Background: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major re-arranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face.Methods: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up.Results: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru.Conclusion: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a number of legal, policy and fiscal milestones, thereby presenting a unique and fertile environment for the expansion of mental health services.

Objective: The Iranian Mental Health Survey (IranMHS) in 2011 has demonstrated that almost 1 out of 4 adult individuals suffer from psychiatric disorders; however, more than two-thirds are left unrecognized and untreated and many of the services have poor quality of care. In this paper we present our experience in developing and employing community-based mental health services through community mental health centers (CMHCs), which has been incorporated in Iran's comprehensive mental and social health services (the Seraj program). Method: The service model of the CMHCs was developed though an evidence-based service planning approach and was then incorporated as the specialized outpatient services model into the Seraj program in 2015. Results: The CMHCs in the Seraj program provide mental health care to patients with common mental and severe mental disorders in a defined catchment area. The services include the collaborative care, the aftercare, and day rehabilitation. The collaborative care model works with primary care providers in the health centers to provide detection and treatment of common mental illnesses. In the aftercare, services are offered to patients with severe mental disorders following discharge from the hospital and include telephone follow-ups and home visits. Day rehabilitation is mostly focused on providing psychoeducation and skill trainings. During the first 4 years of implementation in 2 pilot areas, more than 6200 patients (10% having severe mental disorders) received care at CMHCs. Conclusion: The main challenge of the implementation of the CMHC component in the Seraj program is to secure funds and employ skilled personnel. We need to incorporate Seraj in the existing national health system, and if successful, it can fill the treatment gap that has been so huge in the country.

Spirituality is the sublime aspect of human existence bestowed on all humans to traverse the path of transcendence which is closest to God. Despite many studies in this field, no evidence supports their contribution in treatment and care programs of the mental health system. Simple trainings in the” spirituality and health” can certainly affect our mental health services.

Approximately 21% of children and adolescents experience signs and symptoms of a DSM-IV disorder during the course of a school year, yet fewer than 20% of those needing mental health services actually receive any. Research suggests that schools and teachers can help promote mental health, detect children at risk, and refer them for psychiatric assistance. This study aims to determine the effects of an educational intervention on teachers' knowledge, attitude, self-reliance and practice. This study was carried out in 24 State-run elementary schools in the city of Khorramabad in Lorestan province, Iran, during the academic years 2001 - 3. Of the 64 teachers initially selected, 57 agreed to participate in the study; 27 of these were placed in the intervention group and the remaining 30 in the control group. The intervention group attended a 3-day workshop. Self - administered questionnaires were filled before and after the workshop, and at the end of the project data were collected from teachers and students. Statistical analysis was done by the SPSS package, using mainly nonparametric tests. 49% of the participants were men, 42% had a high school diploma and others had university degrees. Findings showed significant improvements in teachers' knowledge, attitude, and practice in the intervention group. No such improvement was observed in controls. Teachers in the intervention group were able to identify and refer 106 suspected cases, of whom 79 had a mental disorder confirmed by a psychiatrist. Within the same period, only 2 cases had been referred by the control group. Students' knowledge, the main criteria of teachers' practice in mental health education, had significantly improved in the intervention but not in the control group. Results suggest that female teachers had higher KAP levels than their male colleagues. The study confirms that trained teachers have the capabilities required for participating in School - Based Mental Health Services. It also appears that schools are indeed a crucial place for helping children in need of mental health services.      

2Objective(s): Health tourism is a branch of the tourism industry that is of interest to many countries of the world due to its high demand and good income. Therefore, considering the importance of health tourism and the existing potential in Mazandaran province, this study was conducted with the aim of identifying and analyzing the factors affecting the development of the health tourism industry in Mazandaran province. Methods: The present study was conducted using a qualitative method with a content analysis approach. For this purpose, 17 health tourism industry experts and health tourists were selected using the purposeful sampling method. Semi-structured interviews were used to collect data. The interviews were conducted until we reached a point of theoretical data saturation. Results: The findings showed that the health tourism industry in Mazandaran province is affected by structural, process and contextual factors. The structural factors included issues related to infrastructures, potentials/attractions, institutional factors, and expert human resources for health tourism destination. The process factor included issues related to drivers of health tourism, provision of health services and destination situational factors. The contextual-field factor included issues related to sociocultural contexts, potentials and attractiveness of tourism, and economic capacity. Conclusion: Despite the importance of services related to health tourism and considering the increasing demand of this industry, travelers who travel to Mazandaran province need a variety of services, and the need to pay attention to quality service development in tourism destinations is evident. Therefore, the provision of other essentials for health tourists such as infrastructure, destination attractions, financial capacities, sociocultural conditions, human resources, situational factors are  the requirements for the development of this industry.