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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

AIDS, Hepatitis C and Mental Health

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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.

 

Document Name & Link to Document

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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.

 

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

 

Characteristics of HCV positive patients in an Italian urban psychiatric unit HCV infection in psychiatric patients constitutes a major threat to the health of psychiatric patients and is related with unfavorable social background, worse global functioning, hostile or violent behavior, substance-related disorders. It appears also to be a significant risk of suicidal behavior.  

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.

 

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.

 

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.

 

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.

 

Depression in Hepatitis C Patients and Interferon Treatment Power Point presentation 304 kb

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

 

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

 

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

 

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.

 

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

 

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.

 

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.

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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

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.

 

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.

 

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.

 

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.

 

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."

 

Medical Center or Death Camp

Meeting of the California Prison Focus group

21 kb pdf

Mental Illness and HIV Disease

Learning that one is HIV positive can adversely affect mental health…

279 kb pdf

Mental Health The Nation’s contemporary mental health enterprise, like the broader field of health, is rooted in a population-based public health model. The public health model is characterized by concern for the health of a population in its entirety and by awareness of the linkage between health and the physical and psychosocial environment. Public health focuses not only on traditional areas of diagnosis, treatment, and etiology, but also on epidemiologic surveillance of the health of the population at large, health promotion, disease prevention, and access to and evaluation of services Pdf 307 kb

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.

 

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

 

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.

 

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.

 

Mentally ill people are sent to jail more often than hospital "We're not trying to say this is a criminal population," says co-author James Pavle, executive director of the Treatment Advocacy Center, a non-profit based in Arlington, Va. "All they have to do is step over a line — public urination, a misdemeanor. Then they get in jail, and the whole thing can spin out of control."  

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.

 

Other Mental Health Issues

Listing of other articles

 

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.

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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.

 

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.

 

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.

 

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

 

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.

 

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’.

 

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.

 

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.

 

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

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.

 

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

 

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.

 

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

 

Stigma of mental illness and ways of diminishing it

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"

 

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.

 

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

 

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

 

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.

 

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.

 

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