Investigating the Impact of the Social Security Organization's Performance on Community Mental Health with Emphasis on Citizenship Rights in Zahedan

Abstract

The performance of social security systems plays a critical role not only in ensuring economic protection but also in shaping public mental health and perceptions of citizenship rights. In Iran, particularly in socioeconomically marginalized regions such as Zahedan, inefficiencies and inequities in the Social Security Organization (SSO) have raised concerns about their broader psychosocial implications. Despite numerous organizational reforms and policy efforts, the impact of service delivery on citizens' mental well-being and sense of civic inclusion remains underexplored in local contexts. This study aimed to investigate how the performance of the Social Security Organization in Zahedan affects the mental health of citizens, with specific emphasis on the protection and perception of their citizenship rights. This research employed a qualitative design using semi-structured interviews with 21 purposively selected participants from Zahedan, including insured individuals, healthcare professionals, social workers, and legal experts. Data were collected between September 2024 and August 2025. Thematic analysis was conducted through open, axial, and selective coding using NVivo software, with data collection continuing until theoretical saturation was reached. Five core themes emerged: (1) organizational dysfunction, (2) psychological and emotional consequences, (3) erosion of citizenship rights, (4) inequity and social exclusion, and (5) systemic barriers to access. Participants reported emotional distress, loss of trust, and perceived violations of dignity and rights due to bureaucratic inefficiency, lack of mental health support, and discriminatory service delivery. Structural and cultural gaps within the SSO were identified as major contributors to citizens’ psychological burden. The findings highlight a critical link between institutional performance and mental health, suggesting the need for citizen-centered, equitable, and transparent reforms in the SSO, especially in underserved areas like Zahedan.