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 Lower-Middle Income Country 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 mental, neurological and substance use 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.

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, and the 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 a book of life stories and a public photographic installation.

This project is funded by the Arts and Humanities Research Council, Economic and Social Research Council and Global Challenges Research Fund and the research team comprises Paul Heritage (Queen Mary University of London/People’s Palace Projects), Miriam Krenzinger (Federal University of Rio de Janeiro), Stefan Priebe (Unit for Social and Community Psychiatry, East London NHS Foundation Trust and Queen Mary University of London) and Marcelo Santos Cruz (Federal University of Rio de Janeiro) working with research collaborators Luiz Eduardo Soares and Eliana Sousa Silva (Redes da Maré).