behzad damari

It is now confirmed that mental health promotion policies need innovations beyond the scope of the health sector. In this study, an attempt was made to identify the most effective stakeholders of the public sector in the field of mental health promotion in Iran to help the policy-makers and to encourage inter-sectoral collaboration and further involvement of these effective sectors in mental health promotion plans.  

This was a mixed-methods study. From the first step (literature review and a survey), the names of public agencies affected by mental health promotion were extracted. In the next step, a checklist for identifying the main stakeholders was developed. The data of this step were analyzed by the simple additive weighting method. Ultimately, a table was plotted in the form of institutional mapping in order to summarize the organizations affecting each risk factor of mental health promotion.  

The Islamic Consultative Assembly, the Ministry of Interior, the Islamic Republic of Iran Broadcasting, the Ministry of Cooperatives, Labor, and Social Welfare, and the Ministry of Education were identified as the five institutions with the greatest impacts on the social determinants of mental health in Iran.   

Significant impacts can be exerted by institutions such as the Islamic Consultative Assembly (as the legislator), the Ministry of Interior, and its subsidiary entities such as municipalities and governors (as the administrators of homeland security and support for safe and appropriate urban and local facilities), the Islamic Republic of Iran Broadcasting (as the national media), the Ministry of Cooperatives, Labor, and Social Welfare (as the institution in charge of employment, job security, and social welfare), and the Ministry of Education (as the educational institution of the country).

Health governance challenges can make or break Universal Health Coverage (UHC) reforms. One of the biggest health governance challenges is ensuring meaningful participation and adequately reflecting people’s voice in health policies and implementation. Recognizing this, Iran’s Health Transformation Plan (HTP) lays out the country’s blueprint for UHC with an explicit emphasis on the ‘socialization of health’. ‘Socialization’ is seen as a key means to contribute to HTP objectives, meaning the systematic and targeted engagement of the population, communities, and civil society in health sector activities. Given its specific cultural and historical context, we sought to discern what notions such as ‘civil society’, ‘non-governmental organization’, etc. mean in practice in Iran, with the aim of offering policy options for strengthening and institutionalizing public participation in health within the context of the HTP. For this, we reviewed the literature and analysed primary qualitative data. We found that it may be more useful to understand Iranian civil society through its actions, i.e. defined by its motivation and activities rather than the prevailing international development understanding of civil society as a structure which is completely independent of the state. We highlight the blurry boundaries between the different types of civil society organizations and government institutions and initiatives, as well as high levels of overlaps and fragmentation. Reducing fragmentation as a policy goal could help channel resources more efficiently towards common HTP objectives. The national health assembly model which was first launched in 2017 offers a unique platform for this coordination role, and could be leveraged accordingly.

Spousal abuse in pregnancy leads to adverse consequences in mother and neonate and its prevalence is far higher than other dangerous complications during pregnancy. The aim of this study was to determine the prevalence of spousal abuse during pregnancy and its related factors in Guilan Province.

This cross-sectional and descriptive-analytical study included 1541 parous women referring to 160 selected health care delivery units for their babies' two-month vaccination in 2019. We used random multi-stage cluster sampling for sample collection. Data were collected using a valid and reliable self-administered questionnaire consisted of demographic variables and spouse abuse questionnaire during pregnancy. Using SPSS-26 software, data were analyzed by descriptive and analytical tests such as mean, chi-square and binary logistic regression. α <0.05 was considered significant.

The mean (SD) age of the women participating in the study was 29.2±5.6 years. The overall prevalence rate of spousal abuse in pregnancy was 71.3% and women had been abused by their spouses at least once during pregnancy with frequency of "sometimes" to "always". The prevalence rates of emotional (the most common), physical and sexual violence were 69.5%, 32.2% and 15.1% respectively. Husbands' substance abuse (Odd Ratio-OR= 2.38, 95% CI: 1.7, 3.34), couples' dissatisfaction of the gender of the fetus (OR= 1.91, 95% CI: 1.09, 3.35), lack of family support for mothers (OR = 1.63, 95% CI: 1.03, 2.57) and extended family (OR = 1.38, 95% CI: 1.03, 1.84) were found to be positively and significantly associated with spousal abuse during pregnancy.

