a fim de impedir o aumento do consumo que tem sido observado no país nos últimos estudos.

RESUMEN Objetivo: analizar la percepción de daño y beneficios, y su asociación con el uso de marihuana en estudiantes secundarios, así como la intención de uso en un contexto de cambios regulatorios. Método: se diseñó un estudio cuantitativo, exploratorio, transversal, aplicando un cuestionario autoadministrado a 268 estudiantes de nivel secundario. Resultados: Los resultados mostraron que el consumo declarado en la muestra es superior a lo obtenido en estudios previos de Chile, que ya habían alertado del aumento de la prevalencia, respecto a mediciones anteriores. Existe una baja percepción de riesgo asociado al consumo e inseguridad respecto a los beneficios. En el marco de cambios regulatorios, no se observó cambio en la intención de uso. Adolescentes consumidores lo seguirían haciendo tal como hasta ahora, mientras que aquellos que no la han consumido, un 25% la probaría, y el 60% seguiría sin utilizarla. Conclusiones: La discusión actual en el país se ha focalizado en el efecto que el cambio en la ley tendría, por si misma, en el consumo adolescente, sin embargo, es relevante dirigir esfuerzos hacia las percepciones de riesgo y beneficios que ellos tienen, con el fin de detener el aumento en el consumo que se ha observado en el país, en los últimos estudios.

Perception of harm and benefits of cannabis use among adolescents from Latin America and Caribe / Percepción de daños y beneficios del uso de cannabis entre adolescentes de América Latina y Caribe / Percepção de danos e benefícios do uso de cannabis entre adolescentes da América Latina e Caribe

ABSTRACT Objective: to investigate the perception of harms and benefits associated with cannabis use among adolescents and how regulatory changes might affect their intention to use marijuana. Method: this multi-centric cross-sectional survey study. participants included 2717 students aged 15-17 from 10 cities in Belize, Brazil, Chile, Colombia, Dominican Republic, Jamaica, Mexico, St. Kitts and Nevis, and Trinidad and Tobago. Results: an average lifetime prevalence of cannabis use of 30.6% (25.8% past year, 15.8% past 30 days). Most participants reported that their closest friends use cannabis (60%); many (55%) stated that they would not use marijuana, even if it were legally available. Conclusion: statistics revealed that a strong perception of benefits, a low perception of risk, and friends' use of cannabis were associated with individual use as well as intention to use within a hypothetical context of regulatory change.

RESUMEN Objetivo: investigar la percepción de daños y beneficios asociados al uso de marihuana en adolescentes y cómo los cambios regulatorios pueden afectar la intención de uso. Método: estudio multicéntrico, cuantitativo y transversal tipo encuesta. los participantes fueron 2,717 estudiantes entre 15 y 17 años de 10 ciudades de Belice, Brasil. Chile, Colombia, República Dominicana, Jamaica, México, San Cristóbal y Nieves, y Trinidad y Tobago. Resultados: prevalencia de alguna vez en la vida de 30.6% (25.8% ultimo año, 15.8% últimos 30 días). Los adolescentes refieren que amigos cercanos consumen marihuana (60%). Los participantes (55%) declaran que no usarían marihuana, incluso si estuviera disponible legalmente. Conclusión: las estadísticas revelan que la alta percepción de los beneficios, baja percepción de daño y amigos que consumen marihuana, está asociado con el consumo y la intención de uso en el contexto hipotético de cambios regulatorios.

RESUMO Objetivo: investigar a percepção de danos e benefícios associados ao uso de maconha entre os adolescentes e como as mudanças regulatórias podem afetar a intenção de usar maconha. Método: estudo multicêntrico de corte transversal. Os participantes foram 2.717 alunos com idades entre 15 e 17 anos de 10 cidades em Belize, Brasil, Chile, Colômbia, República Dominicana, Jamaica, México, São Cristóvão e Nevis e Trinidad e Tobago. Resultados: prevalência de uso de maconha na vida de 30,6% (25,8% no ano passado, 15,8% nos últimos 30 dias). Os participantes relataram que os amigos mais próximos usam maconha (60%); e metade (55%) afirmou que não usariam maconha, mesmo se ela estivesse legalmente disponível. Conclusão: as estatísticas revelaram que percepção elevada de benefícios, percepção de baixo risco e uso de maconha por parte de amigos estavam associados ao uso individual, bem como à intenção de usar a maconha em um contexto hipotético de mudanças regulatórias.

