According to a 2003 report published jointly by the Pan American Health Organization (Organización Panamericana de la Salud, OPS), the University of Antioquia (Universidad de Antioquia) and the Antioquia Regional Health Directorate (Dirección Seccional de Salud de Antioquia), authorities involved in delivering mental health services to the population of Antioquia faced several cultural and social challenges. These challenges include prevailing societal attitudes that mitigate against the use of mental health services; a tendency on the part of individuals to deny that they are experiencing a mental health problem; and the [translation] "stigmatization" of those suffering from such problems (OPS et al. 2003). No information on whether these challenges are equally present in all regions of the country could be found among the sources consulted by the Research Directorate.

No mention of the treatment of individuals who suffer from a mental health problem by the police or other state agents could be found among the sources consulted. However, "persons suffering from mental disabilities" have been among those targeted for assassination by illegal paramilitary groups as part of their "social cleansing" campaigns in a number of cities (Country Reports 2002 31 Mar. 2003).

In its most recent national mental health survey, the Ministry of Social Protection (Ministerio de la Protección Social) found that 40.1 per cent of the population between the ages of 18 and 65 had experienced at least one mental health "disorder" (trastorno) in their lives (Colombia 26 Mar. 2004). However, only 10 per cent of those with a disorder obtained professional help in dealing with their problem (ibid.).

While the country's health system underwent a restructuring process in 1993 that was "based on managed competition and structured pluralism," "coverage for mental health services" was not included in this initiative (The Journal of Mental Health Policy and Economics 21 Dec. 2003). In an evaluation of the impact of the restructuring process, the authors of a 2003 study found that at the same time that "population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%" (ibid.). In analysing their findings, the authors indicated that the reforms have failed to improve access to specialized mental health services, as well as imposing "challenges" to the "institutional survival" of mental health institutions (ibid.). Difficulties in accessing mental health services were similarly noted in a 2002 report by the Spanish chapter of Doctors Without Borders (Médecins sans frontières, MSF), which claimed that 400 cases have been identified in Bogotá in which mentally disabled individuals had been [translation] "abandoned or left without support."

In addition to the country's 10 public psychiatric hospitals, which in 2000 reported 88,903 outpatient consultations and 13,573 hospitalizations (Disability World 16 Apr. 2001), there are a number of organizations delivering assistance to, or advocating on behalf of, individuals suffering from a mental illness. Examples follow.

The Marai Collective Corporation (Corporación Colectiva Marai), a Bogotá-based non-governmental organization founded in 2002, seeks to enhance the autonomy of individuals with mental health problems by facilitating their access to vocational training and employment opportunities, as well as engaging in other activities that promote such individuals' independence (Federación Colombiana para la Salud Mental n.d.a).

The Manic Depressives' Association (Asociación Maníaco Depresivos, AMD), based in Bogotá, has among its objectives the fostering of greater public awareness of the condition of, and the provision of support to, manic-depressive individuals and their families (ibid. n.d.b).

The Colombian Association Against Depression and Panic (Asociación Colombiana contra la Depresión y el Pánico) is a non-governmental organization active in such cities as Bogotá, Medellín, Pereira, Barranquilla, Bucaramanga and Pasto (ibid. n.d.c). Its activities include the operation of support groups, delivery of public awareness campaigns and research support (ibid.).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of additional sources consulted in researching this Information Request.

References

Colombia. 26 March 2004. Ministerio de la Protección Social. "Boletin No. 26: Resultados preliminares del ESM." http://www.minproteccionsocial.gov.co/MseContent/images/news/DocNewsNo476801.doc [Accessed 31 Dec. 2004]

Country Reports on Human Rights Practices for 2002. 31 March 2003. "Colombia." United States Department of State. Washington, DC. http://www.state.gov/g/drl/rls/hrrpt/2002/18325.htm [Accessed 4 Jan. 2005]

Disability World. 16 April 2001. "Mental Health in Colombia: A Cause for Concern." http://www.disabilityworld.org/05-06_01/news/columbia.shtml [Accessed 31 Dec. 2004]

Federación Colombiana para la Salud Mental. n.d.a. "Corporación Colectiva Marai." http://www.federacionmental.org/marai.htm [Accessed 31 Dec. 2004]

_____. n.d.b. "Asociación Maníaco Depresivos." http://www.federacionmental.org/maniaco_depresivos.htm [Accessed 31 Dec. 2004]

_____. n.d.c. "Asociación Colombiana contra la Depresión y el Pánico." http://www.federacionmental.org/depresion_panico.htm [Accessed 31 Dec. 2004]

The Journal of Mental Health Policy and Economics. 21 December 2003. Vol. 6, No. 4. Mauricio Romero-González, Gerardo González and Robert A. Rosenheck. "Mental Health Service Delivery Following Health System Reform in Colombia." http://www.icmpe.org/test1/journal/issues/v6i4/v6i4abs06.html [Accessed 31 Dec. 2004]

Médecins sans frontières (MSF). 2002. Stella Quintana. "El acceso a los servicios de salud en Colombia." http://www.disaster-info.net/desplazados/informes/msf/accesosaludcol.htm [Accessed 31 Dec. 2004]

Organización Panamericana de la Salud (OPS), Universidad de Antioquia and Dirección Seccional de Salud de Antioquia. 2003. Alvaro Olaya Pelaez and Maria Cristina Franco. "Hacia un plan Operativo de Salud Mental para Antioquia." http://www.disaster-info.net/desplazados/informes/ops/planopant2003/index.htm [Accessed 31 Dec. 2004]

Additional Sources Consulted

Oral sources: The Instituto Colombiano de Salud Mental did not respond within the time constraints of this Response.

Internet sites, including: Asociación Colombiana para el Avance de las Ciencias del Comportamiento, Pan American Health Organization, Revista Cambio [Bogotá], Semana [Bogotá].