"Although statistics from 1997 show a slight
decline in the number of new cases of AIDS in the United States,
the incidence of HIV infection continues to grow because improved
therapies have prolonged life with the disease. Previous studies
have shown that persons with mental illness have an increased prevalence
of HIV-related diseases, and these persons often display multiple
HIV risk factors, including poverty, substance abuse, and engaging
in unprotected sex." Mental Illness Increases the Risk of HIV
Infection
"Public rhetoric over mandatory testing has had an alarmist
cast, but the ethical issues raised by the spread of HIV among the
seriously mentally ill are by no means simple. They have been debated
within the profession for over a decade. Without an effective treatment
to offer in the first years of the epidemic, some experts felt that
the benefits of early detection and treatment were insufficient
to justify the intrusiveness of testing and the distress it caused.
Counseling and confidentiality protections in the mental health
system were thought to be so inadequate that knowledge of one's
HIV status was arguably more burdensome than beneficial. Nevertheless,
advocates for mandatory testing argued that knowledge of a patient's
HIV status was crucial for differential diagnosis of some psychiatric
complaints, and that patients with severe mental illness were often
unaware of their HIV risk and serostatus and thus were unlikely
to seek voluntary testing. It was also proposed that an exception
to the AIDS confidentiality rule be made for psychiatric patients
deemed dangerous.
Recent changes in the logic and prevailing discourse of prevention
provide an important context for our examination of this issue.
One early and influential prevention paradigm focused efforts on
modifying the behavior of the entire population. Any less universal
focus (on, for example, "risk groups") was viewed as undesirable
because it was liable to undermine the message that each individual
was responsible for his or her own protection. In the words of a
popular expression of the period, "AIDS doesn't discriminate."
Targeted prevention, it was held, might also foster an "us-them"
attitude by the public, weakening an already fragile social solidarity.
|
Access
Issues in Behavior Health care
|
Patients
usually ignore the fine print on the back of their insurance
cards. They assume that their medical insurance operates the
same way for behavioral health as it does for other
specialties of medicine.
|
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Blood-Borne Infections and Persons With Mental Illness:
Gender Differences in Hepatitis C Infection and Risks
Among Persons With Severe Mental Illness |
The
authors assessed gender differences in hepatitis
C infection and associated risk behaviors among
persons with severe mental illness.
METHODS: The sample consisted of 777
patients (251 women and 526 men) from four sites.
RESULTS: Across sites, the rate of
hepatitis C infection among men was nearly
twice that among women. Clear differences were noted in
hepatitis C risk behaviors. Men had higher
rates of lifetime drug-related risk
behaviors: needle use (23.1 percent compared with 12.5
percent), needle sharing (17.6 percent compared
with 7.7 percent), and crack cocaine use
(45.2 percent compared with 30.8 percent).
Women had significantly higher rates of lifetime sexual
risk behaviors: unprotected sex in exchange
for drugs (17.8 percent compared with 11.2
percent), unprotected sex in exchange for
money or gifts (30.6 percent compared with 17 percent),
unprotected vaginal sex (94 percent compared
with 89.7 percent), and anal sex (33.7
percent compared with 22.6 percent). Gender appeared
to modify some sex risks. Unprotected sex in
exchange for drugs increased the risk of
hepatitis C seropositivity for both men and
women. In the multivariate model, gender was not
significantly associated with hepatitis C
seropositivity after adjustment for other
risk factors. CONCLUSIONS: Gender differences in
the lifetime rates of drug risks explain the
higher rates of hepatitis C infection among
men with severe mental illness |
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CHRONIC/SERIOUS MENTAL ILLNESS |
. . .
individuals who, through no fault of their own or
their families, suffer from one of several diseases
affecting the brain, the most complex of human organs.
The causes remain unknown, but are probably multiple.
There is no cure, but we do have effective treatment. In
addition to having a brain disease, people with serious
mental illness are (by definition) significantly
functionally impaired by the illness for an indefinite
period of time (diagnosis, disability, duration).
At least 1% of the population are seriously mentally
ill. The problems of victims and their families are
compounded by stigma, one of the cruelest and
most prevalent forms of bigotry that exists. |
|
|
Co-occurring Hepatitis C,
Substance Use, and Psychiatric Illness: Treatment Issues and
Developing Integrated Models of Care |
Hepatitis C virus (HCV) infection is transmitted by
injection drug use and associated with psychiatric conditions.
