HIV and Mental Health

CE / CME

Re:Mind—Making Mental Health Care an Integral Part of HIV Care

Nurses: 0.75 Nursing contact hour

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: maximum of 0.75 AMA PRA Category 1 Credit

Released: July 23, 2024

Expiration: July 22, 2025

Glenn J. Treisman
Glenn J. Treisman, MD, PhD

Activity

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Domains of Psychiatric Evaluation

Recognizing the connection between HIV and mental health conditions, some of the most important actions you can take as an HCP is to screen for and address these mental health conditions. HIV HCPs are in a prime position to screen for mental health conditions during routine patient visits.

In addition to typical items asked during a patient evaluation, it is especially important to ask specific questions when assessing a patient’s social history.

HCPs should ask questions to ascertain indicators for depression, which can include things like disrupted life course, periods of dislocation or disruption of progress, lack of finishing education, occupation changes, and partner choice.

Validated Depression Rating Scales13-17

These are rating scales commonly used in clinical practice. They can be good tools for screening for depression, but keep in mind that they were designed to rate severity of illness and assess response to treatment—they were not validated for screening.

For example, PHQ-9 was designed for patients to rate their depression. It was not designed as a screening or diagnostic tool for depression.

Nevertheless, these tools can be used to alert us to when we should explore further with a patient regarding possible depression.

Substance Use Screening Tool7

Because substance use is more common in people living with HIV, it is important to identify and manage it. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) process is a good framework for assessing substance use.

However, we should not be intimidated by any recommendations for referral to an expert. In the absence of a specialist, a psychiatrist or an infectious disease clinician can treat a person for a substance use disorder.

I have found that initiating treatment for substance use is no more complicated than treating something like hypertension, it is simply more time-consuming.

Effectiveness of SBIRT for Mental Health and Behavioral Health Conditions18

This approach of Screening, Brief Intervention, and Referral to Treatment (SBIRT) has demonstrated effectiveness in various mental and behavioral health conditions. When HCPs intervene to link a person to treatment when there is a mental or behavioral health condition present, people do better.

Screening Processes7

Screening for mental health conditions should be normalized so that it is an expected part of regular HIV care.

Although it is important to screen, this cannot be the final step in the process. There must be time allocated for both the screening for mental health conditions and creation of a treatment plan when a person screens positive.

Unfortunately, many people may be screened and found to have a mental health condition, but owing to lack of time, their condition goes untreated.

Rate your agreement: After participating in this program, I will use a standard process for regularly screening all my patients living with HIV for mental health conditions.