SEATTLE, Washington — After decades of armed conflict, Colombia was finally able to institute a peace agreement with the largest rebel group in the nation in 2016. Lingering violence and years of trauma has come at a cost: high rates of mental illness within populations affected by the conflict. The Colombian Government has enacted new legislation to support the growing number of mental health needs but there are still needs left unmet. There are domestic and international organizations working to bolster the public mental health resources available to improve mental health in Colombia.
Exposure to Conflict and Mental Illness
The armed conflict that transpired in Colombia for more than 50 years exposed millions of civilians to violence and displacement. In 2015, the National Mental Health Survey found that regions with higher rates of permanent and intermittent violence correlated with higher incidences of mental illness. Mood disorders and anxiety were more common in areas that experienced more consistent and intense conflict, while post-traumatic stress disorder (PTSD) was more prominent in areas with intermittent and lower intensity violence.
Some communities have been more vulnerable than others to disruptions in mental health. Colombia’s nearly six million internally-displaced persons (IDPs) have faced an increased risk for developing mental health disorders. One in eight Colombians has dealt with persisting economic uncertainty and threatened security as a result of their displacement. Depression, anxiety, PTSD and substance abuse is elevated within this population. There is less research into the effects on children and adolescents, but providing assistance to help young people process and cope with trauma is still of importance.
Mental Health Treatment Disparities
In an attempt to reach universal healthcare coverage, Colombia has created a two-tiered healthcare system. The impoverished account for a portion of the 56% of Colombia’s citizens that rely on government-subsidized healthcare. There are disparities between the quality of treatment within the subsidized care and the care provided to the rest of the population that receives insurance through their employment.
There is overcrowding in spaces for psychiatric treatment due to insufficient beds. Additionally, 90% of the estimated 900 psychiatrists in the country, as of 2015, are found within Colombia’s 10 largest cities, which leaves rural areas with fewer mental health resources.
Efficacy of Colombian Mental Health Law
The Colombian Government has aimed to make progress within mental health in Colombia since much earlier than the past decade but insufficient funding has hindered the implementation of policy. National mental health policies from 1995 and 1998 were unable to achieve much success due to economic restrictions. Extensive change in legislation and the healthcare system offers hope for a more progressive future for mental health in Columbia.
To directly target the high number of mental health issues that stemmed from national conflict, the Colombian Government passed “The Law of the Victims and Land Restitution,” also known as Law 1448, in 2011. All people affected by violence and internal displacement are ensured resources for mental health treatment under this legislation, including in-patient programs and psychotherapy. Law 1448 requires that mental health services receive at least 10% of the budget of all health prevention and promotion programs.
In January of 2013, mental healthcare was designated as a fundamental right by Law 1616. It places responsibility on the federal government to implement promotion, prevention and intervention for mental health. Developing campaigns the eliminate the stigmatization and discrimination toward mental illness is another significant element of the law.
The Focus of Organizations and International Aid
One way in which disparities within Colombia’s mental healthcare system can be reduced is through international aid. Colombia is one of the focus countries of War Child, a multinational campaign that seeks to protect children living through armed conflict and violence. The campaign’s work in Colombia advocates for better psychosocial wellbeing in children through the provision of educational programs that involve not only the vulnerable children but teachers, caregivers and parents. Peace Circus is just one of War Child’s many projects that encourages peacebuilding and expression in children affected by conflict through the arts.
Mercy Corps carries out a similar intervention to War Child in order to “close the cycle of violence” and create safer futures for the children of Colombia. More than 62,000 young people living in areas of conflict have benefitted from leadership and economic skill-building and psychosocial support from the program.
There are also nongovernmental, national organizations in Colombia that contribute to more comprehensive mental healthcare. The Colombian Association Against Depression and Panic, for example, has developed support groups for individuals and families that have anxiety and depression. The organization also advocates for specific at-risk populations. Prevention techniques and public education on mental health are fundamental to the organization’s mission.
The emergence of peacebuilding in the nation has created opportunities to focus on the long-term consequences of armed conflict on mental health. It is apparent that the Colombian Government has taken substantial steps to improve the quality of mental health in Colombia, but disparities still remain as a result of economic strain. The collaborative efforts of nongovernmental national and foreign organizations are essential for ensuring that more vulnerable individuals, who are struggling under the subsidized-healthcare system, get the support they need.
– Ilana Issula