Dr. James Shultz is the co-principal investigator of the OSITA project in Colombia, supported by Grand Challenges Canada’s Global Mental Health program. For World Mental Health Day 2015, Dr. Shultz writes a blog post about two “heroes” of the OSITA project.
Mental health needs in Colombia are pervasive and population-wide. For eleven consecutive years, Colombia has consistently ranked first or second internationally in numbers of internally displaced persons (IDPs) due to armed conflict, a consequence of one of the world’s longest-running insurgencies. In addition to the continuous armed conflict, Colombia experiences significant narco-trafficking related violence as the world’s primary source of cocaine, community violence at the hands of gangs and criminal bands, and intra-familial and gender-based violence. In 2011, 7 million Colombians were officially designated as “victims of armed conflict.” The highest proportion of these victims is internally displaced persons, who have all experienced extreme loss and trauma.
Elvia and her daughter, Arely, and are two officially-designated “victims of the armed conflict” in Colombia. More than a dozen years ago, Elvia and her family were displaced from their rural home in Antioquia, Colombia as an outcome of atrocities committed by guerrilla and paramilitary. The family migrated under duress, endured an agonizing period of homelessness, and eventually reestablished their lives in the urban heights of Bogotá. Today, Elvia and Arely have emerged as the most accomplished counsellors for OSITA, a project in Bogotá that is supported by Grand Challenges Canada’s Global Mental Health program.
“OSITA” is an acronym for “Outreach, Screening, and Intervention for Trauma,” and is designed to help internally displaced women residing in Bogotá. OSITA uses a “stepped care” model to
- Seek and enroll women internally displaced persons (outreach)
- Assess them for current symptoms of three common mental disorders (screening)
- Provide interpersonal therapy/counseling for women with moderate or severe symptoms of one or more of the disorders (intervention), and
- Refer women with severe symptoms or suicide risks to psychiatric consultation.
Preliminary analyses indicate that about 70% of the 280 women enrolled in OSITA have moderate or severe symptom elevations for one or more of three disorders: major depression, generalized anxiety, or post-traumatic stress disorder. All women have experienced profound losses, and high proportions have also been exposed to trauma multiple times. The need for an evidence-based interpersonal therapy/counselling intervention for this population is clearly evident.
Grand Challenges Canada is known for its Integrated Innovation® approach to research projects, which combines scientific/technological, social, and business innovation. For OSITA, Elvia and Arely have been integral to all three aspects:
- Business: Elvia and Arely were hired to educate OSITA participants about job training and employment programs for “victims.”
- Social: Elvia and Arely exemplify OSITA’s social innovation, focused on empowering women IDPs.
- Scientific/Technical: After months of working for OSITA, Elvia and Arely became OSITA counsellors, providing outreach, screening, and interpersonal counselling/therapy.
Elvia and Arely have been praised by the OSITA team for their extraordinary dedication and their ability to connect to women internally displaced persons. As women “victims” themselves, Elvia and Arely work easily with the community, relate with deep understanding to OSITA participants, and work respectfully with project staff. Their work has been better than all other OSITA counsellors, including masters’ students, doctors, and trained psychologists. They have been extremely effective at recruiting, intervening, and following up with participants.
There is not a single person in Colombia who is certified in interpersonal therapy/counselling, and there is no capacity for in-country training. The OSITA project is actively looking into establishing a training center in Colombia, and we are considering including Elvia and Arely as members of the training team.
Government psychosocial programs in Colombia do not permit “victims of armed conflict” to serve as counsellors. However, Elvia and Arely went from being “victims” to occupying important counsellor roles on a global mental health project. We hope that the experience of Elvia and Arely will educate stakeholders and enlighten the conversation, encouraging the government to consider changing their position.
Among the team of international experts working on OSITA, we refer to Elvia and Arely as the “heroes” and “champions” of the OSITA project. These descriptors are well-deserved.
I would like to acknowledge and thank the OSITA project team for their dedication, leadership and support. OSITA is sited at Universidad de Los Andes, one of Colombia’s leading academic institutions. The co-principal investigator of the project is Dr. Luis Jorge Hernandez and the Project Coordinator is Angela Gomez. OSITA is based on the pioneering work of Dr. Ricardo Araya of the Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine. Dr. Lena Verdel of Columbia University, a world-renowned expert on interpersonal counselling/therapy, trained and supervised the OSITA counsellors. Dr. Yuval Neria, Director of the Trauma and PTSD Program at Columbia University, is guiding the screening and data analysis components. Dr. Zelde Espinel of the University of Miami Department of Psychiatry, a psychiatrist in both Colombia and the U.S., was instrumental in convening this research group.