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Globally, children and youth are more vulnerable to experiencing mental health challenges; early intervention is key to preventing ongoing mental health difficulties into adolescence and adulthood. School-based mental health interventions have proven to be effective but require a significant amount of collaboration between teachers, parents, mental health specialists and other important stakeholders. Equally noteworthy are the significant treatment, resource and capacity gaps between high and low to middle income countries when it comes to child mental health; the SHINE research group seeks to implement a school-based mental health program in countries in the Eastern Mediterranean region. They also intend to scale-up the prevention and intervention capabilities of said countries to improve overall child mental health. This study investigated the role of collaborative care in SHINE’s program development and implementation processes, while examining the cultural and societal challenges associated with implementing a school mental health program developed primarily in high-income countries to specific non-Western contexts. Individual and small-group indepth interviews were conducted with ten key stakeholders from the SHINE team and partner countries (specifically Iran, Jordan and Egypt). Findings identified the potential for the collaborative care approach within the SHINE school mental health program to greatly ameliorate child mental health outcomes. Additionally, participants noted the necessity for clearer stakeholder role definition and differentiation of general vs specific program elements between countries. Challenges associated with implementing the intervention in the Eastern Mediterranean region included the dominant role of the family, challenging societal norms and stigmatization and structural barriers to applying SHINE’s specific program resources. In summary, the role of collaborative care is increasingly important to SHINE’s current efforts in improving child mental health, however, individual cultural and country characteristics should be an area of emphasis moving forward. / Thesis / Master of Science (MSc) / The SHINE research group are implementing a school-based mental health intervention in the Eastern Mediterranean region, alongside a facilitated collaborative learning group involving key local and global stakeholders. This study focuses on the collaborative care element of the school-based mental health program and its impact on the overall functioning of the intervention, in different country contexts. Collaborative care involves the interactions between parents, teachers, mental health professionals and researchers to ensure the sustainability of the program as well as its scalability to different country contexts. This is an exploratory qualitative study with a case study design; data has been collected with ten participants through individual and small group in-depth interviews. Interviews were transcribed, coded and then cross-compared using thematic analysis to identify overarching patterns. The primary goals of the study are to examine the role of collaboration as well as to consider some of the challenges of applying Western psychological interventions to diverse country and cultural contexts.

Culture is critical to delivering effective mental health care, necessitating tailored approaches aligned with the respective cultural contexts. The rise of globalization and transcultural psychiatry highlights the importance of integrating culture comprehensively into mental health and psychosocial interventions within humanitarian contexts. Existing research underscores the significance of culture in mental health. However, a prevailing influence of Western perspectives on mental health is evident globally, leading to the widespread implementation of Euro-American viewpoints in humanitarian fieldwork. This approach negatively impacts individuals affected by crisis by sidelining culturally grounded understandings of illness. While several studies examine the impact of culture on mental health care, there is limited research on how humanitarian organizations perceive and incorporate culture in training materials. This study aims to examine how the Red Cross Red Crescent Movement conceptualizes and integrates culture within its mental health and psychosocial support (MHPSS) intervention. I collected data from nineteen Red Cross guidebooks to conduct a thematic analysis and extract insights into the organization’s approach. I found nine themes: understanding culture through self, culture as behaviour, culture as meanings, community-based approach, assessment, planning and implementation, training, monitoring and evaluation, and universality of mental illness. My findings indicate that the Red Cross conceptualizes culture holistically, and by doing so, they aim to produce culturally relevant care. While the Red Cross emphasizes cultural relativism in its MHPSS responses, encouraging cultural competency, it also tends towards universalism when discussing mental health, reflecting the nuanced nature of MHPSS interventions. This tension highlights the complex relationship between these two perspectives in creating the Movement’s MHPSS responses and speaks to broader challenges in delivering mental health and psychosocial care in humanitarian fields. Further avenues for research lie in exploring strategies to reconcile relativist and universalist frameworks, aiming to produce seamless MHPSSs. / Thesis / Master of Arts (MA) / Effective mental health care respects and incorporates the cultural beliefs and practices of the individuals receiving it. However, according to the literature, there is a pattern amongst international aid agencies of applying Westernized mental health ideas globally. In this study, I investigate how the Red Cross Red Crescent Movement understands and incorporates local culture in its mental health and psychosocial supports (MHPSS). The study reveals that the Movement recognizes culture holistically. The Movement closely works with communities, aiming to ensure that the support matches local ways of understanding well-being and distress. However, the Movement tends to apply a more universal understanding regarding specific mental disorders. This discrepancy highlights issues within the humanitarian field at large. My findings suggest that while the Red Cross does well to integrate cultural understandings of psychosocial distress, there is a need for better collaboration between universal and local perspectives in MHPSS.

