Background: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.Methods: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.Results: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.Conclusion: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.

Background/Objectives: In the literature, few instruments have been identified to measure the stigma of health professionals toward people with mental illness. In Brazil, until 2021, the literature did not indicate the validation of an instrument or the construction of an instrument for this purpose. Considering this gap, this study aimed to validate and estimate the reliability of the Mental Illness: Clinicians’ Attitudes Scale, version 4 (MICA-4) for the Brazilian context, examining the psychometric properties through the analysis of its internal consistency and factor structure. Methods: Psychometric testing was completed in a sample of health professionals from Primary HealthCare Units. Reliability analysis was conducted in SPSS v23. Cronbach’s Alpha and item total correlation were used. The dimensionality of the MICA was explored using exploratory factor analysis (EFA) in Mplus 8.2. Results: A total of 195 health professionals participated in the research. Cronbach’s Alpha was 0.68 and according to the reliability analysis, items 10 and 12 of the original version were deleted, resulting, therefore, in 14 items. In addition, we demonstrated that it is possible to have only two factors instead of five factors, which is the number of factors in the original version of the MICA-4. Conclusions: This validated instrument for the Brazilian context can serve as an important tool in understanding the phenomenon of the stigma of health professionals toward people with mental illness and, consequently, in promoting anti-stigma strategies in Brazil.

Introduction: People with mental illness are highly stigmatized by populations around the world and are perceived to be a burden on society. As a result of stigma, many people with mental illness are discriminated against, which leads to limited life opportunities. Given that beliefs about mental illness can vary based on culture, religion, nationality and ethnicity, it is important to understand the different types of mental illness-related stigma experienced around the world. Materials and Methods: Whittemore and Knafl’s (2005) methodology for integrative reviews was used to analyze 18 studies about lived experiences of mental illness-related stigma in South America. Results: Findings suggest that certain types of stigma in South America are based on gender and social norms, such as the social position of men and women in society. This leads to discrimination, isolation and violence from family, intimate partners, friends, society and health professionals. Employment is also limited for South Americans with mental illness. Other consequences, such a self-stigma, also impact the lives of people with mental illness in many South American contexts. Discussion: Family, friendship and social relationships, including health professionals, can involve processes that lead to the stigma experienced by people with mental illness. Conclusion: This integrative review highlights how mental illness related-stigma impacts

Resumo A Atenção Primária à Saúde é essencial no primeiro acesso às demandas de saúde mental, integrando-se à Rede de Atenção Psicossocial. Este estudo qualitativo teve como objetivo explorar as percepções de pessoas com necessidades de cuidado em saúde mental sobre o atendimento recebido em unidades de Atenção Primária à Saúde, buscando compreender os desafios, as expectativas e as recomendações. Realizado entre janeiro e setembro de 2021 em seis Unidades de Saúde da Família de um município de São Paulo, Brasil, envolveu entrevistas semiestruturadas com 22 usuários, submetidas à análise temática de Braun e Clarke. Os resultados indicaram que, embora os serviços sejam vistos como acolhedores, há relatos de deficiências no preparo dos profissionais para lidar com demandas de saúde mental. Os participantes enfatizaram a necessidade de maior empatia, capacitação e disponibilidade dos profissionais, além de destacarem a importância de práticas de escuta ativa e respeito à autonomia dos usuários. Foram propostas melhorias no atendimento, como a ampliação de equipes multidisciplinares, a criação de grupos terapêuticos e maior integração entre saúde mental e Atenção Primária à Saúde. O estudo reforça o papel da Atenção Primária à Saúde como espaço estratégico para o cuidado em saúde mental, apontando estratégias para o fortalecimento da Rede de Atenção Psicossocial.