Patients with drug use or significant psychiatric illness have
typically been excluded from HCV treatment trials noting the
1997 National Institutes of Health Consensus Statement on HCV
that indicated active drug use and major depressive illness
were contraindications to treatment of HCV infection. However,
the 2002 NIH Consensus Statement recognized that these
patients could be effectively treated for HCV infection and
recommended that treatment be considered on a case-by-case
basis. Treating HCV infection in these patients is
challenging, with drug use relapse possibly leading to
psychosocial instability, poor adherence, and HCV reinfection. |
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|
Considerations on the Stigma of Mental Illness |
Stigma, prejudice, and discrimination are closely related and
tightly interwoven social constructs. These constructs affect
many, based on age, religion, ethnic origin, or
socio- economic status.
|
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Criminal Justice Policies Toward the Mentally Retarded Are
Unjust and Waste Money |
Persons
with mental retardation are a small but increasing portion
of the population under the jurisdiction of the criminal
justice system. In most states, that system makes little or
no allowance for the disabilities of such offenders,
resulting in dispositions that are inequitably harsh and in
all likelihood costlier to the public than need be the case. |
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Criminalization
of the Mentally Ill
|
Police may
resort to arrest even when treatment is clearly needed. Teplin
(1984a,b) found that Chicago police arrested mentally ill
persons when treatment was preferable in cases of deviant
behavior that were so public and visible as to exceed the
limits of tolerance, and when deviant behavior was likely to
continue, proliferate, and require later police intervention
if the person were not removed from the site.
|
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EXPECTATIONS
AND SOCIAL INTERACTIONS OF CHILDREN WITH AND WITHOUT MENTAL
RETARDATION
|
This study
demonstrates that expectations have observable effects on
mentally retarded and nonretarded children's social
interaction with another child. It indicates that nonretarded
children may adopt simple speech when addressing a child with
learning problems, and suggests that some caution should be
used when attribusing differences in social behavior
exclusively to differences in the social skills of retarded
and nonretarded children
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Experience of stigma among Chinese mental health patients in
Hong Kong |
The stigma
attached to a label of ‘mental illness’ can have
a lasting impact on the person so labelled. The expectation
and actual experience of stigmatisation can result in
lowering of self-esteem and quality of life
persistent depression impairment in social
relationships and early treatment discontinuation
Coping with the stigma by avoidance, withdrawal
and secrecy is common, but may result in
demoralisation, social isolation and lost opportunities
for education, employment and housing |
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Fighting Stigma
|
There are many ways we all can fight stigma.
The simplest way is to "come out of the closet" and present
"positive visibility" in the community and the media. Positive
visibility is loosely translated as "your best foot forward."
When you let people in your community know that you, who have
been leading a blameless life right next door, have a mental
illness, it will make them question and (we hope) ultimately
reject the stigmatizing myth |
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Hepatitis C plagues mentally ill at rate 10 times national
average |
Although
the virus is found in about 1.8 percent of Americans, it
infects almost 20 percent of those with severe mental
illness, research suggests. That's because people with
mental illness or substance abuse problems are exposed to
some key risks for the blood-borne virus. |
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Hepatitis C – The Next Psychiatric Epidemic? |
If the AIDS
epidemic has taught us anything, it is that there’s more to
behavior than simple cognitive choice. Most people in the
United States have been informed how to prevent contracting
HIV. So who is still getting HIV? Many are people who are
vulnerable to risky behaviors because of psychiatric illness.
Who are they getting it from? HIV infected persons who are
vulnerable to spread the virus, many because of psychiatric
illnesses |
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HIV
testing Policy of the Serious Mentally Ill-2002,
|
The
working policy consensus developed in the 1980s carried
an implicit image of AIDS patients, their motivations, and
their likely responses to specific policies. Mandatory HIV
testing was initially rejected as unworkable,
politically insupportable, and ethically
problematic. As changes in this implicit image begin
to reflect new epidemiologic and therapeutic realities, the
implications of older policies are not always clear. It remains
to be seen whether HIV testing may be mandated for some people
with serious mental illness.
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HIV,
Hepatitis B, and Hepatitis C in people with severe mental
|
The
prevalence of HIV infection in this sample (3.1%) was
approximately 8 times the estimated US population rate but
lower than rates reported in previous studies of people with
sever mental illness. Prevalence rates of HBV (23.4%) and Hepatitis C Virus
(19.6%) were approximately 5 and 11 times the overall
estimated population rates for these infections.
|
96 kb pdf
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HIV/AIDS
testing policy -mental illness
|
The
working policy consensus developed in the 1980s carried
an implicit image of AIDS patients, their motivations, and
their likely responses to specific policies. Mandatory HIV
testing was initially rejected as unworkable,
politically insupportable, and ethically
problematic. As changes in this implicit image begin
to reflect new epidemiologic and therapeutic realities, the
implications of older policies are not always clear. It remains
to be seen whether HIV testing may be mandated for some people
with serious mental illness.
|
161 kb pdf
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Implications of Educating the Public on Mental Illness,
Violence, and Stigma
|
This study
examined how two types of public education programs
influenced how the public perceived persons with
mental illness, their potential for violence, and
the stigma of mental illness. A total of 161
participants were randomly assigned to one of
three programs: one that aimed to combat stigma, one that
highlighted the association between violence and
psychiatric disorders, and a control group.
