Original Article

Specialized Outpatient Services: Community Mental Health Centers (CMHCs)


Objective: The Iranian Mental Health Survey (IranMHS) in 2011 has demonstrated that almost 1 out of 4 adult individuals suffer from psychiatric disorders; however, more than two-thirds are left unrecognized and untreated and many of the services have poor quality of care. In this paper we present our experience in developing and employing community-based mental health services through community mental health centers (CMHCs), which has been incorporated in Iran's comprehensive mental and social health services (the Seraj program).
Method: The service model of the CMHCs was developed though an evidence-based service planning approach and was then incorporated as the specialized outpatient services model into the Seraj program in 2015.
Results: The CMHCs in the Seraj program provide mental health care to patients with common mental and severe mental disorders in a defined catchment area. The services include the collaborative care, the aftercare, and day rehabilitation. The collaborative care model works with primary care providers in the health centers to provide detection and treatment of common mental illnesses. In the aftercare, services are offered to patients with severe mental disorders following discharge from the hospital and include telephone follow-ups and home visits. Day rehabilitation is mostly focused on providing psychoeducation and skill trainings. During the first 4 years of implementation in 2 pilot areas, more than 6200 patients (10% having severe mental disorders) received care at CMHCs.
Conclusion: The main challenge of the implementation of the CMHC component in the Seraj program is to secure funds and employ skilled personnel. We need to incorporate Seraj in the existing national health system, and if successful, it can fill the treatment gap that has been so huge in the country.

1. World Health Organization. The World Health Report 2001, Mental health: new understanding, new hope. Geneva, WHO. 2001.
2. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016;3(2):171-8.
3. 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.
4. 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.
5. World Health Organization. The World Health Report 2001, Mental health: new understanding, new hope. Geneva, WHO. 2001.
6. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Jama. 2004;291(21):2581-90.
7. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370(9590):841-50.
8. Ministry of Health and Medical Education. National Mental Health Programme [In Persian]. In: Mental Health Office MoH, editor. Tehran1986.
9. Bolhari J. AH, Hajebi A. Evaluation of Mental Health Program Integration into the Primary Health Care System of Iran. IJPCP, 2012;17(4):271-8.
10. Bagheri Yazdi SA, Malek Afzali H, Shah Mohammadi D, Naghavi M, Hekmat S. Evaluation of functions of auxiliary health workers (Behvarzes) and health volunteers in mental health care delivery in the framework of PHC system in Brojen city, Chaharmahal and Bakhtiary province. Hakim Res J. 2001;4(2):100-9.
11. Munizza C, Gonella R, Pinciaroli L, Rucci P, Picci RL, Tibaldi G. CMHC adherence to National Mental Health Plan standards in Italy: a survey 30 years after national reform law. Psychiatr Serv. 2011;62(9):1090-3.
12. Keegan J. Community-based mental health care: bridging the gap between community care and primary care. Aust N Z J Ment Health Nurs. 1998;7(3):95-102.
13. Grunebaum H. The Practice of Community Mental Health. Boston: Little, Brown, and Co.; 1970.
14. Beigel A, Levenson A. The community mental health center. New York: Basic Books.1972.
15. Murthy RS, Burns BJ. Community mental health. Proceedings of Indo-US Symposium. Bangolare: Nimhans; 1992.
16. De Girolemo G, Cozza M. The Italian psychiatric reform: A 20-year perspective. Int J Law Psychiatry. 2000;23(3-4):197-214.
17. kemali D, Maj M, Crepet P. Hospital and community psychiatric care in Italian cities after the reform law. In: Parry-Jones WL, Queloz N, editors. Mental health and deviance in inner cities. Geneva: World Health Organization; 1991.
18. Whiteford HA. Australia's national mental health policy. Hosp Community Psychiatry. 1993;44(10):963-6.
19. Vendsborg PB. Community psychiatry in Copenhagen. Adaptation to increased needs. Ugeskr Laeger. 1998;160(23):3387-93.
20. Sharifi V, Abolhasani F, Farhoudian A, Amin-Esmaeili M. Community Mental Health Centers in Iran:Planning Evidence-based Services. IJPCP. 2014;19(3 ):163-76.
21. Damari B, Hajebi A, Sharifi V. Comprehensive Mental and Social Health Services; Study Protocol for a Pilot Experience in Islamic Republic of Iran. Iran J Psychiatry. 2020(this issue).
22. 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.
23. Amini H, Shakiba A, Sharifi V, Shirazi M, Sadeghi M, Abolhasani F, et al. Evaluation of the performance of general practitioners in a collaborative care program by employing simulated patients. Soc Psychiatry Psychiatr Epidemiol. 2016;51(9):1311-9.
24. Heidari E, Eslami S, Abolhassani F, Sharifi V, Taherzadeh Z, Daneshvar T. Association between Physicians' Adherence to a Pharmacotherapy Guideline and Continuity of Care for Patients with Depression and/or Anxiety Disorder. Arch Iran Med. 2017;20(5):308-13.
25. Sharifi V, Tehranidoost M, Yunesian M, Amini H, Mohammadi MR. Jalali Roudsari M. Effectiveness of a low-intensity home-based aftercare for patients with severe mental disorders: a 12-month randomized controlled study. Community Ment Health J. 2012;48(6):766-70.
26. Sharifi V, Abolhasani F, Farhoudian A, Amin-Esmaeili M. Which of Community-Based Services are Effective for People with Psychiatric Disorders? A Review of Evidence. IJPCP. 2013;19(73):79-96.
27. Mirsepassi Z, Tabatabaee M, Sharifi V, Mottaghipour Y. Patient and family psychoeducation: Service development and implementation in a center in Iran. Int J Soc Psychiatry. 2018;64(1):73-9.
28. Bouras N, Ikkos G, Craig T. From Community to Meta-Community Mental Health Care. Int J Environ Res Public Health. 2018;15(4).
29. Tabatabaee M, Sharifi V, Abolhassani F, Layegh H. Evaluation of “Community Mental Health Centers” program in Tehran, Kerman, Mashad, and Tabriz (KMT Project). 2017.
30. Sharifi V. Urban mental health in Iran: Challenges and future directions, IJPCP. 2009;3(1):9-14.
IssueVol 16 No 1 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v16i1.5383
Aftercare Collaborative Care Community Mental Health Center Day Rehabilitation Primary Health Care

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Sharifi V, Hajebi A, Damari B, Mohammadjafari A. Specialized Outpatient Services: Community Mental Health Centers (CMHCs). Iran J Psychiatry. 16(1):87-93.