PAHO/WHO Collaborating Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
Prim Health Care Res Dev. 2022 Jul 1;23:e37. doi: 10.1017/S1463423622000251.
The detrimental impact of stigma toward people with mental illness and substance use problems (MISUP) is well documented. However, studies focusing on stigma reduction in Latin American primary health care (PHC) contexts are limited. This situational analysis incorporating a socioecological framework aims to provide a comprehensive understanding of MISUP-related stigma in PHC centers in Brazil. The objectives of this analysis are twofold: (1) to understand the current mental health and substance use service delivery context and (2) identify challenges and opportunities for addressing MISUP-related stigma in PHC centers in Ribeirão Preto, Brazil.
Environmental scans of four Family Health Units were conducted in early 2018 to explore population needs and service delivery for individuals with MISUP. In addition, a symposium was organized in October 2018 to consult with diverse stakeholders and gather local perspectives about MISUP-related stigma conveyed in PHC settings. NVivo 12 software was used to conduct a thematic analysis of the qualitative data collected from the environmental scans and the symposium consultation.
Themes identified at the national level in the socioecological framework indicate that political support for national policies related to reducing stigma is limited, particularly regarding social inclusion and the decentralization of mental health services. Themes at the regional, organizational, and interpersonal levels include insufficient mental health expertise and the limited involvement of those with lived experience in decision-making. Suggestions for stigma interventions were provided, including increased contact with individuals with lived experience outside of client-patient interactions, capacity building for professionals, and public education campaigns.
Increased government support, capacity building, and promoting social inclusion will provide opportunities to reduce stigma and reach marginalized populations. These findings will assist with addressing current gaps in PHC mental health service provision and may inform anti-stigma strategies for Brazil and other Latin American low- and middle-income countries.
精神疾病和物质使用问题（MISUP）患者所遭受的污名化影响已得到充分证实。然而，在拉丁美洲基层医疗保健（PHC）背景下，关注减少污名化的研究却很有限。本情境分析结合了社会生态学框架，旨在全面了解巴西 PHC 中心与 MISUP 相关的污名化问题。该分析有两个目的：（1）了解当前的心理健康和物质使用服务提供情况；（2）确定在巴西里贝朗普雷图的 PHC 中心解决与 MISUP 相关的污名化问题的挑战和机遇。
2018 年初，对四个家庭健康单位进行了环境扫描，以探索有 MISUP 的个体的人口需求和服务提供情况。此外，2018 年 10 月还组织了一次专题研讨会，以咨询不同利益攸关方，了解 PHC 环境中传达的与 MISUP 相关的污名化问题的当地观点。使用 NVivo 12 软件对从环境扫描和专题研讨会咨询中收集的定性数据进行主题分析。
社会生态学框架中的国家层面主题表明，减少污名化的国家政策的政治支持有限，特别是在社会包容和精神卫生服务去中心化方面。区域、组织和人际层面的主题包括心理健康专业知识不足以及有经验的人在决策中的参与有限。提出了污名干预措施的建议，包括增加与有经验的人在客户-患者互动之外的接触、为专业人员提供能力建设以及开展公众教育运动。
增加政府支持、能力建设和促进社会包容将为减少污名化和接触边缘化人群提供机会。这些发现将有助于解决 PHC 心理健康服务提供方面的当前差距，并为巴西和其他拉丁美洲中低收入国家的反污名化策略提供信息。
