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

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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"