The conflict in Northeastern Nigeria has left the region with an increasing death toll of 20,000 and has caused mass displacement of over 2.3 million(1)(2). The impacts of conflict are far reaching and has adverse consequences on the mental health of affected populations(3). Nigeria’s mental health system does not have the structure or resources to accommodate its mental health burden. Translating the emergency response in Northeastern Nigeria into sustained improved mental health care may be useful toward implementation of Nigeria’s mental health policy and nationwide mental health reform. The purpose of this thesis is to analyze how the emergency response in Northeastern Nigeria may be leveraged to contribute toward an improved mental health system. A literature review was conducted in order to review case studies of regions which have strengthened their mental health systems after and during an emergency. Additionally, best practices for mental health systems strengthening were reviewed. Findings show that a strengthened mental health system may be achieved by the government making an early commitment to seizing the emergency response as an opportunity to reach this goal. The emergency response could adopt key strategies such as developing a local workforce and using established tools to guide service provision. Additionally, the investment of key stakeholders and a commitment toward decentralization and scaling up community-based services is recommended. Such an approach may be beneficial toward improved mental health care in Northeastern Nigeria and may be useful to Nigeria as a whole.

Estudo de cunho comparativo-descritivo e analítico dos sistemas de saúde mental de Brasil e de Argentina através da consideração de alguns dos desdobramentos e construções da instalação do paradigma antimanicomial nos países em questão, colocando-os em conversação com as normativas emanadas das organizações internacionais, que vêm apoiando a mencionada mudança de paradigma desde 1975 até a atualidade. Nesse sentido, o principal referente será a Declaração de Caracas de 14 de novembro de 1990, produzida na Conferencia Regional para a Reestruturação da Assistência Psiquiátrica na America Latina assinada por ambos os países, que assumem assim o compromisso de reestruturação dos seus sistemas de saúde mental de acordo as recomendações emitidas. A análise se realiza através de três momentos: o estudo das legislações emitidas, o estudo das praticas existentes no campo e um estudo de caso sobre duas experiências pioneiras de instalação da lógica antimanicomial que foram efetuadas simultaneamente, uma em cada país. Toma como referência teórica os pressupostos do Movimento Institucionalista e os trabalhos de Michel Foucault, além do extenso ideário que sustentou a construção do paradigma antimanicomial: Basaglia, Tosquelles, Oury, Castel, e outros / A comparative, descriptive and analytical study of mental health systems in Brazil and Argentina, considering some of the developments and structures of implementation of the anti-asylum trend in the countries analysed and studying these factors in conjunction with regulations issued by international organisations in favour of this change in trend, from 1975 until the present-time. In this regard, the principal reference used in this study is the Caracas Declaration of 14 November 1990, created at the Regional Conference for the Restructuring of Psychiatric Care in Latin America, and signed by both countries, each therein committing to the restructuring of their respective mental health systems in accordance with the recommendations stipulated in the document. The analysis has three strands: a study of the published legislation, a study of existing practice in the Field, and a case study of two pioneering experiments of implementation of anti-asylum logic carried out simultaneously in each of the two countries. The study uses as theoretical reference the hypotheses of the Institutionalization Movement and the work of Michel Foucault, as well as the extensive ideology supporting the development of the anti-asylum trend: Basaglia, Tosquelles, Oury, Castel, and others