Use of effective strategies in order to reduce the factors associated with spousal abuse can be effective in preventing and decreasing the rate of this social problem and its negative consequences.

Health observatory dashboard can assist in promoting the quality of academic and governmental services by generator high-quality information. The aim of this research is to describe the stages of designing and launching the national public health dashboard.  

This study was conducted with a qualitative approach and designing a web application using C#, ASP.NET and JQuery languages. The required data were gathered via 2 sources: (1) reviewing existing documents, and (2) gathering expert opinions.  

The dashboard is developed in 3 sections, including a conceptual model of the indicators, a page for selecting the indicators, and metadata of each indicator. The indicators are demonstrated in 3 classes based on data sources (surveys and routine data collection), health effects (mortality, morbidity, risk factors, service coverage, social factors affecting health, health system functions, financial protection, population indicators, and macro indicators), as well as a plan, including the health reform plan. The page for selecting the indicators includes 190 major indicators encompassing the 3 mentioned areas. The metadata of each indicator includes the indicator name, its definition, its last figure, its source, the section for descriptive and comparative diagrams (the indicator’s trend, provincial distribution, and international comparison of the indicator), and policy options.  

The Health Observatory System of Iran has been launched. The credibility of this system and user satisfaction depends on implementation of the health observatory calendar, qualitative control of the path of the recorded data, and national determination of policymakers.

Divorce is one of the most important social harms. This study investigated the divorce trends, causes, and implemented interventions.

 A qualitative approach with a content analysis method was conducted. The study data were collected by reviewing relevant documents such as scientific articles and official reports, interviewing experts, and holding focus group Discussion. Sampling was performed with purposive sampling and the snowball technique to identify experts and professionals in this area.

 In recent years, the ratio of the divorce to marriage has been increasing, and in 2016, it reached its highest level (25.3 divorce per 100 marriages). Weak literacy and marital skills, changing patterns of matching, increased individualism and self-interest seeking, unemployment, addiction, and cyber ads (online advertising) were considered the most important reasons for divorce, according to the experts’ views. Currently, a program for controlling and decreasing the divorce rate is implemented. However, the most critical challenges of the program are weak inter-sectoral collaboration and community participation, dispersing and islanding social services, and also the effect of political, economic, social, technological, environmental, and international macro factors on mentioned national program.

 Social harms inside the family are complicated. So, it requires the cooperation of scattered and islanding services in the form of comprehensive social care units for the target population throughout the country. Also, capacity building and national programs institution literacy should be strengthened.

Given the importance of psychosocial health in the society there is a need for national and institutional plans for their implementation. This paper sought to assess  national laws and documents in this regard.

The contents of upstream documents and laws were done using websites of the Islamic Consultative Assembly, the Ministry of Health and other sites relating to mental health; assessment was done via the SDH approach.

The findings of the study in the form of a review showed weaknesses in implementation of principles to promote mental health in the society.

Methods to achieve and promote mental health are suggested.

The Ministry of Health influences the executive organizations through the high councils and the decision-making system. It is necessary to adopt an inter-sectoral cooperation approach, seek appropriate support for interacting with these councils, focus on the health taken decisions, and analyze their current situation. This study aimed to investigate the challenges and barriers to the interaction of high councils of health with the Iran Ministry of Health.

The present study is a field-based qualitative study that was conducted to analyze the current situation of the High Councils. Data were collected through interviews, group discussion sessions, and document analysis. To collect the data, 23 interviews and 2 focus group sessions were conducted using purposive sampling. The obtained data were then analyzed using MAXQDA software (version 10).
(Ethic code: 162432750)

The results of the study showed that in terms of activity, the elected high councils are divided into three categories of active, semi-active, and inactive. Challenges facing these councils include lack of financial and human resources, inadequate structure and organization, non-transparent rules and regulations, lack of executive guarantees, poor planning and cross-sectoral coordination, lack of monitoring and evaluation system, low level of awareness and attitude of policy makers and managers about health, poor leadership of the Ministry of Health, and finally the lack of a health appendix in approvals. The improvement of the performance of high councils in applying the health appendix to approvals can be achieved through such interventions as 1. Policy interventions, 2. Executive structure interventions, and 3. Culture building and advocacy.