Made available in DSpace on 2014-07-29T15:29:07Z (GMT). No. of bitstreams: 1 Dissertacao Paulo Verlaine.pdf: 2471983 bytes, checksum: 2b5b94d2bdbc742306bf943ccad71d80 (MD5) Previous issue date: 2009-02-04 / Few studies have been carried out worldwide about ADHD among indigenous children and no study has been conducted in Brazil so far. This study aims to evaluate the estimated prevalence of ADHD among the indigenous populations of Karajá children and adolescents aged 7 to 14 years old. Three of the largest settlements pertaining to this ethnic group were investigated and a sample of 144 subjects of a total population of 350 individuals was collected. The sample was randomly collected and stratified according to the age bands and gender (male and female) proportionally to the size of each participating settlement. Both the CBCL/6-18 (Child Behavior Checklist for ages 6 18) and the TRF (Teacher s Report Form 6-18) were used as instruments of epidemiological tracking of behavioral and emotional problems. Of these instruments, the data used were those compatible with the DSM-IV and ADHD diagnoses as well as Affective Disorder, Anxiety Disorders, Oppositional Defiant Disorders and Conduct Disorders comorbidities. The results indicate a prevalence of 10.4% (95% CI 6.6 14.2) when the respondents are either the parents or the guardians and 2.8% (95% CI 0.7 4.8) when the respondents are the teachers. Of the 144 interviewed participants, 30 had ADHD and comorbidities were 86.7% (95% CI 74.5 98.8) for conduct disorders, 86.7% (95% CI 74.5 98.8) for oppositional defiant disorders, 83.3% Abstract xxviii (95% CI 70.0 96.7) for anxiety disorders and 60% (95% CI 42.5 77.5) for affective disorders. ADHD is then concluded to exist in a population so culturally diverse from that of the east white and to have a high prevalence rate and the comorbidities routinely found in all populations of children from a number of diverse cultures around the globe. / Poucos estudos foram realizados no mundo sobre o TDAH em crianças indígenas, e nenhum no Brasil, até o momento. O objetivo deste estudo é avaliar a prevalência estimada do TDAH na população de crianças e adolescentes índias Karajá, na faixa etária dos 07 aos 14 anos de idade. Três das maiores aldeias dessa etnia foram investigadas, tendo-se colhido de uma população total de 350 indivíduos na faixa de estudo uma amostra de 144 sujeitos. A amostra foi colhida de forma aleatória, com estratificação conforme as faixas etárias e o sexo (feminino e masculino), proporcionalmente ao tamanho de cada aldeia participante. Foram empregados os instrumentos de rastreamento epidemiológico de problemas comportamentais e emocionais CBCL/6-18 (Inventário de Comportamentos para Crianças e Adolescentes de 6 a 18 anos) e TRF (Inventário de Comportamentos Referidos pelo Professor para Alunos de 6 a 18 anos). Desses instrumentos utilizaram-se os dados compatíveis com os diagnósticos pelo DSM-IV do TDAH, bem como para os Transtornos Afetivos, Transtornos de Ansiedade, Transtorno Opositor Desafiante e o Transtorno de Conduta. Os resultados obtidos indicam uma prevalência de 10,4% (IC 95% 6,6 14,2) quando os respondentes são os pais ou responsáveis e de 2,8% (IC 95% 0,7 4,8) quando os respondentes são os professores. Dos 144 entrevistados, 30 eram portadores do TDAH, e as Resumo xxvi comorbidades foram de 86,7% (IC 95% 74,5 98,8) com transtorno de conduta, 86,7% (IC 95% 74,5 98,8) com transtorno opositor desafiante, 83,3% (IC 95% 70,0 96,7) com transtornos de ansiedade e 60% (IC 95% 42,5 77,5) com transtornos afetivos. Conclui-se que o TDAH existe numa população culturalmente tão diversa da branca ocidental, bem como com uma alta taxa de prevalência, com as comorbidades habitualmente encontradas em todas as outras populações de crianças das mais variadas culturas ao redor do mundo.