Participants who completed the education-about-violence
program were significantly more likely to report
attitudes related to fear and dangerousness, to
endorse services that coerced persons into
treatment and treated them in segregated areas,
to avoid persons with mental illness in social situations,
and to be reluctant to help persons with mental
illness. |
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Incarceration is not a solution to mental illness |
The new welfare law denies the disabled benefits. Despite the
fact that prisons cost more and are less effective than
treatment, state governments have slashed mental health
budgets to build more prisons. The result has been more public
demonization and oppression of the mentally ill. |
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Investing in Health and Justice Outcomes: |
Mental
illness is over-represented in the incarcerated population. As
incarcerated populations grow in size and in their
representation of mental illness, state and local officials
are looking for ways to respond that comply with
constitutional requirements and legal mandates, fit the
contours of a fragmented public system, which relies
increasingly on the private sector, and are affordable. Their
affordability is perhaps the most limiting and vexing
challenge, especially in contemporary times of huge budget
shortfalls. The needs of mentally disordered offenders are
complex and multi-dimensional, often including addiction
problems, HIV/AIDS, and some form of personality disorder, and
they are expensive if managed comprehensively. |
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Journey
towards Empowerment
|
Empowerment
is about making choices consistent with the person we are, not
the person others expect us to be. This aspect of empowerment
relates to being an authentic person. Empowerment also
involves acquiring virtues, such as honesty and courage. This
aspect of empowerment accentuates its spiritual dimension.
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MEDICAID
DISCRIMINATION AGAINST PEOPLE WITH SEVERE MENTAL ILLNESSES |
"Increasingly, individuals with mental illnesses are left
to fend for themselves on the streets, where they victimize
others or, more frequently, are victimized themselves.
Eventually, many wind up in prison, where the likelihood of
treatment is nearly as remote." |
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Medical
Center or Death Camp
|
Meeting of
the California Prison Focus group
|
21 kb pdf
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Mental Illness and HIV Disease |
Learning
that one is HIV positive can adversely affect mental health… |
279 kb pdf |
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Mental Health and Illness Research: Millennium and Beyond
|
Three
points were made in that paper: a) practitioners of mental
health and illness research come from diverse disciplinary
backgrounds; b) historical tensions exist between medical and
social science understanding of the etiology of mental health
problems and psychiatric illnesses; and c) a discrepancy also
exists between theoretical developments and the mission of
mental health researchers to provide knowledge which leads to
tangible solutions for mental health problems.
|
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Mental
Illness-Disability insurance Claims |
Not only are
mental illness disability claims expensive and complex; they can
also take years to resolve. In this environment of ever
increasing mental illness diagnoses, only those with a complete
understanding of current treatment protocols, the most recent
cases and the latest rehab strategies for getting mental illness
claimants back to work will be positioned to lower the payment
costs and litigation risks of these claims |
267 kb pdf |
|
Mental
illness increases the Risk of HIV
|
Although
statistics from 1997 show a slight decline in the number of
new cases of AIDS in the United States, the incidence of HIV
infection continues to grow because improved therapies have
prolonged life with the disease. Previous studies have shown
that persons with mental illness have an increased prevalence
of HIV-related diseases, and these persons often display
multiple HIV risk factors, including poverty, substance abuse,
and engaging in unprotected sex
|
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Mental Illness Increases the Risk of HIV Infection
|
Previous
studies have shown that persons with mental illness have an
increased prevalence of HIV-related diseases, and these
persons often display multiple HIV risk factors, including
poverty, substance abuse, and engaging in unprotected sex.
|
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Mentally ill patients at Risk for HIV, TB, and Hepatitis
|
New
research presented at the annual meeting of the Academy of
Psychosomatic Medicine in Palm Springs, California, indicates
that patients in mental hospitals are at greater risk for HIV,
tuberculosis (TB), and hepatitis compared to individuals in
the general population. |
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My
Home is any Empty Bench
|
Severe
mental disorders capture too many of us in their seductive
charms. With omnipresent delusions, imaginings displace
the reality of the streets. We escape the horrors of our lives
by entering a world of our own creation: completely unaware of
the stench of our unwashed bodies, the sun roasting our skin
or the bugs eating our flesh. Very few of us escape: that
requires psychiatric intervention and meds. And whenever we
fall into the hands of the mental health system, discharge is
quick, and once back on the streets our meds are quickly
tossed, future appointments forgotten and we return to our
secret worlds.