According to the results of the study, it is necessary for the health system to develop inter-sectoral cooperation and seek appropriate support from high councils in order to fairly improve community health indicators, take action to reduce barriers to interaction through policy, executive, culture-building, and advocacy interventions.

According to the definition proposed by WHO, social health is a health dimension that impacts, or is affected by, the two physical and mental dimensions. Based on the definition given by the Academy of Medical Sciences of Islamic Republic of Iran, social health includes reciprocal qualitative and quantitative behaviors by individuals towards welfare of the society. Pro-social behaviors and an encouraging environment are considered as the two main components of social health promotion. The purpose of this study was to identify pro-social behaviors in the Iranian society.

This was a qualitative study. Data were collected using 1). Literature review based on sources related to Iranian culture and religious advice, as well as published international experiences, and 2). Expert opinions based on focus group discussions on eight specialized disciplines. The data obtained were content analyzed.

Analysis of the data of this study showed twenty pro-social behaviors (possible to be categorized into three domains/areas of social thinking, speech and expression, and behavior):acceptance of diversity and altruism, understanding human rights, not telling lies, cooperation, humbleness, donation/free contribution, being critical, patience and forgiveness, lack of distrust/suspicion, speaking competence, proper balance/equilibrium, sense of responsibility, brotherhood, personal discipline/order, fidelity, trustworthiness, consultation, cultural exchange, self-identity and, finally, respecting the environment.

Behavior change requires applying evidence-based models, e.g., social marketing. It is, thus, suggested that after investigating and surveying pro-social behaviors in the Iranian society, barriers to pro-social behaviors should be investigated and social marketing programs be developed and implemented aiming to help improve these behaviors.

Phenylketonuria (PKU) is an autosomal recessive disorder that screening and timely control of this disorder can prevent the adverse effects. Regarding the high prevalence of PKU in Iran, the PKU screening program was started in Iran in 2006. This study was conducted to determine the cost-effectiveness of PKU screening in Iran.

An economic evaluation was performed among screened and treated individuals compared to no screening in 2013. The study population included 1356132 newborns that screened for PKU diagnosis. Lifetime costs, quality-adjusted life year (QALY) gains and incremental cost-effectiveness ratio (ICER) were calculated from the perspective of government. A discount rate of 3% was considered for both QALYs and costs. A one-way sensitivity analysis was used for assessing the robustness of the results.

The discounted lifetime cost of intervention and non-intervention were $59528953.8 and $85295501.6 respectively. Therefore, the total estimated cost saving was $25766547.84. PKU screening produces an ICER of $1844420 per QALY gained.

Screening and early treatment for PKU is highly cost-effective. Therefore, the screening can improve quality of life of the patients and increase financial saving in health system.

Three categories of interventions are considered for reducing the prevalence of mental disorders in Iran: mental health promotion, increasing mental health and social service utilization and controlling mental health risk factors. In this regard, we designed a community action program in a national plan to provide comprehensive social and mental health services(SERAJ) that were implemented as a pilot in threedistricts of Iran: Bardasir, Oslo, and Quchan.In this study, we have reviewedthe results of this pilot project.

This study was conducted based on the collaborative evaluation model; first, the program was described and the evaluation indicators of each component of the program were determined. Stakeholders were determined;also, data were collected through literature review, semi-structured interview, and focused group discussion and were analyzed by thematic analysis methods.