Ce mémoire est catégorisé dans la sous-discipline de l'anthropologie culturelle, car la culture - comme phénomène - occupe un rôle important dans l'analyse. Il aborde néanmoins des questions de santé et de santé mentale. On pourrait donc le catégoriser également dans une sous-sous-discipline de l'anthropologie de la santé mentale. / L’étiologie et l’épistémologie biomédicale sont importées par les psychiatres, les thérapeutes et les intervenants-es qui pratiquent en milieux autochtones. Elles entrent parfois en conflit avec des conceptions locales des troubles (Laplantine 1998 ; Summerfield et al. 2016). C'est en réaction à ce problème que des champs d'études interdisciplinaires relativement récents tels que la psychiatrie transculturelle et l’ethnopsychiatrie se sont développés. Ces disciplines proposent une épidémiologie socioculturelle et contextuelle de la santé mentale ainsi que des traitements alternatifs originaux (Lecompte et col. 2006). La différence culturelle ferait partie des obstacles au succès du travail de prévention, au traitement et particulièrement au développement d’une alliance thérapeutique (Chandler et Lalonde 1998 ; Kirmayer 2003 et 2009 ; Sterlin et Dutheuil 2000). Dans le Nord du Québec, l’enjeu de la différence sociale et culturelle s’ajoute au fait que certains services de santé sont parfois difficiles à offrir dans les communautés nordiques et donc éloignées des centres urbains et hospitaliers. De plus, le roulement des employés y serait plus grand (Paré 2004). Cette recherche étudie spécifiquement la rencontre clinique dans un contexte interculturel précis et l‘adaptation des services et des cadres psychothérapeutiques qui en suit. Le travail des intervenantes et leur vécu est documentés et analysés en profondeur. Cette recherche accorde une attention particulière à l’analyser de la dynamique originale du soin de type « fly-in, fly-out » (FIFO) et à ses effets sur l’issue des rencontres cliniques. Les données de l’étude témoignent de plusieurs modifications apportées à la pratique des soignantes suite à ce que j’appelle leur psytinéraire interculturel en contexte colonial. Mon étude est fondée sur une approche inductive et qualitative. L’analyse conjugue des données provenant d'une quinzaine d’entrevues semi-dirigées avec des informateurs-trices psy- de même que du matériel de prévention et de formation que ces informatrices ont développé. En bref, je m’intéresse à la manière dont s’articulent la prévention et les soins de santé mentale et aux défis rencontrés par les intervenantes psy. Les variables mises en cause sont : les effets de l’éloignement et de l’isolement (« fly in fly out » - FIFO), la différence sociale et culturelle et d’autres particularités liées au contexte colonial qui entrent en jeux lors des rencontres thérapeutiques (violences coloniales, traumatismes, pauvreté, etc.). Finalement, je me questionne sur les éléments des modèles d’interventions transculturelle et ethnopsychiatrique qui pourraient être importés dans ce contexte afin que le travail clinique ait davantage de succès. En trame de fond, j’interroge quelle place prend la culture portée par les différents acteurs de la rencontre dans les traitements. Une perspective systémique complémentariste inspirée des travaux de George Devereux et de Grégory Bateson s’est avérée très utile. / This exploratory study focuses on the mental health care services provided within aboriginal communities in Northern Québec, through a systemic and ethnopsychiatric perspective. Based on an approach both inductive and qualitative, this analysis relies on data from some fifteen semi-structured interviews with informants from the psychological and psychiatric fields, combined with educational and prevention materials developed by those actors. This study first wishes to document and examine the peculiar dynamics of mental health care within northern communities and how the medical staff adapts its methods, yet it also wishes to question the very own nature of the provided mental health care system, focusing especially on the impact of the alternating care providing system (the "fly-in, fly-out") on the outcomes of clinical meetings. While presenting some advantages, this structure of care still raises numerous issues, from the constraints emerging from cultural differences, to the geographical and demographical situations of those communities, even raising issues linked to the colonial history of Quebec. In this context, all the boundaries of medical intervention are increased, as well as risks associated with errors, re-traumatization, even neo-colonisation. Consequently, therapists seem to see their practice transcultured once immersed in a new environment. I therefore examine potential elements for a new model of transcultural and ethnopsychiatric intervention, that once developed, might help clinical works be more successful. Moreover, the idea is to think more generally about what should be the place given to the culture of the care providers, in order to start creating an environment more in line with the issues brought by the testimonies I collected. Finally, this Master Thesis wishes to link theories of ethnopsychiatry and transcultural psychiatry to field work in the Northern territories, in order to offer a reflection on the decolonization of mental health care, through the use of a complementarist systemic perspective and a community-based, partnership-based approach.

