Who Are the Stakeholders in Promoting Mental Health?

Background: 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. Methods: 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. Results: 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. Conclusion: 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).

Designing and Launching Health Observatory Dashboard of Islamic Republic of Iran.

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

A policy analysis of the national phenylketonuria screening program in Iran.

BACKGROUND: Phenylketonuria (PKU) screening is a public health measure taken to diagnose and treat the patients with PKU to prevent severe neurological disorders in them. The present study was aimed at analyzing the policies of the national PKU screening (NaPS) program in Iran. METHODS: PKU screening program policies were analyzed in compliance with the policy triangle model. Document review and 38 semi-structured interviews were used for data collection. Document review data were analyzed using content analysis, and interview data were analyzed using framework analysis. RESULTS: The national PKU screening (NaPS) program was a decision made at the genetics department of Ministry of Health and Medical Education (MOHME) in Iran. Many internal and external stakeholders were involved in it and valid evidence was used to formulate the policies. Despite some opposition and insufficient support, the program was implemented due to the continuous persistence of parents, interested executives, formulated valid content and a top-down approach. The main barriers included rapid substitution of managers, shortage of Phe-free milk, little awareness of patients' families, social stigma, and inadequate co-operation of some hospital administrators. CONCLUSIONS: The policy triangle framework contributed to explaining the different components of the PKU screening program. A successful PKU screening program requires more stability of senior managers in MOHME, enough human resources and Phe-free milk, educating patients' families, and commitment of hospitals administrators. Meanwhile, all the stakeholders need to be involved in the program effectively.

A study of Happiness in the Islamic Republic of Iran's work communities.

Background: 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. Methods: 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. Results: 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. Conclusion: Policymakers should consider workers' happiness as an effective factor in production and efficiency.

Situation Analysis of Ear and Hearing Care Program in Islamic Republic of Iran: System's Challenges and Proper Interventions.

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

Iranian centers of excellence in medical sciences: A qualitative study to analyze the current state and design of a future roadmap.

Background: Due to the law for the fifth development plan and Iran's 20- year economic perspective, Centers of Excellence (COEs) were expected to upgrade the level of research and education besides improving infrastructures in Iran. This study is aimed to analyze the current state of national centers of excellence and designing a future roadmap. Methods: In this qualitative study, data was gathered by reviewing relevant national & international literature and upstream documents, interview with experts, and focused group discussions with stakeholders. Finally, a roadmap was prepared for approval. Results: Lack of common understanding of the COEs definition, lack of clear professional orientation for each center, lack of mandate and commitment in using COEs in the health system and community health promotion, weakness in enticing elites, and unresponsive to basic needs of the country were five major challenges COEs encountered. The consensus prospective vision for centers of excellence was developed based on the establishment and management of special institutions of thought and technology in centers of excellence to advise health policymakers and provide the highest level of the regional and global position. Conclusion: Despite over a decade of development of medical COEs, their goals have not been reached yet. Enactment of designed roadmap and its subprojects in the Supreme Council of Centers is the primary steps for functional improvement of COEs.

A National survey on substance use among Iranian industrial workers.

Background: Recent evidence shows that the prevalence of substance abuse is 2.1% in Iranians aged 15-64 years, while reported rates are higher in studies that target industrial workplaces. Our study intends to provide a national picture of substance use among industrial workers in Iran. Methods: This survey was designed to collect data through interviews and dipstick urine tests. Using a multi-stage sampling approach, we recruited our study subjects from a representative sample of industrial workers from all provinces in 2015. Data were weighted to estimate the prevalence rate of substance use. Odds ratios were calculated through adapting logistic regression to test the strength of association between substance use (based on self-report and urine test) and sociodemographic factors including sex, age group, education level, marital status and worker's professional training status. All statistical analyses were conducted using SPSS Version 22. P <0.05 was considered significant. Results: We analyzed the data collected from 13,128 participants; both self-reported use and urine test results. Majority of the respondents were male (n=12077, 92%), aged 21-40 years old (n=9491, 72.3%), had finished middle/secondary school (n=8353, 63.6%) and were married (n=11012, 83.9%). Opium was the most popular abused substance (n=352, 2.7%) followed by alcohol (304, 2.3%), based on self-reports. Urine tests showed that 23.8% (n=3105) of the participants had a positive result for the use of opiates/opioids, crystal meth and/or cannabis. The highest rate of substance use reported from a province was 60.50%; the lowest provincial rate was 9.0%. Conclusion: Nearly a one-fourth of Iranian industrial employees are engaged in use of substances with significant geographical distribution. Urine test is the recommended method to assess the prevalence of drug use among industrial workers in Iran.

Status of Human resources management in Iran's health sector and the path to development: A qualitative study.

