Better Psychological Support Needed

posted: 15/09/2010

People living with HIV are not having their psychological needs met properly, says a new report by NAT (National AIDS Trust).

The report Psychological support for people living with HIV  shows that not getting adequate psychological support can have a severe impact on people's health and well-being. Anxiety, depression and other emotional and mental health problems are all far more common among people with HIV than is usual for people.

NAT says more must be done to give proper support – at present these needs are often overlooked, because the focus is mainly on signs of physical health, like CD4 counts and Viral Load.

People with HIV at George House Trust helped 

People with HIV met at George House Trust to help NAT understand mental and emotional support health needs better, and to talk about the experience of using services.

At George House Trust we gathered black African men and women. Positively Women (now Positively-UK) gathered women, and GMFA gathered a group of gay men. Altogether 32 people talked about emotional and mental health needs and services for people with HIV with workers from NAT. 

Experiences of the immigration system and the impact of these on emotional and mental health were a big issue in Manchester. Women at Positively Women talked a lot about peer support from other women with HIV, and the gay and bi men at GMFA talked about their experience of using mental health services. 
 

There were four main issues leading to the need for support :

• managing HIV - coping with diagnosis, telling others, and coping with the physical effects of HIV and treatment; how poor emotional and mental health affects taking treatments properly; services for older people with mental health problems such as HIV-related dementia
• psycholigical impact of having HIV - anxiety, depression, suicidal thoughts, stigma, low self-esteem, coping by drinking heavily
• managing relationships - telling people, help during a relationship crisis, help with forming relationships, being isolated, bereavement, negotiating safer sex
• the needs of migrants especially asylum seekers - the harm lengthy uncertainty over immigration status causes.

What forms of emotional and mental health support are there?

• HIV support organisations - peer support and meeting with others like yourself is highly valued, where it is available
• HIV clinicians - HIV clinicians rarely ask how people are coping emotionally
• NHS psychological support services - some good experiences but a great deal of frustration about long waiting times, severe cases only being helped, everything has to be strictly HIV-related when many serious issues are indirectly connected
• Counsellors - can be very helpful, but some bad experiences; waiting times and travel costs were problems
• Informal support - from partners, friends, family, community - for gay men this was their main source of support; for women and Africans this can be good or a problem
• Other support - Social Services seen as only for the dying, support from churches can be good or harmful, the internet's potential 

Deborah Jack, Chief Executive of NAT, says:

“People can often find it difficult to come to terms with an HIV diagnosis and deal with the ongoing implications. Psychological support can be as important for the health and well-being of someone living with HIV as going to the doctor or taking treatment. This form of support can be the crucial difference between finding every day a struggle, and feeling able to cope with and enjoy daily life."

"Providing such psychological support is more cost-effective in the long-run as it means that people living with HIV can manage their condition, take treatment properly and stay healthy. It is essential that, at this time of cuts, decisions are not made which may save money in the short-term but will increase the burden on the NHS in the long-run.”

Key findings from the report include:

• Evidence of higher rates of psychological need amongst people living with HIV, compared with the general population
• HIV and mental health problems are both highly stigmatised, and this often makes people even more unwilling to say they are having mental health difficulties
• The psychological needs of people living with HIV are not being met fairly across the whole NHS
• Investing in psychological support for people with HIV has significant benefits in the long-run for individual and public health.

Mark (not his real name), who is living with HIV, spoke about the impact of having a mental health problem:

“They reduce our immunity… If you are carrying so many things in your head there is no way you’re going to cope with your medication. So it comes back to HIV.”

Clinical Benefits

There are clinical reasons why psychological support is beneficial. Research shows the big impact that mental health can have on physical health and how someone copes with having HIV. For example, depression has an effect on how well someone takes HIV treatment properly which is essential. Psychological well-being also influences people’s behaviour, and depressed, anxious and upset people are more likely to have unsafe sex, drink too much and use drugs.
NAT argues that investing in better psychological support for people living with HIV saves money in the long run, not only because people will be healthy for longer, but also because people are then less likely to miss medication or have unsafe sex, and this reduces the risk onward HIV transmission to other people.
 

Psychological Care Standards for HIV
One of the recommendations of the report is that the British Psychological Society and others interested publish standards for psychological support services for people with HIV. The British Psychological Society has formed a working group to prepare these standards, and NAT is a member of this group. For more information about these standards or to order hardcopies of the report contact policyandcampaigns@nat.org.uk.