La présente étude en anthropologie médicale propose d’examiner la dimension socioculturelle des désordres fonctionnels gastro-intestinaux (DFGI) en considérant l’expérience de six familles québécoises francophones où un pré-adolescent souffre de symptômes associés à un DFGI. Le regard anthropologique qui nous a permis d’appréhender ces expériences de douleur s’appuie principalement sur les travaux issus de la psychiatrie transculturelle, de même que sur les influences de l’anthropologie du corps et de la phénoménologie. À travers ce regard, la somatisation est considérée comme une forme de communication de la douleur, modulée de manière importante par le contexte socioculturel et représentative d’une certaine souffrance sociale. Ce langage ponctué d’idiomes de détresse et de métaphores permet aux individus d’exprimer leur souffrance et de mobiliser un soutien social efficace pour la prendre en charge. Dès lors, le corps doit être perçu comme un corps vécu; comme un lieu de marquage du social, mais également comme un instrument de positionnement social et une frontière où des mouvements d’appartenance et de divergence sont exprimés. Par l’exploration, dans chacune de ces familles, des différentes manières de décrire les symptômes, de les interpréter et d’y réagir, nous avons procédé à la reconstruction d’histoires particulières pour voir comment ces symptômes venaient s’inscrire dans la biographie individuelle et familiale. À travers l’analyse de la construction du sens de la douleur et des pratiques adoptées pour la contrôler, la douleur abdominale nous est apparue comme intimement liée à l’expérience sociale et la médicalisation comme une base pour une meilleure appréhension de cette douleur. Par ses maux de ventre, l’enfant exprime ses limites corporelles et sociales. À l’intérieur de la famille, l’expression de cette limite peut être parfois dérangeante, confrontante, et même entraîner des rapports conflictuels. C’est ainsi qu’est « négociée » une approche appropriée à la douleur qui redéfinit les rôles de chacun par rapport à cette dernière. Le ventre devient le médiateur qui permet le compromis nécessaire au « vivre ensemble » ou au « vivre dans le monde ». À l’issue de ii cette négociation qui implique la participation du médecin traitant, les rapports sont parfois reconstruits et la relation au monde et aux autres peut devenir différente. / This study in medical anthropology is an exploration of the sociocultural dimension of functional gastrointestinal disorders (FGID) considering the experience of six frenchspeaking families of Québec where a pre-teenager suffers from symptoms associated with FGID. The anthropological perspective that allowed us to approach these experiences of pain is based mainly on work from tanscultural psychiatry, as well as on the influences of the anthropology of the body and phenomenology. Through this view, somatization is considered to be a form of communication of distress, modulated in an important way by sociocultural context and reflecting social suffering. This language punctuated with idioms of distress and metaphors allows individuals to express their suffering and to mobilize an efficient social support. From then on, the body must be seen as a lived body; as a place of social marking, but also as an instrument of social positioning and a border where movements of belonging and divergence are expressed. By exploring, in each of these families, different ways of describing the symptoms, interpret them and respond to them, we proceeded to the reconstruction of particular stories to find how these symptoms were part of the individual’s and family’s biography. Through the analysis of how those families make sense of the pain and adopte practices to control it, abdominal pain appeared to us as intimately linked to social experience and the medicalization as a basis for a better apprehension of this suffering. While telling his or her pain, the child is also expressing his or her bodily and social boundaries. Within the family, the expression of this limit can sometimes be disturbing, confrontational, even lead to conflict. Thus was “negociated” an appropriate approach to pain that redefines the roles of each in relation to it. The abdomen becomes the mediator who allows the compromises needed to “live together” or to “live in the world”. Following this “negociation” that involves the participation of the attending physician, bonding within the family is sometimes positively transformed and the relation to the world and to the others can become different.