The community action program consists of fourcomponents: A Memorandum of Understanding(MoU) between the departments of the districts, People’s Participation House(PPH), Self-reliance Unit(SRU), and actions taken for stigma reduction. A total of 48% of the actions set out in the threeMoU of threedistricts have been executed. The PPH was formed in all threedistricts. A total of 816 social referrals were admitted to SRU for which a self-reliance process has been initiated. Moreover, 47% of referrals have received services and at least 10 messages for stigma reduction and promoting mental disorders have been sent from different sources at the district level.

Strengthening vertical cooperation between the national and provincial levels is essential for the full implementation of the Memorandum of Understanding(MoU) and self-reliance processes. Referring individuals for receiving social support with collaboration between the primary and secondary programs reported to be successful, but feedback to the primary and secondary levels which provides basic and specialized services, is nottransparent. Therefore, we suggest an electronic system as an option to solve this problem. The careful selection of representatives of the people's network and empowerment of PPH and directors of the district on community action skills are essential. Theexperiences of the governors and chairs of health networks of the threedistricts should be presented at a national conference

 Sexual health has been considered as a necessary condition for achieving reproductive health, rather than being a part of it. This study aimed to identify the challenges of sexual health in Iran and the strategies for its improvement.

 In this qualitative study using content analysis, a semi-structured interview was used to collect data. The participants were 16 experienced experts who were selected using a purposive sampling method. After individual interviews and theoretical data saturation, data analysis was performed using the deductive content analysis method.

 Five main themes including the taboo of sexuality and low public awareness, unconventional sexual behaviors and emerging social ills, stigma and discrimination, lack of the political commitment of the government, and lack of statistical indicators and not utilization of existing capacities were identified as the challenges of sexual health in Iran. The strategies to address them included: Public education and empowerment with a special focus on the adolescents and young people, adopting policies and revising the related laws in line with social changes; gaining the political support of the government, promoting the right attitude with a focus on banishing stigma and discrimination against groups with high-risk sexual behaviors, collecting indicators and designing interventions using human resources and existing capacities, and promoting professional ethics and gender equity.

 For addressing the challenges and achieving the highest levels of sexual health in Iran, it requires the political commitment of the government, revising laws, and inter-sectoral cooperation to design and implement multidisciplinary and multidimensional interventions.

Happiness, a factor in social, political, and economic development, leads to higher performance, increase in production, and great efficiency. The goal of this study was to assess the level of happiness in Iran’s work communities.

In this cross-sectional survey study, we randomly selected 13842 people from 380 workplaces in 31 provinces of Iran. Trained interviewers based on structured questionnaires collected data. Reliability of the questionnaire determined by using internal consistency. Collected data were analyzed through SPSS 16 software (SPSS Inc., Chicago, IL) and the charts and tables were prepared to indicate each province’s happiness level and the national mean.

Average age of employees was 35.4±7.78 years. The majority of the respondents were male(n=11835, 85.5%), had finished middle/secondary school (n=7142, 51.6%) and were married (n=11323, 81.8%). The level of happiness varied from the highest value 148.97±21.49 in Boushehr Province and the lowest 130.39± 25.28 in Hormozgan Province.  The mean ± SD value of happiness in the work communities of Iran was 141.22±22.89.

Policymakers should consider workers’ happiness as an effective factor in production and efficiency.

More than 6.8% of the world's population suffer from disabling hearing impairment. Hearing impairment can cause lifelong or even life-threatening problems and has a significant impact on the health and quality of life. This study aimed to analyze the current situation of the ear and hearing care (EHC) in the frame of Iran health system.

This situation analysis was performed over a 5-year period (2013-2017) using the Strengths, Weaknesses, Opportunities, and Threats analysis method. First, after formation of the steering committee, all relevant published and unpublished articles and reports were reviewed and analyzed. In the next step, focused group discussion sessions (FGDs) were held with the participation of the experts, stakeholders, and Steering Committee members. Through the scissor-and-sort technique, the relevant data were highlighted and main categories evolved.