Attitudes toward persons who abuse drugs in one urban community on the island of New Providence, Bahamas / Atitudes frente las personas que abusan drogas en una comunidad urbana en la isla de New Providence, Bahamas / Atitudes frente às pessoas que abusam drogas em uma comunidade urbana de New Providence, Bahamas

ABSTRACT Objective: to explore the attitudes toward persons who abuse drugs (alcohol, marijuana, and cocaine) in one urban community on the Island of New Providence, in the Bahamas. Method: a cross-sectional survey was utilized to get the data. The sample size was 126 respondents. Results: attitudes toward persons who abuse cocaine were significantly more negative compared to attitudes toward persons who abuse marijuana and alcohol. Age and level of educational attainment were associated with more negative attitudes toward persons who abuse cocaine. Personal use of marijuana and knowing someone who abused the substance were correlated with more positive attitudes toward persons who abuse marijuana. Conclusion: attitudes toward persons who abuse drug in the Bahamas varied depending on the type of drug abused.

RESUMEN Objetivo: explorar las actitudes frente a las personas que abusan de las drogas (alcohol, marihuana, y cocaína) en una comunidad urbana en la Isla de New Providence en las Bahamas. Método: la metodología de estudio transversal fue utilizada para colectar los datos. El tamaño de la muestra fue de 126 personas. Resultados: las actitudes hacia las personas que abusan de cocaína eran significativamente más negativas respecto a las actitudes hacia las personas que abusan de la marihuana y el alcohol. Edad y nivel de logro educativo se asociaron con las actitudes más negativas hacia las personas que abusan de la cocaína. Uso personal de marihuana y conocer a alguien que abuso de la sustancia se correlacionaron con actitudes más positivas hacia las personas que abusan de la marihuana. Conclusión: las actitudes hacia las personas que abusan de la droga en las Bahamas variaron dependiendo del tipo de droga abusada.

RESUMO: Objetivo: explorar as atitudes com relação à pessoas que abusan de drogas (álcool, maconha e cocaina) em uma comunidade urbana da Ilha de New Providence em Bahamas. Método: a metodologia de pesquisa transversal foi utilizada para coletar os dados. O tamanho da amostra foi de 126 respondentes. Resultados: Atitudes em relação a pessoas que abusam de cocaína eram significativamente mais negativas em comparação com as atitudes para com as pessoas que abusam de álcool e maconha. Idade e nível de escolaridade foram associados com atitudes mais negativas para as pessoas que abusam de cocaína. Uso pessoal de maconha e conhecer alguém que abusaram da substância foram correlacionados com atitudes mais positivas para pessoas que abusam de maconha. Conclusão: atitudes em relação às pessoas que abusam de drogas nas Bahamas variou dependendo do tipo de drogas abusadas.

Perception of harm and benefits of marijuana and its relationship with the intention of use and consumption in colombian adolescents / Percepção de danos e benefícios da maconha e sua relação com a intenção de uso e consumo em adolescentes colombianos / Percepción de daños y beneficios de la marihuana y su relación con la intención de uso y consumo en adolescentes colombianos

ABSTRACT Objective: analyze the relationship between the perception of harm and benefits associated with the use of marijuana and its relation to real consumption, as well as the intention to use it in a context of regulatory changes, in young students, between 15 and 17 years old, of a public school in Bogota Colombia. Method: a quantitative, cross-sectional survey was carried out. 268 students in grade 9th to 11th from a public school in the city of Bogotá, Colombia participated of the study. Results: results reveled that there is an association between the perception of benefits and the consumption of marijuana. In addition, how a low perception of risk is associated with an intention to use in a context of legalization. Conclusion: this is one of the first studies in Colombia which explores the intention to use (at age 18) in a context of regulatory changes, as well as the attitude of young people towards the legalization of marijuana for medicinal and recreational use.

RESUMO Objetivo: analisar a relação entre a percepção de danos e benefícios associados ao consumo de maconha e sua relação com o atual consumo, bem como com a intenção de uso em um contexto de mudanças regulatórias, em jovens entre 15 e 17 anos, estudantes de um colégio público em Bogotá, Colômbia. Método: realizou-se estudo quantitativo, transversal, tipo questionário. Participaram 268 estudantes do 9º ao 11º grau de um colégio público da cidade de Bogotá, Colômbia. Resultados: os resultados mostraram que existe uma associação entre a percepção de benefícios e o consumo de maconha. Além disso, também demostraram como uma baixa percepção de risco está associada a uma intenção de uso em um contexto de legalização. Conclusão: este é um dos primeiros estudos na Colômbia que explora a intenção de uso (aos 18 anos) em um contexto de mudanças regulatórias, bem como a atitude dos jovens em relação à legalização da maconha para uso medicinal e de lazer.

