Annual Incidence of First Episode of Psychosis Presenting to a Community Mental Health Center

Abstract

This prospective observational study aimed to estimate the annual service-based incidence of individuals with First Episode Psychosis (FEP) and high-risk states for psychosis presenting to a public Community Mental Health Center within a defined urban catchment area in Northwestern Greece. It offers novel real-world insights into early intervention in psychosis within a resource-constrained, post-crisis health care setting. All individuals aged ≥16 years who presented to the Community Mental Health Center of the University of Ioannina between January 2023 and December 2024 were assessed. Those diagnosed with FEP or identified as being at a high risk for psychosis using the Comprehensive Assessment of At-Risk Mental States were included, while duration of untreated psychosis (DUP) was estimated with the Symptom Onset in Schizophrenia inventory. Among 1115 service users, 51 (4.6%) met criteria for FEP (N = 33) or high-risk states (N = 18), rising to 7.5% among those aged 16–36 years. The annual service-based incidence of FEP was 10.26 per 100,000 in the general population, increasing to 51.62 in individuals aged 16–36 and 63.17 in those aged 16–26. Including high-risk cases, service-based incidence reached 109.71 per 100,000 in the 16–26 age group. Mean DUP was 39.4 weeks but was 7.0 weeks among 80% with DUP < 1 year. Most FEP patients (63.6%) required brief hospitalization, and over half reported family history of mental illness. These findings highlight substantial community caseloads and the need to strengthen early intervention services.

1. Introduction

Schizophrenia and related psychotic disorders are chronic conditions that often present dramatically during adolescence and early adulthood. Over the past few decades, early intervention services for first-episode psychosis (FEP) have been established—initially in Melbourne [1] and subsequently in many regions around the world [2,3,4]. These services aim primarily to reduce the duration between the onset of psychosis and the initiation of effective treatment, and to provide continuous, comprehensive care during the critical early phase of the disorder [5].

A critical metric for understanding the onset and early development of psychotic disorders within a population is their annual incidence. Monitoring the incidence of FEP is essential for public health planning, as it informs the allocation of mental health resources—particularly within community mental health services, the design of early intervention strategies, policy development, and the prioritization of research efforts.

Globally, the annual incidence of schizophrenia in the general population has been reported to range between 7.7 and 43.0 per 100,000, with a median value of 15.2 per 100,000 [6]. However, these incidence rates vary significantly across countries and are influenced by factors such as age, gender, migration status, and geographic context. For example, studies conducted in urban areas tend to report significantly higher rates compared to those in mixed urban–rural settings [6]. Moreover, when focusing on high-risk populations, particularly those aged 16 to 26, studies have reported FEP incidence rates as high as 137.2 per 100,000 [7]. It has also been observed that FEP incidence is not temporally stable, with increases of up to 33% reported in specific catchment areas when comparing data across different years [8].

A previous study conducted within the broader catchment area—namely, the Mental Health Sector encompassing the prefectures of Ioannina and Thesprotia—reported a rough estimate of the annual incidence of first-episode psychosis (FEP) at approximately 30 new cases per 100,000 population [9]. However, this study was retrospective in nature and based on the analysis of caseload data collected from multiple mental health providers, including hospital psychiatric departments, a mobile mental health unit operating in rural areas, and both public and private outpatient clinics. As such, the figure reported more accurately reflects annual FEP prevalence rather than true incidence. Furthermore, the estimation of the catchment area’s population—urban and rural—was not derived from official data provided by the Hellenic Statistical Authority, and no reference was made to FEP prevalence or incidence within high-risk age groups, such as individuals aged 16–26 or 16–36 years.

In an effort to more accurately determine the annual incidence of individuals with FEP seeking mental health care through public community services within our catchment area—and given that our Early Intervention Unit was ultimately integrated into the Community Mental Health Center (CMHC) of the University of Ioannina—the aim of the present study was to assess the annual service-based incidence of FEP cases presenting to the CMHC over a two-year period, rather than true population incidence. This approach also allowed us to estimate the proportion of individuals with FEP who seek care at the CMHC, to evaluate whether our mental health services are adequately staffed, and to inform future planning regarding the staffing, funding, and infrastructure required to meet the needs of the community.

