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Abstract
Iran’s rural mental health care system emerged in a context that included experiments in health care prior to the 1979 Revolution and the establishment of a primary health care (PHC) system after the Revolution. Beginning in the 1980s, Iran integrated mental health care into the existing PHC system by treating mental illness much like a communicable disease. Iran advanced treatment options compatible with the existing system, added new training for existing care providers, and incorporated specialists. The integration of mental health care led to the rapid improvement of health outcomes. The integration also created the unintended consequence of privileging pharmaceutical treatments and overlooking mental illnesses affected by somatization.
ORCID
Alex Keivahn Smith http://orcid.org/0000-0002-4841-4961
Notes
1 World Health Organization, “Metrics: Disability-Adjusted Life Year (DALY).”
2 Naghavi, et al., “The Burden of Disease and Injury in Iran 2003,” Table 3.
3 Institute for Health Metrics and Evaluation, “Country Profile: Iran.”
4 See Good and Kleinman, “Culture and Depression.”
5 Steinforth, “Whose Madness?”
6 Deanne, “From Sadness to Madness.”
7 World Health Organization, The World Health Report 2001, x.
8 Ibid., 3.
9 Mental Health Liaison Group, Responding to the Mental Health Needs, 3.
10 World Health Organization, The World Health Report 2001, 36.
11 Ibid., 36.
12 Mehryar, “Primary Health Care and the Rural Poor,” 10 (Table 3).
13 Ibid., 10 (Table 3).
14 Behrouzan, Prozak Diaries, 54.
15 Ibid., 54.
16 Javanparast et al., “A Policy Review,” 265.
17 Ronaghy and Solter, “The Auxiliary Health Worker in Iran,” 428.
18 Javanparast et al., “A Policy Review,” 264.
19 Ronaghy and Solter, “The Auxiliary Health Worker in Iran,” 428.
20 Ibid., 428.
21 Javanparast et al., “A Policy Review,” 265.
22 Yasamy et al., “Mental Health in the Islamic Republic,” 382; Javanbakht and Sanati, “Psychiatry and Psychoanalysis in Iran.”
23 Yasamy et al., “Mental Health in the Islamic Republic,” 382.
24 Mohit, “Lessons Learned,” Section 3.1.
25 Behrouzan, Prozak Diaries, 42.
26 Ibid., 47.
27 Mohit, “Lessons Learned,” Section 3.1.
28 Yasamy et al., “Mental Health in the Islamic Republic,” 382.
29 Mental Health Liaison Group, Responding to the Mental Health Needs, 4.
30 Ibid., 4.
31 World Health Organization, The World Health Report 2001, 86.
32 World Health Organization, “Declaration of Alma-Ata,” 1 [emphasis added].
33 Javanparast et al., “A Policy Review,” 264.
34 Countless articles and books have been written about the Iranian PHC system. For a more complete discussion, see: Shadpour and Shadpour, Networking Primary Health Care; Mehryar, “Primary Health Care and the Rural Poor”; Malekafzali, “Primary Health Care in the Rural Area.”
35 Mohit, “Lessons Learned,” Section 2. World Health Organization, “Iran: Nationwide Integration,” 127.
36 World Health Organization, “Cuba’s Primary Health Care Revolution.”
37 Couper, “Rural Primary Health Care in Iran,” 37; Couper, “Medicine in Iran,” 6.
38 Shadpour, “Primary Health Care Networks,” 824, Table 1.
39 Mehryar, “Primary Health Care and the Rural Poor,” 10, Table 3.
40 Javanparast et al., “A Policy Review,” 265.
41 Sen, Development as Freedom.
42 World Health Organization, “Iran: Nationwide Integration,” 127.
43 Mohit, “Lessons Learned,” Section 2.
44 Couper, “Medicine in Iran,” 6.
45 Mohit, “Lessons Learned,” Section 2.
46 World Health Organization, “Iran: Nationwide Integration,” 128.
47 Mohit, “A Brief Overview,” 1.
48 Underwood, Child Health under Revolutionary Regimes, 123.
49 Gheissari and Nasr, Democracy in Iran, 57.
50 Underwood, Child Health under Revolutionary Regimes, 125.
51 Arjomand, Turban for the Crown, 174
52 Kurzman, “Death Tolls of the Iran–Iraq War.”
53 Gheissari and Nasr, Democracy in Iran, 98.
54 Behrouzan, Prozak Diaries, 53.
55 Afary, Mostofi, and Avery, “The Iran–Iraq War.”
56 See Abrahamian, Iran Between Two Revolutions, 483, which says that Sami was actually a psychologist.
57 Bashiriyeh, The State and Revolution in Iran, 73.
58 Ibid., 73.
59 Teimourian, “Murdered Ex-Minister.”
60 World Health Organization, “Iran: Nationwide Integration,” 129.
61 Ibid., 130; Mohit, “A Brief Overview,” 1.
62 World Health Organization, “WHO-AIMS Report,” 8; Khadivi, Shakeri, and Ghobadi, “The Efficiency of Mental Health Integration,” Introduction.
63 World Health Organization, “WHO-AIMS Report,” 8.
64 World Health Organization, “Iran: Nationwide Integration,” 130.
65 Ibid., 128.
66 Shadpour, “Primary Health Care Networks,” 824.
67 Javanparast et al., “A Policy Review,” 270.
68 World Health Organization, “Iran: Nationwide Integration,” 127.
69 Noorbala et al., “Vazʿīat Salāmat Ravān Āfrād.”
70 World Health Organization, “WHO-AIMS Report,” 19.
71 Good, “The Heart of What’s the Matter,” 48.
72 Seifsafari et al., “A Symptom Profile Analysis,” 26.
73 Behrouzan, Prozak Diaries, 40.
74 Ibid., 40.
75 Javanbakht and Sanati, “Psychiatry and Psychoanalysis in Iran.”
76 Ibid.; Mohit, “Lessons Learned,” 3.1.
77 World Health Organization, “Iran: Nationwide Integration,” 130.
78 World Health Organization, “Iran: Nationwide Integration” 131.
79 Mansouri et al., “The Change in Attitude and Knowledge,” Background.
80 Mohit, “Lessons Learned,” Section 3.1.
81 Ibid., Section 3.1.
82 Ibid., Section 3.1.
83 World Health Organization, “Iran: Nationwide Integration,” 128.
84 Mohit, “Lessons Learned,” Section 3.1.
85 Javanbakht and Sanati, “Psychiatry and Psychoanalysis in Iran.”
86 World Health Organization, “WHO-AIMS Report,” 19–20.
87 Couper, “Medicine in Iran,” 5.
88 Khadivi, Shakeri, and Ghobadi, “The Efficiency of Mental Health Integration,” Discussion.
89 Dejman, “Cultural Explanatory Model of Depression,” 18.
90 Maturo, “Medicalization.”
91 Ibid.
92 World Health Organization, “Iran: Nationwide Integration,” 129.
93 World Health Organization, “WHO-AIMS Report,” 10.
94 Yasamy et al., “Mental Health in the Islamic,” 383.
95 World Health Organization, “Iran: Nationwide Integration,” 131.
96 Khadivi, Shakeri, and Ghobadi, “The Efficiency of Mental Health Integration,” Results.
97 Ibid., Discussion.
98 Yasamy et al., “Mental Health in the Islamic Republic,” 383.
99 Khadivi, Shakeri, and Ghobadi, “The Efficiency of Mental Health Integration,” Discussion.
100 Noorbala et al., “Mental Health Survey,” 71. For another survey of mood disorders, see: Mohammadi et al., “Prevalence of Mood Disorders in Iran.”