Mental Health Status of HIV Patients Often Ignored
Nov. 3, 1999 (New Orleans) -- It was early in the AIDS epidemic when Marshall Forstein, MD, now a medical director of the Fenway Community Health Center in Boston, came to realize that people with HIV and mental illness were doubly stigmatized. "The first two decades of the epidemic, mental health was kind of seen as a luxury item. It wasn't seen as an integral part of primary assessment and treatment," says Forstein
In 1981, Forstein was working at Massachusetts General Hospital when he treated a psychotic man with AIDS that his colleagues were unwilling to treat. "It became very clear that this was an area that needed attention," Forstein tells WebMD.
In fact, Forstein believes that still more attention should be lavished on this issue today. He and his colleague Francine Cournos, MD, a professor at Columbia University in New York, made their case recently at the 51st Institute on Psychiatric Services of the American Psychiatric Association (APA). They say that although it may not be obvious, HIV/AIDS is very much a mental disorder.
HIV can affect mood, memory, how information is processed in the brain, and a person's ability to function. Once the virus is in the brain, Forstein says, it can create a type of dementia. Other symptoms of mental illness are also common.
With all the issues confronting a patient with HIV, including substance abuse, properly comprehending his or her mental functioning and mood is a challenge. "There's been a real problem with primary care physicians [not] recognizing the extent of cognitive impairment in patients," says Forstein. He also says as many as 50% of HIV-positive patients are taking antidepressants.
What Forstein and Cournos want to do is reach primary care physicians with the message that there's more to caring for those with HIV than simply passing out anti-HIV/AIDS drugs. Cournos tells WebMD that people have to feel safe enough with their doctors to say if and why they're not taking their medication properly.
While taking additional time with patients to address their mental health costs more, Forstein and Cournos say there's a big payoff. For instance, a little counseling can make a tremendous difference in whether or not a patient stays on his drugs.
Forstein says that insurers need to understand the value of these mental health services. "The reality here is that health insurance companies are the barrier in many cases to providing these adequate services. Because we can't bill for a lot of the support services that we need," he says.
Cournos and Forstein are working on an APA task force to develop new guidelines to treat HIV positive patients with mental illness. A final version should be ready next year.