Estudo de cunho comparativo-descritivo e analítico dos sistemas de saúde mental de Brasil e de Argentina através da consideração de alguns dos desdobramentos e construções da instalação do paradigma antimanicomial nos países em questão, colocando-os em conversação com as normativas emanadas das organizações internacionais, que vêm apoiando a mencionada mudança de paradigma desde 1975 até a atualidade. Nesse sentido, o principal referente será a Declaração de Caracas de 14 de novembro de 1990, produzida na Conferencia Regional para a Reestruturação da Assistência Psiquiátrica na America Latina assinada por ambos os países, que assumem assim o compromisso de reestruturação dos seus sistemas de saúde mental de acordo as recomendações emitidas. A análise se realiza através de três momentos: o estudo das legislações emitidas, o estudo das praticas existentes no campo e um estudo de caso sobre duas experiências pioneiras de instalação da lógica antimanicomial que foram efetuadas simultaneamente, uma em cada país. Toma como referência teórica os pressupostos do Movimento Institucionalista e os trabalhos de Michel Foucault, além do extenso ideário que sustentou a construção do paradigma antimanicomial: Basaglia, Tosquelles, Oury, Castel, e outros / A comparative, descriptive and analytical study of mental health systems in Brazil and Argentina, considering some of the developments and structures of implementation of the anti-asylum trend in the countries analysed and studying these factors in conjunction with regulations issued by international organisations in favour of this change in trend, from 1975 until the present-time. In this regard, the principal reference used in this study is the Caracas Declaration of 14 November 1990, created at the Regional Conference for the Restructuring of Psychiatric Care in Latin America, and signed by both countries, each therein committing to the restructuring of their respective mental health systems in accordance with the recommendations stipulated in the document. The analysis has three strands: a study of the published legislation, a study of existing practice in the Field, and a case study of two pioneering experiments of implementation of anti-asylum logic carried out simultaneously in each of the two countries. The study uses as theoretical reference the hypotheses of the Institutionalization Movement and the work of Michel Foucault, as well as the extensive ideology supporting the development of the anti-asylum trend: Basaglia, Tosquelles, Oury, Castel, and others

Mental disorders are now the most common disorders for sick leave benefit and the second most common for long periods of sick leave. They are also the most common reason for receiving disability pensions. Long term work-stress or burnout is a prevalent cause of mental disorders and since it’s causes could be clinical or societal, there is a need to systematically address it from different perspectives. The aim of this thesis is to construct an overarching model that encompasses more than the medical side to help local authorities develop a mental health strategy for work-stress mental health illnesses. The work-stress mental health situation in Stockholm is addressed using a systems mapping approach to visualize the effect of future strategies of relevant institutions. Literature is reviewed to understand the national context of mental health in Sweden, identify relevant actors which affect work stress mental health and highlight their roles. This is then presented in a systems map through which the impact of policies can be shown across sub-systems. It is presented to several experts for validation which results in agreement on the accuracy and relevance of the model, identification of more sub-systems, actors that can be added to the model and the limitations of important actors such as occupational health centres and primary care. The exercise also entailed insights on how national and local level mental health policies could factor in the individuals’ resources and support employers with wellness and rehabilitation to counteract stress at workplace. / Psykiska störningar är nu de vanligaste sjukdomarna för sjukfrånvaro och de näst vanligaste under långa sjukperioder. De är också det vanligaste skälet för att få invaliditetspension. Långvarig arbetstress eller utbrändhet är en vanlig orsak till psykiska störningar och eftersom orsakerna kan vara kliniska eller samhälleliga finns det ett behov av att systematiskt ta itu med det ur olika perspektiv. Syftet med denna avhandling är att konstruera en övergripande modell som omfattar mer än den medicinska sidan för att hjälpa lokala myndigheter att utveckla en mentalhälsostrategi för psykiska sjukdomar i arbetet. Arbetsstressens mentalhälsosituation i Stockholm behandlas med hjälp av en systemkartläggningsmetod för att visualisera effekten av framtida strategier för relevanta institutioner. Litteraturen granskas för att förstå den nationella kontexten för psykisk hälsa i Sverige, identifiera relevanta aktörer som påverkar arbetsstress mental hälsa och belyser deras roller. Detta presenteras sedan i en systemkarta genom vilken effekterna av policyer kan visas över delsystemen. Det presenteras för flera experter för validering som resulterar i en överenskommelse om modellens noggrannhet och relevans, identifiering av fler delsystem, aktörer som kan läggas till modellen och begränsningarna för viktiga aktörer som arbetshälsocentraler och primärvård . Övningen innehöll också insikter om hur psykisk hälsopolitik på nationell och lokal nivå skulle kunna påverka individens resurser och stödja arbetsgivare med wellness och rehabilitering för att motverka stress på arbetsplatsen.

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