Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills (CBIS) 2022 Version 2.0

According to the World Health Organization (WHO), mental health challenges are becoming the number one cause of years-lived with disability worldwide. Depression, one of the most prevalent and costly conditions in our society, affects over 400 million people globally, and ranks as the single largest contributor to global disability at 7.5% of all years lived with disability in 2015. When mental health challenges co-occur with other chronic medical conditions, there is a higher morbidity and cost to the healthcare system. Even though the vast majority of “People with Lived Experience” (PWLE) can be handled early and effectively in a primary care setting, more than half of individuals do not receive help.

The stigmatization of people living with mental health challenges and substance use disorders is all too common, even within healthcare environments. People with lived experiences of mental health challenges, including substance use problems, often report feeling devalued, dismissed, and dehumanized by many of the healthcare professionals with whom they come into contact. Stigma in healthcare settings can manifest in subtle and largely unintended ways. Providers feel that their efforts result in no measurable change, are commonly less optimistic about treatment adherence and outcomes, refer PWLE more frequently to specialty services, delaying early intervention, and tend to attribute physical illnesses to the mental health diagnosis. Such practices have resulted in poor patient care, which increases morbidity and mortality within this vulnerable population.

Stigma can be related to a lack of skills and confidence when working with PWLE. Furthermore, healthcare providers lack awareness of their own prejudices and have an incomplete understanding of how important they are in the process of recovery (Knaak & Patten, 2016). Thus, mental health-related stigma remains a significant barrier to effective treatment and recovery. To address this growing public health issue, PAHO formed a partnership with the Mental Health Commission of Canada (MHCC) to address stigma at the clinical level.

The Understanding Stigma (US) and Strengthening Cognitive Behavioral Interpersonal Skills (CBIS) program combines two evidenced-based MHCC complementary stigma-reduction programs, which was piloted across the English-speaking Caribbean countries and territories in 2021.

Understanding Stigma is a self-directed web-based program designed to provide professionals with an opportunity to recognize attitudes and behaviors that could potentially lead to stigma, its impact on PWLE, and practical approaches to address some of its challenges. The Cognitive Behavioral Interpersonal Skills program is a tutor facilitated skills building component designed to reduce providers’ sense of helplessness and anxiety, which can lead to clinical distancing when caring for PWLE.

Educational approach 

The educational methodology will consist of a blended, online self-learning and tutor-guided approach for primary healthcare providers. Didactic sessions are balanced with integrated discussion and interactive activities throughout to facilitate an active and participatory learning environment, accessible and engaging for learners. A core element of the program is social contact with PWLE (First Voice videos), in which they share their experience living with mental health challenges and their recovery journey. This approach allows for an improved meaningful learning linked to practical performance.

Course purpose

The purpose of this program is to reduce mental health related stigma and improve clinical and practice management skills among primary care providers when working with individuals experiencing mental health challenges.

Main objective

After this course, participants will have a better understanding of mental health-related stigma, its impact, how to reduce it, and how a structured training program that targets improved practitioners’ knowledge, management skills and confidence when caring for this population group, leads to diminished social distance and stigmatization.


The course has been tailored for participants who fulfill the following criteria: 

  • Primary care practitioners from English-speaking Caribbean countries, who are working as: MD general practitioners, specialized nurse practitioners, clinical psychologists and other mental health care providers directly involved in PWLE care.
    • Two or more years of clinical working experience in health care (preferably in mental health services).
    • Interested in enhancing their capacity to understand stigma and implicit biases when treating mental health patients within their Primary Health Care networks.
    • Have the support of the Ministry of Health /Supervising Body and from their own institutional work supervisors.

Duration / Workload

This course will be delivered virtually via PAHO’s Virtual Campus for Public Health.

The 16-week tutor-led course will be offered in English to groups of 60 -100 primary health care providers (maximum) from across the English-speaking Caribbean countries and territories. The course will have a duration of 60 hours and it will take place from August 15 until November 30, 2022.

Trainees will also commit to participate in individual and group work that will require: 

  • Approximately three to four hours a week of work in different synchronous and asynchronous activities, as well as turning in written assignments and course work in a timely manner.
    • The weekly 3-4 hours would include the “Individual Work” requirement between sessions (action period) in which you are asked to practice (in-office) with your own clients the skills you learned.
    • While participation schedules are flexible, the overall agenda of the course activities must be met.
      • The course lasts 16 weeks in total, with individual and group activities, as well as orientation and support from a course tutor consultant.
      • Training modules and content might be adjusted according to the needs.

Course structure

Understanding Stigma online self-learning
Module 1: Raising awareness
Module 2: Impact of stigma
Module 3: Challenging stigma and discrimination
Strengthening Cognitive Behavioral Interpersonal Skills
Module 4: Introduction to CBIS program
Module 5: Problem List & Action Plan care pathway
Module 6: Diagnostic Assessment Interview (DAI) care pathway
Module 7: Self- Assessment Questionnaire care pathway

Evaluation and certification of participants

Healthcare providers will be evaluated in multiple ways. Active participation to classes will be considered, while preparatory reading and understanding of presented material will be directly assessed through quizzes and individual and group assignments. Participants will also need to submit original work around the file of “Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills”.

Participants will work alone and together in groups to complete their weekly work assignments and final group project.

Participants who successfully obtain a passing grade of 80% of the course modules assignments and participation in seven modules, will be able to download their course completion certificate issued by the Pan American Health Organization.

Last update: 22/May/2024