2. Materials and Methods

2.1. Participants and Setting

The Ioannina Early Intervention for Psychosis Unit (EIU) was established in 2007 within the Department of Psychiatry of the University of Ioannina [10]. It was the first specialized service of its kind in Greece, addressing the needs of patients referred with an FEP. In the years that followed, the financial crisis and subsequent austerity measures placed considerable strain on the Greek mental health system, contributing to workforce limitations, service fragmentation, and a regressive shift toward more hospital-centered patterns of care, with implications for the continuity and accessibility of community-based services [11,12,13,14]. These systemic pressures led to a scaling back of community-based activities and a redistribution of staff toward inpatient services, reinforcing hospital-centered care pathways.

In 2022, efforts to reverse this trend were initiated through the addition of new staff to the EIU, made possible by the NGO “Society for the Promotion of Mental Health in Epirus” (SPMHE), following an agreement between the University Hospital and the SPMHE. In the same year, the revitalized EIU was relocated from the hospital setting to the state-funded Community Mental Health Center (CMHC) of the University of Ioannina, situated in the center of the city. The CMHC serves as the primary gatekeeper for mental health care provision within a defined catchment area covering the Prefecture of Ioannina in Northwestern Greece, with a total population of 160,773, including 31,961 individuals aged 16–36 (Hellenic Statistical Authority, 2021). This age group constitutes the main target population of the EIU, although older patients experiencing an FEP are also treated, given evidence that the duration of untreated psychosis (DUP) in public sector patients within the broader region can be as high as 60 months [9].

The present study included all individuals who consecutively sought care at the Community Mental Health Center of the University of Ioannina between 1 January 2023 and 31 December 2024 and were either diagnosed for the first time with an FEP or identified as being at high risk for developing psychosis. Eligibility criteria for receiving care through the EIU included being over the age of 16, residing within the defined catchment area, and either (a) meeting diagnostic criteria for an FEP—i.e., the presence of threshold-level psychotic symptoms on a daily basis for at least one week [7]—or (b) being assessed as at-risk for psychosis according to the Comprehensive Assessment of At-Risk Mental States (CAARMS) (Beta Medical Publications, Neo Psichiko, Greece) [15].

2.2. Study Procedures and Sources of Information

The sample consisted of all individuals who, at the time of entry into the Early Intervention Unit (EIU), were either diagnosed with a first episode of psychosis (FEP) or identified as being at high risk for developing psychosis, as determined by the Comprehensive Assessment of At-Risk Mental States (CAARMS). Demographic information—including sex, educational attainment, and family status—was extracted from the service’s registration records. The duration of untreated psychosis (DUP) was assessed by trained clinicians within the Early Intervention Unit (two psychiatrists and one psychiatric nurse) using the Symptom Onset in Schizophrenia (SOS) inventory as a structured framework [16]. The clinicians had received formal training in standardized clinical assessment instruments, including certification in the Positive and Negative Syndrome Scale (PANSS) and training in the Comprehensive Assessment of At-Risk Mental States (CAARMS), supporting consistency in clinical evaluation [17]. Estimation of symptom onset was based on a combination of patient interviews, collateral information from family members when available, and review of clinical records, to enhance accuracy and reduce recall bias.

All procedures were conducted in accordance with the ethical standards for research involving human participants, as set forth in the Declaration of Helsinki. The collection of core demographic and clinical data was carried out as part of routine clinical practice within the Unit, under prior approval granted by the Scientific/Ethics Committee of the University Hospital of Ioannina (Reg. No. 227/22 June 2011). A subsequent approval (Reg. No. 3/5 February 2025) was obtained to extend the research protocol to include additional assessment instruments and research variables (e.g., structured psychometric measures) beyond routine clinical data collection. All patients agreed to participate, and written informed consent was obtained prior to their inclusion in the study. All data used for research purposes were anonymized prior to analysis.

Statistical Analysis

Descriptive statistics were used to summarize the data. Continuous variables are presented as means and standard deviations (SDs), while categorical variables are presented as frequencies and percentages. Comparisons between FEP and at-risk individuals were conducted using appropriate statistical tests (independent samples t-test for continuous variables and chi-square test for categorical variables). All analyses were performed using IBM SPSS Statistics, version 31.0.0 (IBM Corporation, Athens, Greece, 1989; 2025).

3. Results

The number of individuals who sought care at our Community Mental Health Center between 1 January 2023 and 31 December 2024 is presented in

Table 1. Distribution of First Episode of Psychosis (FEP) and high-risk cases according to the Comprehensive Assessment of at-Risk Mental States among Community Mental Health Center visits.

