"We need to change attitudes and mindsets about mental health at all levels."

“The biggest challenge we face globally is combating stigma and discrimination. People with mental health problems are reluctant to talk about it for fear of being judged in every way, including their ability to manage their lives. The level of stigma and discrimination is very high worldwide. In some countries, for example, if you have a mental health diagnosis, you cannot get a job in the public sector or obtain health insurance, which is extremely discriminatory.”

We must overcome this situation, and that means changing attitudes and mindsets at all levels , both in society and in the design of public policies. That is why at the WHO our field of action for change operates at different levels. One cannot exist without the other. If you don't change mindsets, you won't change policy, so we must make an effort to ensure that change occurs in all sectors of society and that addressing stigma and discrimination is truly understandable.

For example, in the case of law enforcement, if officers have a negative mindset toward someone who may have a mental health disorder and are intervening in a crisis, they are more likely to use violence or excessive force because of those preconceived notions. Or, in the case of a child with a mental health problem, perhaps at school they are considered less capable of contributing, less capable of studying, and, because of those preconceived notions, they don't make the same effort to accommodate them as they would if the child were a generally high-achieving student.

The problem is that stigma and discrimination can be very subtle or even written into public policies, which is why we must address different levels: changing attitudes and mindsets, introducing training and programs in different sectors, and changing policies at all levels.

"Well, I think it's an interesting approach to describing what's happening. Society is going through many changes and transformations, such as increased awareness of climate change, an interest in living in a more sustainable society, a commitment from many young people to creating a different future, and, along with all of this, there has also been a general consensus on the importance of mental health, which has been a central concern due to the impact of the COVID-19 pandemic and which many people are still dealing with today."

This is relevant because it underscores how important mental health has been for people over the past two years, whether or not you had a diagnosis, and the crucial role that the community has played.

I believe that the situation we have experienced has helped to improve understanding and increase empathy towards mental health problems, but we cannot forget that the crisis is bringing an increase in unfavorable social determinants that put many people at risk of developing a mental health problem or worsening an existing one, and that force us to consider how we are going to address this situation.

“ Quality Rights is working in all of these different areas. Through capacity building, service evaluation, civil society engagement, and policy reform , this project offers a comprehensive approach to ending coercion and promoting a recovery approach, in order to leave a lasting legacy of respect for human rights.”

The training is open to everyone: healthcare professionals, social and educational professionals, law enforcement officers, legal professionals, NGOs, and the general public. It's truly a training program designed to empower diverse groups to transform attitudes, mindsets, and practices through evidence-based effectiveness, which has already led to dramatic changes in stigma and discrimination.

The initiative also seeks to transform the mental health and support services that people come into contact with. We are moving from institutionalization to community-based services, which are not only located within the community but also truly promote community inclusion using a recovery approach.

Mental health recovery

Read more

Monograph

Instead of the traditional biomedical model, we promote recovery-based mental health services where individuals can truly explain their problems, where someone listens attentively, where a support plan is developed collaboratively, and where the different areas of their lives where they need support are addressed. In this sense, we are investing in community mental health centers where the care model departs from the traditional approach, in home-based care, and so on.

In addition to reforming countries' policies, strategies, and planning, we want to strengthen a specific model of care and ensure that people with lived experience of mental health issues are at the center and lead all actions at different levels.

"It's incredibly important. I know, from my own experience and that of my colleagues, that this change wouldn't have happened without firsthand associations . In fact, I myself am a clear example. When I joined the WHO more than 20 years ago, my mindset was biomedical, due to my training. It was through dialogue and exchange with people who had lived experience in mental health, people who had been within the system, that I changed my mindset. In this sense, the work I've been doing for the last 15 years has changed dramatically."

This is truly thanks to the associative movement and all they have contributed in this area. The fact that they were able to obtain approval from the International Convention on the Rights of Persons with Disabilities It's a very important milestone, both because of its scope and because it legitimizes them. It's a United Nations human rights instrument that has legal implications for signatory countries. It was a huge step and a benchmark you can always return to because it's a standard in international human rights.

