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.

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 that mental health services constitute the largest growing area of unmet need among people living with HIV and their families.

Recognizing the importance of addressing these barriers, the HIV/AIDS Bureau at the Massachusetts Department of Public Health funded five mental health/HIV pilot projects in 1998 to offer non-traditional mental health services to people living with HIV and AIDS. 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.

Mental Health Service Program Review

HDWG conducted an assessment of the mental health programs and agencies funded by the Department of Public Health’s HIV/AIDS Bureau. The primary goal of this assessment was to assist the Bureau to better understand these programs’ structure and service model, to learn what services they are providing with their public health dollars, and examine the frequently occurring mental health issues that HIV infected substance abuse users being served by these agencies experience.

The HDWG administered a telephone survey to each agency. The survey contained questions pertaining to service descriptions, staff qualifications, financing, and client demographics. It also focused on the organization and how services provided through Bureau funding related to other services provided, referral practices, and client sharing between case management and mental health clinical staff.

Project Staff: Key HDWG staff involved in this project were Carol Tobias, M.M.H.S., Chinwe Johnson, M.D., M.P.H., and Bethlyn Vergo, M.S.W.