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Evaluation
of Community-Based Mental Health Support Services for People Living
with HIV
Recent advances in the treatment of HIV/AIDS have slowed AIDS death
rates and the progression of disease for many individuals. This
opportunity for improved health presents new challenges for people
living with HIV and AIDS, as individuals must maintain strict adherence
to complicated treatment regimens in order to benefit from the new
therapies. However, adherence to treatment can be supported by a
relatively stable lifestyle, a good understanding of the impact
of different medications, and strong life management skills. Adherence
is also enhanced by the ability to adapt to changes that arise as
a result of medication side effects, other health issues, or challenging
social and personal circumstances.
For some individuals
living with HIV or AIDS, mental health problems stand directly in
the path of seeking treatment to begin with, or adhering to treatment
once prescribed. The availability of mental health and support services
can have an important impact on the ability to access and adhere
to complicated treatment regimes. At the same time, there is a growing
recognition, documented by local and national needs assessments,
that mental health services constitute the largest growing area
of unmet need among people living with HIV and their families.
Furthermore,
a large percentage of individuals with significant mental health
issues also have a substance abuse disorder. Traditionally trained
mental health clinicians generally are not able to address the needs
of this triply diagnosed population – people with HIV/AIDS, mental
health disorders, and substance abuse disorders. For example, many
mental health clinics and clinicians require that an individual
be substance-free before providing treatment for the mental health
issues.
Recognizing
these barriers and the importance of addressing them, the HIV/AIDS
Bureau at the Massachusetts Department of Public Health funded five
mental health/HIV pilot projects in 1998. These pilot projects were
designed to offer non-traditional mental health services to people
living with HIV and AIDS. The goal was to provide clinically appropriate
and culturally sensitive mental health services that would assist
individuals in alleviating the impact of mental health stressors
on physical health status, increase their ability to access and
adhere to complicated treatment regimes, and better enable them
to negotiate changing life circumstances.
These programs
were specifically directed to:
- Support capacity
not reimbursed by Medicaid and other insurers;
- Engage hard-to-reach
clients;
- Show alternative,
creative approaches to providing mental health services to people
living with HIV and AIDS;
- Provide short-term
mental health supports rather than long term mental health services;
- Use trained,
master’s-level mental health clinicians to provide care;
- Demonstrate
a flexible delivery model and provide care in a wide range of
settings;
- Link to existing
HIV services in the community; and
- Develop a
referral capacity for services beyond the immediate or short-term
interventions of the programs.
In 2000, two of
the five programs were awarded continued funding for an additional
two years; a third received continuation funding through a Centers
for Disease Control grant awarded to the Department.
The
HDWG is serving as the evaluator of the DPH pilot mental health
projects. Key evaluation staff included Mari-Lynn
Drainoni, Ph.D., Senior Evaluator and Karin Haberlin, M.A.,
Project Manager, and Réginalde
Gerlus, M.P.H., Research Analyst.
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