HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP): What mental health providers should know

2016 ◽  
Vol 33 (S1) ◽  
pp. S70-S71
Author(s):  
T. Hall
Keyword(s):  
Mental Health ◽  
Risk Reduction ◽  
Hiv Risk ◽  
Undetectable Viral Load ◽  
Developed Countries ◽  
The United States ◽  
Treatment As Prevention ◽  
Mental Health Providers ◽  
Health Providers ◽  
Exposure Prophylaxis

Pharmacologic methods of treating and preventing HIV have advanced tremendously in recent years. Understandings of HIV risk and recommendations for risk-reduction strategies have also changed substantially. A majority of new cases of HIV in many developed countries are now acquired through sex with long-term partners who are unaware of their HIV-positive status, rather than from casual or anonymous sexual encounters. Persons with bipolar disorder and substance use disorders are at particularly high risk. Mental health providers who work with LGBT persons and other populations at higher risk for HIV need to understand strategies their patients are using for HIV risk reduction, and to refer appropriate patients for consideration for pre-exposure prophylaxis (PrEP). PrEP is the daily use of an antiretroviral (ARV) medication for prevention of HIV infection in higher-risk individuals. The United States approved tenofovir + emtracitabine for PrEP in 2012; this is under review in several European countries, Canada, and Australia, and is already prescribed off-label in many. Additionally, studies have shown that treatment with ARV medications to an “undetectable viral load” greatly reduces the risk of further transmission by persons already infected with HIV, called “treatment as prevention” (TasP). As of September 2015, WHO recommends early ARV treatment for all persons with HIV, and consideration of PrEP for men who have sex with men. This paper reviews findings from the PrEP studies (especially iPrEx, iPrEx Ole, IPERGAY, and PROUD) and TasP, and looks at their impact on LGBT and HIV+ communities, with relevance for mental health providers.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals An mHealth Intervention to Improve Young Gay and Bisexual Men’s Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context (Preprint)

2017 ◽  
Author(s):  
Corina Leluțiu-Weinberger ◽  
Monica Manu ◽  
Florentina Ionescu ◽  
Bogdan Dogaru ◽  
Tudor Kovacs ◽  
...  
Keyword(s):  
Mental Health ◽  
Identity Development ◽  
Risk Reduction ◽  
Hiv Risk ◽  
Behavioral Skills Training ◽  
Skills Training ◽  
The United States ◽  
Large Trial ◽  
Hiv Risk Reduction ◽  
And Bisexual

BACKGROUND Young gay and bisexual men (YGBM) in some Eastern European countries, such as Romania, face high stigma and discrimination, including in health care. Increasing HIV transmission is a concern given inadequate prevention, travel to high-prevalence countries, and popularity of sexual networking technologies. OBJECTIVE This study aimed to adapt and pilot test, in Romania, a preliminarily efficacious mobile health (mHealth) HIV-prevention intervention, created in the United States, to reduce HIV risk among YGBM. METHODS After an intervention formative phase, we enrolled 43 YGBM, mean age 23.2 (SD 3.6) years, who reported condomless sex with a male partner and at least 5 days of heavy drinking in the past 3 months. These YGBM completed up to eight 60-minute text-based counseling sessions grounded in motivational interviewing and cognitive behavioral skills training with trained counselors on a private study mobile platform. We conducted one-group pre-post intervention assessments of sexual (eg, HIV-risk behavior), behavioral (eg, alcohol use), and mental health (eg, depression) outcomes to evaluate the intervention impact. RESULTS From baseline to follow-up, participants reported significant (1) increases in HIV-related knowledge (mean 4.6 vs mean 4.8; P=.001) and recent HIV testing (mean 2.8 vs mean 3.3; P=.05); (2) reductions in the number of days of heavy alcohol consumption (mean 12.8 vs mean 6.9; P=.005), and (3) increases in the self-efficacy of condom use (mean 3.3 vs mean 4.0; P=.01). Participants reported significant reductions in anxiety (mean 1.4 vs mean 1.0; P=.02) and depression (mean 1.5 vs mean 1.0; P=.003). The intervention yielded high acceptability and feasibility: 86% (38/44) of participants who began the intervention completed the minimum dose of 5 sessions, with an average of 7.1 sessions completed; evaluation interviews indicated that participation was rewarding and an “eye-opener” about HIV risk reduction, healthy identity development, and partner communication. CONCLUSIONS This first mHealth HIV risk-reduction pilot intervention for YGBM in Eastern Europe indicates preliminary efficacy and strong acceptability and feasibility. This mobile prevention tool lends itself to broad dissemination across various similar settings pending future efficacy testing in a large trial, especially in contexts where stigma keeps YGBM out of reach of affirmative health interventions.

