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Structural adjustments since the 1980s, changes in the international system with the end of the Cold War, and the accompanying shifts in international norms have transformed the vulnerability of African states and altered the nature of conflicts and coups. In this context, what causes illegal and forced leader exits – coups and regime seizures by rebel groups, and why? I present a theory that emphasizes the connection between coups and conflicts and underscores the significance of transnational non-state actors, due to the vulnerabilities of African states. Specifically, the presence of foreign-mobilized rebels before the onset of an insurgency increases the likelihood of fatal consequences for regime leaders. The result suggests that threats to African leaders are not solely a product of domestic vulnerabilities but are also influenced by the vulnerabilities of neighboring countries and international hostilities.

This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates. ; Kings Coll London, Inst Psychiat, Hlth Serv & Populat Res Dept, London, England ; Univ Addis Ababa, Fac Med, Dept Psychiat, Addis Ababa, Ethiopia ; Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo, Brazil ; Dartmouth Psychiat Res Ctr, Lebanon, NH USA ; Natl Ctr Neurol & Psychiat, NIMH, Tokyo, Japan ; Douglas Mental Hlth Univ Inst, Montreal, PQ, Canada ; McGill Univ, Montreal, PQ, Canada ; New Zealand Mental Hlth Commiss, Wellington, New Zealand ; Schizophrenia Res Fdn SCARF, Chennai, Tamil Nadu, India ; Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo, Brazil ; Web of Science

This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates.