Adapting DIALOG+ and building capacity in schools to support mental wellbeing and resilience in post-conflict Colombia during the COVID-19 pandemic

It is estimated that here are around 8.5 million victims of armed conflict in Colombia. Tolima is one of the areas most affected as it was were guerrilla groups formed and it served as a key strategic corridor during the armed conflict. The national Mental Health Study (ENSM-2015) found high levels of mental distress and illness in Colombia's children and adolescents, including high levels of post-traumatic stress symptoms, in the context of poor levels of access to treatment.

Tolima specifically is facing many challenges in the transition from conflict to peace, and one of the governmental programmes in place is the Development Programs with Territorial Approach (PDET) which aims to stimulate development, in part by prioritising healthcare access. Throughout the armed conflict and also as the region moves into peacebuilding, there has been a lack of access to mental health professionals, made harder by the fact that there are as few as 1.84 psychiatrists per 100,000 population in Colombia.

This means that the role of teachers and school counsellors is key in providing mental health support for children and adolescents in this region. Mental health and well-being through adolescence is important for an optimal transition to adulthood and hence to sustain mental health later in life. In recent years there has been increased attention to the psychological consequences of conflict on adolescents.

However, the impact of the armed conflict on children and adolescents is still poorly understood and there is a current need for a well-structured intervention to improve and deliver mental health interventions to this vulnerable group. Pontificia Universidad Javeriana has developed an online diploma to support mental health in the school community, which has proven to be effective in improving school interventions in mental health and improving the skills and knowledge of teachers.

Likewise, the Queen Mary University of London team has developed and tested a mental health intervention called DIALOG+, a low-cost/cost saving evidence-based therapeutically effective mental health intervention, which has been used and assessed in many clinical contexts internationally. DIALOG+ was developed based on quality of life research, concepts of patient-centred communication, developments in information technology, and components of solution-focused therapy.

The overall aim of this study is to improve the mental health, resilience and quality of life of children and adolescents from Tolima, Colombia, taking into account the additional context of this post-conflict setting during the added stress of the current COVID-19 pandemic. This will be done by training (online and face-to-face) teachers and school counsellors from this region in mental health in order to allow them to develop strategies for the promotion of mental wellbeing and the prevention and early detection of mental health problems.

Strengthening of educators' capacities will be achieved whilst modifying and exploring DIALOG+ - a proven technology-assisted tablet/smartphone-based and resource-oriented intervention - as a generic approach for mental health problems identified in adolescents. This exploratory study will provide the information required to conduct a definitive trial that will show if this intervention will help reduce the current treatment gap experienced by children and adolescents with symptoms of mental distress in this, and similar contexts.