La présente étude en anthropologie médicale propose d’examiner la dimension socioculturelle des désordres fonctionnels gastro-intestinaux (DFGI) en considérant l’expérience de six familles québécoises francophones où un pré-adolescent souffre de symptômes associés à un DFGI. Le regard anthropologique qui nous a permis d’appréhender ces expériences de douleur s’appuie principalement sur les travaux issus de la psychiatrie transculturelle, de même que sur les influences de l’anthropologie du corps et de la phénoménologie. À travers ce regard, la somatisation est considérée comme une forme de communication de la douleur, modulée de manière importante par le contexte socioculturel et représentative d’une certaine souffrance sociale. Ce langage ponctué d’idiomes de détresse et de métaphores permet aux individus d’exprimer leur souffrance et de mobiliser un soutien social efficace pour la prendre en charge. Dès lors, le corps doit être perçu comme un corps vécu; comme un lieu de marquage du social, mais également comme un instrument de positionnement social et une frontière où des mouvements d’appartenance et de divergence sont exprimés. Par l’exploration, dans chacune de ces familles, des différentes manières de décrire les symptômes, de les interpréter et d’y réagir, nous avons procédé à la reconstruction d’histoires particulières pour voir comment ces symptômes venaient s’inscrire dans la biographie individuelle et familiale. À travers l’analyse de la construction du sens de la douleur et des pratiques adoptées pour la contrôler, la douleur abdominale nous est apparue comme intimement liée à l’expérience sociale et la médicalisation comme une base pour une meilleure appréhension de cette douleur. Par ses maux de ventre, l’enfant exprime ses limites corporelles et sociales. À l’intérieur de la famille, l’expression de cette limite peut être parfois dérangeante, confrontante, et même entraîner des rapports conflictuels. C’est ainsi qu’est « négociée » une approche appropriée à la douleur qui redéfinit les rôles de chacun par rapport à cette dernière. Le ventre devient le médiateur qui permet le compromis nécessaire au « vivre ensemble » ou au « vivre dans le monde ». À l’issue de ii cette négociation qui implique la participation du médecin traitant, les rapports sont parfois reconstruits et la relation au monde et aux autres peut devenir différente. / This study in medical anthropology is an exploration of the sociocultural dimension of functional gastrointestinal disorders (FGID) considering the experience of six frenchspeaking families of Québec where a pre-teenager suffers from symptoms associated with FGID. The anthropological perspective that allowed us to approach these experiences of pain is based mainly on work from tanscultural psychiatry, as well as on the influences of the anthropology of the body and phenomenology. Through this view, somatization is considered to be a form of communication of distress, modulated in an important way by sociocultural context and reflecting social suffering. This language punctuated with idioms of distress and metaphors allows individuals to express their suffering and to mobilize an efficient social support. From then on, the body must be seen as a lived body; as a place of social marking, but also as an instrument of social positioning and a border where movements of belonging and divergence are expressed. By exploring, in each of these families, different ways of describing the symptoms, interpret them and respond to them, we proceeded to the reconstruction of particular stories to find how these symptoms were part of the individual’s and family’s biography. Through the analysis of how those families make sense of the pain and adopte practices to control it, abdominal pain appeared to us as intimately linked to social experience and the medicalization as a basis for a better apprehension of this suffering. While telling his or her pain, the child is also expressing his or her bodily and social boundaries. Within the family, the expression of this limit can sometimes be disturbing, confrontational, even lead to conflict. Thus was “negociated” an appropriate approach to pain that redefines the roles of each in relation to it. The abdomen becomes the mediator who allows the compromises needed to “live together” or to “live in the world”. Following this “negociation” that involves the participation of the attending physician, bonding within the family is sometimes positively transformed and the relation to the world and to the others can become different.