BACKGROUND: There is an urgent need to address the poor quality of mental healthcare and human rights violations within mental health systems and communities. To achieve this, efforts must focus on changing the attitudes that perpetuate stigma and discrimination against individuals with mental health conditions, as well as psychosocial, intellectual and cognitive disabilities. The World Health Organization (WHO) QualityRights e-training on mental health, recovery and community inclusion is tackling these issues in several countries; however, its global impact has yet to be evaluated. AIMS: This study aims to assess the changes in attitudes following the completion of the WHO QualityRights e-training in countries worldwide. METHOD: Data from 3026 participants were analysed in this pre-post intervention study. Changes in scores on the WHO QualityRights Attitudes questionnaire were evaluated with the paired t-test and Wilcoxon signed-rank test. RESULTS: The mean differences from baseline to post-training on the WHO QualityRights Attitudes questionnaire were 9.91 (95% CI 9.58-10.24, d = 1.07) for the total sample, 8.95 (95% CI 8.59-9.31, d = 0.99) for the high-income countries sample; and 12.75 (95% CI 12.03-13.47, d = 1.33) for the low- and middle-income countries sample. These findings indicate that participants, after completing the e-training, showed a decrease in negative attitudes toward individuals with mental health conditions and psychosocial, intellectual and cognitive disabilities. CONCLUSIONS: This study suggests that the WHO QualityRights e-training has a positive, large effect in reducing negative attitudes toward individuals with mental health conditions and psychosocial, intellectual and cognitive disabilities, and can contribute to reduced stigma and greater alignment with rights-based approaches. These findings support the scale-up of the WHO QualityRights e-training programme.

Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy

Department of Mental Health Ministry of Health Nairobi Kenya

Department of the Presidency Government of Catalonia Barcelona Spain

European Network of Users and Survivors of Psychiatry Madrid Spain

European Network of Users and Survivors of Psychiatry Tbilisi Georgia

Health Care Department Ministry of Health Prague Czechia

Institute for Population and Development Banja Luka Bosnia and Herzegovina

Mental Health Authority Ministry of Health Accra Ghana

National Mental Health Programme Ministry of Public Health Beirut Lebanon

Pamumvuri PVO Harare Zimbabwe

Pan American Health Organization World Health Organization Regional Office for the Americas Washington DC USA

Policy Law and Human Rights Unit Department of Mental Health Brain Health and Substance Use World Health Organization Geneva Switzerland

Policy Linkages Office Commission on Human Rights of the Philippines Manila The Philippines

Research Department University Psychiatric Hospital Vrapce Zagreb Croatia

Tunawiri Community Based Organisation Nairobi Kenya

WHO Collaborating Centre for Research and Training in Mental Health Lille France

World Health Organization Estonia Country Office Tallinn Estonia

World Health Organization Regional Office for Europe Copenhagen Denmark

World Health Organization Turkey Country Office Ankara Turkey

World Health Organization Zimbabwe Country Office Harare Zimbabwe

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