RESUMEN Objectivo: analizar la relación entre la percepción de daños y beneficios asociados al consumo de marihuana y su relación con el actual consumo, así como con la intención de uso en un contexto de cambios regulatorios, en jóvenes entre los 15 y 17 años estudiantes de un colegio público en Bogotá, Colombia. Método: se realizó un estudio cuantitativo, transversal tipo encuesta. Participaron 268 estudiantes de grado 9º a 11º de un colegio público de la ciudad de Bogotá, Colombia. Resultados: los resultados mostraron que existe una asociación entre la percepción de beneficios y el consumo de marihuana. Adicional a que como una baja percepción de riesgo está asociada a una intención de uso en un contexto de legalización. Conclusión: este es uno de los primeros estudios en el Colombia que explora la intención de uso (a los 18 años) en un contexto de cambios regulatorios, así como la actitud de los jóvenes hacia la legalización de la marihuana para uso medicinal y recreacional.

Risk perception and driving a motor vehicle under the influence of cannabis: a study with college students of a private institution / Percepción de riesgo y conducción de vehículo automotor bajo los efectos de la marihuana: un estudio con universitarios de una institución particular / Percepção de risco e condução de veículo automotor sob o efeito de maconha: um estudo com universitários de uma instituição particular

ABSTRACT Objective: to analyze the relationship between risk perception and behaviors related to driving a motor vehicle under the influence of cannabis. Method: The research was carried out through a cross-sectional survey. 382 undergraduate students between the ages of 17 and 29 were interviewed at a private higher educational institution in the Federal District, Brazil. Descriptive and inferential statistics (cross tabulations and chi-square) were used to analyze the data. Results: they indicate that more than 1/3 of the participants used cannabis in the past 12 months, and 36.4% reported problematic use. It was possible to establish a relationship between the behaviors of perception of risk and driving a motor vehicle under the influence of cannabis: 1) the perception of being sanctioned as a driver and driving a motor vehicle under the influence of cannabis (χ2(1) = 3.96, p=≤0); 2) to perceive damages as driver and driving a motor vehicle under the influence of cannabis (χ2(1)=3.96, p = ≤05); 3) perception of damages as passenger and driving a motor vehicle under the influence of cannabis (χ2(1)=3.96, p=≤5.0). Conclusion: damages caused by cannabis are underestimated by university students, since they have a very low risk perception, especially when compared to alcohol. In Brazil, there is also a lack of regulation and sanctions with respect to driving a motor vehicle under the influence of cannabis, which may contribute to an important risk among this population.

RESUMEN Objetivo: analizar la relación entre percepción de riesgo y conductas relacionadas a la conducción de vehículo automotor bajo los efectos de la marihuana. Método: investigación realizada por medio de un survey transversal. Se entrevistaron a 382 estudiantes de grado entre 17 y 29 años de edad en una institución privada de enseñanza superior en el Distrito Federal, Brasil. Para analizar los datos, se realizaron estadísticas descriptivas e inferenciales (tabulaciones cruzadas y chi-cuadrado). Resultados: indican que más de 1/3 de los participantes consumieron marihuana en los últimos 12 meses; 36,4% relató uso problemático. Se pudo establecer una relación entre la conducta y la percepción de riesgo en el vehículo propulsado y conducido bajo los efectos de la marihuana: 1) la percepción de ser sancionado como conductor del vehículo y el efecto de conducción de la marihuana (χ2(1) = 3,96, p = ≤ ,0); 2) notar los daños como conductor del vehículo y conducir el vehículo bajo los efectos de la marihuana (χ2(1) = 3,96, p = ≤05); 3) la percepción del daño como pasajero y conducción de un vehículo automotor bajo los efectos de la marihuana (χ2(1) = 96, p = ≤5,0). Conclusión: los estudiantes universitarios subestiman las pérdidas que genera la marihuana, dado que para ellos presenta una percepción de riesgo muy reducida, sobre todo cuando se la compara con el alcohol. En Brasil, también hay una falta de reglamentación y sanciones en relación a la conducción de vehículo automotor bajo efecto de la marihuana, lo que puede contribuir a un riesgo importante en esta población.

