As a result of the sharp demographic rise in the population of older adults worldwide, the number of older individuals who need treatment for mental disorders is also increasing rapidly. The distribution of the population in Iran has shifted swiftly in both the number and proportion of the population aged 60 and over (1). Mental health problems among older people exact a large social and economic toll on patients, their families, and careers (2). Between 15% and 25% of older adults experience some form of mental illness, ranging from depression, anxiety, bereavement adjustment problems, and substance abuse to schizophrenia, personality disorders, paranoia, compulsive behaviors, and dementia (3). Mental health services for older adults should be able to respond effectively to individual needs and take account of the social and cultural factors affecting recovery and support. Improving the prevention, care, and treatment of mental health problems in old age depends on (1) provision and promotion of mental health services, (2) early recognition and management of mental health problems, and (3) access to specialist care (4).
Urbanization in developing countries involves changes in social support and life events, which have been shown to affect mental health, mainly through depression and anxiety (5). Dekker et al. (6), indicated that the impact of urbanization on mental health was approximately equal for almost all major psychiatric disorders in young and elderly individuals and higher levels of urbanization were linked to higher 12-month prevalence rates for almost all major psychiatric disorders. Studies have revealed that the prevalence of mental disorders ranges from 22% to 29% among the adult population of Iran, with anxiety (15.6%) and major depression (13%) constituting the most common disorders (7-9).
There are many advantages in integrating mental health services into community: (1) reduced stigma for individuals with mental disorders and their families, (2) improved access to care, (3) reduced chronicity and improved social integration, (4) human rights protection, (5) better health outcomes for individuals treated in primary health care, and (6) improved human resource capacity for mental health (10).
Community mental health teams for older people emerged in an ad hoc manner during the 1980s, as part of old age psychiatry services which had evolved following the rundown of mental hospitals from the 1960s (11). Recent decades have witnessed an increasing emphasis on the delivery of community-based mental health care for older adults. It is equally important to focus on the long-term care of older adults suffering from mental disorders, as well as to provide caregivers with education, training, and support (12). There is considerable variation around the country in mental health services in both health and social care for older individuals (13). Community mental health services in Iran encompass emergency psychiatric services, short- and long-term care services, home-based and home-visit services, and day-care services. It is anticipated that stakeholders such as the Ministry of Health and Medical Education, Ministry of Labor and Social Affairs, State Welfare Organization, Municipality, Police Department, WHO EMRO, and Imam Khomeini Relief Foundation will involve in this project.
Rashedi V, Rezaei M, Foroughan M, Delbari A. Validity and reliability of the depression in old age scale (DIA-S) in Iranian older adults. Arch Gerontol Geriatr. 2016;66:193-7. doi: 10.1016/j.archger.2016.06.009. [PubMed: 27351463].
Rashedi V, Asadi-Lari M, Foroughan M, Delbari A, Fadayevatan R. Mental health and pain in older adults: findings from urban heart-2. Community Ment Health J. 2017;53(6):719-24. doi: 10.1007/s10597-017-0082-2. [PubMed: 28124258].
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Birren JE, Cohen GD, Sloane RB, Lebowitz BD, Deutchman DE, Wykle M, et al. Handbook of mental health and aging. Elsevier Science; 2013.
Harpham T. Urbanization and mental health in developing countries: A research role for social scientists, public health professionals and social psychiatrists. Social Sci Med. 1994;39(2):233-45. doi: 10.1016/0277-9536(94)90332-8.
Dekker J, Peen J, Koelen J, Smit F, Schoevers R. Psychiatric disorders and urbanization in Germany. BMC Public Health. 2008;8:17. doi: 10.1186/1471-2458-8-17. [PubMed: 18201380]. [PubMed Central: PMC2266738].
Mohammadi MR, Davidian H, Noorbala AA, Malekafzali H, Naghavi HR, Pouretemad HR, et al. An epidemiological survey of psychiatric disorders in Iran. Clin Pract Epidemiol Ment Health. 2005;1:16. doi: 10.1186/1745-0179-1-16. [PubMed: 16185355]. [PubMed Central: PMC1253522].
Yousefi-Nooraie R, Mohammadi MR, Salesian N, Amin-Esmaeeli M, Mansouri N, Mesgarpour B, et al. Prevalence of psychiatric disorders in Iran: A systematic review. Iran J Psychia. 2007;2(4):137-50.
Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian mental health survey, 2011. Arch Iran Med. 2015;18(2):76-84. [PubMed: 25644794].
World Health Organization. Integrating mental health services into primary health care. Geneva; 2018.
World Health Organization. Mental health of older adults. 2018. Available from: http://www.who.int/en/news-room/fact-sheets/detail/mental-health-of-older-adults.
Tucker S, Wilberforce M, Brand C, Abendstern M, Crook A, Jasper R, et al. Community mental health teams for older people: variations in case mix and service receipt (I). Int J Geriatr Psychiatry. 2015;30(6):595-604. doi: 10.1002/gps.4191. [PubMed: 25204548].