	Total Visits (N = 1115)	Visits Aged 16–36 (N = 681)
FEP	33 (2.95%)	33 (4.84%)
High-Risk	18 (1.61%)	18 (2.64%)
Total	51 (4.57%)	51 (7.48%)

. During the study period, a total of 1115 individuals attended the CMHC. The overall sample consisted of 55.9% females, with an age range of 16 to 88 years (mean = 34.8, SD = 15.0; median = 29), while 5.6% were aged over 65 years. The majority of service users presented with common mental disorders, including anxiety, depressive, and somatoform disorders, whereas psychotic spectrum disorders were relatively rare and were more commonly managed in the outpatient department of the university hospital. Among the 1115 service users, 681 individuals (61.1%) belonged to the Early Intervention Unit’s target age group (16–36 years). Thirty-three individuals (3.0%) were diagnosed with an FEP, and 18 (1.6%) were identified as being at high risk for developing psychosis, raising the EIU’s total caseload to 51 clients. This corresponds to 4.6% of the total clientele seeking care at the CMHC. All EIU clients belonged to the Unit’s designated age group (16–36 years), raising the overall proportion of young individuals (16–36) at risk or diagnosed with FEP who sought care at the CMHC to 7.5%.

As shown in

Table 2. Service-based annual incidence per 100,000 population of cases with a First Episode of Psychosis (FEP) and at a high risk for developing Psychosis according to the Comprehensive Assessment of At-Risk Mental States.

	All Ages	Aged 16–36	Aged 16–26
Population of the Prefecture of Ioannina	160,773	31,961	15,038
FEP	10.26	51.62	63.17
High-Risk	5.59	28.15	46.54
Total	15.85	79.77	109.71

, the annual service-based incidence of people with an FEP presenting to the CMHC in the first two years of the EIU operation in the CMHC was 10.26/100,000, rising up to 51.62/100,000 for ages 16–36 and up to 63.17/100,000 for the high-risk-for-psychosis age group (16–26 years), reaching 109.71/100,000 for this age group when including people considered at a high risk for developing psychosis.

Table 3. Demographic and clinical characteristics.

	FEP N = 33	High-Risk N = 18
Age (years, mean ± SD)	26.48 ± 7.57	23.88 ± 3.89
Gender female, N (%)	20 (60.6)	11 (61.1)
Family status: single, N (%)	26 (78.8)	18 (100.0)
Education
Primary, N (%)	-	1 (5.6)
High school, N (%)	23 (69.1)	8 (44.4)
University, N (%)	10 (30.3)	9 (50)
Profession
Unemployed, N (%)	11 (33.3)	9 (50)
Full-time job, N (%)	7 (21.2)	3 (33.3)
Student, N (%)	15 (45.5)	6 (16.7)
Duration of Untreated Psychosis (DUP)
Total sample-Range (weeks)	0.0–384.0	-
Total sample (weeks)–Mean (SD)	39.4 (87.5)	-
Total sample median (weeks)	4.00	-
DUP < 1 year, N (mean ± SD), (weeks)	28 (7.0 ± 9.9)	-
History of substance abuse, N (%)	9 (27.3)	-
Family history for mental illness, N (%)	17 (51.5)	12 (66.7)

Note: FEP, cases diagnosed with a First Episode of Psychosis; High-Risk, cases considered at a high risk for developing psychosis according to the Comprehensive Assessment of At-Risk Mental States (CAARMS).

presents the demographic and clinical characteristics of the sample. The female-to-male ratio was approximately 3:2. The mean age of onset of psychosis among individuals with FEP was 25.73 years (SD = 7.55), with a median of 23.69 years and a range from 17.15 to 53.54 years. No statistically significant differences were observed between males (mean = 25.68, SD = 5.18) and females (mean = 25.76, SD = 8.89) in age of onset (t = 0.03, p = 0.976), with a negligible effect size. Most clients were single and had received secondary or higher education. Roughly half of the FEP patients were undergraduate university students. More than half of all clients reported a family history of mental illness. No statistically significant differences were observed between FEP and at-risk individuals in any of the above characteristics. Twenty-one FEP patients (63.6%) required short-term hospitalization. One-quarter of the FEP patients reported a history of substance use or abuse; among them, eight reported heavy cannabis use and one reported occasional cocaine use.

