Challenges and Requirements in Community-Based Care for Severe Mental Illness in Iran: A Qualitative Study

Background: Severe mental illnesses (SMI) are currently managed through various community-based interventions; however, these initiatives face numerous challenges. Objectives: The present study seeks to assess the challenges and requirements related to community-based care services in Iran. Methods: The current study employed a qualitative content analysis based on the approach developed by Elo and Kyngas. The research targeted adults aged 18 to 65 with severe mental illness, along with their families, healthcare providers, health experts, and policymakers. To capture a wide range of perspectives and experiences, purposive sampling utilizing a maximum variation technique was implemented. Data collection involved in-depth semi-structured interviews, with questions designed according to the World Health Organization (WHO)’s conceptual framework. To ensure the study’s accuracy and validity, the researcher adhered to the criteria established by Lincoln and Guba. A total of 32 interviews (7 patients, 5 caregivers, 16 healthcare providers, 4 policymakers) were conducted with qualified participants. Following each interview, the recordings were transcribed verbatim, and the data were subsequently analyzed with MAXQDA2020 software. Results: After analyzing the interview data and extracting the primary codes, we identified a total of 14 main categories and 38 subcategories that align with the eight generic categories of the WHO’s conceptual model. The main categories identified include: The development and integration of services; moral and legal support; economic barriers; structural and communication barriers; physical and equipment barriers; treatment and care barriers; the need for financial credit; lack of human resources; the requirements and competencies of the treatment team; the necessity for educational infrastructure; provision of comprehensive care; destigmatization; sources of awareness; and the imperative for research and technology development. Conclusions: Integrating community mental health care centers into the national health system addresses funding and manpower challenges while enhancing service accessibility. To establish a sustainable community-based care delivery, it is essential to secure reliable funding, maintain adequate staffing levels, and promote ongoing professional development, all while actively addressing the reduction of stigma associated with care services.