When Mental Health Impacts on Sexually Transmitted Disease Risk Marc Safran, MD, MPA CAPT, US Public Health Service Senior Medical Officer / Senior Psychiatrist Centers for Disease Control and Prevention USPHS Scientific and Training Symposium, June 20, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

Ground Rules  This brief workshop is meant to foster open interactive dialogue regarding mental health and STD challenges facing our communities and our nation  Comments expressed during this workshop do not necessarily represent opinions of CDC or PHS  Please avoid sharing information that could jeopardize a person’s privacy or otherwise cause someone harm

Part I – Overview Part II – Audience Discussion National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention When Mental Health Impacts on STD Risk

Mental Health Is “successful performance of mental functions in terms of thought, mood and behavior.” Results in “productive activities, fulfilling relationships,… and... ability to adapt… and to cope…” Source: Mental Health: A Report of the Surgeon General, 1999.

Mental Disorders “…health conditions characterized by alterations in thinking, mood, or behavior … associated with distress and/or impaired functioning.” Reference: Mental Health: A Report of the Surgeon General, 1999.

Prevalence of Mental Disorders a decade ago Data source: Mental Health: A Report of the Surgeon General, in 5 Americans 1 in 5 Americans

Mental health disparities remain prevalent: In the general population In specific populations served by the U.S. Public Health Service In the way mental health is treated within the health system References: Safran MA, Mays RA; Huang LN, McCuan R, Pham PK, Fisher SK, McDuffie KY, Trachtenberg A. Mental Health Disparities. American Journal of Public Health. 2009, 99(11): Safran MA. Achieving recognition that mental health is part of the mission of CDC. Psychiatric Services. 2009, 60(11):

DSM IV Multiaxial Assessment Axis I - clinical disorders and other conditions Axis II - personality disorders and mental retardation Axis III - general medical conditions Axis IV - psychosocial and environmental problems Axis V - global assessment of functioning Source: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.

Some potential symptoms of Bipolar Disorder Elevated, expanded or irritable mood Grandiosity Less need for sleep More talkative Racing thoughts Distractible increased goal-directed activity (either socially, at work, or school, or sexually) or psychomotor agitation” “excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)”

Some potential symptoms of Major Depression Sadness Anhedonia Too much or too little sleep Excessive guilt Decreased energy Impaired concentration Appetite and weight changes Psychomotor changes Suicidal thoughts

Some potential symptoms of Schizophrenia Hallucinations Delusions Behavioral Disorganization Speech Disorganization Negative Symptoms

Accessing different systems of care

HIV/AIDS In 1994, the CDC National AIDS Hotline was the largest public health hotline in the world, fielding over a million calls a year Evaluation showed the Hotline was receiving mental health- related calls as part of its overall call mix Staff training needs were identified and addressed within the context of the Hotline’s role as an HIV information hotline Safran MA, Waller RR. "Mental health-related calls to the CDC National AIDS Hotline." AIDS Education and Prevention, 1996, 8, 1,

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention When Mental Health Impacts on STD Risk Part II - Audience Discussion The floor is open for audience members to share examples of situations where mental health impacted STD risk* The audience is also asked to think about potential strategies for mental health aspects of STD prevention * As a reminder, please avoid sharing information that could jeopardize a person’s privacy or otherwise cause someone harm

Closing Questions  What are three ways in which mental health and STD prevention are inter-related?  What are two strategies for promoting STD prevention via attention to mental health?  How might mental health and STD prevention be better addressed?

Thank you! Marc Safran, MD, MPA Captain, US Public Health Service Senior Medical Officer/ Senior Psychiatrist Centers for Disease Control and Prevention 1600 Clifton Road, NE, Mail Stop E-44 Atlanta, GA