Background: Resource generation, stewardship, financing, and provision of health care services are 4 major functions of the health system. In this study, human resource management, as a vital aspect of resource generation, was studied and some interventions have been suggested for Iran. Methods: This was a mixed method study. Data were collected through the review of the relevant articles and government documents, interviews with human resources managers and experts in the health sector, and focus group discussions with selected authorities. The interview questions were based on a model proposed by the WHO. Results: The collected data were categorized into 3 broad sets: description of the current status, factors contributing to the current status, and suggested interventions for improvement. Lack of a comprehensive human resources management policy and inattention to the human resources management in the developmental plans are some of the most common problems in Iran's health sector. Also, unequal distribution, unemployment, migration of graduates, and inadequate and ineffective participation of faculty members in universities are some other problems referred to as lack of a unified stewardship and dearth of a comprehensive human resources planning. Suggested interventions have focused on stewardship function of the health care system. Conclusion: A policy brief on the human resources for health needs should be developed and added as a separate article to the upstream documents of the country (eg, Iran's 20-year outlook plan). Implementing and monitoring operational plans for policy execution at Ministry of health has a major role in executing the adopted strategies.

Status of substance abuse literacy in manufacturing and production sites in Iran: Results from a nationwide survey.

Background: Due to highly risk-taking behaviors such as alcohol and drug use status of health literacy at workplace is a major concern for health policy makers. Substance abuse literacy (SAL) includes the individuals' skills to obtain, understand and use substance-relevant health information. This will help to establish a healthy communication in a workplace setting and developing professional knowledge on workplace safety regulations, risky approaches and behaviours that may hurt the community workers. Since poor SAL status would inevitably cause serious harms to both community workers' health and facilities this study aimed to determine the status of SAL among manufacturing and production workers in Iran. Methods: This is a nationwide cross-sectional survey conducted on 13,600 subjects who were selected through simple randomization into 380 workplaces in 31 provinces of Iran during February 2015 to January 2016. Data were collected through an author-made structured questionnaire by some trained interviewers. The study tool was developed using the literature and then sent to some experts for approving internal validity; minor changes were applied. Internal reliability test in 30 samples yielded Cronbach's alpha of 0.82. All the questionnaires were administered at the participants' workplaces following obtaining their consent on releasing blinded information. Results: Given that the score range was from 1 to 5, the mean for SAL in substance abuse was 4.04, so that the highest and lowest means were related to East Azerbaijan (4.22±0.74) and Hormozgan (3.69±0.73) provinces, respectively. Conclusion: This study revealed that the Iranian workers SAL status was fairly high despite the reported high rate of substance abuse (30%) among Iranian workforces. This apparently contradictory finding could be resolved using Syndemics in which refers to clustering of several issues in a society that contribute to and result from socioeconomic and cultural factors and inequalities. Therefore, it is still necessary for policy makers and other researchers to take this issue into consideration in Iranian manufacturing and production plants.

Nutrition and food security policy in the Islamic Republic of Iran: situation analysis and roadmap towards 2021.

BACKGROUND: All government policies and programmes for food and nutrition security should include providing healthy food, as well as providing economic and social availability for all people. AIM: This study aimed to analyse the current situation of Iranian food and nutrition security and establish a road map towards 2021. METHODS: The applied methods were situation analysis and a mixed qualitative-quantitative method. The conceptual method used for developing this national document encompassed three areas: sustainable food supply, food safety and nutrition. RESULTS: The outcomes of the Iranian food and nutrition security system in the past three decades include development of management infrastructure and improvement in food and nutrition security status. However, analysis of current programmes showed that there were some overlapping, intertwining and parallel works in the responsibilities of related organizations in the field of supervision of food safety (from production to supply). The national document produced as the outcome of this paper was communicated by the Iranian Ministry of Health in 2012 and has been running for 2 years. Selected ministries are responsible for implementation of 20 national programmes by the end of the 5th Economic, Social and Cultural Development Programme (2016-2011). The consensus of stakeholders by the end of the 6th Development Programme (2021) is to put all of the provinces in a safe or very safe situation in terms of food and nutrition security. CONCLUSION: The most important challenge in establishing national documents is to make them operational. This aim was achieved by an intersectoral nutrition and food security working group, which produced a general memorandum of understanding with the main organizations, the media, universities and private sector.

Developing a Training Course for Spiritual Counselors in Health Care: Evidence from Iran.

