Mental Health Services Integration in Primary Health Care in Iran: A Policy Analysis
Abstract
Objective: The National Mental Health Services (N-MHSs) in Iran was integrated with Primary Health Care (PHC) in 1988. This study aimeds to analyze the policy of integrating N-MHSs in PHC, focusing on the analysis of the current situation, pathology, and the existing challenge.
Method: This qualitative research was conducted in 2020 using a case study approach. This study used the policy triangle model to analyze the policy. The required data were collected via interviews, literature review, and document analysis. The interviews were conducted with 23 experts, stakeholders across the country who were selected through purposive sampling, and the data were analyzed using the content-analysis method.
Results: The main goals of this policy were to raise mental health literacy among the people and eliminate its stigma in the society, while implementing the referral system for N-MHSs. Twenty weaknesses were extracted in eight areas, including negative views of mental health, weaknesses in human resource training, compensation for the service of psychologists, unfavorable working conditions of the workforce, inappropriate service delivery facilities, lack of meaningful communication between different levels of service delivery, poor inter-sectorial communication, and the challenging nature of mental health care. De-stigmatizing psychological disorders in the society and identifying hidden patients are some of the most significant achievements of this policy.
Conclusion: Despite the successful implementation and significant achievements in integrating N-MHSs in PHC, the results of the present study indicate that there are many challenges in this field that require serious planning and attention from relevant authorities.
2. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72(4):334-41.
3. Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, Rahimi-Movaghar A. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):0-.
4. Naghavi M, Abolhassani F, Pourmalek F, Lakeh M, Jafari N, Vaseghi S, et al. The burden of disease and injury in Iran 2003. PHM. 2009;7:9.
5. Noorbala AA, Akhondzadeh S. Mental health study process into prevalence of mental disorders in Iran. Arch Iran Med. 2015;18(2):74-5.
6. Ahmadzad Asl M, Shamshiri A, Hajebi A, Naserbakht M, Saberi Zafarghandi M, Davoudi F. Geographical distribution of human resources in mental health provision system in 2007. IJPCP. 2011;17(2):143-50.
7. Ivandic I, Freeman A, Birner U, Nowak D, Sabariego C. A systematic review of brief mental health and well-being interventions in organizational settings. Scand J Work Environ Health. 2017;43(2):99-108.
8. Bolhari J, Mohit A. Evaluating of Mental Health integration in primary Health care in rural areas of Hashtgerd 1991-1993. Journal of thought and behavior. 1995;2(1):16-24.
9. Bolhari J, Ahmadkhaniha H, Hajebi A, Bagheri Yazdi SA, Naserbakht M, Karimi-Kisomi I, Tahmasebi S. Evaluation of mental health program integration into the primary health care system of Iran. IJPCP. 2012;17(4):271-8.
10. Tairi F, Asgharnejad Farid A-a, Bolhari J, Ghazizade A. Evaluation of mental health program integration into the primary health care system of Sanandaj district. IJPCP. 2007;12(4):403-9.
11. Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353-70.
12. Walt G, Shiffman J, Schneider H, Murray SF, Brugha R, Gilson L. 'Doing' health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan. 2008;23(5):308-17.
13. Schmeer K. Stakeholder analysis guidelines. Policy toolkit for strengthening health sector reform. 1999;1:1-35.
14. Buse K, Mays N, Walt G. Making health policy: MHE (UK); 2012.
15. Khodayari-Zarnaq R, Ravaghi H, Mohammad Mosaddeghrad A, Sedaghat A, Mohraz M. HIV/AIDS policy agenda setting in Iran. Med J Islam Repub Iran. 2016;30:392.
16. Coyne IT. Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? J Adv Nurs. 1997;26(3):623-30.
17. Guba EG, Lincoln YS. Epistemological and methodological bases of naturalistic inquiry. Ectj. 1982;30(4):233-52.
18. Noorbala AA, Faghihzadeh S, Kamali K, Bagheri Yazdi SA, Hajebi A, Mousavi MT, et al. Mental Health Survey of the Iranian Adult Population in 2015. Arch Iran Med. 2017;20(3):128-34.
19. Organization WH. WHO-AIMS report on mental health system in the Islamic Republic of Iran. Tehrran, Iran: WHO —assessment instrument for mental health systems. 2006.
20. WHO. WHO REPORT.Mental health Atlas country profile (IRAN). 2014.
21. Mohammadi MR, Davidian H, Noorbala AA, Malekafzali H, Naghavi HR, Pouretemad HR, et al. An epidemiological survey of psychiatric disorders in Iran. Clin Pract Epidemiol Ment Health. 2005;1:16.
22. Ferrannini L, Ghio L, Gibertoni D, Lora A, Tibaldi G, Neri G, Piazza A. Thirty-five years of community psychiatry in Italy. J Nerv Ment Dis. 2014;202(6):432-9.
23. Organization WH, Colleges WOoN, Academies, Physicians AAoGPF. Integrating mental health into primary care: a global perspective: WHO; 2008.
24. Organization WH. WHO-AIMS report on mental health system in Republic of Korea. Gwacheon City: WHO and MoHW, Republic of Korea. 2007.
25. De Campos Souza PJ, Crise A, da Reforma DE. SERVIÇO DE URGÊNCIA PSIQUIÁTRICA DE BELO HORIZONTE.
26. Shahmohammadi S, Yaghobi H, Bolhari J, Moshirpour S. Integration of mental health care in primary health care program in Iran: A systematic review. IJPCP. 2013;19(1):3-8.
27. Bagheri YS, Malek AH, Shahmohammadi D, Naghavi RM, Hekmat S. Evaluation of functions of auxiliary health workers (behvarzes) and health volunteers in memal health care delivery in the framework of PHC system in Brojen city, Chaharmahal and Bakhtiary province. 2001.
28. Salehi M, Kelishadi M, Zandiyeh M, Keshavarz J, Bagheri-Yazdi S. Effectiveness of the volunteer women health connection training in knowledge and attitude in Esfehan. Iran J Med Educ. 2005;5(2):111-9.
29. Wahl OF. Mental health consumers' experience of stigma. Schizophr Bull. 1999;25(3):467-78.
30. Irajpour A, Alavi M, Abdoli S, Saberizafarghandi MB. Challenges of interprofessional collaboration in Iranian mental health services: A qualitative investigation. Iran J Nurs Midwifery Res. 2012;17(2 Suppl 1):S171-7.
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Issue | Vol 19 No 1 (2024) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/ijps.v19i1.14339 | |
Keywords | ||
Integration Mental Health Policy Analysis Primary Health Care |
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