Improving mental health and human capital: developing a mental health intervention for 'Youth in Action' programme in post-conflict areas in Colombia

哥伦比亚经历了50多年的武装内部冲突，在哥伦比亚青年中留下了高比率的心理健康问题。冲突和相关的心理健康问题也给人力资本造成巨大损失。这些障碍通常是长期的，通常与其他身体/精神状况共存。尽管有这些有害后果，但几乎没有证据表明，有有效的心理健康干预措施可以帮助受冲突影响的年轻人。对于大多数有精神健康问题的冲突受害者来说，大多数服务都是支离破碎、不充分和难以获得的。这是一个为期36个月的项目，旨在解决为受冲突影响的年轻人设计更好的心理健康干预措施的需要，这不仅有助于缓解他们的心理健康问题，而且使这些年轻人能够更好地利用现有援助，改善他们未来的经济前景。该项目旨在制定一种可行和可接受的心理健康干预措施，通过社区广泛参与的共同设计过程来解决共病的心理健康问题。这一干预措施将被纳入哥伦比亚最大的社会方案之一（青年在行动”或Jóvenes en Acción JeA），以帮助生活在贫困中的弱势青年人口。拟定的干预措施随后将在受冲突影响的青年人比例很高的三个城市执行和评价，这些城市有JeA。评估将考虑对接受干预的有心理健康问题的年轻参与者的心理健康以及培训和教育成果的影响。项目将采用三个阶段的方法：我们将更新这一主题的文献综述，并通过与参与者，特别是受冲突影响的参与者和JeA工作人员的访谈，深入探讨心理健康需求、可用资源和当地环境。我们将根据现有证据制定干预措施，确定可能有用的组成部分和策略。将通过共同设计的参与性程序（涉及JeA受益人、JeA工作人员和其他相关利益攸关方）实施一项可能可行的干预措施，以收集关于该干预措施是否可能可行并可被目标人群接受的意见。一旦达成初步协议，将通过另一个更密集的适应过程，使用类似的共同设计过程。一旦在提供干预措施的内容和策略方面达成协议，将与潜在用户的小样本进行组装和测试，以确保在提供干预措施时不存在重大技术问题。最后，共同开发、批准和可用的干预措施将在试点研究中进行测试，使用适当的科学方法来评估“实际环境”中的可行性、可接受性和有用性。结果将告知干预措施是否改善了那些使用它的人的临床、教育和就业前景。我们将与利益攸关方和政策制定者分享调查结果，争取为我们的人口提供更多更好的精神卫生服务。所有参与者将提供知情同意，项目将获得伦理批准。我们的多学科团队由来自哥伦比亚和英国一些最好的研究中心的经验丰富的专业人士组成，他们已经在一起工作了近十年，展示了公平和成功合作的良好记录。我们还与政府和民间社会的代表建立了良好的伙伴关系。我们对环境有深入的了解，并与政策制定者建立了良好的联系，以确保以更广泛和可持续的方式实施。

Colombia endured more than five decades of armed internal conflict leaving behind high rates of mental health problems among the Colombian youth. Conflict and associated mental health issues also cause great cost to human capital. These disorders are usually long-lasting and commonly co-exist with other physical/mental conditions. Despite these harmful consequences, there is little evidence of effective mental health interventions for helping young people affected by the conflict. Most services are fragmented, inadequate, and difficult to access for the majority of those victims of the conflict with mental health problems. This is a 36-month project to address the need for better designed mental health interventions for younger people affected by the conflict that can help not only to provide relief with their mental health problems but also allow these young people to make better use of the assistance available to improve their future economic prospects. The project aims to develop a feasible and acceptable mental health intervention that addresses comorbid mental health problems through a co-design process with extensive involvement of the community. The intervention will be embedded within one the largest social programmes (Youth in Action' or Jóvenes en Acción JeA) in Colombia to assist young vulnerable populations living in poverty. The intervention developed will be subsequently implemented and evaluated in three municipalities with high proportion of young people affected by the conflict and where JeA is available. The evaluation will consider the impact on the mental health as well as on the training and educational outcomes of the young participants with mental health problems receiving the intervention.To project will use a three-phase approach:1. We will update a review of the literature in the subject and explore in depth the mental health needs, resources available, and local contexts through interviews with participants, especially those affected by the conflict, and JeA staff.2. We will undertake the development of the intervention identifying potentially useful components and strategies based on the existing evidence. A potentially feasible intervention will be put through a co-designed, participatory process (involving JeA beneficiaries, JeA staff, and other relevant stakeholders) to gather ideas as to whether this intervention can be potentially feasible and acceptable to the target population. Once a preliminary agreement is reached this will go through another more intensive process of adaptation using similar co-designed processes. Once an agreement is reached in terms of the content and strategies to deliver the intervention, this will be assembled and tested with a small sample of potential users to ensure there are no major technical problems to deliver the intervention.3. Finally the co-developed, approved and usable intervention will be tested in a pilot study using appropriate scientific methods to evaluate the feasibility, acceptability and usefulness in 'real-settings'. Results will inform if the intervention improves clinical and educational and employment prospects among those who use it. We will share findings with stakeholders and policymakers to argue for more and better mental health services to serve our populations. All participants will provide informed consent and projects will receive ethical approval.Our multidisciplinary team of experienced professionals from some of the best research centres in Colombia and the UK has been working together for almost a decade, showing an excellent track record of equitable and successful collaboration. We also have well-established partnerships with representatives from government and civil society. We have a deep knowledge of the settings and have developed excellent connections with policymakers to ensure implementation in a larger and sustainable way.