Volume 27, Issue 1 (Spring 2021)                   IJPCP 2021, 27(1): 104-119 | Back to browse issues page

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Malakouti S K, Keshavarz Akhlaghi A, Shirzad F, Rashedi V, Khlafbeigi M, Moradi Lakeh M et al . Urban Mental Health Initiative: Developing Interdisciplinary Collaboration, the Role of the Family Physician in Management of Severe Mentally Ill Patients. IJPCP 2021; 27 (1) :104-119
URL: http://ijpcp.iums.ac.ir/article-1-3130-en.html
Urban Mental Health Initiative: Developing Interdisciplinary Collaboration, the Role of the Family Physician in Management of Severe Mentally Ill Patients
Seyed Kazem Malakouti1 , Amirabbas Keshavarz Akhlaghi2 , Fatemeh Shirzad3 , Vahid Rashedi4 , Mitra Khlafbeigi5 , Maziar Moradi Lakeh6 , Ahmad Hajebi 7
1- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
2- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
3- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
4- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
5- Department of Occupational Therapy, School of Rehabilitation Sceinces, Iran University of Medical Sceinces, Tehran, Iran.
6- Family Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
7- Department of Psychiatry, Research Center for Addiction and Risky Behaviors (ReCARB), Iran University of Medical Sciences, Tehran, Iran. , hajebi.a@iums.ac.ir
Keywords: Mental health, Community-based services, Urban mental health, Family physician
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1. Introduction
Studies on the integratation of mental health into primary health care in Iran have been conducted since 1986, which was later implemented successfully within the Rural Family Physician Program in 1988. In urban areas, there is no structured mental health care system and the private sector provides health care services mostly focused on the biomedical model of care. Due to demographic changes in Iran’s population, urban sprawl, and the changes in the urban/rural proportion, the need for a coherent plan to provide mental health services in urban areas is felt more than ever. This study aims to investigate the feasibility of establishing the urban mental health care system for patients with severe psychiatric diseases based on collaboration between organizations in Iran.

2. Materials and Methods
The study reviews the integrated plan for urban mental health services in Iran. First, a systematic review was conducted to get acquainted with the models of providing urban mental health services worldwide, including the World Health Organization (WHO)’s model in the field of mental health care. Then, the situational analysis of the services provided in Iran was carried out using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS). Legal duties of beneficiary organizations, and the Inter-sectoral collaboration of the Ministry of Health and beneficiary organizations were reviewed along with seeking for the opinions of international and national experts using the Delphi method. The model estimates the need for mental health services in cities with 100,000 population.

3. Results
The prevalence of mental diseases in Iran was similar to the global rate. The most prevalent mental disease was major depressive disorder followed by substance abuse. The number of male and female patients with mental diseases was not equal. The proposed model was mainly for severe mental diseases such as severe depression, bipolar mood disorder, and the spectrum of psychotic disorders that account for the highest number of admissions to psychiatric hospitals. According to the results of the literature review and based on the opinions of experts, the urban mental health care system should provide the following services to psychiatric patients: (a) Integrated emergency psychiatric services in the form of crisis hotlines, mobile crisis intervention teams, and inpatient wards. Some of the crisis hotlines that are currently operational in Iran are the Police (Dial 110), Medical Emergency (Dial 115), and Social Emergency (Dial 123). There is no need to provide more similar services, especially new crisis hotlines and mobile crisis intervention teams; (b) Short- and long-term hospitalization services. Considering a point prevalence of 22% for psychiatric disorders in Iran according to the results of the systematic review and meta-analysis, a minimum estimate of 3% for the annual prevalence of severe psychiatric disorders was considered as the criterion for calculating the number of beds and providing other future services. Based on the made calculations, there was a need for 12 beds for acute psychiatric diseases and 5 beds for short- and long-term hospitalization for a population of 100,000 in case of providing community mental health services; (c) Home visit services. The psychiatric patients can be classified into two groups according to their disease severity: a group requiring more follow-up care and a group with the need for less follow-up care. For the first group, home visit services are currently provided by the welfare organization and community-based mental health care centers. For the second group, family education services, psychosocial rehabilitation, and emergency services can be provided by dialing 110 or 115; (d) Daycare and rehabilitation services. For a population of 100,000, about 100 people would be eligible for receiving daycare services, which requires the establishment of 2-4 daycare centers so that each center can provide services to 30-50 people; (e) Vocational rehabilitation services: According to various studies, an unemployment rate of 70% seems reasonable for psychiatric patients. Based on the calculation results, for 750 patients with severe mental diseases, there would be a need for providing vocational rehabilitation service to 52 people, which can be met through supportive/productive workshops and training of business owners, industries, and non-governmental organizations; (f) Accommodation services. In Iran, according to the cultural situation and extended families, the number of homeless psychiatric patients is 1%. In other words, for 750 severe psychiatric patients per 100,000 population, there would be about 8-10 homeless patients. On the other hand, for a typical family of four in Iran, there would be a need for an 80-m2 apartment; i.e. per 100,000 population, they can be accommodated in two 80-m2 apartments each with a capacity of 4 people.

4. Discussion and Conclusion
This study aimed to provide an optimal model of comprehensive urban mental health services and rehabilitation for patients with severe psychiatric diseases, based on collaboration between family physicians and the organizations that provide health care services. Since the current health system allocates a very small amount of budget to psychiatric hospitals which provide services to acute psychiatric patients for hospitalization, a coherent system can be useful for optimal management of at least one-fifth of the mental health needs of the community. There is a need for coordination between the organizations providing these services to plan carefully, eliminate similar services, and prevent the waste of human capital and resources.




Ethical Considerations
Compliance with ethical guidelines
All included studies would be cited in all reports and in all future publications.

Funding
This project was supported by the Ministry of Health, the Office of Mental Health and Addiction, and the Vice-Chancellor for Research and Technology of Shahrekord University of Medical Sciences.

Authors contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflict of interest. 

Acknowledgements
We want to thanks the Mental Health Office Social and addiction Ministry of Health and Medical Education, and the Vice-Chancellor for Research and Technology of Shahrekord University of Medical Sciences.

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Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2019/11/23 | Accepted: 2020/06/20 | Published: 2021/04/20
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