مراکز سلامت روان جامعه‌نگر در ایران: طراحی خدمات مبتنی بر شواهد

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.