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HIV Mental Health Care
Making Mental Health Care an Integral Part of HIV Care

Released: June 07, 2024

Expiration: June 06, 2025

Chelsea Gulden
Chelsea Gulden, MSW
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • HIV and mental health conditions frequently coexist.
  • The process to access mental health care services should be simplified, destigmatized, and incorporated into preventive care services.

My Story
I was diagnosed with HIV—at the same time found out I was pregnant—when I was 20 years old and starting my senior year of college. At the time, I was exiting a long-term relationship with a partner I lived with, and I did not have many friends. I felt incredibly broken and isolated but, fortunately, I connected with a therapist almost immediately.

My experience with mental health care up to that point was that of a bullheaded teenager whose mother wanted them to go to therapy. Because of this, mental health care felt like a punishment to me. Entering therapy when I was 20 felt doubly stigmatized both because of my past experience and because of the stigma of having HIV. Luckily, I found an amazing therapist who helped me on my road to acceptance of my diagnosis.

I am now a medical social worker, and because of my positive experience with receiving mental health care, I have become an advocate for linking people living with HIV to mental health care.

Connecting With a Mental Health Care Provider
As a patient, I think finding someone whom you feel comfortable with, where you can be open and not feel judged, is so important. If you are not comfortable, you are not going to get the care that you need.

Sometimes it takes time to find the right mental health care professional, so it is important to help people stay encouraged if their first experience is not what they wanted it to be. When that happens, I encourage people to try a different mental health care professional and keep trying until they find the professional who fits their needs.

Breaking Down Barriers

Avoid Stigmatizing Language
I have trained my staff to avoid asking stigmatizing questions like “Do you want a mental health care referral?” or “Do you think you are depressed?” These questions can be triggering and can turn people away from seeking the mental health care that they need. Instead, I encourage conversations like: “Do you want to talk with someone once a week? We have someone who can call you once a week, and you can talk to them about whatever is important to you.”

It is important to meet the patient where they are and approach the conversation about mental health care in a way that is nonstigmatizing. In healthcare, it can be easy to let electronic health records or checklists drive mental health referrals in a sterile, nonpersonal way, but we need to make sure that we are using the right language when linking people to mental health care.

Peer and Patient Navigators
Peer and patient navigators can be hugely helpful in linking people with—and helping them persist in—mental health care. Peer-based navigators can help overcome stigmas associated with both HIV and mental health conditions. Clinic-based navigators can assist with things like making sure insurance is covering the mental health services being accessed, making sure necessary paperwork has been completed, and arranging transportation to appointments.

Mental Health Care as Preventive Care
I think it’s beneficial from a healthcare provision and healthcare insurance standpoint to view mental health care like we view preventive care.

There may be some upfront costs and time associated with providing mental health care, but the downstream benefits to the patient and the healthcare system are huge. It is less expensive to treat someone in the outpatient setting than to treat someone in the intensive care setting after an uncompleted suicide attempt. We should view this as analogous to why we treat blood pressure and manage hypertension in the outpatient setting to avoid someone having a heart attack or stroke and ending up in the hospital.

Also, treating mental health conditions helps with adherence to HIV management. If someone is depressed, they may miss medical appointments and stop taking their antiretrovirals. And if their viral load increases and they go from being undetectable to detectable, there are detrimental consequences to their health, as well as the risk of passing their infection to another person through unprotected sex.

Conclusions
As both a person living with HIV and an advocate, I have first-hand experience with the importance of connecting people living with HIV to mental health care services—as well as the positive outcomes. I think that the process to access mental health care services should be simplified, destigmatized, and incorporated into preventive care services.

Your Thoughts?
How do you approach connecting your patients who are living with HIV to mental health care services? Join the discussion by posting a comment.