Original Article

Integrating Mental Health Services into the Primary Health Care System: The Need for Reform in Iran

Abstract

Objective: The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran’s Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presented

Method: This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts’ opinions were observed.

Results: In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed.

Conclusion: A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.

1. Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):76-84.
2. Amin-Esmaeili M, Motevalian A, Rahimi-Movaghar A, Hajebi A, Sharifi V, Mojtabai R, et al. Bipolar features in major depressive disorder: Results from the Iranian mental health survey (IranMHS). J Affect Disord. 2018; 241:319-24.
3. Rahimi-Movaghar A, Sharifi V, Motevalian A, Amin-Esmaeili M, Hajebi A, Radgoodarzi R et al, National Mental Health Survey-2011. First Edition. Tehran: Ministry of Health & Medical Education of the Islamic Republic of Iran; 2013. (Persian)
4. Islamic Republic of Iran. Department for Mental Health and Substance Abuse. Situational Analysis of Mental Health Services in Iran. Tehran: Ministry of Health & Medical Education; 2014. (Persian)
5. Islamic Republic of Iran. Deputy for Therapeutic Affairs. Psychiatric Beds in the Health System of Iran. Tehran: Ministry of Health & Medical Education; 2014. (Persian)
6. Abhari M. Descriptive Report on Mental Health Services and Integration of Mental Health into the Primary Health Care in Savojbalagh. IJPCP, 2000; 4(3): 29-40.
7. Hassanzadeh M. Investigating the Integration of Mental Health Services into the primary Health Care System of Shahreza. Darou va Darman Monthly, 1992; 10(110): 23-27. (Persian)
8. Shahmohammadi D. Comprehensive Report on Mental Health Integration into PHC in Rural Areas of Shahrekord. Tehran: Center for Disease Control & Prevention of the Ministry of Health & Medical Education of the Islamic Republic of Iran, 1992. (Persian)
9. Shahmohammadi D, Bagheri Yazdi SA, Palahang H. Nationwide Integration of Mental Health into Primary Health Care in Iran: Case Summary for WHO. Tehran: Majd Publications; 1994. (Persian)
10. Bolhari, J., & Mohit, A. Integration of mental health into primary health care in Hashtgerd. IJPCP, 1995; 2(1&2), 16-24. (Persian)
11. Mohit A, Shahmohammadi D, Bolhari J. Independent evaluation of Iranian National Mental Health Program. IJPCP, 1995; 3(3): 4-16. (Persian)
12. Bolhari J, Ahmadkhaniha H, Hajebi A, Yazdi SAB, Naserbakht M, Karimi-Kisomi I, et al. Evaluation of mental health program integration into the primary health care system of iran. Iranian Journal of Psychiatry & Clinical Psychology. 2012;17(4):271-8.
13. Islamic Republic of Iran. Bagheri Yazdi, SA, Bashti, S. Comprehensive report of national mental health programs of Iran after 20 years of experiences. Tehran: Ministry of Health & Medical Education (Persian)
14. Mohit A, Shahmohammadi D, Bolhari J. Independent evaluation of Iranian National Mental Health Program. IJPCP, 1995; 3(3): 4-16. (Persian)
15. World Health Organization, & World Organization of Family Doctors. Integrating mental health into primary care: a global perspective. Geneva: World Health Organization, 2008.
16. Planning and Budget Organization. Analysis of Population and Housing Census Results. Deputy of Economic Affairs and Coordination, Tehran; 2017. (Persian)
17. Karimi A. An Analysis on the spatial pattern, dimensions and related factors to urbanism growth of contemporary in Iran (Emphasizing on development and livelihood indexes). 2018; 6(3): 605-27.
18. Forouzanfar MH, Sepanlou SG, Shahraz S, Dicker D, Naghavi P, Pourmalek F, et al. Evaluating causes of death and morbidity in Iran, global burden of diseases, injuries, and risk factors study 2010. Arch Iran Med. 2014;17(5):304-20.
19. Forouzanfar MH, Sepanlou SG, Shahraz S, Dicker D, Naghavi P, Pourmalek F, et al. Evaluating causes of death and morbidity in Iran, global burden of diseases, injuries, and risk factors study 2010. Arch Iran Med. 2014;17(5):304-20.
20. Damari B, Alikhani S, Riazi-Isfahani S, Hajebi A. Transition of Mental Health to a More Responsible Service in Iran. Iran J Psychiatry. 2017;12(1):36-41.
21. Naserbakht M, Taban M. Evaluation of integration of mental health services into the primary healthcare system. Tehran: Ministry of Health & Medical Education; 2017. (Persian)
22. World Health Organization. Declaration of Alma-Ata. In: International Conference on Primary Health Care; 1978-09-06; Alma-Ata, USSR; 1978.
23. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457-502.
24. Haggerty J, Burge F, Lévesque JF, Gass D, Pineault R, Beaulieu MD, et al. Operational definitions of attributes of primary health care: consensus among Canadian experts. Ann Fam Med. 2007;5(4):336-44.
25. Mohammadi E, Oliaeemanesh AR, Majd-Zade R, Kabir MJ, Atri m, Asgari K, et al. Effects of the Health Transformation Plan (HTP) on implementation process, rules and regulations of basic health insurance organizations in Iran. Hakim Health system research, 2019; 21(4): 255-65.
26. Haggerty JL, Pineault R, Beaulieu MD, Brunelle Y, Gauthier J, Goulet F, et al. Practice features associated with patient-reported accessibility, continuity, and coordination of primary health care. Ann Fam Med. 2008;6(2):116-23.
27. Talbot-Smith A, Gnani S, Pollock AM, Gray DP. Questioning the claims from Kaiser. Br J Gen Pract. 2004;54(503):415-21; discussion 22.
28. Feachem RG, Sekhri NK, White KL. Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente. Bmj. 2002;324(7330):135-41.
29. Or Z. Exploring the Effects of Health Care on Mortality across OECD Countries. Labour Market and Social Policy Occasional Papers no. 46. Paris: Organization for Economic Cooperation and Development, 2001.
30. Damari B, Alikhani S, Riazi-Isfahani S, Hajebi A. Transition of Mental Health to a More Responsible Service in Iran. Iran J Psychiatry. 2017;12(1):36-41.
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IssueVol 16 No 3 (2021) QRcode
SectionOriginal Article(s)
Published2020-06-02
DOI https://doi.org/10.18502/ijps.v16i3.6258
Keywords
Iran Mental Health Services Mental Disorders Primary Health Care Risk Factors

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How to Cite
1.
Hajebi A, Sharifi V, Abbasinejad M, Asadi A, Jafari N, Ziadlou T, Khadem S, Asgardoon MH, Damari B. Integrating Mental Health Services into the Primary Health Care System: The Need for Reform in Iran. Iran J Psychiatry. 2020;16(3):320-328.