Mental health is regarded as an integral part of an individual’s capacity to lead a fulfilling life. Disturbances of a person’s mental well-being can thus adversely compromise this capacity as well as choices made in this respect, resulting not only in diminished functioning at individual level but also broader welfare losses for households and society [1].
Although effective interventions have been thus far introduced and affordable methods for their delivery have been shown to work, scaling-up the quality of mental health services has not occurred in most countries. Accordingly, mental health care should be included as an essential component of universal health coverage (UHC) and even fully integrated into global response to other health priorities whereas access to quality of care and financial risk protection is ensured [2].
To note, depression and anxiety are also responsible for more than 10% of the global burden of disease (GBD) and cost $1 trillion every year in terms of lost productivity. This is accordingly a significant cost with regard to the years of (healthy) life lost (YLL) and the existing situation makes life much harder for the most vulnerable people in the world. Three quarters of the mental health disease burden is observed in low-to-middle-income countries (LMICs), and governments and households - those least able to afford it - bear the burden of mental health care costs [3].
Current coverage of essential mental health care services in LMICs is very limited. Resources made available by governments for provision of community-based and person-centered mental health care services are often very modest. The resources that are made available are also typically directed towards more specialized and institutional services, which are not easily accessible. Without appropriate access to decent services and adequate protection, individuals with mental disorders and their families are correspondingly facing a difficult choice, namely, paying out of pocket for treatments of variable and sometimes poor quality or going without treatments altogether [4].
The economic consequences of low investments in mental health are staggering, with an estimated loss of US$16 trillion to the global economy due to mental disorders (for the period: 2010-30), driven in part by the early age of onset and loss of productivity across the life course. In 2011, the Grand Challenges in Global Mental Health initiative led by the United States (US) National Institute of Mental Health (NIMH) prioritized implementation research questions to reduce treatment gaps for mental disorders. The first priority identified was the integration of core packages of mental health care services into routine primary health care (PHC) ones [2].
Addressing the large and growing burden of mental, neurological, and substance use (MNS) disorders at the population level via scaled-up implementation of evidence-based treatment and prevention has been repeatedly essential over the past decade, and it can be expected to place new resource demands on the health systems of LMICs [4].
In Iran, about 3% of health care expenditure is allocated to mental health. For this purpose, there are 61.2 mental health workers per 100,000 Iranians, far exceeding Iran’s geographical neighbors. Outpatient facilities in this country are also active, treating nearly one in 100 of the general population while there are about 18 beds per 100,000 populations, in various settings including community-based facilities and hospitals [5].
Based on the transition of mental health care in Iran within about two decades, from introducing basic mental health care in PHC to the experience of community-based mental health centers (CMHC) for urban areas, 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 five years.
The first mental health program was piloted from 1992 to 1994 and after more than two decades, it now covers 18 million (82.8%) rural residents and 10 million (21.7%) citizens in urban areas. The program mainly addressed severe mental health disorders, epilepsy, and mental retardation. While it has been proven successful for villages, this program is not sufficient for those residing in urban areas. In response to the need of urban dwellers, the structure of CMHC for urban areas was designed to target those with neurotic disorders including depression and anxiety as well as severe mental disorders such as schizophrenia, bipolar disorder, and suicide attempts [6].
The new socio-mental health service model is thus comprised of two levels of health services, i.e., basic and advanced mental health services. The basic level services include public education on the basics of socio-mental health skills and screening. At this level, cases with target mental conditions are recognized by community health workers and then referred to mental health specialists for further evaluations and interventions. Using an inter-sectorial approach, patients in need of social services should be referred to a relevant service provided by other organizations in order to strengthen their social support [6].
The advanced socio-mental health services take account of facilities for mental and social emergencies and provide treatments for referrals from level one. Such services should be delivered by a collaborative care team comprised of psychologists, clinical psychiatrists, etc. at the integrated mental health settings such as PHC health centers, CMHCs, and hospitals [6].
Accordingly, scaling-up mental health services in a successful manner involves putting a range of human, physical, and other resource inputs together in order to deliver interventions and services capable of improving mental health status and related outcomes. In view of that, an essential element of evidence-based mental health service planning and scaling-up is related to an assessment of what resources are required for delivering of services to populations in need and meeting program goals [7].
Therefore, this study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs to make an investment case to be considered by policy-makers for further evidence-based policy-making.