Systematic Reviews of Clinical of Acupuncture as Treatment for Depression:How Systematic and Accurate Are They?

CNS Spectrums ◽  
2008 ◽  
Vol 13 (4) ◽  
pp. 293-300 ◽  
Author(s):  
Uriel Halbreich
Keyword(s):  
Mental Health ◽  
United States ◽  
Medical Education ◽  
Affective Disorders ◽  
The United States ◽  
Treatment Seeking ◽  
Mental Health Providers ◽  
Health Providers ◽  
Education Programs ◽  
Number Of Patients

Complementary and alternative medicine (CAM) is very popular in the United States, Canada and other Western societies, and the number of patients seeking treatment by CAM practitioners is increasing. This trend also affects treatment-seeking patients with affective disorders. Many patients and mental health providers update their information and formulate opinions and decisions based on second-hand digested summaries and scientific reviews of the literature. This results in the proliferation of review articles and journals that are exclusively dedicated to reviews. Since most medical schools do not teach CAM and most continuing medical education programs still ignore these subjects, it is of interest to examine the reliability of reviews that claim to be “systematic” and not to take their procedures and conclusions for granted.

Islam and mental health

2021 ◽  
pp. 183-200
Author(s):  
Ahmed Okasha ◽  
Tarek A. Okasha
Keyword(s):  
Mental Health ◽  
Belief Systems ◽  
Developed Countries ◽  
Mental Health Providers ◽  
Health Providers ◽  
Religious Thought ◽  
Mental Health And Illness ◽  
The World ◽  
Health And Illness ◽  
Scientific Base

Psychiatry is the branch of medicine that most prominently incorporates the humanities and social sciences in its scientific base and in its treatment of illness. Psychiatry has often needed to go well beyond the world of natural science into the philosophical realm. Psychiatry and religion both draw upon rich traditions of human thought and practice. Mental health providers in developed countries are increasingly treating patients whose backgrounds are very different from their own, so it is important for them to understand cultural belief systems including religious thought and practice that relate to mental health and illness. Psychiatry and religion are parallel and complementary frames of reference for understanding and describing the human experience and human behaviour.

scholarly journals Implementation Strategies to Promote Measurement-Based Care in Schools: Evidence from Mental Health Experts Across the United States

2021 ◽  
Author(s):  
Elizabeth H Connors ◽  
Aaron R Lyon ◽  
Kaylyn Garcia ◽  
Corianna Sichel ◽  
Sharon Hoover ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Implementation Strategies ◽  
Health Service Delivery ◽  
The United States ◽  
Mental Health Providers ◽  
Health Providers ◽  
Mental Health Service Delivery ◽  
Measurement Based Care ◽  
Patient Reported

