Urban mental health initiative: Developing interdisciplinary collaboration, the role of the family physician in management of severe mentally ill patients

Abstract

Objectives Mental health program in Iran has been approved since 1988 and has been integrated into the primary care system especially in rural areas, and has been developed greatly over the past few de-cades. Due to demographic changes in the country’s population and the rapid expansion of cities, there is a need for a coherent plan to provide mental health services in urban areas. This study aims to provide a practical model for mental health services in patients with severe psychiatric disorders in urban areas. Methods This study was conducted based on reviewing literature, using the experiences of other coun-tries, the model of the World Health Organization, the services available in Iran, description of the re-sponsibilities of beneficiary organizations, collaboration between the Ministry of Health and various organizations responsible for providing mental health, and using the opinios of national and international experts. In this model, urban mental health services are estimated for a population of 100,000 people. Results The developed model proposed to provide immediate psychiatric services with more coherence, increase the training and skills of the staff of 110, 115, 1480, and 123 hotlines, and determine a space for hospitalization of 3-5 emergency patients next to the public hospital. Depending on the number of patients per 100,000 population, there would be a need for community-based health service providers, including 2-3 rehabilitation teams for home visits (each cover 80 patients), and 3 daycare centers to provide services to 40 patients. In case of providing community-based services, there would be a need for 12 beds for acute psychiatric patients and 5 beds for mid and long term rehabilitation. Moreover, vocational rehabilitation services should provide to 50 patients, and two apartments with an area of about 80 m2 would be needed to accommodate about 8 patients. The provision of above mentioned services would require equal participation of beneficiary organizations. The family physician would play an essential role in follow-up of patients under the constant supervision of specialists. Conclusion To achieve the desired model of urban mental health services so that it can provide comprehensive services to patients at different levels from prevention and care to treatment and rehabilitation, there is a need for collaboration between organizations providing these services. In this model, the use of existing services imposes lower financial burden on the country’s mental health management system.