BACKGROUND: Spiritual health can cause mental health promotion and well-being of the people's lives but it is still neglected in practice so that there is no trace of spiritual training in medical education in Iran. This study was conducted to develop a training course for spiritual counselors in the Iranian health-care system. METHODS: In this qualitative study, senior managers of the Ministry of Health (MOH) and experts in the related fields were purposively selected as the participants. Semi-structured interviews and focused group discussions (FGDs) were conducted to collect the data. After transcription of the interviews and FGDs, the data were analyzed using content analysis. RESULTS: In this package, community-based spiritual health services are offered in three forms of spiritual lifestyle education, introducing social facilities, and collaborating with the related organizations. Hospital services are offered in four forms of assessment of the spiritual status and referral, spiritual care, spiritual counseling, and providing a spiritual environment in the hospital. CONCLUSION: According to the results of the study, it is suggested that a strategic committee be established at the MOH level for establishment of these training courses as well as another strategic committee for evaluation, review, and service package promotion, and its training courses should be formed. In addition, a set of skills for spiritual assessment of patients and the related interventions should be designed for clinical skill centers of the country in the form of skill training packages.

Iranian drug use survey in workplaces: A study protocol.

Background: Addiction is a serious concern in workplaces, as it can lead to accidents, absenteeism, and loss of productivity, neglect, delay, arguing, unhappiness, production cuts, and irregular working pattern. This national survey was conducted to assess the prevalence and pattern of drug use among employees of industrial environments in Iran. Methods: In this cross sectional study, the sample size was determined to be 13489 using multistage cluster sampling method during November 2013 and November 2014. Data were collected by trained interviewers using a structured questionnaire developed by the research team. Urine drug test was done for participants using laboratory rapid kits. A total of 13 286 questionnaires were completed with remarkable responsiveness such that only 1.2% of them were excluded due to defects in urine drug tests, and the rest were analyzed after the review. Results: The response rate to the questionnaires was 98.4% and 13 128 individuals took the urinary drug test. Many participants who had positive urine test did not express drug use and positive tests were more than self-reported cases. Compared to information about the pattern of drug use, data on the estimated prevalence of drug use was more reliable. Conclusion: This study presents the protocol of a well-designed national survey, including sampling procedure, appropriate instrument and test, field work, and discussion on the strengths and limitations of the study, and thus its results can be used effectively by policymakers.

Healthy housing: A case study of intersectoral collaboration for better health.

Residency areas are primary social factors that directly and indirectly affect health and in synergy with other factors, changes health equity indices. Qazvin as one of the provinces in the Islamic Republic of Iran has been a pioneer in the provision of an integrated health program with intersectoral collaboration approach and the participation of residents. In this study required data was gathered in a qualitative method by reviewing documents, group discussions with stakeholders and residents and interviews with key informed individuals. In the beginning, stakeholder's analysis revealed highly effective organizations and their method of cooperation. Insufficient access to housing, weak security, insufficient swage system and deficiency of entertainment and park environment are four top urgent issues which are related to housing. Strategic goals for each issue has been designed in a four-year time frame and projects for reaching the goals that are considered in three categories: promotional, facilitator and mandatory. Cooperation of multiple stakeholders including managers and residents are features of preparing this program. A change of stakeholders' perspective to health-oriented performance in housing is the added value of this public act.

Stakeholders' network in Iranian health policy-making: A model for participatory policy-making.

Background: Stewardship, resource generation, financing, and providing services are the 4 main functions in any health system. Using intelligence and common sense in making policies and decisions is a subcomponent of the stewardship. The present study aimed at designing a model that provides better access to the stakeholders' wisdom. Methods: This was a qualitative study in which the data were collected through reviewing documents and references, focused group discussions with experts, and interviewing the stakeholders. The data were analyzed and summed up as a conceptual framework. Then, the framework was developed as a health policy-making stakeholders' network protocol, which included the goal, structure, system process, procedures and standards, management style, and resources. Results: The goal of establishing this network was to facilitate and accelerate the access of policy-makers to the stakeholders' opinions. Members of the network were divided into 2 groups of thematic experts and administrative managers, as real or legal persons. Health policy issues were categorized into 4 fields and defined in 18 subfields. The network was established through forming a national secretariat, under the supervision of the Minister of Health, with the presence of trained experts, and with an exclusive budget. The stakeholders participated in the network both actively and passively. The website and email were the first communication methods although there were also other policy dialogue means, which were publicly declared through the annual calendar. Stakeholders were motivated by being invited to meetings, keeping up their intellectual ownership, and encouraging them. Conclusion: Strengthening the health system stewardship depends on using common sense and information in addition to vision formation and establishment of controlling mechanisms. The stakeholders' network could help establish the 2 last components sustainably. Annual evaluation of the network and its consolidation has also been suggested in this study.

Achievements and future path of Tehran municipality in urban health domain: An Iranian experience.

