Provider-initiated HIV counselling and testing (PICT) in the mentally ill

The prevalence of HIV infection is substantially higher in mentally ill individuals than in the general population. Despite this; HIV testing is not yet standard practice among the mentally ill population; and many mental health settings do not encourage HIV testing. This paper discusses provider-initiated HIV counselling and testing (PICT) and some of the ethical dilemmas associated with it; on the basis that PICT may be used to increase the number of mentally ill persons tested for HIV. The authors conclude that PICT should be promoted to all psychiatric admissions and mentally ill individuals receiving outpatient services; and that this is within the parameters of existing policies and legislations in South Africa

A review of the applications for involuntary admissions made to the Mental Health Review Boards by institutions in Gauteng in 2008

Aim. To review applications for involuntary admissions made to the Mental Health Review Boards (MHRBs) by institutions in Gauteng. Method. A retrospective review of the register/database of the two review boards in Gauteng for the period January - December 2008. All applications for admissions (involuntary and assisted inpatient) and outpatient care (involuntary and assisted), and periodic reports for continued care (inpatient or outpatient care) were included. Results. During the study period the two MHRBs received a total of 3 803 applications for inpatient care, of which 2 526 were for assisted inpatient care (48.1 regional hospitals, 29.6 specialised psychiatric hospitals, 22.2 tertiary academic hospitals). Of the applications for involuntary inpatient care, 73.1 were from the specialised psychiatric hospitals (65.2 from Sterkfontein Hospital). Applications for outpatient care; treatment and rehabilitation (CTR) numbered 1 226 (92 assisted outpatient CTR). Although the health establishments in northern Gauteng applied for more outpatient CTR compared with those in southern Gauteng (879 v. 347; respectively), the ratios of assisted to involuntary outpatient applications for CTR for each region were similar (approximately 12:1 and 9:1, respectively). The boards received 3 805 periodic reports for prolonged CTR (93.5 inpatient, 6.5 outpatient) in the majority of cases for assisted CTR. Conclusion. The study suggests that in the 4 years since the promulgation of the Mental Health Care Act (MHCA) in 2004, there have been significant strides towards implementation of the procedures relating to involuntary admission and CTR by all stakeholders. Differences in levels of implementation by the various stakeholders may result from differences in knowledge, perceptions, attitudes and understanding of their roles and therefore indicate the need for education of mental health care professionals and the public on a massive scale. The Department of Health also needs to invest more funds to improve mental health human resources and infrastructure at all health establishments

HIVin South Africa - depression and CD4 count

Objective: Published studies on the prevalence of depressive symptoms using rating scales and the relationship between depression and immune status offer inconsistent results. Depressive symptoms are common and impact on functioning; quality of life; and health status; highlighting the importance of diagnosis and treatment of patients with HIV infection. The aim of the study was to determine the occurrence of depression among HIV-positive patients using the Beck's Depression Inventory (BDI) and to determine a relationship; if any; between depressive symptoms and CD4 count. Method: 41 patients aged 18 years or more were recruited from an HIV outpatient clinic in South Africa [date not given]. All the subjects completed the 21-item BDI and their CD4 counts were determined. Patients who had a score of 10 or more on the BDI were considered positive for a depressive disorder. Results: More than half (56) of the study sample had a BDI of =10 indicating significant symptoms of depression. There was no significant difference in the CD4 counts between the depressed and non-depressed groups (p0.05); and no correlation between CD4 counts and BDI scores in the total study sample (r=0.27; p0.05). The affective components of the BDI contributed significantly to the overall BDI score compared with the somatic component (p0.05). Conclusion: The evidence from the study supports the BDI as a suitable measure for identifying those patients who meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for minor or major depression. The HIV epidemic is the most serious health challenge in South Africa and it is imperative that HIV-infected patients who complain of fatigue or insomnia be screened routinely for major depression; followed by a structured interview to confirm the diagnosis