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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
CME/CE Information

Activity

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Course Completed

Impact of Combining HIV Treatment and Mental Health Services7

It is of utmost importance to integrate HIV and mental health care to improve patient outcomes. Per the Substance Abuse and Mental Health Services Administration, “Integrated primary HIV and behavioral health care improves physical health outcomes and leads to increased savings in healthcare costs through:

  • Reduced emergency room use
  • Increased efficiency
  • Reimbursable use of staff time.”

UNAIDS and WHO: Key Principles of Integration of Mental Health Services and HIV Care19

Integrated HIV and mental health services must incorporate:

  • A focus on human rights
  • Gender and sex equality
  • A life-course and multisectoral approach
  • Empowerment
  • People-centered services and care

Access to quality healthcare and support

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Levels of Care Integration20

There are many levels to care integration, but to me, the most important is colocalization of mental health and HIV care. When “one-stop-shopping” is accomplished, it mitigates the need for other HCPs and nonmedical staff.

People are much less likely to attend their mental health appointments if they are located somewhere other than within the clinic where they receive their HIV care. Colocation of services reduces barriers to accessing mental health care.

If everything that the person needs cannot be accomplished in a “one-stop-shop” approach, then case managers and care coordinators can be leveraged to create a simulated integrated care setting.

Other strategies, like utilizing nonmedical staff to perform mental health screenings, using a shared electronic health record, and providing annual training to improve communication between healthcare teams will be discussed below.

However, colocating HIV and mental health care services is by far the best approach to ensure timely diagnosis and follow-up.

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When designing an integrated HIV and mental health care service at your practice, which should be your top priority that will improve visit attendance for people living with HIV who are screened and referred for mental health care?

Combining Outpatient HIV and Mental Health Services: Improvements Needed1,21

Many studies have shown that when HIV and mental health care services are integrated, people living with HIV are much more likely to achieve an undetectable HIV-1 RNA level and experience significant improvements in their mental health condition.

The rates of achieving undetectable HIV-1 RNA status are dramatically higher in healthcare settings where HIV and mental health care are colocated vs in those that are not.

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Show Value in Screening and Share Positive Outcomes7,22

Being able to share successes and best practices in integrating HIV and mental health care can inspire and encourage other HCPs and health systems to do the same.

This slide shows many examples of such successes.

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Utilize Nonmedical Staff to Perform Simple Mental Health Screenings23

Utilizing nonmedical staff to perform mental health screenings can free up HCPs’ time to address the screening results and create a treatment plan.

One of the biggest limitations to HCPs acting on a new mental health diagnosis is time, so we need to do a better job of leveraging resources that create additional time for the HCP to create a care plan.

This study of 19 case managers trained across 4 hospitals shows that this approach can work. In people living with HIV, they screened quarterly for mental health conditions, leading to confirmatory diagnoses.

In cases like this, it is important that the linkage to care is facilitated following a positive screening because even though it is helpful to identify people with mental health conditions, the act of identifying them does not improve visit attendance when referred for care.

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Ensure That Referrals Are Followed Through7

Similar to how screening is not effective when not followed up with a treatment plan, referrals to mental health HCPs are not effective when not followed through.

Ideally, HIV care and mental health care will take place in the same physical location to improve receipt of mental health care when referred.

Other ways to ensure follow through include:

  • Recognizing that not every integrated HIV and mental health service has access to every behavioral healthcare need
    • Create formal partnerships with external entities when possible
  • Providing warm handoffs when possible
  • Utilizing support staff (eg, health educator, case manager, peer/patient navigator) for activities like filling out paperwork and securing transportation

Foster Collaboration7

Collaboration between the patient’s primary HCP and their mental health HCP is key to achieving positive patient outcomes. Communication should be timely and, when feasible, in-person for optimal impact.

Communication through a common electronic health record can be helpful too, though is not a substitute for things like warm handoffs to increase visit rate attendance when people with HIV are referred for mental health care.

Similarly, annual training is important for improving and maintaining good communication, but components of care integration like having colocated care are critical for ensuring that people identified as having mental health conditions follow up with their referral to care.

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Facilitate Communication and Obtain Key Stakeholder Buy-in7

Support from key stakeholders can be crucial to the success of integrated HIV and mental health care. Even when an HCP knows it is the best thing to do for patient care, it often takes additional staff and resources to make the integrated care environment come to fruition.

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Take-home Points

HIV and mental health conditions frequently coexist, and all people living with HIV should be screened for mental health conditions.

Integration of HIV and mental health care is key to ensure appropriate follow-up and treatment of each. Nonmedical staff can be utilized for support of mental health condition screenings, referrals, and appointment assistance.

If a referral to a mental health service or HCP is necessary, it is critical that the referral is followed through. Colocation of HIV care and mental health care can substantially improve follow-up rates.

Rate your agreement: I prioritize discussing and offering mental health treatment at all HIV care appointments.

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