Title: Mapping Mental Health Resources for Young People Living in a Conflict Con-text at The Colombian Pacific Region
Funder: Economic and Social Research Council

Abstract: This research addresses insufficient understanding of available mental health care systems and services for conflict experienced youth in Colombia. It has three research questions: 1. What formal mental health service provision exists for conflict-affected young people in Colombia? 2. How is community care provided to conflict-affected young people in the Pacific Region? 3. How can formal and community services work in partnership to effectively support conflict-affected young people with their mental health? The project has a number of core objectives: 1. Developing innovative approaches to mental health linking maco, meso and micro levels of analysis with a mixed methods approach drawn from clinical and social sciences. This research will shed light on a generation of young people raised under conditions of constant conflict and will provide evidence of mental health needs. The project seeks to develop the approach for other post-conflict contexts where the demobilisation of combatants and the experience of mental health among those affected by conflict is under-researched and where the links between clinical and social science approaches are poor. 2. Addressing a knowledge gap in a critical area for Colombia; mental health of rural, conflict- affected areas susceptible to future conflict or on-going violence. Research will focus on health inequalities providing evidence to improve opportunities for young people facing a high risk of remaining in poverty. This will be the first research project of its kind in Colombia focusing on youth mental health and integrated service development. 3. An innovative feature is to recognise that formal mental health services do not reach most rural areas where the conflict has been present most intensely and for the longest time. Nevertheless, we recognise that despite the stigma associated with mental health many communities deal with those affected by conflict and traumatised in some way through a variety of mechanisms ranging from alienation through to community care. The first step of the research will be to map the range of activities and coping strategies at the community level to understand and analyse the current situation. This is reflected in our three research questions: What formal mental health service provision exists for conflict-affected young people in Colombia? How is community care provided to conflict-affected young people in the Pacific Region? And; How can formal and community services work in partnership to effectively support conflict-affected young people with their mental health? 4. The research programme will aim to formalise an existing set of links between academics at the University of Birmingham and at the Universidad de Los Andes, across social sciences and clinical medicine. The participation of an academic group across multiple disciplines and encompassing the Institute of Mental Health at Birmingham is an important step towards locating mental health in to the lived experience of those who experience conflict, and it is intended that the approach adopted could be expanded within and beyond Colombia. 5. The work packages and outputs of the programme are specifically designed to maximise the participation and co-production of outputs that are usable within the community. As such, the research aims to not only co-produce excellent academic outputs, but also to co-produce impactful approaches and documents that are usable to local communities. 6. There is a significant element of early career researcher development within the project. Both Co-Is in the UK and the Co-I in Colombia are early career researchers and they will work an existing Colombian PhD student and potentially more. In addition, the co-production elements are designed so that academic researchers will work alongside non-academic staff at the local level, facilitating an open research approach that recognises knowledge exchange and knowledge ownership.

Lay abstract: This project is about what happens to the mental health of people, particularly young people, when they have been exposed to conflict and violence for a long time. We know a lot about PTSD and what that can do to former combatants, but there are a lot of other mental health issues that can affect young people as a result of violence itself, or the stress of existing in a conflict situation. At the minute there is gap in understanding here between the experience on the ground and the large studies done by centralised health providers that concentrate on formal, clinical records of mental health. What we want to do is to involve social science together with clinical approaches and to move away from the urban areas where there are available formal records. Most conflicts happen in the countryside and yet these rural areas are frequently neglected in terms of service provision. This is certainly the case in Colombia where there are big inequalities between urban and rural areas and across regions. Young people find it very hard to integrate in to society after experiencing mental health issues after violence and conflict. These issues including depression, other mental disorders and psychosocial problems related specifically to young people, have been largely ignored. This may be particularly serious in contexts where local social and community environments have been degraded or undermined, there have been breaches of human rights, or where there are limited economic opportunities as a result of conflict. The Pacific Region was one of the most conflict-affected areas, has some of the highest rates of poverty in Colombia, is primarily rural, and continues to have high rates of mental health as a result of ongoing exposure to violence. This research takes an innovative approach in three ways: it explicitly links the local, the meso and the macro levels, recognising that much mental health care, such as it is, exists at the local level and that is where there may be an opportunity for effective intervention; it represents co-production both between Colombian and UK teams, but also with civil society organisations at the local level; and it uses an innovative mixed methods approach linking social science and clinical approaches to mental health. This means that we can links SDG3 on Health and Well Being with SDG16 on Peace, Justice and Strong Institutions, specifically through addressing mental health as a form of exclusion in societies affected by conflict. An integral element of the Sustainable Development Goals is inclusion of marginalised groups, and those suffering from mental health issues are among the most marginalised, often resulting from behavioural problems, substance abuse or depression The result of these approaches will provide initial evidence to focus policy and services in order to try and reduce inequalities in access to health care, and to provide evidence to improve the provision of mental health services in order for young people to have better opportunities and face a lower risk of remaining in poverty. The development of an integrated model of working for formal mental health care services in partnership with community services will support conflict-affected young people's mental health needs. This will be the first research project of its kind in Colombia focusing on youth mental health and integrated service development and has excellent potential for application in other areas going through similar transitions after conflict.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: MENTAL HEALTH