A copy of the report is going to each HIV clinic in the UK, funded by the drug company Abbott.

“Mental health has become a major focus for Abbott's HIV community engagement. Despite the advances in and access to treatments, many people living with HIV tell us that the psychological burden of the disease significantly compromises their quality of life. NAT's report will help inform all stakeholders about the need to consider the psychological impact of living with HIV on the quality of life and, consequently, health care provisions,” said an Abbott spokesperson.

The report is available here

and to download direct from NAT, with more information on HIV and psychological issues 
 

Final Demand – mental health and debt

posted: 27/05/2009

Chris Fitch, a researcher for the Royal College of Psychiatrists, is the author of Final Demand, a booklet written to help health and social care staff, and accompanying resources for to use in support.
He talks here about his background and experience in debt advice with people who are depressed, anxious, or who have other mental health problems, all of which are very common among people living with HIV.
 

How did you get involved in debt and mental health?
Doing field work in 2003, I met people living with "debt and a diagnosis", and not getting help. At the time, I figured there must be a solution, but when there wasn't one, I tried to fill the gap a little.

What is Final Demand about
Final Demand is a pocket guide about debt and health. It shows health and social care workers how to help indebted clients, with the aim of preventing financial or mental health crises. It has been sent to 110,000 GPs, nurses, psychiatrists and social workers.

What is the relationship between debt and mental health problems?
Debt can be stressful, anxious, and downright depressing. Although associated with economic circumstance, debt can trigger major life changes, and individuals often struggle with a toxic cocktail of financial and personal issues. Four million adults could be living with debt and mental health problems. One in eleven British adults are seriously in debt. Half of adults in debt have a mental disorder, while one in four people with mental disorders also have debts.
 

Are you expecting mental health issues to increase in the recession?
Unemployment, repossession, and debt will increase demand for mental health services. As the recession continues, people not used to financial difficulty will increasingly be hit hard mentally. We can stop short-term distress becoming long-term disorders by maintaining existing mental health services, health advice and support for the jobless and indebted, and investing in linking money advice with health services.
 

What should professionals do?
They should consider debt as an underlying cause in stress-related illness, ask simple questions about debt in routine assessment, refer people to an appropriate debt advice service and don't just refer and forget, but support the adviser and the client/patient.
 

How can we improve the situation?
Governments should invest in tackling debt and mental health, as they have with unemployment and mental health. Banks should acknowledge that one in six of their customers have mental health problems, and take this into account when recovering debts.
 

At the Final Demand website you will find

• Final Demand booklet - an online web version
• Final Demand booklet - a pdf version you can download and print
• Tools for workers - Debt and Mental Health Evidence Form
• Getting help

Final Demand is funded by the Financial Services Authority and published by the Royal College of Psychiatrists.

Source

Help with Prescription Costs

posted: 01/12/2008

Who has the right to help with prescription costs?

Greater Manchester HIV clinics will now only prescribe HIV treatment drugs and drugs for managing any side effects. This leaves medicines for anything else (depression, sexual dysfunction, contraception etc.) to GPs to prescribe, and that means some people have to pay for those GP prescriptions.

Many people are entitled to free prescrriptions; some can get free prescriptions because of low income, and there is a discount scheme to cut your costs. 

Other help with healthcare costs is available, including for travel expenses to and from hospital.

Citizens Advice Bureau has clear infomation here on all the help that is available for healthcare costs.

For prescriptions, some people can get them free, some people can get a full exemption on grounds of low income, and some people can get a discount by buying a prepayment certificate.

Free Prescriptions

You are entitled to get prescriptions free of charge if you:

• are over 60
• are on Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or the guarantee credit part of Pension Credit. Your partner and children will also be entitled to free prescriptions. (If you are getting Working Tax Credit and/or Child Tax Credit, you may be entitled to free prescriptions, depending on your income - see below - Help with health costs if you are on a low income)
• have a listed medical condition (HIV is NOT listed, see page 30 here for full list) and have a valid medical exemption certificate. You have to ask your GP if you think this might apply to you - ask for Form FP92A
• have a continuing physical disability which means you cannot go out without help from another person and have a valid medical exemption certificate - ask the doctor, hospital or pharmacist for Form FP92A
• are under 16 in England or Scotland. You must show age proof to the pharmacist
• get a war or service disablement pension, need prescriptions for your war / service disability and hold an exemption certificate - ask the doctor, hospital or pharmacist for Form FP92A
• are a prisoner
• are pregnant, or have had a baby in the last twelve months and have a valid exemption certificate. This includes if you have had a miscarriage after the 24th week of pregnancy, or your baby was stillborn. Ask the doctor, midwife or health visitor for Form FW8.
• you live in Wales

To claim, just tick the box on the back of the prescription form.

