1. BY: SHAREEN BOOMGAARD PROFESSIONAL NURSE LUTHANDO CLINIC CHRIS HANI BARAGWANATH HOSPITAL BASIC MENTAL HEALTH ASSESSMENT

2. MENTAL ILLNESS & HIV Because HIV affects the brain  It has effects on mental health MOOD EMOTIONS THINKING BEHAVIOUR Can all be affected!

3. MENTAL ILLNESS IN HIV Mental illness is more common in HIV The mentally ill are more likely to contract HIV due to the nature of their illness  These patients have stressors e.g. money, relationships, stigma  The direct effect of HIV on the brain  Medication they take for HIV or TB have mental side-effects  They are more likely to engage in risky sexual behaviours  Substance Abuse  Their ability to make good decisions and choices are affected!

4. MENTAL ILLNESS IN HIV STIGMA is a negative/bad thought that you or others may have about you These patients’ have to deal with a “DOUBLE STIGMA”  HIV and mental illness - This may hinder access to HIV clinics for HAART - This may result in poor adherence, hence viral resistance This is why it is important to be able to identify patient’s with mental disorders so that they can be referred for help.

5. CONFIDENTIALITY When you enquire about someone’s mental health you need to at all times take into consideration the importance of confidentiality. You are in a unique position to receive personal and private information about the patient. You need to respect this by not sharing it with anyone except another health professional so that their condition can be managed properly

6. IN GENERAL… People working with HIV + patients need to be aware that these patients can present with psychiatric/mental illness. In your everyday encounters with people we usually make assessments automatically How is he/she dressed? Is he/she clean and looking after themselves Does the person look worried or sad ? Agitated? Nervous Suspicious? Aggressive ?

7. BAD MOOD vs ILLNESS It is usual for any particular person to have changes in mood, within one day, and every few days depending on the events, happenings, stressors, etc at the time. NORMAL BIRTHDAYPAYDAYHOLIDAY NORMAL MONDAYARGUMENT

8. MOOD DISORDERS DEPRESSION - With a depressive disorder the mood stays low for many days – weeks. - It is worse than usual and affects the patient’s ability to carry out their daily activities normally. You need to ask how the patient has been feeling lately, and also notice whether or not the person’s body language seems to match what he/she is saying.

9. DEPRESSION SYMPTOMS OF DEPRESSION - Sadness - Loss of interest/pleasure - Disturbed sleep - Disturbed appetite/ change in weight - Poor concentration - Tiredness - Guilty feelings - Suicidal thoughts

10. When to refer? When symptoms are severe Eg: not eating/drinking at all or suicidal Since depression symptoms are similar to the physical symptoms of HIV eg loss of weight, tiredness  The differentiation between the two needs to be made. If unsure  refer for an assessment

11. THE SUICIDAL PATIENT - There are times in an HIV + patients life when they feel like they have no hope left to live Eg: when they find out about their HIV status. when their loved one dies from HIV when their CD 4 count drops when they are diagnosed with TB or cancer ASK THE PATIENT: How do you feel? Do you feel that life is not worth living? Do you have thoughts of wanting to kill yourself? Do you have a plan to kill yourself? When someone is suspected of being suicidal, it is ALWAYS NECESSARY to refer them to a mental health nurse or doctor.

12. THOUGHTS Getting to know what the patient spends time thinking about provides a window into the mind Negative thoughts may suggest depression On the other hand… Thoughts may be jumbled up or be about things that cannot be true e.g.he is an alien. The patient may have odd/unusual experiences eg. Hearing voices or they have been speaking to themselves These would indicate that the person is PSYCHOTIC = “out of touch with reality”

13. COGNITION This is our ability to think, remember, understand and organize information. Patients living with HIV/AIDS are at risk of developing problems with these functions This is called HIV Dementia They usually struggle with everyday activities, like cooking, cleaning, or taking medication

14. HIV DEMENTIA It is useful to take note when the patient has clear difficulties in paying attention, not being able to remember questions or other facts, and has slow thinking ASK YOURSELF: Does thinking seem slow? Is the person able to concentrate? Does the memory seem impaired - Refer these patients for a specialized assessment as HIV Dementia is a WHO stage IV condition and the patient qualifies for HAART.

15. SUBSTANCE ABUSE ALCOHOL When people are drunk, or under the influence of drugs, they are more likely to take risks which put them at risk of contracting HIV, or spreading it. When patients are intoxicated they forget to take their ARV’s and other important medication and this prevents them from becoming well Substance abuse can lead to anxiety, depression and psychosis.

16. CONCLUSION If you identify mental health problems in a patient  referral to a clinic sister or doctor is the next step REMEMBER: Patients are less likely to admit to having mental disturbances. We need to make them feel comfortable enough to open up to us. We need to have a non-judgemental attitude and gain their trust. This would help us to get them the help they need.

17. THANK YOU!!! QUESTIONS????