Specialized Outpatient: Community Mental Health Centers (CMHCs)

Abstract

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.

Epidemiological aspects of individuals with mental disorders in the referral system: the experience of a Community Mental Health Center in the northeast of Iran

“…For example In Iran, 18% of the health organization's budget is spent on mental health problems in mental hospitals, while patients with a history of admission in psychiatric hospitals are the minority of people with mental health condition [ 21 ]. CMHC as a specialized outpatient providing mental health care was found to have positive impacts on the cost effectiveness and efficacy of in Iran and other countries [ 15 , 17 , 22 , 23 ]. Five years after the establishment of CMHC in Iran, Sharifi et al suggested that skilled staff, a better source of funding, and more integration into the healthcare system can enhance the performance and efficacy of CMHC [ 17 ].…”

“…Aftercare focuses on treatment and follow-up for patients with severe mental illnesses, including those with a history of psychiatric hospitalization, and offers home care and telephone follow-up. CMHCs also provide mental health education for patients and their families [ 14 – 17 ]. Patients typically come to CMHCs via referral from PHCs or psychiatric hospitals.…”

Stigma as a barrier to suicide prevention efforts in Iran

“…For example, in a small community trial in three districts in Iran, SERAJ was associated with improved mental health literacy and decreased prevalence of mental disorders in the intervention districts ( 33 ). After 6 years, the program has been expanded to 23 districts, however, the SERHJ program has not yet been fully scaled to a national level, despite the promising outcomes during the trial ( 34 ).…”

Scaling-up a new socio-mental health service model in Iran to reduce burden of neuropsychiatric disorders: an economic evaluation study

“…Based on the transition of mental health care in Iran within about 2 decades, from introducing basic mental health care in PHC to the experience of communitybased mental health centers (CMHC) for urban areas [7], a new socio-mental health service model, with two basic and advanced service strata, has been so far proposed. The given model has been piloted in eight cities in this country over the last 5 years.…”