They do random checks afterwards to check that people who ticked the box were eligible. There is a penalty charge and possible prosecution for people caught claiming when not eligible.

In England, for full details of people who can get help with prescription charges, see the Department of Health leaflet HC11 Help with health costs.

If none of the categories mentioned in this list applies to you, you may still be able to get free prescription on the grounds of low income – see next section: Prescriptions for low income

Prescriptions for low income

If you have difficulty in meeting your health costs and do not qualify for any other kind of help, you may be able to get help under the NHS low income scheme.

The amount of help you get will depend on the amount of income you have. You might not be entitled to any help at all if you have too much in savings / capital. There are two types of certificate: a full help certificate (HC2), and a limited help certificate (HC3), which tells you how much you have to pay.

Full help certificate

If you are entitled to a full help certificate, you will get:-

• free NHS prescriptions
• free NHS dental treatment, including check-ups
• free NHS sight tests (including sight tests at home) and full value vouchers for glasses or contact lenses
• full repayment of necessary travel costs for hospital treatment
• full repayment of travel costs if travelling abroad for treatment
• free NHS wigs and fabric supports
• travel costs if travelling abroad for treatment.

Limited health certificate

If you are entitled to a limited help certificate, you will get no help with prescription charges (but see Prepayment Certificates for prescriptions below) but may be able to get some help with the costs of:-

• dental treatment and check ups
• private sight tests
• vouchers for glasses or contact lenses
• wigs and fabric supports
• necessary travel costs to and from hospital for NHS treatment
• travel costs if travelling abroad for treatment.

How to apply for help on the low income scheme

To apply for either a full help certificate (HC2) or a limited help certificate (HC3), complete form HC1, which is available from local benefit offices, NHS hospitals, dentists, opticians and pharmacists. Form HC1 can also be filled in online.

Do not wait until you need a prescription or treatment before you apply for a certificate. Getting a refund after you have paid is better avoided. You would need to ask the pharmacist for a special receipt when you get your prescription, which you then have to use to reclaim the money. If you don't get the special receipt when you hand in the prescription, you can't claim a refund.

Remember, if you don't qualify now because your income is too high, if your income drops you can always make a fresh claim.

Send the completed form HC1 to

NHS Business Services Authority
PO Box 370
Newcastle Upon Tyne
NE99 2ZA
0845 850 1166
website

Prepayment Certificates for prescriptions

If you need frequent prescriptions but do not qualify to get them free of charge, you can buy a prepayment certificate which could save you money.

Prepayment certificates save you money if you have to pay for more than three prescription items in a three-month period, or more than 14 items in a twelve month period. Remember each drug prescribed counts as a seperate item, so two drugs on one prescription counts as two items.

In England prepayment certificates last for either three or twelve months. You can pay for the twelve month certificate by direct debit, in ten equal monthly instalments.

Before buying a prepayment certificate, make sure you are not entitled to free prescriptions, as it can be difficult to get a refund once you have paid for your certificate.

You can buy a prepayment certificate:

• over the phone from the NHS Business Services Authority 0845 850 0030
• online from the NHS PPA website
• from the pharmacist
• from your Primary Care Trust

You are sent a plastic card (like bank card) that you show to the pharmacist each time you hand in your prescriptions and tick the box on the back of the prescription to say you have a Prepayment Certificate.

Health Care Help

Help with health care costs can be for:

• prescription charges
• NHS dental charges, including check-ups
• sight tests
• vouchers towards the cost of glasses and contact lenses
• travel costs to and from hospital for NHS treatment
• travel costs if travelling abroad for treatment
• wigs and fabric supports, for example, abdominal and spinal supports, and support tights.

Details of all the NHS health care help available.