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.

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.

About Us: The Ontario COVID-19 Science Advisory Table is a group of scientific experts and health system leaders who evaluate and report on emerging evidence relevant to the COVID-19 pandemic, to inform Ontario's response.Our mandate is to provide weekly summaries of relevant scientific evidence for the COVID-19 Health Coordination Table of the Province of Ontario, integrating information from existing scientific tables, Ontario's universities and agencies, and the best global evidence.The Science Table summarizes its findings for the Health Coordination Table and the public in Science Briefs.The Mental Health Working Group comprises scientific experts and public health leaders with specific expertise in mental health.Their expertise spans mental health of children and youth, adults and geriatric populations, mental health of health care providers, women's health, mental health among LGBTQ persons, mental health among Black, Indigenous, and other racialized populations, and COVID-19.The Working Group evaluates emerging scientific evidence related to maintaining mental health during COVID-19, the mental health burden of disease and public health interventions on individuals across the lifespan, including children and adolescents,

The determinants of health and public mental health frameworks define the factors that shape health, calling for more effective partnerships across organizations and levels of society to address those factors. A consensus exists that it is the combination of risk and protective factors rather than factors taken individually that determines the impact on mental health. A range of cost-effective interventions are described. Nurses and others can also be effective in treating episodes of common mental disorders. It is necessary to recognize the social determinants of health, and work towards a change in health-care and social systems, as well as in the education of doctors. The social determinants of health (SDOH) model posits that genetic endowment interacts with social and physical environments to determine individual biological and behavioural responses that are influenced by access to and quality of health-care services.

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].

About Us: The Ontario COVID-19 Science Advisory Table is a group of scientific experts and health system leaders who evaluate and report on emerging evidence relevant to the COVID-19 pandemic, to inform Ontario's response.Our mandate is to provide weekly summaries of relevant scientific evidence for the COVID-19 Health Coordination Table of the Province of Ontario, integrating information from existing scientific tables, Ontario's universities and agencies, and the best global evidence.The Science Table summarizes its findings for the Health Coordination Table and the public in Science Briefs.

Many jurisdictions are developing and implementing COVID-19 vaccine certificates as falsification-proof, verifiable proof of immunization in secure digital or paper-based formats. Vaccine certificates can be used to regulate entry into discretionary settings that pose a high risk for SARS-CoV-2 transmission (e.g., indoor dining, bars, gyms, cultural and sports events). Vaccine certificates can also be used in non-discretionary settings (e.g., schools, universities, congregate settings, and workplaces), especially in settings that require mandatory vaccination. On a short-term basis, vaccine certificates could enable the re-opening of high-risk settings sooner and/or at increased capacity. Vaccine certificates will be of particular importance to maintain economic and societal reopening if public health measures need to be reintroduced. Some jurisdictions are also implementing vaccine certificates with the goal of incentivizing COVID-19 vaccination. On a longer-term basis, vaccine certificates can serve as a verifiable, secure, standardized, accessible and portable records of immunization. There is currently no scientific evidence of the direct impact of COVID-19 vaccine certificates on SARS-CoV-2 transmission or population vaccination rates, and there are important ethical, legal, accessibility, and privacy considerations concerning their development and implementation.

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.

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.

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.

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.

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.

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.

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.