RESUMO Objetivo: analisar a relação entre percepção de risco e comportamentos relacionados à condução de veículo automotor sob efeito de maconha. Método: A pesquisa foi realizada por meio de um survey transversal. 382 estudantes de graduação entre 17 e 29 anos de idade foram entrevistados em uma instituição privada de ensino superior no Distrito Federal, Brasil. Foram realizadas estatísticas descritivas e inferenciais (tabulações cruzadas e qui-quadrado), utilizadas para a análise dos dados. RESULTADOS: indicam que mais de 1/3 dos participantes usaram maconha nos últimos 12 meses, 36,4% relataram uso problemático. Foi possível estabelecer uma relação entre os comportamentos percepção de risco e condução de veículo automotor sob efeito de maconha: 1) a percepção de ser sancionado como motorista e condução de veículo automotor sob efeito de maconha (χ2(1)=3,96, p=≤,0); 2) perceber danos como motorista e condução de veículo automotor sob efeito de maconha (χ2(1)=3,96, p=≤05); 3) percepção de dano como passageiro e condução de veículo automotor sob efeito de maconha (χ2(1)=,96, p=≤5,0). CONCLUSÃO: a maconha tem prejuízos subestimados pelos estudantes universitários, pois apresentam uma percepção de risco muito reduzida, especialmente quando comparada ao álcool. No Brasil, também há uma falta de regulamentação e sanções em relação à condução de veículo automotor sob efeito de maconha, o que pode contribuir para um risco importante entre essa população.

Stigma towards mental illness and substance use issues in primary health care: Challenges and opportunities for Latin America.

Stigma towards mental illness and addictive disorders is a global problem and one of the main obstacles in tackling this issue remains the effective integration of mental health services into primary health care (PHC). In Latin America, information has significantly increased on the existence of stigma; however, little is known about effective interventions to prevent stigma and promote recovery-oriented practices in PHC. The aim of this study is to understand the existing evidence regarding mental health stigma in PHC with a special focus on the Latin American region. A scoping review of the literature related to mental health stigma in PHC was conducted. Two hundred and seventeen articles were evaluated; 74 met inclusion criteria and 14 additional articles were selected from references of search results. Results were subdivided into five different perspectives: users, family members and significant others, health professionals, contextual factors, and potential effective interventions. Only nine studies were based in Latin America, and only one described an intervention to reduce stigma in mental health services, not specifically in PHC. We found an urgent need to develop interventions to understand and reduce stigma in PHC settings, especially in Latin America.

Examining the Application of the Opening Minds Survey in the Community Health Centre Setting.

OBJECTIVE: Stigma has been identified as a complex and problematic issue. It acts as a major barrier to accessing care and can exacerbate the experience of a health condition, particularly for clients with mental illness and substance use issues. Scales designed to assess stigmatising attitudes towards those with mental illness and substance use problems among health care providers are necessary to evaluate programs designed to reduce that stigma. The goal of this study was to evaluate the internal reliability and external validity of the Opening Minds Survey for Health Care Providers (OMS-HC). METHODS: The current study examined the use of the OMS-HC in assessing stigma held by Community Health Centre (CHC) staff towards clients with mental and/or substance use problems. Participants represented staff from 6 CHCs in the Greater Toronto Area ( n = 190). RESULTS: The OMS-HC was found to have acceptable internal reliability for the 15-item version of the scale (α = 0.766) and mixed reliability for its subscales (α = 0.792-0.673). Confirmatory factor analysis showed good absolute (root mean square error of approximation = 0.013) and relative fit (Tucker-Lewis index = 0.996) for the current data. The OMS-HC was also shown to correlate with a series of scales commonly used in stigma research. CONCLUSIONS: After testing for internal validity and comparing the OMS-HC to other commonly used scales for assessing stigma and attitudes concerning recovery, the scale was found to be appropriate for the CHC setting and may be advantageous over the use of multiple scales.

Protocol: a cluster randomised control trial study exploring stigmatisation and recovery-based perspectives regarding mental illness and substance use problems among primary healthcare providers across Toronto, Ontario.

