Mental block
This summer a group of eminent psychiatrists demanded that mental health be
given a bigger role in HIV and Aids care in developing countries. Outlining
their demands to the World Health Organisation, these doctors listed no fewer
than five distinct HIV-related mental health problems common to people with
HIV. Isolation caused by stigma and discrimination; the psychiatric effects
of some HIV drugs; substance misuse; depression and anxiety caused by the
effect of HIV on people’s lives and cognitive impairment caused by HIV
infection were all on the list. I imagine few readers will be able to complete
this list without mentally ticking at least one of these. Not surprising when
you think about what people living with HIV have to deal with. And this is
not just supposition. Time after time studies show that people living with
HIV suffer at least double the rates of depression and anxiety found in the
general population. But with their eyes fixed on the developing world, many
psychiatrists and mental health experts fail to see that here in the UK we
are also failing the
mental health needs of people living with HIV. Only last week a friend told
me that you had to be “near suicidal” to get a referral to the
specialist mental health service linked to his HIV clinic. And when Chelsea
and Westminster Hospital faced budget cuts earlier this year it was the specialist
mental health service, accessed by many people with HIV, first in line for
the chop (until activists forced them to back down). And I cannot count the
number of times people have told me how badly they have been let down by both
acute and community mental health services that are ill-equipped to deal with
HIV positive people and their specific needs.
Of course, some clinics buck the trend (I am reliably informed that Brighton
is one of these). But much of the time HIV positive people are left to cope
alone with yet another highly stigmatising condition. Many are still nervous
or distrustful about trying to access counselling or therapies through
their GP who many not even know their HIV status. October 10 is World Mental
Health Day and to mark it this month’s issue explores the complex relationship
between mental health, sex, depression, medication and living well with
HIV. Surely there can also be no better time for the NHS to take proper stock
of its mental health services and the quality of the provision people with
HIV with a view to making them more responsive and effective? While a national
network of HIV-specific specialist mental health services across the UK is
probably a pipe-dream, training mental health professionals to be more HIV-friendly
and more HIV-aware is not.
Amanda Elliot, managing editor
