Highlight: Identifying barriers to mental healthcare for civilians affected by protracted armed conflict in Colombia "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 fromthe 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 services
2) social, health, and demographic drivers of treatment delay, quality of care, and outcome in people with conflict-related
mental health needs who successfully access services
3) the extent to which gender-based and sexual violence mediates conflict-related mental health needs and poor treatment
access / outcome in women and girls
All 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." We will improve understanding of barriers to mental health service access and quality of care for victims of the Colombian armed conflict with mental health needs in those responsible for addressing them - policy makers, service managers and activists - in a way that identifies practical targets for change. We will complete three major data science studies on inequalities and barriers to access and quality of care in PAPSIVI, Colombian's national mental healthcare programme for civilians affected by the Colombian armed conflict. Using innovative data linkage, we will identify some of the hardest groups to research, the invisible victims of conflict - those with conflict-related mental health needs who never access services - at scale. We will also identify barriers to quality of service in those that successfully access treatment. We will deliver a programme of policy-maker, public and community engagement. We will continue to co-produce the project with people personally affected by the armed conflict. To complete this, our specific objectives are: Objective 1. Publish a co-produced peer-reviewed scientific study identifying social, health, mental health, and demographic drivers of being i) an invisible victim of armed conflict - someone who has conflict-related mental health needs but never registers or receives treatment; ii) a semi-visible victim who registers with authorities but never receives treatment; compared to iii) a registered-and-treated victim. Objective 2. Publish a co-produced peer-reviewed scientific study identifying social, health, mental health, and demographic drivers of inadequate attention, treatment drop-out and outcome for victims of the armed conflict who access PAPSIVI services. Objective 3. Publish a co-produced peer-reviewed scientific study testing to what extent sexual and gender-based violence mediate the association between conflict-related mental health problems and visibility / quality of outcome when treated. Objective 4. Engage i) Colombian policy makers responsible for delivering services to under-served groups in mental health services for victims of armed conflict with the results and recommendation of the study through direct communication, meetings, events, technical and accessible publications. We will engage ii) communities affected by armed conflict involved with study results to co-produce the final publications and reports. We will disseminate findings and recommendations to the international armed conflict and mental health scientific and service development community. Objective 5. Deliver formal training and mentorship for Colombian early career researchers on the team in large scale mental health data science and policy engagement. Objective 6. Create a freely accessible online resource containing annotated analysis code that accompanies the peer reviewed studies to provide an important resource for researchers in low resource countries and particularly those using these datasets in Colombia.