For us, the Quality Rights strategy and objectives are not only positive, but more than that. It's about complying with human rights standards that countries have signed on to.

Human rights and mental health

Read more

Monograph

" Quality Rights is a community training program for all sectors, regardless of prior knowledge on the subject. Essentially, this training will give people a better understanding of mental health issues , how to support someone with a mental health problem, how to help themselves with their own mental health issues, what the risk factors are, and a deeper understanding of what recovery means."

We're focusing on a model based on understanding who people are in their lives, helping them address their main concerns, which have to do with relationships, meaningful connections, having a job, getting better housing, and dealing with discrimination they may have experienced. We're taking a much more holistic approach.

This training also helps people reconsider their preconceived notions of mental health . We need to understand that this is how people have been educated over the last 30 years through the media and audiovisual culture. Most people still think of mental health as a brain problem, simply a neurotransmitter issue that needs to be corrected. That's how the general population views mental health.

Therefore, this training aims to correct this mentality and make people understand that it is a social problem and that each of us can help people with mental health problems: by connecting, talking, supporting, being there, advising, helping them and solving problems.

In addition to personal and professional development, the training also covers mental health services. The message is that things can be done differently, supporting people's legal capacity. We also know that by supporting people and their choices about what they want to do with their lives and their treatment, we will achieve better results in the medium and long term than with a traditional approach where we tell people what they should do.

"The studies we are conducting reveal a 40% improvement in attitudes and practices regarding recorded discrimination . The data is there and is based on thousands of people who have completed the training. In terms of concrete experiences, what the trained individuals tell us is that their professional lives have completely changed in aspects such as avoiding coercion in treatments, improving their ability to listen and respect the people they serve, and truly making decisions in consensus with the individual."

We have the most experience in countries like Ghana, Kenya, Turkey, the Czech Republic, the Philippines, and several European countries. Many people wonder how the program works in such diverse locations. The truth is, we're training people from all over the world, and the response we get is always similar, regardless of the country.

This is because from the outset we designed the program with global reach in mind. This requires you to have a very clear understanding of the principles and values, and to carefully select the examples and how you explain them so that they work anywhere in the world, remaining flexible and adaptable. You have to allow students to use their imagination to identify these examples in their own countries.

It's difficult and probably can be improved, but what's most interesting is that the experiences of people with mental health problems are similar all over the world . Whether you're someone being mechanically restrained in Ghana or in Spain, what you're going to feel is the same. It's a matter of human reaction, regardless of where you're from; that's common. The same is true when you're "disempowered," when you can't decide about your treatment or your future, here, in France, or in Kenya, or when someone starts making decisions for you simply because you've been diagnosed with a mental health problem. These are universal issues, human rights issues, and the feelings and being of people.

The program works because of the universality of the human response to certain situations and because we're trying to connect with people on an emotional level. Without that emotional connection, you can't achieve commitment and, therefore, you can't achieve change. That's how we've designed the training.

“We are getting a very good response. The WHO is a global organization, but we have a particular commitment to supporting low- and lower-middle-income countries, though we work worldwide—we never lose sight of that. Initially, we started with low- and lower-middle-income countries, but now we are also working with high- and upper-middle-income countries. So, at the April launch, we had the announcement of commitments from countries like France, which will hold a national launch; Portugal, Slovenia, Italy, and others. It always happens that as soon as high- and upper-middle-income countries commit, everything starts to move forward.”

"The goal is to have 5 million accredited professionals by the end of 2024 , and I think it's possible if individuals, organizations, and governments truly commit. Just think of how many people work in healthcare, social services, law enforcement, education, technical fields, or associations in every country… It's about highlighting the value of this training and encouraging people to pursue it. There are many strategies for this. In Italy, for example, they're offering it as part of continuing professional development, and it counts towards job placement benefits."