Why access to mental health services needs to be consistent across the country
By Natasha Dhumma, Head of Policy & Campaigns
Poor mental health is significantly more common among people living with HIV than the wider population. The need for adequate mental health services for people living with HIV, fully equipped to deal with the specific challenges they can face, is clear. But there is not consistent access to such services and, as we grapple with the impact of COVID-19, the already existing issues around mental health provision for people living with HIV are even more pertinent.
Mental health issues were reported by half of people living with HIV in 2017, twice the rate of the general public. A third of people living with HIV are diagnosed with depression and a quarter with anxiety. This disparity is also evident in at the sharper end of mental health, with the suicide rate among men being five times higher than the general population in the first year following HIV diagnosis.
Looking beyond diagnosed mental illness, Someone’s HIV status can impact how they feel about themselves and manifest in low levels of self-worth. The Stigma Index found only 64% of participants felt positive about life with over half reported experiencing shame, guilt, low self-esteem and/or self-blame in relation to their HIV status in the past year. It is also important to consider how wider structural failings compound factors in poor mental health. A recent APPG HIV and AIDS report identifies the benefits system as a source of significant anxiety and insecurity for people living with HIV.
HIV specialist psychologist services have become rarer in recent years. The HIV support services that can address isolation and provide community interventions before mental health worsens, are increasingly struggling to operate.
The NHS-run IAPT (Improved Access to Psychological Therapies) is a service for those with mild to moderate mental health problems. While IAPT can provide valuable support for those adjusting to some long-term health conditions, we are concerned that the complexities that may be associated with HIV call for more bespoke psychological support. For example, IAPT does not address stigma, sexual risk or drug use, nor would a generic mental health professional be expected to possess an understanding of HIV. For these reasons NAT is currently undertaking some work looking at how IAPT could be developed to meet the needs of people living with HIV.
All of this is without considering how COVID-19 has exacerbated poor mental health for some people living with HIV.
Uncertainty and anxiety around how healthcare needs, such as getting HIV medication, will be met have been widely reported by community organisations. There is also anxiety about the risks of COVID-19 itself. In the early weeks of the crisis the Government guidance for people living with HIV was unclear. We know that many are still anxious and this is heightened further by reports about the disproportionate impact of COVID-19 on BAME groups and among those for whom social distancing is difficult perhaps due to their home or work life.
Beyond healthcare the lack of social interaction intensifies feelings of loneliness for people living with HIV, especially if they are living with others who may not be aware of their status. In such situations not only may they be reluctant to confide themselves, they also have to manage the risk of having flatmates or family members overhear phone or online conversations if they seek out support elsewhere. While much needed support services have swiftly adapted to online provision they acknowledge this is not accessible to everyone. Digital poverty, the lack of devices or data to connect to others, is further isolating their most vulnerable clients.
As lockdown eases extra consideration should also be given to those who are required to continue shielding, and the prolonged feelings of isolation and exclusion that will no doubt entail.
For Mental Health Awareness Week we are calling for HIV care to extend beyond the clinical to include the psychological. The level of unmet need was clear before COVID-19, it’s now critical, so let’s move beyond awareness to action.