BACKGROUND: According to national laws and world experiences; provision, maintenance, and improving citizens' health are considered to be the essential functions of municipalities as a "social institute". In order to equitably promote health conditions at urban level, particularly in marginal areas, since 2004 targeted efforts have been implemented in the municipality of Tehran metropolis. This study was intended to identify and analyze these targeted measures and tries to analyze health interventions in a conceptual framework and propose a future path. METHODS: This is a qualitative study with content analysis approach. Reviewing documents and structured interviews with national health policy making and planning experts and executive managers of 22-region municipalities of Tehran metropolis were used to collect data. The data were analyzed on the basis of conceptual framework prepared for urban health in 4 domains including municipal interventions, goal achievements, drivers and obstacles of success, and the way forward. RESULTS: From the viewpoint of interviewees, these new health actions of Tehran municipality are more based on public participation and the municipality was able to prioritize health issue in the programs and policies of Tehran city council. Tehran municipality has accomplished three types of interventions to improve health, which in orders of magnitude are: facilitative, promotional, and mandatory interventions. Development and institutionalization of public participation is the greatest achievement in health-oriented actions; and expansion of environmental and physical health-oriented facilities and promoting a healthy lifestyle are next in ranks. CONCLUSION: Since management alterations seriously challenges institutionalization of actions and innovations especially in the developing countries, it is suggested that mayors of metropolitan cities like Tehran document and review municipal health measures as soon as possible and while eliminating overlapping of interventions with other sectors, design and approve the charter of "health promoting municipality". The most important role of municipalities in this charter would be coordinating health improvement of citizens. This charter, when approved as a national policy could be used for other cities too.

Designing a national plan for improving sexual health in Iran: An experience of an Islamic country.

BACKGROUND: Prevalence of sexual dysfunction varies from 20% to 40% in men and women in different studies in Iran. Despite its high prevalence, it seems that this issue has been neglected, particularly in Islamic countries. The aim of this study was to assess sexual health in Iran. This was a mixed method study. METHODS: Data were collected through evaluating country's sexual health programs and literature review. Sexual health status was drafted and formed following a sound analysis by stakeholders. After conducting interviews and focus group discussions, the main points of the meetings, influencing factors of the present status and oncoming strategies were obtained upon experts' opinions. RESULTS: Review of general policies and the literature showed that although there is adequate support for improving sexual health status in the country, sexual health status has been decreased in the last decade. Based on Iranian sexual health indicators and experts' opinions, the focus points could be divided into the following groups: Structural and functional -political, legal-behavior, and cultural. CONCLUSION: Breaking the taboo of sexual health issues would require attention from the policy makers especially in Islamic nations to facilitate the steps on the road to sexual health. In this regard, clarified vision, strategic goals and interventional policies are proposed. An inter-sectional cooperation is needed to implement interventions to promote sexual health status.

How to integrate social care services into primary health care? An experience from Iran.

BACKGROUND: Social issues have prominent effects on the peoples' physical and mental health and on the health risk factors. In Iran, many organizations provide social care services to their target population. This study aimed to explore the roles and functions of Primary Health Care (PHC) system in providing social care services in Iran. METHODS: This was a qualitative study, for which data were collected via three sources: A review of the literature, in-depth interviews and focus group discussions with experts and stakeholders. The main objective was to find a way to integrate social care into the Iranian PHC system. A conventional content analysis was performed to explore the data. RESULTS: Overall, 20 experts were interviewed and the acquired data were classified into four major categories including priorities, implementation, requirements and stewardship. The main challenges were the existing controversies in the definition of social care, social service unit disintegration, multiple stewards for social care services, weaknesses of rules and regulations and low financing of the public budget. Social care services can be divided into two categories: Basic and advanced. Urban and rural health centers, as the first level of PHC, could potentially provide basic social care services for their defined population and catchment areas such as detecting social harms in high risk individuals and families and providing counseling for people in need. They can also refer the individuals to receive advanced services. CONCLUSION: Iran has a successful history of establishing the PHC System especially in rural areas. This network has an invaluable capacity to provide social health services. Establishing these services needs some prerequisites such as a reform PHC structure, macro support and technical intersectoral collaboration. They should also be piloted and evaluated before they could be implemented in the whole country.

People's Voice and Civil Society Participation as a Core Element of Universal Health Coverage Reforms: Review of Experiences in Iran.

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, ie, 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 (CSOs) 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 (NHA) model which was first launched in 2017 offers a unique platform for this coordination role, and could be leveraged accordingly.

How Much Should We Pay to Deliver Comprehensive Mental and Social Health Services? Experiences from Iran.

Objective: 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. Method : 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. Results: 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. Conclusion: 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.

Interventions for Decreasing Drug Abuse and Social Problem in Iran's Comprehensive Mental and Social Health Services.

Objective: 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. Method : 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. Results: 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. Conclusion: 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.