Colombia is currently facing a two-sided social and political scenario. On the one hand, the country finds itself in a period of reduced armed conflict with the guerrilla as a consequence of the signing of the peace accord in December 2016. On the other hand, the country's armed conflict has not actually come to an end and seems to be heating up again with the emergence of new forms of social and political violence and diverse forms of exclusion.
The described social and political scenario poses certain challenges for mental healthcare in Colombia. These challenges revolve primarily around three main pillars: challenges for the evaluation, care and rehabilitation of the mental health of Colombians resulting from the armed conflict; challenges to promote beliefs and behaviours in civil society that help reduce the hostility between human groups and promote the signing of agreements; and challenges to promote new leaderships and cultures in society that lead to reconciliation and social reintegration.
A careful look at these challenges highlights the role that psychiatry currently plays in the country. According to the Encuesta Nacional de Salud Mental 2015 [2015 Mental Health Survey in Colombia], there is a high prevalence of mental problems and disorders in the country among those people who have directly experienced armed conflict and its consequences, including forced displacement, poverty, alienation, social stigma and loss of autonomy. Those communities that have directly experienced armed conflict in particular exhibit a high prevalence of affective disorders, anxiety disorders and stress-related disorders. In addition, armed conflict experiences and related mental disorders are associated with an increased prevalence of chronic non-communicable diseases, including cardiometabolic diseases and diseases of the brain, such as sporadic neurodegenerative diseases.
Unfortunately, those communities that were directly affected by armed conflict also have other social risks that increase the likelihood of negative health outcomes. As a result, the medical community and healthcare decision-makers are invited and encouraged to promote programmes aimed at the integral mental healthcare of those individuals who have directly and persistently experienced the consequences of war.
Colombia is also indebted to the generation of national evidence-based programmes to promote cultures of peace and changes in behaviours and beliefs in civil society that help reduce hostility between groups and encourage reconciliation. Different global academic initiatives in the field of cognitive science, behavioural science and social neuroscience have generated calls to implement actions targeting this objective. As a result, solid evidence has been reported supporting the implementation of social and individual interventions that are aimed at significantly reducing hostility between groups, promoting empathy and cooperation, and attenuating violent human outbursts, encouraging the signing of agreements by other deliberative approaches.
This scientific evidence is also backed by national contributions aimed at the generation of a culture of peace, memory and reconciliation, which has been achieved thanks to the implementation of social and cultural programmes in high exposure areas, such as the contributions of the Tejedoras de Mampuján [Embroiderers of Mampuján: a group of women who have survived the war who help communities overcome the trauma through art] in María la Baja, province of Bolívar, or the recent collective entrepreneurship initiatives promoted by signatories of the 2016 peace accord in the Espacios Territoriales de Capacitación y Reincorporación [Territorial Spaces for Training and Reintegration: for reintegrating former guerrilla members].
In addition, the country needs to consolidate news ways of handling conflicts between individuals without resulting in violence and exclusion. For this to be possible, programmes must be implemented and new leaderships promoted to generate cultural changes in order to strengthen national processes of reconciliation, memory, forgiveness and social participation. These initiatives must be combined with Colombia's attempts to promote the signing of peace accords with different armed groups. Our plea to the State departments is for them to integrate these initiatives into civil society, into academic circles working in the field of behavioural science, social neuroscience and human and social science, and into mental and physical healthcare teams to promote evidence-based actions focusing on individual and collective change that allow us to consolidate new social players interested in reconciliation and thereby encourage scenarios of collective agreement and growth.
