Assessing contextual factors for implementing evidence-based care in a middle income country in the wake conflict: the Colombian mental health system
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Citation
Abstract
The negative impact, or burden of disease, for mental health problems is high across the globe, especially in low- and middle-income countries (LAMICs) in the aftermath of violent conflicts. Evidence-based psychological treatments (EBPTs) are time-limited and cost-effective and potentially could be implemented across mental health service delivery systems in LAMICs. In addition, EBPTs that are culturally-adapted have been shown to be effective at alleviating mental health symptoms and improving individuals’ functioning in LAMICs. Colombia has recently emerged from over 50 years of war, resulting in the largest number of internally displaced persons in any one country and 8 million officially recognized victims. As a result, the Colombian leadership has passed legislation to address the mental health needs of victims. The current study aimed to identify perceptions of EBPTs as well as barriers and facilitators that may impact wide-scale dissemination of EBPTs in Colombia for victims of the armed conflict who suffer from anxiety, mood, and traumatic stress symptoms.
Data were gathered from 35 stakeholders (e.g., leaders, providers, victims) from the Colombian health care system utilizing mixed-methods of qualitative (i.e., semi-structured interviews) and quantitative measurement (i.e., questionnaires). Findings indicate that, at the individual level, victims of the armed conflict face many barriers to care (e.g., economic hardship; internalized stigma impairing treatment seeking). At the system-level, victims face barriers to access to care (e.g., few available services). In addition, system-level barriers include ineffectual applications of laws and policies for victims’ care, ineffective quality checks for services, high turnover of providers and moderately unfavorable view of EBPTs at the provider and leader levels. Some mitigating factors that may facilitate care for victims include demonstrated satisfaction with treatment by victims as well as laws that ensure provision of care. At present, barriers outweigh facilitators to providing services, including EBPTs, to victims of the armed conflict. These barriers and facilitators should be taken into account when implementing services and should be the subject of future research and policy development to best provide highly needed services to the many victims of the armed conflict in Colombia.