Building the barricades: Three interdisciplinary studies on Mental and Substance Use Disorders in the context of armed violence in Brazil

这项研究旨在了解武装冲突对生活在马雷建筑群暴力背景下的人们的心理健康和福祉的影响--马雷建筑群是里约热内卢16个外围社区的聚集地，人口超过14万*。这项研究聚焦于巴西--一个LMIC国家--该国对周边城市地区(贫民窟)进行军事干预，受到毒品交易武装团伙的监管--试图将对MNS障碍的理解置于周边地区武装冲突的激烈程度之中，这些冲突是世界上许多最贫穷和最不发达国家的特征。这项研究将寻求对生活在一个受到多重压力因素(社会经济排斥、暴力水平高、接触文化网络和机构的机会有限等)的社区内的人们的心理健康和福祉有新的理解。在这个社区，日常生活受到多方面的武装监管和战斗的限制，这场战争是由所谓的“禁毒战争”引起的。虽然MNS障碍的情况在LMIC许多大城市外围的脆弱地区很严重，但里约热内卢的贫民窟的特点是销售、消费、冲突和滥用，使这项研究的核心领域的具体分析成为为未来研究开辟新途径的适当手段。在缺乏资金或国家结构能够开发、评估和维持小岛屿发展中国家复杂的心理健康干预措施的情况下，民间社会组织利用现有的个人和社会资源，这些资源可以通过训练有素的非专业人员、志愿者、同龄人和家庭提供。这项建议将借鉴并开发在里约热内卢反毒品战争的城市战场背景下被发现有效的低成本方法。将研究设在马雷具有重要意义，因为它允许研究问题在一个有15个地区用于公开毒品交易的地区的背景下进行，在当地被称为“cracolandias”**[http://bit.ly/2moGPC4]；2016年马雷警方行动造成的致死率(12.8：10万居民)是巴西(1.6：100)的八倍，是里约热内卢州(2015年：3.9：)的三倍]，以及为患有MNS疾病的人提供的非正式护理网络。马雷是一个小城市的规模，有一个组织Redes da Maré，该组织在暴力和公共安全研究领域以及在照顾吸食可卡因、酒精和其他毒品的人方面拥有长期经验。该研究提出了3项研究：研究1对200名生活在马雷社区内和社区边界内的街道上或面临生活风险的可卡因使用者进行研究，调查受访者现有的心理健康状况，他们对MNS疾病的了解和看法，自我和社区护理的可能性，非正式护理网络的存在。研究2：调查受高度暴力和不安全影响的人的精神健康和福祉，重点是他们的精神健康、吸毒模式(合法和非法)、家庭和教育背景、创收以及获得社会、健康和药物治疗方案的机会。它将包括对马雷1,200名居民的调查，来自16个社区的受访者，以及对患有精神障碍和/或药物滥用的调查受访者的20次半结构化访谈研究3：以艺术为基础的做法来产生挑战与MNS障碍相关的污名和排斥的叙事和图像，从而产生关于生活故事和公共摄影装置的信息。*人口数据来源：巴西地理和统计研究所2011年http://bit.ly/2mgzu6M**Rui，Taniele巴西市政当局简介。“Luz”和“cracolandia”的用法：空间实践的实地考察

This research aims to understand the impact of armed conflict on the mental health and wellbeing of people living in the context of violence in the Complex of Maré - a conglomeration of 16 peripheral communities in Rio de Janeiro with a population of over 140,000 people*. By focusing on Brazil - a LMIC in which the state pursues a military-style intervention into peripheral urban territories (favelas) regulated by armed gangs trading drugs - the research seeks to locate an understanding of MNS disorders within the intensity of armed conflicts in peripheral territories that characterise many of the world's poorest and least developed countries. The research will seek to bring new understanding about the mental health and wellbeing of people living within a community subject to multiple stress factors (socio-economic exclusion, high levels of violence, limited access to cultural networks and institutions, etc) where daily lives are circumscribed by multi-faceted armed regulation and combat resulting from the so-called 'war on drugs'.While the situation of MNS disorders is acute in fragile territories on the peripheries of many major cities in LMICs, the favelas of Rio de Janeiro are characterized by a narcotic narrative of sale, consumption, conflict and abuse that makes the territorially-specific analysis at the heart of this research an appropriate means to open up new avenues for future research. In the absence of funding or state structures that can develop, evaluate and maintain complex mental health interventions in LMICs, civil society organizations that utilize existing personal and social resources that can be provided through trained lay people, volunteers, peers, and families. This proposal will learn from, and develop low-cost approaches that are found to be effective within the context of the urban battlefields of the war on drugs in Rio de Janeiro.Locating the research in Maré is significant since it allows the contextualization of the research questions in a territory where there are 15 areas used for the open dealing of crack, known locally as 'cracolandias'** [http://bit.ly/2moGPC4]; a lethality rate due to police actions in Maré in 2016 (12.8:100,000 inhabitants) eight times higher than that of Brazil (1.6:) and three times that of Rio de Janeiro state (3.9:) in 2015], as well as informal care networks for people living with MNS disorders. Maré is of the scale of a small city and has an organization, Redes da Maré, which has a long experience in the field of studies on violence and public safety and in the field of care for people who use crack, alcohol and other drugs.The research proposes 3 studies: Study 1 on 200 crack-cocaine users living on or at risk of living on streets within and on the borders of the Maré communities, investigating existing mental health of the respondents, their knowledge and perception about MNS disorders, possibilities of self- and community-based care, existence of informal care networks. Study 2: an investigation of the mental health and wellbeing of people affected by high levels of violence and insecurity, with a focus on their mental health, patterns of drug use (legal and illegal), family and educational background, income generation and access to social, health and drug treatment programmes. It will include a survey of 1,200 residents of Maré with respondents from each of the 16 communities and 20 semi-structured interviews with respondents from the survey who are living with mental disorders and/or substance abuse Study 3: Arts-based practices to produce narratives and images that challenge stigma and exclusion associated with MNS disorders, resulting in of life stories and a public photographic installation.* Population data source: IBGE - Brazilian Institute of Geography and Statistics' Profile of Brazilian Municipalities 2011 http://bit.ly/2mgzu6M** RUI, Taniele. Usage of "Luz" and "cracolandia": fieldwork of spatial practices"