Abstract Background: Despite an established, comprehensive taxonomy of implementation strategies, minimal guidance exists for how to select and adapt strategies to specific services and contexts. We employed a replicable method to identify the most feasible and important implementation strategies to increase mental health providers’ use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments. Methods: A national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on “go-zone” graphs and compared across providers and researchers to identify top-rated strategies. Results: The initial 33 strategies were rated as “relevant” or “relevant with changes” to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; importance ratings (3.61 - 4.48) were higher than feasibility ratings (2.55 – 4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: 1) assess for readiness and identify barriers and facilitators; 2) identify and prepare champions; 3) develop a usable implementation plan; 4) offer a provider-informed menu of free, brief measures; 5) develop and provide access to training materials; and 6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, and providers reported higher feasibility of train-the trainer approaches than researchers; researchers reported higher importance of monitoring fidelity than providers. Conclusions: The education sector is the most common setting for child and adolescent mental health service delivery in the United States. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents and their families. This empirically-derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.

scholarly journals Governance of Protecting Patients

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S126-S126
Author(s):  
Sureshkumar Bhatt
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
The United States ◽  
Involuntary Commitment ◽  
Mental Health Providers ◽  
Health Providers ◽  
Legal Structure ◽  
Protective Custody

AimsInvoluntary commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into inpatient or outpatient treatment. These criteria vary between nations. The goal of this presentation is to compare the governance of protecting patients among different parts of the world.BackgroundUnderstanding the relevance of the judicial committeemen in psychiatry is an essential part of good psychiatric practice. A majority of patients who need inpatient psychiatric treatment fall into one of the following categories: dangerous to self, dangerous to others, or gravely disabled.In the United States, the Parens Patriate doctrine has had great application in the treatment of mentally ill persons, children, and other individuals who are legally incompetent to manage their affairs. The states, which act as parens patriae, can make decisions regarding mental health treatment. State law governs involuntary commitment, and procedures may vary among states.MethodOne of the essential duties of St. Tammany Parish Coroner Office, Louisiana, USA is Mental Health Service, From January 2017 to October 2019, 887 Order of Protective Custody (OPC), 17,838 Physician Emergency Certificates (PEC), and 13096 Coroner Emergency Certificates (CEC) were issued. These certificates allow legal authority to transport a patient to the nearest ER for assessment by physician and mental health providers.ResultPatients with active Physician Certificate are examined by a coroner according to patient's mental history and clinical presentation. Coroner Certificate helps the treatment facilty detail the patient for diagnosis and treatment for fifteen days.ConclusionSt. Tammany Parish Coroner Office is fulfilling its responsibility to provide proper mental health to psychiatric patients. It is necessary for each country/state/parish to have legal structure and provide proper care who are dangerous to self or others, or gravely disabled. The procedures of OPC, PEC, and CEC will be presented.

scholarly journals Language Discordance in Mental Health Services: An Exploratory Survey of Mental Health Providers and Interpreters

Societies ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 66
Author(s):  
Mansha Mirza ◽  
Elizabeth Harrison ◽  
Jacob Bentley ◽  
Hui-Ching Chang ◽  
Dina Birman
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Best Practices ◽  
Limited English Proficiency ◽  
Language Barriers ◽  
The United States ◽  
Mental Health Providers ◽  
Health Providers ◽  
Snowball Sampling

Global migration has contributed to greater language diversity in many parts of the world. Many migrants experience language barriers in their adopted countries. Language barriers hinder access to healthcare, including mental health. There exists little research on the extent of communication difficulties during language discordant mental health services. A cross-sectional observational study design was used to examine prevalence of communication challenges, use of communication best practices, and training needs among mental health providers and interpreters working with immigrants with Limited English Proficiency (LEP) in the United States. Using snowball sampling methods, 38 providers and 34 interpreters were recruited to complete online surveys. Challenges reported by interpreters pertained to technicalities of communication, while those reported by providers pertained to content of communication. Communication best practices such as pre-session briefings and post-session debriefings were used infrequently by providers in the sample. Providers with higher education levels were more likely to endorse some best practices. Fifty-four percent of the providers and 84% of the interpreters were interested in additional training in working with patients with LEP. Findings suggest the need for customized trainings for providers and interpreters to improve the quality of mental healthcare for patients with LEP.

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