Highlight: Identifying barriers to mental healthcare for civilians affected by protracted armed conflict in Colombia

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Colombia has endured a brutal and extensive armed conflict with 9 million registered victims. A national cost-free mental health programme for people with conflict-related mental health needs is being under-used by the most affected and it's unclear why, amplifying conflict-related inequalities. To overcome this, we need to understand barriers facing the invisible victims of conflict - who have conflict-related mental health problems but never access services and who have been hard to research for this reason - and barriers affecting treatment delay and quality of care in those that do access services.This will be the first project to identify invisible victims using innovative data-linkage between i) a nationally representative psychiatric epidemiological study (N=12k+) that used active case ascertainment in the general population, and; ii) data from the national mental health programme (N=1 million+), and the first to examine quality of care at the population level.We will use robust statistical analysis to identify:1) social, health, and demographic drivers of being an invisible victim of conflict - who has conflict-related mental health needs but who never accesses services2) social, health, and demographic drivers of treatment delay, quality of care, and outcome in people with conflict-related mental health needs who successfully access services3) the extent to which gender-based and sexual violence mediates conflict-related mental health needs and poor treatment access / outcome in women and girlsAll 3 aims address urgent national policy issues. Aim 3 was suggested, and most prioritised by, our panel of people with lived experience of the armed conflict who will continue to co-produce this project.Given the large-scale longitudinal data and robust statistical methods, this project will provide high-quality evidence on barriers to equality of access and quality of care. These will translate directly into on-the-ground policy changes and community engagement, while providing an evidence base for Colombia and other conflict-affected countries in Latin America.Access to this data is unique to our research group and no such analysis has been completed or proposed before. This project could only be possible through collaboration between our unique team of international collaborators.The project is led by a team of Colombian and UK academics specialising in the Colombian armed conflict and mental health. Fundación Santa Fé de Bogotá will work in collaboration with the UCL Centre for Outcomes Research and Effectiveness, UCL Clinical Psychology, and UCL Epidemiology and Applied Clinical Research - world-leading centres in data science of mental health and social inequalities.This project is timely. The results of this study will be directly communicated to the new government in Colombia, for whom addressing conflict-related mental health inequalities is central to their 'total peace' policy. We will engage national and international NGOs and women's organisations who have underlined the need for this information to reach the most marginalised communities and inform their programmes.Using a grassroots community involvement programme, led by our panel of lived experience collaborators, we will engage communities most affected by the conflict in the results of the study to directly inform our interpretation, framing and recommendations.This project will develop capacity in Colombia through a planned programme of training and supervision of our Colombian ECR collaborators to facilitate their involvement and through immersion in equal partnership with three world-leading research groups in the UK. They will be trained in advanced epidemiological analysis, policy engagement, and open science methods. In addition, we will publish open access code repositories that will leave a permanent legacy to facilitate future analysis of these datasets by other Colombian researchers.