The duration of untreated psychosis (DUP) ranged from 0 weeks to 96 weeks, with a maximum duration of 384 weeks (approximately 7.4 years), and a mean DUP of 39.4 weeks. However, the median DUP for the entire sample was 4 weeks. Most FEP patients (N = 28, 80%) had a DUP of less than one year, with a mean (±SD) of 7.0 ± 9.9 weeks. One patient had a DUP of 96 weeks, another of 144 weeks, two of 240 weeks, and one of 384 weeks (Table 3).

4. Discussion

We report an annual service-based incidence of FEP among individuals presenting to a public Community Mental Health Center of 10.26 per 100,000 in the general population, 51.62 per 100,000 among individuals aged 16–36 (the target group of the EIU), and 63.17 per 100,000 for the high-risk age group (16–26 years). Additionally, we report an annual incidence of 46.54 per 100,000 for individuals aged 16–26 identified as being at high risk for developing psychosis, based on the CAARMS assessment. To the best of our knowledge, this is the first study in Greece to provide a service-based incidence estimate of individuals at high risk for psychosis using a validated structured assessment instrument [15,16].

Importantly, our findings reflect service-based (treated) incidence rather than true population incidence. As such, they likely underestimate the actual incidence of FEP in the general population, as a proportion of individuals may seek care through alternative pathways, including private sector services, hospital-based care, or may delay help-seeking altogether. Nevertheless, service-based incidence provides clinically meaningful information regarding real-world service utilization, demand on community mental health resources, and pathways to care within a defined catchment area.

The incidence rate observed in the general population in our study is lower than that reported in a previous study conducted in the broader region (10.3 vs. 30.0 per 100,000) (9). It should be noted, however, that the previous study was not restricted to an urban catchment area and employed a different sampling framework. In contrast, the incidence rate reported in the present study pertains exclusively to individuals seeking care in a Community Mental Health Center (CMHC), and the sample primarily comprised an urban population. Although higher incidence rates are typically reported in urban settings, the rates observed in our study were lower than the median global incidence (15.2 per 100,000) while remaining within the reported global range (7.7–43.0 per 100,000) [6]. This discrepancy may partly reflect the service-based nature of our study, as incidence estimates derived from individuals presenting to a CMHC may underestimate the true population incidence.

A further explanation may relate to the relatively recent establishment of the CMHC, which has been operating for approximately three years. While it serves as the primary mental health service for the local population, service utilization may not yet have reached its expected level, as reflected in the steadily increasing number of visits. It is therefore plausible that some individuals experiencing an FEP may initially access care through alternative pathways, such as hospital-based outpatient clinics or psychiatric departments. Longitudinal assessment will be important, particularly given evidence that FEP incidence may show temporal variability, with reported year-to-year increases of up to 33% in some regions [8].

In addition to incidence patterns, certain demographic characteristics of the sample warrant further consideration. Our sample included a higher proportion of females than males, which contrasts with the male predominance commonly reported in populations with psychotic spectrum disorders [18]. This finding may reflect the service-based nature of the sample and local pathways to care, as help-seeking behavior, referral patterns, and access to community-based services may differ by gender, influencing which individuals present to CMHC services.

The mean age of onset observed in our sample (approximately 26 years) is consistent with previous findings indicating that psychotic disorders typically emerge in early adulthood. In contrast to studies reporting an earlier onset in males compared to females [19], we did not observe significant gender differences in age of onset. This may be related to the relatively small sample size but could also reflect service-level factors influencing the timing of presentation to care. In addition, it has been shown that the gender difference in age of onset in schizophrenia is smaller than previously thought and appears absent in studies using ICD [19].

The relatively low rates of substance use disorders observed in our sample and the absence of substance use disorders among high-risk individuals differ from findings commonly reported in FEP populations, where substance use—particularly cannabis—is frequently observed. This discrepancy may reflect the local pathways to care, as well as potential underreporting or differences in detection within routine clinical practice. It is also possible that individuals with prominent substance use are more likely to present to alternative services, such as emergency or addiction services, rather than to CMHCs. Cannabis use, in particular, has been consistently associated with increased risk for psychosis and is commonly reported in FEP cohorts, highlighting the need for careful assessment in early intervention settings [20].

