Outcomes of an inner-city HIV mental health programme integrated with primary care and emphasizing cultural responsiveness

Abstract

Effectiveness of HIV-related mental health practice in inner cities has not been adequately documented despite an urgent need for interventions for populations disproportionately affected by the epidemic. Practices must take into account and respond to cultural issues of people of colour and the needs of those infected through injection drug use or heterosexual sex with IDUs. We report the effectiveness of an HIV mental health programme integrated with primary care and emphasizing cultural responsiveness. A sample of 47 of 188 patients who received psychiatric and psychotherapy services was compared with other subjects. The 47 had an average of 8.34 encounters over an average of 36.23 weeks. Consumers of project services used mental health care at a higher rate than did comparison subjects. Regression analyses indicated that utilization was related to reduction in reported mental health problems, HIV-related physical symptoms, and use of alcohol and powdered cocaine, as well as to improvement in social functioning. Our clients, individuals often viewed as not likely to avail themselves of or benefit from mental health care, were highly motivated for self-improvement and, given access to competent, convenient and culturally respectful services, improved their well-being in significant domains.

Interventions and approaches to integrating HIV and mental health services: a systematic review

“…In terms of treatment modalities, 6 out of the 20 studies involved interventions that integrated HIV and mental health services (Farber et al 2014, Feldman et al 2012, Harris and Williams 1995, Hyam et al 2012, Feingold and Slammon 1993, Nakimuli-Mpungu et al 2014. In five other studies, the process was part of a larger package of integration with other services, including general primary health care (PHC) (Coleman et al 2012, Winiarski et al 2005 obstetrics and gynaecology (O&G) services (Dodds et al 2004), risk reduction interventions (Namata Mbogga Mukasa et al 2014), TB services (Jonsson et al 2011) and non-communicable disease screening and treatment services (Namata Mbogga Mukasa et al 2014). Three studies involved interventions that integrated HIV, mental health and substance abuse services within a HIV clinic setting (Surah 2013, Vergara-Rodriguez et al 2012, Esposito-Smythers et al 2014 while six others involved integration with primary health care (Cohen et al 2011, Dillard et al 2010, Wood 2008, Hepatitis C treatment (Tetrault et al 2012), risk reduction interventions (Nebelkopf and Penagos 2005) and specialist services (Kobayashi and Standridge 2000) in a single site.…”

“…16 were full papers and four were conference abstracts (Namata Mbogga Mukasa et al 2014, Surah 2013, Cohen et al 2011, Vergara-Rodriguez et al 2012. Of these, there were eight descriptive studies (Feingold and Slammon 1993, Dillard et al 2010, Dodds et al 2004, Harris and Williams 1995, Kobayashi and Standridge 2000, Namata Mbogga Mukasa et al 2014, Wood 2008, Jonsson et al 2011, four cohort studies (Farber et al 2014, Nebelkopf and Penagos 2005, Vergara-Rodriguez et al 2012, Esposito-Smythers et al 2014, three retrospective record reviews (Coleman et al 2012, Cohen et al 2011, Feldman et al 2012, two non-randomized intervention studies (Winiarski et al 2005, Surah 2013), one RCT (Tetrault et al 2012), one mixed-methods study (Hyam et al 2012), and one qualitative study (Nakimuli-Mpungu et al 2014). In terms of treatment modalities, 6 out of the 20 studies involved interventions that integrated HIV and mental health services (Farber et al 2014, Feldman et al 2012, Harris and Williams 1995, Hyam et al 2012, Feingold and Slammon 1993, Nakimuli-Mpungu et al 2014.…”

“…The heterogeneity of the study locations indicates that this model of integration has been implemented in a wide range of different settings; although most commonly, services were integrated within primary care clinics (Farber et al 2014, Harris and Williams 1995, Feingold and Slammon 1993, Winiarski et al 2005, Dodds et al 2004 or in a HIV clinic (Coleman et al 2012, Namata Mbogga Mukasa et al 2014, Jonsson et al 2011, Esposito-Smythers et al 2014, Surah 2013, Vergara-Rodriguez et al 2012, Wood 2008, Tetrault et al 2012, Kobayashi and Standridge 2000. In six of the studies in these settings, mental health services comprised of specialized psychiatric liaison services or consultative treatment (Coleman et al 2012, Harris and Williams 1995, Kobayashi and Standridge 2000, Surah 2013, Hyam et al 2012, Vergara-Rodriguez et al 2012.…”

“…Four studies described that care coordination was implemented through regular case conferences bringing together members of the multidisciplinary team (Nebelkopf and Penagos 2005, Winiarski et al 2005, Wood 2008, Kobayashi and Standridge 2000, while in one case, individual discussions, voicemails and shared medical notes were used as additional means to coordinate care (Winiarski et al 2005). One study described an internal referral system to facilitate interdepartmental care coordination (Feldman et al 2012).…”

“…Of the 45 papers, only two studies described integrating HIV services within existing mental health services (Rosenberg et al 2010, Lemmon andShuff 2001) while in the remaining papers, mental health and/or substance abuse services were integrated within existing HIV services. In 10 of these papers, these services were integrated in primary care settings (Farber et Williams 1995, Winiarski et al 2005, Feingold and Slammon 1993, Wolfe et al 2003, Zaller et al 2007, Wright and Shuff 1995, Esposito-Smythers et al 2014, Nebelkopf and Penagos 2005, Dodds et al 2004). …”