“The professionals weren’t from here”: provision of mental health services in the context of the Colombian armed conflict

Background: 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. Methods: 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. Results: 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. Conclusions: 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.