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Other
Mental Health Issues
|
Listing of
other articles
|
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Prevalence of
Anxiety, Depression, and Substance use Disorders in an Urban
General medicine Practice |
Clinically
significant depression, anxiety, substance use, and suicidal
ideation are quite common in this practice and associated with
significant functional impairment. Primary care practices that
serve poor urban immigrant populations have a critical need to
provide access to mental health services |
199 kb pdf |
|
Prevalence
of HIV, Hepatitis B, and Hepatitis C
|
This study
assessed seroprevalence rates of HIV, hepatitis B virus (HBV),
and hepatitis C virus (Hepatitis C Virus) among individuals with severe
mental illness.
|
100 kb pdf
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Prevalence
of HIV, hepatitis B, and hepatitis C in people with severe
mental illness
|
Abstract:
This study assessed seroprevalence rates of HIV, hepatitis B
virus (HBV), and hepatitis C virus (Hepatitis C Virus) among individuals with
severe mental illness.
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Psychosexual Development in Adolescents With Chronic Medical
Illnesses |
The
author found that little systematic research on the
psychosexual implications of medical
illnesses for adolescents has been undertaken,
but existing studies suggest that psychosexual
development is negatively affected by medical
illness. A three-phase model of adolescent
psychosexual development is presented, with specific
psychosexual tasks associated with each phase.
Impediments to progressing through adolescent
psychosexual phases due to medical conditions
are identified, and case examples are provided. The
author concludes that clinicians working with
adolescents with medical conditions should
attend to the possibility of psychosexual
impediments in these adolescents and use developmentally
appropriate methods for assessing and
treating these difficulties when they arise.
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Psychological Issues in Pediatric HIV/AIDS Patients |
It has
become generally recognized that acute and chronic
medical conditions in the pediatric population have the
potential to bring about a range of psychosocial
challenges not only to patients, but also to family
members and health care workers. Of these conditions,
HIV/AIDS presents perhaps the most complex psychosocial
issues of any medical condition. The overlapping of
social, individual, family, financial, cultural, and
illness factors poses a challenge to communities and
healthcare teams that strive to provide comprehensive
services to this population. |
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Shifting the responsibility of untreated mental illness
|
There
is something fundamentally wrong when for some families the
only way to get involuntary treatment for the mentally ill
family member is to have that person arrested. |
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Significance of AIDS |
Mental
Illness and HIV/AIDS both share a ‘
stigma’, however the
‘stigma’
associated with HIV/AIDS is more severe than
that associated with any other life-threatening condition
and extends beyond the disease itself to providers, and even
volunteers involved with the care of people living with HIV.
I believe through my
'stigmata' theory that HIV/AIDS sufferers
must also experience
‘emotional stigmata’. |
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STEREOTYPING MENTAL ILLNESS BY VISUAL PERCEPTION |
The link
between stereotyping and mental illness was examined. The
data showed for each picture that was presented,
significance was found. The purpose of the examination was
to find out if people, while looking at a picture of another
person determined them to be mentally ill based solely on
their appearance. Some persons were known to be ill while
other subjects were known not to be ill. Based on the
photographs people did stereotype these persons.
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Stigma and Mental
Health
|
It is widely accepted that a negative attitude toward those
with psychiatric disorders exists, in fact, this is often a
reason cited for the delay or avoidance of treatment
|
Pdf 45 kb
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Stigma as a Barrier to Recovery: The Consequences of Stigma
for the Self-Esteem of People With Mental Illnesses
|
One of the
most tragic consequences of the stigma of mental
illness is the possibility that it engenders a significant
loss of self-esteem—specifically, that the stigma
of mental illness leads a substantial proportion
of people who develop such illnesses to conclude
that they are failures or that they have little
to be proud of. |
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STIGMA IN GLOBAL CONTEXT: MENTAL HEALTH STUDY |
The public
health ramifications of not knowing the underlying workings of
stigma are costly. According to the Surgeon General of the
U.S., stigma is the “most formidable obstacle to future
progress in the arena of mental illness and health” (1999:3).
