BASIC MENTAL HEALTH
ASSESSMENT
BY: SHAREEN BOOMGAARD
PROFESSIONAL NURSE
LUTHANDO CLINIC
CHRIS HANI BARAGWANATH HOSPITAL
MENTAL ILLNESS & HIV
 Because HIV affects the brain
It has effects on mental health
 MOOD
 EMOTIONS
 THINKING
 BEHAVIOUR
Can all be affected!
MENTAL ILLNESS IN HIV
 Mental illness is more common in HIV
 The mentally ill are more likely to contract HIV due to the nature of their
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illness
These patients have stressors e.g. money, relationships, stigma
The direct effect of HIV on the brain
Medication they take for HIV or TB have mental side-effects
They are more likely to engage in risky sexual behaviours
Substance Abuse
 Their ability to make good decisions and choices are affected!
MENTAL ILLNESS IN HIV
 STIGMA is a negative/bad thought that you or others may have
about you
 These patients’ have to deal with a “DOUBLE STIGMA”
 HIV and mental illness
- This may hinder access to HIV clinics for HAART
- This may result in poor adherence, hence viral resistance
 This is why it is important to be able to identify patient’s with
mental disorders so that they can be referred for help.
CONFIDENTIALITY
 When you enquire about someone’s 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 GENERAL…
 People working with HIV + patients need to be aware that these
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patients can present with psychiatric/mental illness.
In your everyday encounters with people we usually make
assessments automatically
How is he/she dressed?
Is he/she clean and looking after themselves
Does the person look worried or sad ?
Agitated?
Nervous
Suspicious?
Aggressive ?
BAD MOOD vs ILLNESS
 It 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.
BIRTHDAY
PAYDAY
HOLIDAY
NORMAL
MONDAY
ARGUMENT
 NORMAL
MOOD DISORDERS
 DEPRESSION
- With a depressive disorder the mood stays low for many days –
weeks.
- It is worse than usual and affects the patient’s 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 person’s body language seems to match
what he/she is saying.
DEPRESSION
 SYMPTOMS OF DEPRESSION
- Sadness
- Loss of interest/pleasure
- Disturbed sleep
- Disturbed appetite/ change in weight
- Poor concentration
- Tiredness
- Guilty feelings
- Suicidal thoughts
When to refer?
 When symptoms are severe
 Eg: not eating/drinking at all or suicidal
 Since depression symptoms are similar to the physical
symptoms of HIV eg loss of weight, tiredness
The differentiation between the two needs to be made.
 If unsure  refer for an assessment
THE SUICIDAL PATIENT
- There are times in an HIV + patients life when they feel like they have no hope
left to live
Eg: 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 cancer
ASK 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.
THOUGHTS
 Getting to know what the patient spends time thinking about
provides a window into the mind
 Negative thoughts may suggest depression
 On the other hand…
 Thoughts 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 themselves
 These would indicate that the person is PSYCHOTIC
= “out of touch with reality”
COGNITION
 This is our ability to think, remember, understand and
organize information.
 Patients living with HIV/AIDS are at risk of developing
problems with these functions
 This is called HIV Dementia
 They usually struggle with everyday activities, like cooking,
cleaning, or taking medication
HIV DEMENTIA
 It 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 thinking
ASK 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 ABUSE
 ALCOHOL
 When 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 ARV’s
and other important medication and this prevents them from
becoming well
 Substance abuse can lead to anxiety, depression and
psychosis.
CONCLUSION
 If you identify mental health problems in a patient
  referral to a clinic sister or doctor is the next step
REMEMBER:
 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????