Integrating Mental Health Services into Primary HIV Care for Women: The Whole Life Project

Abstract

The high rate of mental health problems in HIV-infected women jeopardizes the health of this vulnerable population, and constitutes a mandate for integrating mental health services into HIV primary care. The Whole Life project—a collaboration of the departments of Psychiatry and Obstetrics/Gynecology at the University of Miami School of Medicine—successfully integrated mental health services into primary HIV care for women. This article describes the conceptual framework of the integration, implementation strategies, effects of the service integration, and lessons learned. Funded by the Health Resources and Services Administration (HRSA) as a Special Program of National Significance (SPNS), Whole Life efforts have been sustained beyond the demonstration funding period as a result of the changes brought about in organizational structures, service delivery, and the providers' conceptualization of health for HIV-infected women.

Interventions and approaches to integrating HIV and mental health services: a systematic review

“…Of the 45 papers, only two studies described integrating HIV services within existing mental health services (Rosenberg et al 2010, Lemmon andShuff 2001) while in the remaining papers, mental health and/or substance abuse services were integrated within existing HIV services. In 10 of these papers, these services were integrated in primary care settings (Farber et Williams 1995, Winiarski et al 2005, Feingold and Slammon 1993, Wolfe et al 2003, Zaller et al 2007, Wright and Shuff 1995, Esposito-Smythers et al 2014, Nebelkopf and Penagos 2005, Dodds et al 2004). …”

“…From these papers, two distinct integration models were identified involving integration in a singlefacility and integration across multiple facilities. Twelve other Integrated care defined as mental health services provided on-site at the medical clinic Coleman et al 2012 Collaborative care defined by: (1) its guiding principles as described in The Chronic Care Model (CCM) which includes taking a team-based, patient-centered, collaborative approach that incorporates elements of patient care such as patient registries, patient education, screening or assessment tools, adherence monitoring, and evidence-based treatment guidelines; and (2) the degree of collaboration described as a continuum from less to more collaborative Weaver et al 2009 The merging of health and medical services conceptualized on a continuum of care ranging from coordinated, meaning that care is delivered in different settings with information sharing among programs; to co-located, meaning that services are delivered at one location; to integrated, meaning that medical and behavioral healthcare components are merged in one treatment plan Dodds et al 2004 Integrated service systems defined as multifaceted approaches to providing services for patients with complex needs, whereby two or more entities develop linkages to improve outcomes for their clients and combine efforts to serve clients more responsively. This means that providers from multiple disciplines share referrals, collaborate on case planning, and activate the resources of multiple agencies rather than constraining clients to a single agency or program papers described interventions that integrated services exclusively at the micro level through the use of case managers, serving as the 3 rd distinct model of integration identified.…”

“…16 were full papers and four were conference abstracts (Namata Mbogga Mukasa et al 2014, Surah 2013, Cohen et al 2011, Vergara-Rodriguez et al 2012. Of these, there were eight descriptive studies (Feingold and Slammon 1993, Dillard et al 2010, Dodds et al 2004, Harris and Williams 1995, Kobayashi and Standridge 2000, Namata Mbogga Mukasa et al 2014, Wood 2008, Jonsson et al 2011, four cohort studies (Farber et al 2014, Nebelkopf and Penagos 2005, Vergara-Rodriguez et al 2012, Esposito-Smythers et al 2014, three retrospective record reviews (Coleman et al 2012, Cohen et al 2011, Feldman et al 2012, two non-randomized intervention studies (Winiarski et al 2005, Surah 2013), one RCT (Tetrault et al 2012), one mixed-methods study (Hyam et al 2012), and one qualitative study (Nakimuli-Mpungu et al 2014). In terms of treatment modalities, 6 out of the 20 studies involved interventions that integrated HIV and mental health services (Farber et al 2014, Feldman et al 2012, Harris and Williams 1995, Hyam et al 2012, Feingold and Slammon 1993, Nakimuli-Mpungu et al 2014.…”

“…In terms of treatment modalities, 6 out of the 20 studies involved interventions that integrated HIV and mental health services (Farber et al 2014, Feldman et al 2012, Harris and Williams 1995, Hyam et al 2012, Feingold and Slammon 1993, Nakimuli-Mpungu et al 2014. In five other studies, the process was part of a larger package of integration with other services, including general primary health care (PHC) (Coleman et al 2012, Winiarski et al 2005 obstetrics and gynaecology (O&G) services (Dodds et al 2004), risk reduction interventions (Namata Mbogga Mukasa et al 2014), TB services (Jonsson et al 2011) and non-communicable disease screening and treatment services (Namata Mbogga Mukasa et al 2014). Three studies involved interventions that integrated HIV, mental health and substance abuse services within a HIV clinic setting (Surah 2013, Vergara-Rodriguez et al 2012, Esposito-Smythers et al 2014 while six others involved integration with primary health care (Cohen et al 2011, Dillard et al 2010, Wood 2008, Hepatitis C treatment (Tetrault et al 2012), risk reduction interventions (Nebelkopf and Penagos 2005) and specialist services (Kobayashi and Standridge 2000) in a single site.…”

“…The heterogeneity of the study locations indicates that this model of integration has been implemented in a wide range of different settings; although most commonly, services were integrated within primary care clinics (Farber et al 2014, Harris and Williams 1995, Feingold and Slammon 1993, Winiarski et al 2005, Dodds et al 2004 or in a HIV clinic (Coleman et al 2012, Namata Mbogga Mukasa et al 2014, Jonsson et al 2011, Esposito-Smythers et al 2014, Surah 2013, Vergara-Rodriguez et al 2012, Wood 2008, Tetrault et al 2012, Kobayashi and Standridge 2000. In six of the studies in these settings, mental health services comprised of specialized psychiatric liaison services or consultative treatment (Coleman et al 2012, Harris and Williams 1995, Kobayashi and Standridge 2000, Surah 2013, Hyam et al 2012, Vergara-Rodriguez et al 2012.…”