HIV Service Provision for People with Severe Mental Illness in Outpatient Mental Health Care Settings in New York

Abstract

People with severe mental illness evidence significantly higher rates of HIV infection than the general population in the United States. Frequently, the only access to health care for this population is through their outpatient mental health care providers. In order to determine how these providers were dealing with the increased risk of HIV infection among this group, a survey of all licensed and certified outpatient mental health care centers in New York State was conducted. The data were compared to a similar previous survey conducted in 1997.

HIV Testing Among Adults with Mental Illness in the United States

“…Implementing routine HIV testing in mental health settings (where screening is low due to: limited availability of on-site testing, clinician discomfort providing risk reduction counseling and administering HIV tests, and provider concerns that HIV testing may detract from the delivery of mental health care) and targeting outreach and testing campaigns towards those with mental illness may help improve testing rates in this at-risk population. [37][38][39][40] In addition, mentally ill persons who use illicit drugs should be screened for HIV when initiating treatment for substance abuse. 41 Lastly, linkage to and retention in HIV care are necessary, given poorer HIV outcomes for persons with versus those without psychiatric disorders.…”

Provider-initiated HIV counselling and testing (PICT) in the mentally ill

“…[13,16] In a survey of psychiatric hospitals and outpatient mental health centres, the majority of staff reported that they only encouraged a few patients to get tested. [17] Joska et al [18] report that state psychiatrists in SA's Western Cape Province do not test routinely for HIV infection (14.6% of patients with serious mental illness were tested in 2006), largely because of ethical constraints.…”

“…[8] Ideally, mental health clinicians can provide pre-and post-test counselling that is tailored for individuals with a mental illness, addressing patients' barriers to testing and allaying concerns about testing, confidentiality and stigma. [17] Mental health settings are also ideal because patients located here avoid the need for additional transportation or appointments. [17] HIV testing could be recommended during consultation, together with all other relevant tests.…”

“…[17] Mental health settings are also ideal because patients located here avoid the need for additional transportation or appointments. [17] HIV testing could be recommended during consultation, together with all other relevant tests. [23] If the patient actively refuses HIV testing, this would be documented in their clinic file.…”

Assessing the STIRR Model of Best Practices for Blood-Borne Infections of Clients With Severe Mental Illness

“…First, most providers offer none of these services to clients, despite being their major point of access to health care. In New York, where prevalence is high and HIV services are mandated, less than half of the psychiatric providers routinely do risk assessment, and only 16% offer blood testing for HIV (8,9). Mental health providers appear to be reluctant to offer core services for the following reasons: limited financial resources; reluctance to inquire about risk behaviors; reluctance to promote testing for infection; lack of knowledge about blood-borne infections; inadequate skills and confidence in dealing with positive test results; inability to help clients access appropriate medical care (10).…”