A Participatory Psychosocial Care Approach to of Mental Health in Colombia (PPC-Colombia)

背景：50多年来，哥伦比亚一直遭受着世界上影响最大、持续时间最长的暴力武装冲突之一。到目前为止，约有800万人流离失所（是全世界境内流离失所者人数最多的国家）。直接遭受暴力和流离失所，加上提供的心理健康服务不足和不均衡，对全国的心理健康造成了巨大影响。受武装冲突影响最严重的地区之一是属于苏克雷和玻利瓦尔行政区的蒙特斯德玛丽亚。在1958年至2018年期间，特别是从1996年到2006年，这些地区遭受了大规模杀戮，暗杀，失踪和性暴力案件的最高数量。在此期间，有21.5万人流离失所。政府为改善受影响人群的精神卫生服务的努力通常是基于药物，很少关注当地的现实情况，最近受到新一轮武装暴力，委内瑞拉难民到来，自然灾害以及最近的COVID-19的严重阻碍。因此，弱势群体（即女性、土著人民、农村社区、流离失所者）社区的数百万人面临严重的心理健康挑战。考虑到目前流行病造成的情况，迫切需要采用基于证据的方法，利用现有知识，利用社区和个人资源，提供与环境相关的可持续精神卫生支持。项目目的：因此，在本发明中，我们的跨学科建议旨在建立一个概念框架，在现有的基础上，以社区和个人资源为基础，提供可持续的治疗干预措施。通过全面分析现有的心理健康和冲突数据库，（哥伦比亚和解晴雨表、记忆观察站和哥伦比亚武装冲突数据库）;（社会治疗）和社会心理学（社交网络和社会互动）方法。（一）建立跨学科（研究人员、社区合作伙伴和国家机构）合作，以确定蒙特斯德玛丽亚地区当地社区在当前条件下的具体精神健康需求，即被迫流离失所、移民和流行病; B）共同创建一个基于当地进程的概念框架，并考虑社会、政治和文化背景，以支持基于社区的干预措施; c）试行一个可持续的和背景相关的心理社会干预措施，以改善和促进心理健康和社会凝聚力。蒙特斯德玛丽亚地区的最弱势群体（即女性、土著人民、农村社区、流离失所者）将最直接地从这项研究中受益，因为他们将参与拟议项目的构思、设计和实施。他们将有机会获得社会支持来源，将获得有关在该地区寻求和获得心理健康支持的具体方面的宝贵信息。主持人将受益于基本培训，使他们能够继续提供支助。当地社区将扩大其支助该区域境内流离失所者的能力。最后，研究助理和早期职业研究人员也将受益，因为他们将获得跨学科研究的概念化和实施方面的宝贵经验，并扩大他们的研究网络。我们将制定的概念框架很可能经过调整，以应对其他地方弱势群体面临的类似挑战。

Context: For over 50 years Colombia has suffered from one of the most impactful and long enduring violent armed conflicts worldwide. So far, around 8 million people have been displaced (the highest number of internally displaced people (IDP) worldwide. Direct exposure to violence and displacement coupled with inadequate and uneven provision of mental health services have had enormous consequences for mental health nationwide. One of the regions that is most affected by the armed conflict is Montes de Maria that forms part of Sucre and Bolivar administrative divisions. Between 1958-2018, and especially from 1996 till 2006, the regions suffered some of the highest number of mass killings, assassinations, disappearances, and sexual violence cases. During the same time 215,000 people have been displaced.Governmental attempts to improve mental health provisions for the affected populations are generally pharmaceutically based with little attention to the local realities and have recently been critically hampered by renewed armed violence, arrival of Venezuelan refugees, natural disasters, and most recently by COVID-19. As a result, millions of individuals in communities with vulnerable populations (i.e. females, indigenous peoples, rural communities, the displaced) face serious mental health challenges. Given the current conditions imposed by the pandemic there is an urgent need for evidence based approaches that employ the existing knowledge and tap into communal and individual resources to provide context relevant and sustainable mental health support.Project Aims: Thus, our multidisciplinary proposal aims to co-create a conceptual framework to provide sustainable therapeutic interventions grounded in communal and individual resources on the basis of the current political and social context in Colombia by comprehensively analysing existing databases of mental health (NMHS) and conflict (Colombian Reconciliation Barometer, Observatory of Memory and Conflict Database Database of Armed Conflict in Colombia); and integrating community based (socio-therapy) and social psychological (social networks and social interactions) approaches.Main Objectives: a) establish interdisciplinary (researchers, community partners and state agencies) collaboration to identify the specific mental health needs of the local communities in the Montes de Maria Region in the wake of the current conditions, i.e. forced displacements, immigration, and the pandemic; b) co-create a conceptual framework based in the local processes and one that considers the social, political, and cultural context to support community based interventions; c) pilot a sustainable and context relevant psycho-social intervention to improve and promote mental-health, and social cohesion.Applications and Benefits: The most vulnerable (i.e. females, indigenous peoples, rural communities, the displaced) in the Montes de Maria regions will benefit most directly from this research as they will be involved in the conceptualization, design, and implementation of the proposed project. They will have access to social support sources, will gain valuable information on the specific aspects seeking and obtaining mental health support in the region. The facilitators will benefit from basic training that will enable them to continue to provide support. The local communities will broaden their capacity to support the IDPs in the region. Finally, the research assistants and early career researchers will also benefit as they will gain valuable experience in conceptualization and implementation of interdisciplinary research and extend their research network. The conceptual framework we will develop is likely to be adapted to address similar challenges that the vulnerable communities face elsewhere.