Beyond these service utilization patterns, our findings can be more fully understood within a pathways-to-care and health systems framework. The duration of untreated psychosis (DUP) does not solely reflect individual help-seeking behavior, but is shaped by the structure, accessibility, and organization of mental health services. In this context, pathways to care—including the initial point of contact (e.g., primary care, emergency departments, private practitioners), referral processes, and delays in recognition or access—play a critical role in determining when and how individuals with FEP reach specialized services.

In our setting, these pathways must be interpreted in light of the broader transformations of the Greek mental health system over the past decade. The financial crisis and subsequent austerity measures led to a contraction of community-based services and a partial reversion toward hospital-centered care, disrupting continuity and accessibility of early intervention pathways. As described in the Introduction, our initial Early Intervention Service experienced a period of reduced capacity, with staff redeployment and limited outreach activity, which may have contributed to delays in identification and referral of FEP cases.

Importantly, these challenges are not unique to the Greek context but reflect broader trends observed across European mental health systems undergoing the transition toward community-based care. Similar tensions between the ideals of deinstitutionalization and the constraints of limited resources, workforce shortages, and service fragmentation have been reported in other European settings [21].

Τhe recent re-establishment and relocation of the EIU within a Community Mental Health Center (CMHC) appears to have begun to restore more direct and accessible pathways to care, potentially contributing to the relatively short DUP observed in the majority of our sample. In addition, the Unit implemented targeted community outreach and awareness activities following its relocation, including informational sessions, collaboration with primary care providers and local services, and efforts to improve early recognition and referral of psychosis. Such initiatives may facilitate earlier help-seeking and are associated with shorter treatment delays in psychosis [22].

At the same time, the lower service-based incidence rates reported in this study may partly reflect incomplete capture of cases within the catchment area, as individuals may continue to access care through alternative routes, including private sector services or hospital-based pathways. Although the present study does not allow for a precise quantification of the proportion of FEP cases bypassing the CMHC, it is likely that a subset of individuals continues to access care through alternative pathways, including hospital-based services and private sector providers.

Taken together, these findings highlight the importance of considering not only incidence and DUP as isolated metrics but as outcomes embedded within specific health system configurations. Strengthening early detection and intervention in psychosis therefore requires not only clinical expertise but also the optimization of care pathways, inter-service coordination, and community-level accessibility.

Building on this pathways-to-care perspective, our findings also have direct implications for general medical practitioners, who frequently represent the first point of contact for individuals experiencing early psychotic symptoms. Primary care physicians and emergency department clinicians are often in a key position to recognize early signs of psychosis, initiate timely referrals, and thereby reduce the duration of untreated psychosis (DUP).

The service-based incidence rates reported in this study, particularly among younger age groups, highlight the importance of maintaining a high index of suspicion for psychotic symptoms in adolescents and young adults presenting with behavioral changes, functional decline, or non-specific psychological complaints. Early identification at the primary care level, followed by rapid referral to specialized early intervention services, may significantly improve clinical outcomes.

In this context, strengthening collaboration between CMHCs and primary care services—through targeted training, clear referral pathways, and ongoing communication—may facilitate earlier access to care and more efficient navigation of the mental health system. Such integration is especially critical in health care systems undergoing structural transitions, where variability in care pathways may contribute to delays in treatment initiation.

Importantly, we observed an incidence rate of 63.2 per 100,000 in the high-risk population (16–26 years). Although this figure is lower than those reported in other countries (e.g., up to 117.6 per 100,000) [7], it underscores the need for proactive clinical care, community outreach, and early identification efforts aimed at young people and their families. Early detection and intervention remain crucial in preventing clinical deterioration and meeting the mental health needs of the community.

Our finding that 4.6% of individuals who sought care at the CMHC were either diagnosed with FEP or identified as being at high risk—and that this proportion rises to 7.5% when focusing on the EIU’s target age group (16–36 years)—warrants serious consideration. CMHC clinicians and staff should remain vigilant and prioritize timely referrals of FEP and at-risk individuals to the EIU. These findings may also inform public health officials and policymakers in allocating adequate personnel, financial resources, and infrastructure to ensure that community mental health services can effectively respond to local needs.