The main challenges included inadequate health literacy, weak intrasectoral and intersectoral cooperation, the inadequacy of policy responses, nonintegration of the EHC in the primary health care system, poor standard processes, and resources of EHC, and lack of EHC surveillance system. The 6 major interventions and strategies extracted as identifying the capacities of both the public and private sectors, reinforcement of intersectoral cooperation and intersectoral collaboration, standardizing the processes and integrating of EHC services in the PHC, reorganizing the referral system, promoting hearing health literacy, and minimizing hearing loss risk factors.

Implementing the proposed interventions and strategies is essential to improve the situation of Iran EHC management system during the next 5 years.

A national program on providing comprehensive social and mental health services, entitled “SERAJ”, was developed and piloted in three districts of Iran. The present study aims to thoroughly explain the educational needs for implementing the provision of comprehensive mental and social health services in districts of Iran (SERAJ).

In this study, we have interviewed service providers, held focused group discussions (FGDs) and used the knowledge, attitude, and practices (KAP) model for analyzing the duties of the service providers.

To implement SERAJ, Mental and Social Health Professionals and Healthcare professionals should be trained on various contents in the fields of mental health, social health, and addiction to provide ‎primary care services in Iran. Such training materials and schedules are necessary for providing secondary, and community action care ‎services as well.

The educational program resulting from this study should be piloted and after removing the barriers and solving the limitations, it should be expanded throughout the country.

The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran’s Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presented

This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts’ opinions were observed.

In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed.

A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.

Objective (s):

Deaths from non-communicable diseases have become a major concern worldwide. Functional foods such as probiotics, prebiotics and synbiotics are effective nutritional factors in controlling non-communicable diseases. The purpose of this study was to review and organize the existing situation and design the future roadmap.

The present study was a qualitative study that conducted by the Society of Probiotic and Functional Foods in collaboration with the National Institute of Health Research of the Islamic Republic of Iran in 2015. The policy brief was used in design and was formulated in three parts: cognition, orientation, and establishment of system. The information was collected through three methods of scientific resource review, stakeholder focus group discussion and written questionnaire. Data were analyzed using content analysis method.

The number of probiotic factories was 85 and 163 probiotic products had received production licenses in the country. The annual growth of the probiotic market from 2009 to 2014 was negative (54%). The policy focus areas for the development of probiotics and functional foods were distributed in three areas: legal policy, behavioral culture and operational structure and the development of this industry depends on planning and implementation in all three areas.

To develop the probiotic industry it is necessary to increase the knowledge of policy makers and consumer groups about probiotic products. Indeed, investment security in this area be provided and a system be deployed to monitor the development of the industry and solve its problems.

In this study, the basic criteria, models, and indicators of intersectoral collaboration in health promotion were investigated to facilitate the implementation of collaboration.

This scoping review was conducted using datasets of Embase, Web of Science, Scopus, and PubMed, and search engines of Google, Google Scholar, and ProQuest.

52 studies were included, and 32 codes in Micro, Meso, and Macro level, were obtained. Micro-level criteria had the highest frequency. Among the models used in the reviewed studies, social network analysis, Diagnosis of Sustainable Collaboration, Bergen, and logic models had the highest frequency. Among the indicators studied, the number of participants and the level of collaboration as well as its sustainability were the most frequent indicators.

The findings identified the most important and widely used criteria, models, and indicators of intersectoral collaboration in health promotion which can be useful for decision-makers and planners in the domain of health promotion, in designing, implementing, and evaluating collaborative programs.

A national program on providing comprehensive social and mental health services, entitled “SERAJ” was developed and piloted in three districts of Iran. The present study aimed to evaluate the effectiveness of SERAJ by conducting assessments before and after the implementation in the intervention and the control areas.

This was a controlled community trial that was assessed by conducting repeated surveys in the intervention and the control areas. In total, 2952 and 2874 individuals were assessed in the intervention and the control areas, respectively. The change in prevalence of mental disorders (using the Composite International Diagnostic Interview; CIDI), service utilization, mental health literacy, happiness, and perceived social support were measured over 18 months in three districts of Osko, Bardsir, and Quchan as the intervention areas, which were compared with three matched districts as the control areas.

