Paradoxes in the implementation of public policies in mental health: A case study of the Colombian context

Mental health policies are essential to promote and encourage a comprehensive approach to mental health. The objective of this research was to explore the challenges for the implementation of public mental health policy in Colombia from the experience and perspective of key actors in mental health. A qualitative approach research was carried out, whose data were collected through semi-structured interviews and a recorded and transcribed discussion group, in which 447 mental health professionals from multiple regions of Colombia participated, within the framework of a strategy to strengthen the primary health care. The data were analyzed thematically for causal loop diagram. Four relevant categories were identified, which question the effectiveness of the guidelines that guide mental health in Colombia, around the meanings attributed to human rights, financial profitability, quality and access to services, and stigma and discrimination. The thematic analysis allowed the construction of a diagram of causal loops that involve the categories described above, evidencing the interrelationships between the different factors identified in the thematic analysis that influence the effective implementation of public mental health policies in Colombia. The findings of this study show the paradoxes and challenges faced by the implementation of public policies on mental health in Colombia. Despite having some solid regulatory elements consistent with international guidelines, it has other regulations that make the implementation of this evidence difficult, especially in financing. • There are implementation gaps in some mental health systems. • Implementation problems can occur due to contradictory public policies. • Community mental health in Colombia, despite being recognized as a priority, does not have clear financing mechanisms. • Despite the lack of official financing, some communities generate their own implementation mechanisms for these strategies.