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  Objectives : The study aimed at reviewing evidence of effectiveness and cost-effectiveness of community-based services for psychiatric disorders. Method: Cochrane and PubMed bibliographic databases and reference lists of relevant studies were investigated. Systematic reviews and controlled randomized clinical trials were analyzed. The inclusion criteria were having effectiveness and cost-effectiveness scales for community-based services models . These scales were compared for services delivered to patients with mild severe and mild psychiatric disorders. Results: Provided services were assertive community treatment, case management, home visit, crisis intervention services , prompting, patient and family education and supported employment. The effectiveness and cost-effectiveness of assertive community treatment and family education had the strongest evidence and were effective on hospital admission rate, duration of hospital stay and maintaining contact with treatment system. The evidence for other services were insufficient or contradictory. For the mild psychiatric disorders, the service models included screening of disorders and feedback alone, continuous medical education, using practice guidelines, telephone-based intervention/care, referral system and consultation- liaison service, internet-based prevention and treatment programs, school-based prevention program and collaborative care. The most effective and cost-effective models were collaborative and internet-based care programs. Some of the positive outcomes of interventions were symptom reduction, patient’s satisfaction and decrease in economic burden of disease on family. Conclusion: The evidence for the models of delivering services to patients with mild psychiatric disorders mainly support collaborative models for delivering services and for more severe disorders support active follow-up and family education. These models are effective and feasible to clinical outcomes with a desirable cost - effectiveness .

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Objectives: Service delivery through Community Mental Health Centers (CMHCs) is a strategy for improving urban mental health. The current paper presents the process of designing structure and planning the services for CMHCs through an evidence-based approach. Method: Using a systematic review approach, the needs and available mental health services in urban areas, and effectiveness and cost-effectiveness of mental health services for addressing those needs were identified and accordingly urban mental health services plan was devised as CMHCs. Results: Depression, schizophrenia and other psychotic disorders, bipolar disorders and anxiety disorders respectively comprise the top four psychiatric disorders, according to burden of diseases, in Iran. Urban areas have richer resources than rural areas in the country, though there are no out-of-hospital and out-of-office mental health services and the network system and the primary care for presenting mental health services are ineffective due to the current restrictions. Therefore, it was arranged that the CMHCs’ services being delivered to two groups of patients including patients with neurotic (depressive and anxiety) disorders and patients with severe mental and psychotic disorders. The services for neurotic patients were presented according to improving recognition style and the management of neurotic disorders conducted by general practitioners (GP) using collaborative care model and forming collaborative units. The services for patients with severe psychiatric disorders included home visiting and telephone follow up accompanied with the patient and the family psychological education provided by specialized team from the CMHCs. Conclusion: The CMHCs’ services based on scientific evidence available across the world and using national experiences and infrastructures was designed for two groups of disorders which comprised a large burden of disease in the country. These services are currently being piloted in Tehran and Zanjan.