BASIC MENTAL HEALTH ASSESSMENT

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

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

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!

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.

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

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 ?

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

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.

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

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

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.

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”

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

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.

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.

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.

THANK YOU!!! • QUESTIONS????

BASIC MENTAL HEALTH ASSESSMENT