Duration of untreated psychosis (DUP) is widely recognized as a critical prognostic factor in the course of schizophrenia-spectrum disorders [23]. A meta-analysis by Marshall et al. [24] reported a positive association between longer DUP and poorer treatment outcomes, including reduced general functioning, greater severity of positive symptoms, and lower quality of life. Similarly, a meta-analysis by Perkins et al. [25] demonstrated that shorter DUP was associated with more favorable outcomes, including reduced overall psychopathology, lower severity of both positive and negative symptoms, and improved global functioning.

In our study, the mean DUP was found to be 39.4 weeks. However, when outliers—i.e., individuals with extremely long DUP—were excluded, the mean DUP for the remaining 80% of participants (those with a DUP under one year) dropped to just 7 weeks. These figures are markedly lower than those reported in a previous study conducted over a decade ago in the broader region, which found a mean DUP of 72.8 weeks among public sector patients [9]. Compared to the recent multicenter study of FEP patients in rural Greece (mean DUP = 31.4 weeks) [26], our overall sample shows comparable or even lower rates when outliers are excluded. Nevertheless, it should be noted that the estimation of DUP is inherently subject to recall bias, particularly in cases with prolonged duration, as it relies on retrospective reporting and clinical reconstruction of symptom onset, despite the use of structured assessment methods and trained raters.

Data on DUP in community-based settings remain limited. In the United States, a mean DUP as high as 193.5 weeks has been reported [22], while studies conducted in academic clinical settings in the U.S. report average DUPs ranging from 61 to 166 weeks [27,28,29]. The relatively low DUP observed in our sample may reflect the community outreach and early intervention efforts of the former EIU, which, despite being understaffed and operating from the general hospital’s outpatient department, contributed to raising public awareness regarding the availability of early psychosis care.

Nonetheless, to further reduce DUP, it is necessary to investigate the specific components of treatment delay in our local community setting and to design and implement feasible strategies for bridging current gaps in the pathway to specialized FEP care. Bringing DUP in line with the internationally recommended benchmark of less than three months [30] should remain a central objective of future applied research and service development efforts [22].

5. Conclusions and Policy Implications

The findings of this study indicate that a community mental health center operating within a defined catchment area can expect to serve a considerable number of individuals experiencing a first episode of psychosis or presenting a high risk of developing such an episode. Among age groups considered at risk, this number may reach or even exceed 7% annually, while the corresponding incidence may be higher than 10 per 100,000 in the general population and as high as 63 per 100,000 in high-risk groups.

It is important to note that these estimates may still underrepresent the actual need for services. As the CMHC becomes more established and recognized in the community as gatekeeper, it is likely that an increasing number of individuals with or at risk for FEP will turn to it rather than seeking help from more traditional services, such as outpatient units of general hospitals or psychiatric clinics. This gradual shift may result in a higher incidence of detected cases over time. Additionally, although the study employed validated tools, the precise estimation of the duration of untreated psychosis (DUP) remains a methodological challenge, as determining the true onset of symptoms often involves retrospective reporting and clinical judgment. Another limitation of the study is that migration status was not systematically recorded in the present study, and only a very small number of participants were identified as immigrants, precluding meaningful analysis of its potential impact.

Despite these limitations, the study presents notable strengths. Recruitment was prospective, continuous, and consecutive, ensuring a representative sample of FEP cases seeking care in the CMHC. Moreover, incidence rates were calculated using official population data from the Greek Bureau of Statistics based on the specific geographic area served by the CMHC.

These findings carry important implications for mental health policy and service planning. From a service development and policy perspective, our experience also highlights several practical components that may facilitate the transition from hospital-based to community-based early intervention models. These include the implementation of targeted community outreach and awareness activities, the strengthening of collaboration with primary care and local services, the establishment of clear and accessible referral pathways, and the promotion of continuity of care within a community-based framework. In addition, flexibility in workforce allocation and sustained support for multidisciplinary teams appear to be critical for maintaining service accessibility and responsiveness in real-world settings. Mental health professionals working in community-based settings should be aware of the expected caseload in order to be adequately prepared to provide timely and high-quality care. They should also be equipped to identify and refer individuals requiring specialized treatment to early intervention units.

At the same time, policymakers must take these data into account when designing and implementing mental health services. Ensuring the availability of adequate human and financial resources is essential for the proper staffing and functioning of community mental health centers. Only through sustained investment and planning can these centers fulfill their critical role in delivering accessible, evidence-based, and high-standard mental health care to the populations they serve.