INTRODUCTION: Primary care settings are often the first and only point of contact for persons with mental health and/or substance use problems. However, staff experience and training in this area are often limited. These factors as well as a multitude of other components such as structural and systemic stigma experienced by staff can lead to clients being stigmatised, leading to poorer outcomes. By developing a comprehensive intervention for primary care staff working at community health centres (CHCs) aimed at reducing stigma towards people with mental health and substance use problems (MHSUP), we sought to test an innovative and contact-based intervention consisting of staff training, raising awareness, a recovery-focused art programme and an analysis of internal policies and procedures. All of these components can inform and support staff so they can provide better care for people who are experiencing MHSUP. CHC staff members and clients will be included in this project as active participants. METHODS AND ANALYSIS: This mixed-methods project will consist of repeated surveys of staff and clients, as well as in-depth, semistructured interviews with a sample of clients and staff. A cluster randomised control trial design will test the effectiveness of an antistigma intervention for CHCs in Toronto, Canada. Six CHCs-three receiving the intervention and three controls-will be included in the study. Using a variety of measures, including the Opening Minds Scale for Health Care Providers (OMS-HC), Mental Illness: Clinicians Attitudes (MICA) Scale, Modified Bogardus Social Distance Scale, Perceived Devaluation-Discrimination Scale, Discrimination Experience subscale of the Internalized Stigma of Mental Illness (ISMI) Scale and the Recovery Assessment Scale (RAS), we hope to gain a thorough understanding of staff members' attitudes and beliefs and clients' perceptions of staff beliefs and behaviours. In-depth interviews will reveal important themes related to clients' experiences of stigma both within and outside the healthcare setting. ETHICS AND DISSEMINATION: If demonstrated to be successful, this intervention can be used as a model for future initiatives aimed at reducing MHSUP-related stigma among healthcare providers in an organisational context. Adapting this work in other settings is a key strategic goal of this project. The project will also advance knowledge about stigma reduction and the experience of encountering stigma within a healthcare setting. TRIAL REGISTRATION: NCT03043417; Post-results.

Mental health and addictions capacity building for community health centres in Ontario.

PROBLEM ADDRESSED: In recent years, there has been increased recognition in Canada of the need to strengthen mental health services in primary health care (PHC). Collaborative models, including partnerships between PHC and specialized mental health care providers, have emerged as effective ways for improving access to mental health care and strengthening clinical capacity. Primary health care physicians and other health professionals are well positioned to facilitate the early detection of mental disorders and provide appropriate treatment and follow-up care, helping to tackle stigma toward mental health problems in the process. OBJECTIVE OF PROGRAM: This 4-year mental health and addiction capacity-building initiative for PHC addressed competency needs at the individual, interprofessional, and organizational levels. PROGRAM DESCRIPTION: The program included 5 key components: a needs assessment; interprofessional education; mentoring; development of organizational mental health and addiction action plans for each participating community health centre; and creation of an advanced resource manual to support holistic and culturally competent collaborative mental health care. A comprehensive evaluation framework using a mixed-methods approach was applied from the initiation of the program. A total of 184 health workers in 10 community health centres in Ontario participated in the program, including physicians, nurses, social workers, and administrative staff. CONCLUSION: Evaluation findings demonstrated high satisfaction with the training, improved competencies, and individual behavioural and organizational changes. By building capacity to integrate holistic and culturally appropriate care, this competency-based program is a promising model with strong potential to be adapted and scaled up for PHC organizations nationally and internationally.

General Beliefs and Stigma Regarding Illicit Drug Use: Perspectives of Family Members and Significant Others of Drug Users in an Inner City in Brazil.

People who use drugs are continuously subjected to harsh stigmatization through a process of relational and social degradation, which limits their possibility for recovery. This quantitative study explores the perspectives of family members or significant others of illicit drug users, regarding general beliefs about illicit drug use and their stigma. Respondents agree that most people do not trust people who use drugs, disregard individuals who have been hospitalized due to drug problems and do not think people who use drugs are as intelligent as the general population. These findings reveal a high level of public stigma regarding illicit drug use.

Developing a holistic policy and intervention framework for global mental health.

INTRODUCTION: There are significant gaps in the accessibility and quality of mental health services around the globe. A wide range of institutions are addressing the challenges, but there is limited reflection and evaluation on the various approaches, how they compare with each other, and conclusions regarding the most effective approach for particular settings. This article presents a framework for global mental health capacity building that could potentially serve as a promising or best practice in the field. The framework is the outcome of a decade of collaborative global health work at the Centre for Addiction and Mental Health (CAMH) (Ontario, Canada). The framework is grounded in scientific evidence, relevant learning and behavioural theories and the underlying principles of health equity and human rights. METHODS: Grounded in CAMH's research, programme evaluation and practical experience in developing and implementing mental health capacity building interventions, this article presents the iterative learning process and impetus that formed the basis of the framework. A developmental evaluation (Patton M.2010. Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use. New York: Guilford Press.) approach was used to build the framework, as global mental health collaboration occurs in complex or uncertain environments and evolving learning systems. RESULTS: A multilevel framework consists of five central components: (1) holistic health, (2) cultural and socioeconomic relevance, (3) partnerships, (4) collaborative action-based education and learning and (5) sustainability. The framework's practical application is illustrated through the presentation of three international case studies and four policy implications. Lessons learned, limitations and future opportunities are also discussed. CONCLUSION: The holistic policy and intervention framework for global mental health reflects an iterative learning process that can be applied and scaled up across different settings through appropriate modifications.