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暴力环境中的人的心理健康和福祉的影响，该地区是里约热内卢16个周边社区的集合体，人口超过140，000人。通过关注巴西-一个LMIC，其中国家追求军事式干预到由武装团伙交易毒品管制的外围城市领土（贫民窟）-研究旨在找到MNS障碍的理解在外围领土的武装冲突的强度，困扰着世界上许多最贫穷和最不发达国家。这项研究将寻求对生活在一个受到多种压力因素影响的社区内的人们的心理健康和幸福带来新的理解（社会经济排斥、暴力行为严重、利用文化网络和机构的机会有限，等），日常生活受到多方面的武装管制和战斗的限制，虽然MNS疾病的情况在LMIC许多主要城市周边的脆弱地区非常严重，但里约热内卢的贫民窟的特点是销售，消费，冲突和虐待，使本研究的核心地域具体分析成为一种适当的手段，为今后的研究开辟新的途径。在缺乏资金或国家结构的情况下，可以在中低收入国家制定，评估和维持复杂的心理健康干预措施，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外行人，志愿者，同伴和家庭提供。这项建议将借鉴并发展在里约热内卢禁毒战争城市战场上被证明有效的低成本方法，将研究地点设在马雷具有重要意义，因为它可以将研究问题置于一个有15个地区用于公开交易快克的地区的背景下，这些地区在当地被称为“cracolandias”** [http：//bit.ly/2moGPC4]; 2016年，由于马雷的警察行动导致的死亡率（12.8：100，000居民）是巴西（1.6：）的八倍，是里约热内卢州（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，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可卡因、酒精和其他毒品使用者护理领域拥有长期经验。研究1：200名生活在Maré社区内和边界街道上或有可能生活在这些街道上的快克可卡因使用者，调查受访者的现有心理健康状况，他们对MNS疾病的知识和看法，自我和社区护理的可能性，非正式护理网络的存在。研究2：对受高度暴力和不安全影响的人的心理健康和福祉进行调查，重点是他们的心理健康、吸毒模式（法律的和非法的）、家庭和教育背景、创收以及获得社会、保健和戒毒治疗方案的机会。它将包括对1，200名Maré居民的调查，其中包括来自16个社区的受访者，以及对调查中患有精神障碍和/或药物滥用的受访者进行的20次半结构化访谈研究3：基于艺术的实践，以制作叙事和图像，挑战与MNS疾病相关的耻辱和排斥，从而产生生活故事和公共摄影装置。人口数据来源：巴西地理统计局-巴西地理和统计研究所《2011年巴西城市概况》，http://bit.ly/2mgzu6M** RUI，Taniele。“Luz”和“cracolandia”的使用：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"