Similarly, the WHO and the World Psychiatric Association mark
public stigma and discrimination as the critical barrier to
the appropriate care and inclusion of persons with MI in
society, and as the “chief nemesis” to improving and assuring
the quality of life for persons with severe mental illness |
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Stigma
of mental illness: Changing minds, changing behaviour
|
Conferring a psychiatric diagnosis on an individual or
admission to a psychiatric facility has multiple personal,
social, vocational and financial consequences. Patients who
have been labelled begin to perceive themselves as different,
and self-stigmatisation may occur
|
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|
Beyond any
definition, stigma has become a marker for adverse
experiences (see Box 1 ).
First among these is a sense of shame. Mental
illness, despite centuries of learning and the ‘Decade
of the Brain’, is still perceived as an indulgence, a
sign of weakness. Self-stigmatisation has been
described, and there are numerous personal
accounts of psychiatric illness, where shame
overrides even the most extreme of symptoms. In
two identical UK public opinion surveys, little change was
recorded over 10 years, with over 80% endorsing
the statement that "most people are embarrassed
by mentally ill people", and about 30% agreeing
"I am embarrassed by mentally ill persons" |
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STIGMA: THE HIDDEN KILLER |
People who
live with mental illness and their families often state that
the stigma associated with their diagnosis was more
difficult to bear than the actual illness. Stigma is
all-encompassing. It affects the ability to find housing and
employment, enter higher education, obtain insurance, and
get fair treatment in the criminal justice or child welfare
systems. Stigma is not limited to the attitudes and actions
of others. Self-stigma relates to internalized negative
stereotypes that lead people with mental illness and their
families to adopt attitudes of self-loathing and self-blame
leading the a sense of helplessness and hopelessness. |
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Strategies for reducing stigma toward persons with mental
illness |
Corrigan
and Watson have identified three approaches for reducing
stigma: protest, education, and contact. Although these
approaches have promise, they are not without weaknesses. A
potential disadvantage of using protest (i.e., telling the
public to stop believing negative views about mental
illness) is that it may actually increase, rather than
decrease stigma. In fact, research has shown that
instructing individuals to ignore or suppress negative
thoughts and attitudes towards a particular group can have
paradoxical rebound effects; stigma will be augmented rather
than reduced |
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Television & the Press: Purveyors of Prejudice or Slayers of
Stigma?
|
Whilst clinicians are often sensitive to the effects of
stigma upon an individual patient and his or her family, as a
profession we are guilty of turning a blind eye to the
prejudicial attitude towards the mentally ill that pervades
all strata of society. Professor Sartorius contends that in
most developed countries there is enough money to help those
with mental illness but that it is not made available because
of the mind-set of political decision makers1. He
argues that attitudes within the higher echelons of society,
where important financial decisions are made, reflect opinions
prevalent amongst the wider public
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The D.C. Court of Appeals |
The D.C.
Court of Appeals recently handed down an important en banc
decision reversing a trial's court order evicting a mentally
ill tenant whose messy apartment violated the lease. The
court found that the tenant's request for a stay of the
eviction proceeding to allow the tenant to receive services
to clean up the apartment and thereby cure the lease
violation constituted a request for a reasonable
accommodation that should have been granted. See Douglas v.
Kriegsfeld Corp., 2005 WL 2600210. |
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The Impact of Stigma on Service Access and Participation |
Research
has shown that the psychiatric symptoms, psychological
distress, and life disabilities caused by many mental
illnesses are significantly remedied by a variety of
evidence- based practices (EBPs). Central to the success of
these treatments is an obvious rule: people with
psychiatric disorders must participate in treatment to enjoy
its benefits. Unfortunately, research suggests many people
who meet criteria for treatment, and who are likely to
improve after participation, either opt not to access
services or fail to fully adhere to treatments once they are
prescribed. Health belief theorists have shown that a
rational consideration of the costs and benefits of
participating in specific treatments will directly impact
whether a certain route of intervention is pursued. A
significant cost to engaging in mental health treatment is
the stigma associated with it. Many people choose to not
pursue mental health services because they do not want to be
labeled a .mental patient. nor do they wish to suffer the
prejudice and discrimination this label entails. |
Pdf 132 kb |
|
We
Still Need to Do a Better Job of Treating Depression
|
Depression
Study showed that many depressed patients received inadequate
treatment. Results from 2 recent studies indicate that
undertreated depression and low remission rates still exist.
|
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Widening the Circle" Collaborative Research for Mental Health
Promotion in Native Communities
|
Collaboration
between several groups to promote the development and
evaluation of effective and culturally appropriate mental
health programs for Native populations and communities in
Quebec
|
467 kb pdf
|
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