No significant difference was found in the mean score of happiness between the intervention and the control areas throughout the study period. Most aspects of mental health literacy were improved in the intervention areas after implementing the intervention. The mean score of social support decreased after implementing the intervention in all areas. The prevalence of mental disorders in the intervention districts was significantly reduced after 18 months. The rate of using any mental health services after the intervention was not statistically different between the intervention and the control areas.

There was no significant change in some indicators in the intervention compared with the control areas. We suggest evaluating SERAJ’s achievements and challenges in the three intervention districts before expanding the implementation of this pilot experience into other districts.

Social problems and drug abuse, especially addiction, divorce, poverty, crime, violence, alcohol consumption, and substance abuse, have increased in Iran over the past two decades. The present study aims to determine an approach to decrease drug abuse and social ‎problems in the Islamic Republic of Iran.

A national program on providing comprehensive social and mental health services, entitled “SERAJ”, was developed and piloted in three districts of Iran. To compile this study, three types of data collection have been used: (1) review of the literature, (2) an in-depth interview with experts and stakeholders, (3) focused group discussions.

In our proposed model for decreasing drug abuse and social ‎problems, comprehensive mental and social health service are provided. Social care is integrated into the primary health care and six types of services, including social health education, screening for risk factors of social problems, and drug abuse, identifying underlying psychiatric, psychological, or social causes, short consultations, referral to social workers, and follow-up.

Theoretically, if mental disorders are reduced, social harm and addiction will also be reduced because it is one of the important risk factors for divorce, violence, crime, drug abuse, and alcohol consumption. SERAJ reduces mental disorders; therefore, it can reduce social problems and addiction.

Comprehensive mental and social health services is the new benefit package which had been aimed to provide mental health services to people who suffer from mental disorders. The aim of this study was to estimate the cost of plan and its drivers to provide evidence for decision-making by national policymakers.

We used the bottom-up costing approach to estimate the cost of plan. We identified the cost centers, services delivery process, and facilities. Data were collected via different sources and tools such as the new financial system, registration forms, and performance reporting forms. We categorized the cost into 4 groups and selected appropriate measures to estimate the cost. We estimate the total and unit cost for 3 levels in 2 scenarios by considering the 2017 prices.

Screening resulted in 8.9% new detection with a different incidence in urban and rural areas (urban: 16.5%; rural: 2.7%). Also, 61 842 million IRR was spent for the screening, diagnose, treatment, and rehabilitation of detected people in 2017. Personal cost is responsible for 90.6% and primary screening for 66.4% of the total cost.

For the development of the program (from screening to rehabilitation) 530 513 IRR should be spent per capita. The cost of detection per client can vary due to differences in disease prevalence, especially treatment and rehabilitation costs. It is suggested to consider the variation of the prevalence in expanding the plan to the whole country. Integrating the services in primary health care lead to huge cost saving.

The social component of health plays a significant role in improving the mental health of the people of a district. A national program on providing comprehensive social and mental health services, entitled ‎‎“SERAJ”, was developed and piloted in three districts of Iran. The present study aims to determine its model for improving the indicators of the social component of mental health.

This study is a system design for which a literature review, interviews with experts, and focused group discussions with stakeholders were used.

Community action in promoting the mental health of the districts has three main components: strengthening intersectoral collaboration through the memorandum of understandings (MoU), increasing people's participation by establishing People’s Participation House (PPH) with the presence of the representative of current People’s network, and social protection of people suffering from mental disorders by establishing the Social Support Unit (SSU) for self-reliance activity. All three components are controlled by the governor and with supervision and technical consult of the health network of the district and stakeholder participation.

The model uses the inner capacities of the city instead of creating new structures. The prerequisites for the effective function of the main three components are educating departments, educating members of the PPH, and hiring a social worker at the SSU. The effective measures taken by the departments to reduce the risk factors for mental disorders are dependent on the technical and financial support of relevant organizations at the provincial and national levels.

