Zahedan University of Medical Sciences

Report from: Zahedan University of Medical Sciences, International Affairs Office
Published on: 27 May 2023

Equitable mental health services to underprivileged populations scaled up with WHO support

Increasing psychological problems and psychiatric disorders and consequently reducing the workforce productivity and the quality of life of people of different ages, highlights the importance of the need for specialized care and social support for patients with mental health disorders. In addition, social stigma and inadequate access to standard mental health services, as well as the economic and financial burden of specialized treatments on families and society, especially in the disadvantaged areas, and the follow up of mental health patients and their families after hospital discharge requires special attention and investment.

The results of the latest national mental health survey conducted in 2013 showed that the prevalence of mental disorders was 23 percent in the country and 31 percent in Sistan and Balouchestan Province. Also, the prevalence of drug addiction was 2% nationally and 7% provincially. The higher burden of the mental disorders in the province, as compared with the national figures, could be partly explained by a larger number of underprivileged people living in this province.

The impact of the Covid-19 pandemic on mental health, with increased social isolation, business closures, financial problems, the loss of family members and the resulting grief and sadness, has led to an increased burden on the provincial health system. Therefore, the possibility of serious mental health disorders and suicide was imminent and it needed to be duly addressed as part of Covid-19 response programs.

Strengthening mental health service provision was discussed during the visit of Dr. Syed Jaffar Hussain, WHO Representative in Iran to Zahedan in February 2022. It was agreed that with the financial support from WHO and the Ministry of Interior, a mental health team consisting of psychiatrists, physicians, psychologists and social workers scale up providing a set of free-of-charge mental health services at the Shirabad Community Mental Health Center (CMHC) also known as SERAJ center, located in outskirts of Zahedan, for the population residing in this area of more than 80 thousands.

As part of this joint project, with the approval of the mental health office of the Iran"s Ministry of Health, the mental health service package in this center was reviewed to include the following activities:

• Active care services after discharge
• Home visit services
• Telephone follow-up service
• Free-of-charge medications for identified cases with mental health disorders

 A total of 13,120 individuals 5 years and older residing in the Shirabad neighborhood were approached during the implementation of the project, out of which 1032 subject had a positive initial screening for mental health disorders. Overall, 371 of cases were confirmed by the team psychiatrist as having mental health disorders. Moreover, 2745 individuals received psychological counseling services provided by psychologists.

In addition to mental health services, home visits, post-discharge telephone follow-up, patient and family education sessions, social support for patients referred from psychiatric hospitals and comprehensive health service centers are being provided by CMHC social workers with intersectoral cooperation.

Patient Stories
Patients are at the center of all that we do, and here we share some stories of lived experiences from patients who inspired us to boost mental health services in this region. They represent countless patients who are themselves living proof that lives can be changed through science and a greater understanding of what we can do.

Ahmad
Ahmad a 32 years old married man, born and living in Zahedan, has 2 children and has 5 years of schooling. He is the eighth child of a family with nine children. The patient"s family immigrated to Iran almost 60 years ago due to insecurity and war in Afghanistan. Ahmed did not have any special problems in his early life. But 10 years ago, at the age of 22, he developed symptoms that disrupted every aspect of his life. In April 2022, the patient went to SERAJ Center with his wife and two children and complaining of the symptoms such as: fear of death - anxiety, practical obsession (repeated washing), fear of going out (fear of being alone), worry, anxiety, restlessness, and thoughts of self-harm. Ahmad couldn"t leave the house by himself and needed someone to accompany him.

After the visit and taking a complete history by the psychiatrist at the SERAJ Center, he was diagnosed with Agoraphobia, a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control.

At the beginning, drug treatment was started, after controlling disturbing thoughts with drugs, counseling and psychotherapy sessions were started by a psychologist.
This treatment process brought a positive result after 26 visit sessions, so that in September 2022 he started working for a wheat warehouse far from home. His disease has been controlled and improved to a great extent.

The patient has also benefited from free medicine and livelihood assistance packages. The last time we visited Ahmad he told us "I do not look like a patient; your friends don"t believe you".

Yasin
Yasin is a 14 years old boy, born in Afghanistan and living in Zahedan. His father immigrated to Iran many years ago due to unfavorable conditions and war in Afghanistan. He is not able to go to school due to his repeated seizures.

Yasin is the first of three children in the family, he has two younger sisters. Yasin"s problems started with seizure episodes when he was two years old. Since then, visiting doctors and doing follow ups have been a great challenge for his family due to their poverty and the distance between their house and medical centers.

His family was very upset and complained about the condition of his disease. Despite all the family"s efforts to control Yasin"s disease and seizures and numerous visits to the doctor offices and taking different medicines, the disease was progressing and he had 2-3 seizure attacks each day.

In March 2022, Yasin"s mother brought him to the SERAJ CENTER. He had a history of irritability, verbal aggression, auditory hallucinations (hearing the sound of a child crying), dangerous activities (arsonist actions), anorexia and insomnia.

After numerous examinations and various tests by the psychiatrist of the center, the possibility of mitochondrial dysfunction was considered as a cause of seizure episodes. With the diagnosis of the disease, drug treatments and ketogenic diet began. Due to the family"s financial problems, 100% adherence to this treatment was faced with difficulties, but with the use of drugs at the beginning of the treatment, seizures reduced to 1 time per week. And to some extent it made the patient"s family happy.

By a close follow up of the patient"s condition, including 16 visits that have been made so far, the seizures episodes have reached once every two or three months.

The patient"s family is very satisfied with the responsible and frequent follow-up of the psychiatrist and psychologist of SERAJ CENTER and they have also benefited from free medicines and livelihood support packages.

Yasin"s family hopes that the trend of decreasing seizures will continue so that they can lead their son to resuming his school study.

Zoleykha
Zoleykha, a 32 years old female from Afghanistan, is the first of eight children born to a family. She is divorced and lives in Zahedan and she has two children who live with their father.

The divorce and separation from her children has given her a very heavy emotional blow. Zolyekha lost her mother two years ago, and after a short period of time, her father remarried, which seems very unfortunate and caused a lot of discomfort and stress to the patient in such a way that the patient"s life is disturbed to the point where her family is very unhappy with her, and one of her neighbors took her to the SERAJ Center.

In February 2022, Zolyekha presented with symptoms of low mood, very little verbal and eye contact, apathy, constant discomfort, suicidal thoughts, aggression, irritability, insomnia, and anorexia.
The diagnosis of depression was made for the patient and drug and psychological treatment was started. Due to lack of financial ability and difficulty in commuting, the home visit services were scheduled for her treatment. After 25 home visit sessions by the medical doctor and psychiatrist of the SERAJ CENTER, the patient is recovering and the symptoms of the disease have been controlled. And now she is helping the family with housework.The interpersonal relationship of the patient, especially with her father and stepmother has improved.

She has also received free medicine services and livelihood support packages.

Copyright © 2023 Zahedan University of Medical Sciences. All rights reserved. Date updated: 27/05/2023
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