Rubio-León Diana Carolina, Cano-Sierra Laura, Reyes-Rivera María-Juliana, Forero-García Sara Lucia, García-Padilla Dennys, Abitbol Pablo, López-López Wilson
Psychology and Health Research Group, School of Psychology, Pontificia Universidad Javeriana, Bogotá, Colombia.
Social Ties and Cultures of Peace Research Group, School of Psychology, Pontificia Universidad Javeriana, Bogotá, Colombia.
Arch Public Health. 2025 May 7;83(1):123. doi: 10.1186/s13690-025-01561-z.
The provision of mental health care services in different municipalities of Colombia has been significantly affected by the armed conflict, especially in rural areas. From the Social Determinants of Health (SDH) perspective, this study aimed to understand the characteristics of the provision of mental health services in the context of armed conflict from the perspectives of healthcare personnel and administrative staff involved in mental health care in the Montes de María region.
A descriptive qualitative study was carried out with 49 participants from the healthcare and administrative sectors. Data were collected through 15 semi-structured interviews and 7 focus groups held in 2023 and 2024. A content analysis was conducted using NVivo 14.
Two main categories were identified: (1) Deficiencies in Service Provision and Access, where professionals reported issues in the provision of mental health services in Montes de María, including shortcomings in public policy, barriers to access and continuity of the services, infrastructure limitations, bureaucratic obstacles, high staff turnover, lack of contextualization, limitations in the conceptualization of mental health, ethical and professional misconduct, and security threats due to the ongoing armed conflict; and (2) Successful Approaches to Mental Health Care, in which participants highlighted effective strategies characterized by implementing context-sensitive interventions, incorporating community involvement in service provision planning, and transcending an individual and psychopathological perspective of mental health.
This study highlights how both the provision of health services and armed conflict act as key social determinants of mental health. In Montes de Maria, the complex mental health and psychosocial needs of the population remain unmet due to the absence of adequate, context-sensitive health services. Moreover, existing regulations designed to ensure access to mental health services fail to translate into effective implementation in the region. A potential solution lies in the sustained community engagement, from the initial planning of healthcare services to the direct involvement of community members as health promoters. The proposed SDMH framework, along with this study's findings, should serve as the foundation for updating Colombia's National Mental Health Policy, ensuring a dedicated section that addresses the specific needs of regions affected by armed conflict.
哥伦比亚不同城市的心理健康护理服务提供受到武装冲突的严重影响，特别是在农村地区。从健康的社会决定因素（SDH）角度来看，本研究旨在从参与蒙特斯德玛利亚地区心理健康护理的医护人员和行政人员的角度，了解武装冲突背景下心理健康服务提供的特点。
对来自医疗和行政部门的49名参与者进行了描述性定性研究。通过2023年和2024年进行的15次半结构化访谈和7次焦点小组收集数据。使用NVivo 14进行内容分析。
确定了两个主要类别：（1）服务提供和获取方面的不足，专业人员报告了蒙特斯德玛利亚地区心理健康服务提供方面的问题，包括公共政策的缺陷、服务获取和连续性的障碍、基础设施限制、官僚主义障碍、高人员流动率、缺乏情境化、心理健康概念化的局限性、道德和职业不当行为以及持续武装冲突带来的安全威胁；（2）心理健康护理的成功方法，参与者强调了有效的策略，其特点是实施因地制宜的干预措施、将社区参与纳入服务提供规划以及超越心理健康的个体和精神病理学视角。
本研究强调了卫生服务提供和武装冲突如何成为心理健康的关键社会决定因素。在蒙特斯德玛利亚，由于缺乏适当的、因地制宜的卫生服务，民众复杂的心理健康和心理社会需求仍未得到满足。此外，旨在确保获得心理健康服务的现有法规在该地区未能有效实施。一个潜在的解决方案在于持续的社区参与，从医疗服务的最初规划到社区成员作为健康促进者的直接参与。拟议的SDMH框架以及本研究的结果应作为更新哥伦比亚国家心理健康政策的基础，确保有专门章节解决受武装冲突影响地区的具体需求。
