BASIC MENTAL HEALTH ASSESSMENT

BY: SHAREEN BOOMGAARDPROFESSIONAL NURSELUTHANDO CLINICCHRIS HANI BARAGWANATH HOSPITALBASIC MENTAL HEALTH ASSESSMENTMENTAL ILLNESS & HIVBecause HIV affects the brainIt has effects on mental healthMOODEMOTIONSTHINKINGBEHAVIOUR

Can all be affected!

MENTAL ILLNESS IN HIVMental illness is more common in HIVThe mentally ill are more likely to contract HIV due to the nature of their illnessThese patients have stressors e.g. money, relationships, stigmaThe direct effect of HIV on the brainMedication they take for HIV or TB have mental side-effectsThey are more likely to engage in risky sexual behavioursSubstance Abuse Their ability to make good decisions and choices are affected!

MENTAL ILLNESS IN HIVSTIGMA is a negative/bad thought that you or others may have about youThese patients have to deal with a DOUBLE STIGMA HIV and mental illnessThis may hinder access to HIV clinics for HAARTThis may result in poor adherence, hence viral resistanceThis is why it is important to be able to identify patients with mental disorders so that they can be referred for help.

CONFIDENTIALITYWhen you enquire about someones 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 GENERALPeople 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 automaticallyHow is he/she dressed?Is he/she clean and looking after themselvesDoes the person look worried or sad ?Agitated?NervousSuspicious?Aggressive ?

BAD MOOD vs ILLNESSIt 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.

NORMALBIRTHDAY PAYDAYHOLIDAY NORMALMONDAYARGUMENTMOOD DISORDERSDEPRESSIONWith a depressive disorder the mood stays low for many days weeks.It is worse than usual and affects the patients 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 persons body language seems to match what he/she is saying.

DEPRESSIONSYMPTOMS OF DEPRESSIONSadnessLoss of interest/pleasureDisturbed sleepDisturbed appetite/ change in weightPoor concentrationTirednessGuilty feelingsSuicidal thoughts

When to refer?When symptoms are severeEg: not eating/drinking at all or suicidalSince depression symptoms are similar to the physical symptoms of HIV eg loss of weight, tirednessThe differentiation between the two needs to be made.If unsure refer for an assessment

THE SUICIDAL PATIENTThere are times in an HIV + patients life when they feel like they have no hope left to liveEg: 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 cancerASK 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.

THOUGHTSGetting to know what the patient spends time thinking about provides a window into the mindNegative thoughts may suggest depressionOn the other handThoughts 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 themselvesThese would indicate that the person is PSYCHOTIC= out of touch with reality

COGNITIONThis is our ability to think, remember, understand and organize information.Patients living with HIV/AIDS are at risk of developing problems with these functionsThis is called HIV DementiaThey usually struggle with everyday activities, like cooking, cleaning, or taking medication

HIV DEMENTIAIt 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 thinkingASK 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 ABUSEALCOHOLWhen 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 ARVs and other important medication and this prevents them from becoming wellSubstance abuse can lead to anxiety, depression and psychosis.

CONCLUSIONIf you identify mental health problems in a patient referral to a clinic sister or doctor is the next stepREMEMBER: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????