Evaluation of Community-Based Mental Health Support Services for
People Living with HIV
Recent advances in the treatment of HIV/AIDS have slowed AIDS death rates
and the progression of disease for many individuals. This opportunity for
improved health presents new challenges for people living with HIV and AIDS,
as individuals must maintain strict adherence to complicated treatment regimens
in order to benefit from the new therapies. However, adherence to treatment
can be supported by a relatively stable lifestyle, a good understanding
of the impact of different medications, and strong life management skills.
Adherence is also enhanced by the ability to adapt to changes that arise
as a result of medication side effects, other health issues, or challenging
social and personal circumstances.
For some individuals living with HIV or AIDS, mental health problems stand
directly in the path of seeking treatment to begin with, or adhering to
treatment once prescribed. The availability of mental health and support
services can have an important impact on the ability to access and adhere
to complicated treatment regimes. At the same time, there is a growing recognition,
documented by local and national needs assessments, that mental health services
constitute the largest growing area of unmet need among people living with
HIV and their families.
Furthermore, a large percentage of individuals with significant mental health
issues also have a substance abuse disorder. Traditionally trained mental
health clinicians generally are not able to address the needs of this triply
diagnosed population – people with HIV/AIDS, mental health disorders,
and substance abuse disorders. For example, many mental health clinics and
clinicians require that an individual be substance-free before providing
treatment for the mental health issues.
Recognizing these barriers and the importance of addressing them, the HIV/AIDS
Bureau at the Massachusetts Department of Public Health funded five mental
health/HIV pilot projects in 1998. These pilot projects were designed to
offer non-traditional mental health services to people living with HIV and
AIDS. The goal was to provide clinically appropriate and culturally sensitive
mental health services that would assist individuals in alleviating the
impact of mental health stressors on physical health status, increase their
ability to access and adhere to complicated treatment regimes, and better
enable them to negotiate changing life circumstances.
These programs were specifically directed to:
• Support capacity not reimbursed by Medicaid and other insurers;
• Engage hard-to-reach clients;
• Show alternative, creative approaches to providing mental health
services to people living with HIV and AIDS;
• Provide short-term mental health supports rather than long term
mental health services;
• Use trained, master's-level mental health clinicians to provide
care;
• Demonstrate a flexible delivery model and provide care in a wide
range of settings;
• Link to existing HIV services in the community; and
• Develop a referral capacity for services beyond the immediate or
short-term interventions of the programs.
In 2000, two of the five programs were awarded continued funding for an
additional two years; a third received continuation funding through a Centers
for Disease Control grant awarded to the Department.
The HDWG is serving as the evaluator of the DPH pilot mental health projects.
Key evaluation staff included Mari-Lynn Drainoni, Ph.D., Senior Evaluator
and Karin Haberlin, M.A., Project Manager, and Réginalde Gerlus,
M.P.H., Research Analyst.
National Evaluation and Program Support Center to conduct a multi-site evaluation of outreach activities designed to engage and retain individuals with HIV in medical care. Funded by Health Resources and Services Administration
A national evaluation of peer education training programs for people living with HIV.
A National Center working to advance the Healthy People 2010 objective that all children with special health care needs have access to adequate health insurance and financing for their care.
A cross-disciplinary training curriculum in HIV and substance abuse, designed for health care providers, support service providers and substance abuse treatment providers.