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AIDS, Hepatitis C
and Mental Health
Main topics can be found within
the left column; sub-topics and/or research reports can be found
near the bottom of this page. Thank you
"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.
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Document Name & Link to Document |
Description |
File Size /Type |
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Access Issues in Behavior Health care
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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. |
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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
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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
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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
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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
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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
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Meeting of the California Prison Focus group
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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
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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 |
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Mental illness increases the Risk of HIV
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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
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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
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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
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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
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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 |
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Prevalence of HIV, Hepatitis B, and
Hepatitis C
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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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100 kb
pdf |
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Prevalence of HIV, hepatitis B, and
hepatitis C in people with severe mental illness
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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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PSYCHIATRIC STIGMA follows you everywhere
you go for the rest of your life |
A
problem you should think about before consulting a
mental health professional, or encouraging someone else
to do so, is the stigma of having received the so-called
therapy. If you seek counseling or "therapy" from a
psychiatrist or psychologist, how are you going to
answer questions on job applications, applications for
occupational or professional licenses, a driver's
license, applications for health or life insurance, and
school and college applications, such as "Have you ever
had psychiatric or psychological therapy?" When you
apply for a job or occupational license or a driver's
license or apply for an insurance policy or admission to
an educational program you will often be required to
answer this or a similar question. When you answer such
questions candidly and admit having received psychiatric
or psychological "help", the result often will be loss
of important opportunities |
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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 |
The
1999 report on mental health by the Surgeon General of
the United States was regarded as a landmark document in
the United Kingdom, as well as the United States. This
was because of its straightforward identification of the
stigma associated with mental illness as the chief
obstacle to effective treatment of persons with mental
disorders. Stigma (plural, stigmata) is a Greek
word that in its origins referred to a kind of tattoo
mark that was cut or burned into the skin of criminals,
slaves, or traitors in order to visibly identify them as
blemished or morally polluted persons. These individuals
were to be avoided or shunned, particularly in public
places. The word was later applied to other personal
attributes that are considered shameful or discrediting. |
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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
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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 is Social Death: Mental Health
Consumers/Survivors Talk About Stigma In Their Lives |
People described a number of sources of stigma. Major
sources included family, friends and intimates, the job
market and co-workers, neighbors, people at church and
in school. They also described the practices of the
housing market, insurance companies and the social
security system as being stigmatizing. While respondents
cited a variety of sources of stigma, most frequently
mentioned were the attitudes and practices of the mental
health system and its workforce. Following are
attitudes, beliefs and practices within the mental
health system thought to be stigmatizing. |
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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
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We Still Need to Do a Better Job of
Treating Depression
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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
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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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