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).

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.

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.

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.

The Iranian Mental Health Survey (IranMHS) indicated that almost 1 in 4 people had one or more psychiatric disorders (23.6%); however, two-thirds of patients did not benefit from health interventions, many provided services were inadequate and imposed a high burden on Iranian families. Therefore, the development of a national program on providing comprehensive social and mental health services, entitled “SERAJ”, became necessary. The present study aims to develop and outline the protocol for the pilot implementation of SERAJ.

This study is an action research with the collaborative mode. To compile the protocol, a broad review of the literature, interviews with experts and stakeholders, and focused group discussions were conducted.

The pilot implementation should be divided into 4 phases: (1) preparing documentation and work team, (2) preparing the prerequisites for providing pilot services, (3) providing pilot services, and (4) implementation and evaluation.

SERAJ considered both preventive and treatment measures for mental and social health disorders and their risk factors. Moreover, the entire population can have access to primary and secondary services. Therefore, SERAJ is more comprehensive than the current situation in the country's mental health services. We suggest piloting and evaluating SERAJ in three districts of Iran.

Prostitution is one of the alarming social harms in any population with considerable challenges and concerns. Many prostitutes have been victims of unfavorable social conditions. The purpose of this study was to determine and explain the goals, service patterns, challenges and proposed solutions for the Program of Rehabilitation of Socially Harmed Women in the Iranian Welfare Organization (IWO).

A qualitative study was conducted in 2016. The participants included managers and experts of the general departments of the IWO in 31 provinces, 21 members of public mediators and stakeholder organizations, and 5 senior staff managers and senior experts of the IWO Deputy Director’s Office for Social Affairs. Data were collected using document analysis and in-depth individual interviews and focus group discussions and analyzed using the content analysis method.

Based on the data collected, the challenges of the program implementation were found to be as follows: non-acceptance of these women by the society, identity problems of the children borne to them (legally), poor chances of employment, sexual abuse of the women by the employers and mental disorders of the women, as well as poor intersectoral collaboration in IWO and lack of sufficient manpower. Proposed solutions for improvement of the situation included increasing financial credits, creating a national database, informing and sensitizing the people and approving some new judicial laws, as well as reforming some of the existing judicial laws.

Despite the services delivered in this national program, the program faces challenges at the government and public levels. In order to improve the current situation, it is essential to apply the proposed solutions, as well as review and modify the relevant processes.

After leaving home, runaway girls face many problems that threaten their physical, mental, and social health. One of the programs implemented by the Welfare Organization is the establishment of separate and special centers for these people throughout the country. This study was conducted to explain the goals, service model, challenges and strategies to improve this program.

A qualitative study was conducted in 2016. Participants in the study included managers and experts from the departments of the Welfare Organization in 31 provinces, 21 members from the public mediators and partner organizations and 6 senior managers and experts in charge of the social deputy of the Welfare Organization. In order to collect data, three methods of document analysis and in-depth interviews and focus group discussion were used and the data were analyzed by content analysis.

Health centers for girls exposed to social harms have been set up in all provinces of the country since 1999.  The goals of the program are to support and care for girls exposed to social harms, to provide them with education, employment, self-sufficiency and independence, and to recognize their talents and abilities and guide them to use their abilities. The program faces challenges including poor public awareness and attitudes, insufficient cooperation broadcasting information, inadequate distribution, and inadequate allocation of financial budget, and insufficient commitments to implement the memorandums. Recommended solutions to improve the program include increasing the awareness of stakeholders, reviewing relevant guidelines, strengthening and updating training packages, developing an early audience identification protocol, creating opportunities for continuing education and employment for clients, strengthening and expanding places and programs. It is suitable for girlschr('39') leisure time, strengthening intersectoral coordination, passing and amending judicial laws in order to protect these girls.

Despite the services provided in health homes for runaway girls, it faces the challenges at the government and public levels. In order to improve the current situation, it is necessary to use the proposed solutions along with reviewing and correcting related processes.