HIV and Mental Health

1
HIV and Mental Health

• Gus Cairns, MA

2
Introduction To Course

• Aim of Training
• To educate and inform volunteers about aspects of
  HIV and mental health
• To help you discuss own experiences of dealing
  with clients with mental health and emotional
  support issues
• To help you deal with and relate to people with
  specific emotional support needs

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The Day

• Introductions
• Emotions and dealing with stress
• TEA BREAK
• Stress and HIV
• How stress may turn into dis-stress
• LUNCH
• Stigma and mental distress
• Diagnoses, definitions and types
• TEA BREAK
• Types of clients and issues they bring
• Issues for workers
• Evaluation and feedback

4
Activity
GROUP CONTRACT OR LEARNING AGREEMENT
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Guidelines

• Confidentiality Sharing the experience but not
  any identifying information
• Safety respect others viewpoints, even if
  different from yours. They may have different
  experience
• Responsibility take care of yourself, ask
  anything you want, say no if you need to

6
Think about

• Two or three feelings or problems that living
  with HIV, or working with people with HIV, gives
  you

7
Introductions

• Name
• What do you do?
• One sentence why you work with HIV
• Two of the three problems you thought about just
  now

8
Four Primary Emotions

• Happiness
• Anger
• Fear
• Sadness
• and Confusion

9
Pair Exercise
Activity
My bad day, and what I did about it
10
Flipchart Exercise
Activity

• Dealing with stress is self-therapy.
• Sometimes its good therapy, sometimes not so
  good!

11
BREAK
BREAK
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A Side-Journey Into STRESS

• The state arising when the individual perceives
  that the demands placed on them exceed (or
  threaten to exceed) their capacity to cope, and
  therefore threaten their wellbeing.
• Stress is not mental illness
• Stress is a normal part of life
• Stress has physical effects
• The result of stress depends on what you do with
  these physical effects
• To energise you
• To give you ideas
• To make you angry
• To shut you up
• To make you depressed
• To make you ill

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What problems cause stress to people with HIV?

• Flipchart exercise
• Dont have to be HIV-specific

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Stress Scale Top 10
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HIV issues

• Physical HIV illness, dementia
• Drug side effects Body changes
• New diagnosis
• Finance
• Housing
• Immigration status
• Stigma and isolation
• Disclosure
• Long term survivors Lazarus effect Im not
  special any more
• Work and career
• Loss and bereavement
• Sex and love
• Life issues that may have let to HIV depression,
  addictions, abuse, vulnerability

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How common? London 2002
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Africans in England, 2003Project Nasah Survey
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Why do some people deal better with stress than
others?
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Symptom Cycle(From Positive Self-Management
Programme)
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Gestalt Cycle (Fritz Perls, 1951)A model for
how we process experience Mental ill-health is
seen as an interruption/block in the cycle
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A model for how we deal with adaptation to loss
and change On Death and Dying by Elisabeth
Kübler-Ross
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Fight, Flight or Freeze

• Normal reaction to a threat (stress) is to fight
  it or run away. Either is a way of controlling it
• Adrenaline mobilises the Fight or flight
  reaction
• When fight or flight a third option is possible
  freeze.
• Acetylcholine produces relaxation
• In the presence of sympathetic arousal it
  produces dissociation the Freeze reaction
  like an animal playing dead
• Dissociation (Its not happening to me) lies
  behind many adjustment disorders and stuck
  states see below.
• It doesnt take control of the threat just
  protects bodily functions while its happening

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LUNCH
LUNCH
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Quickfire list

• Words or associations to do with mental illness

25
Put the emotions into the box
Activity

• See which box is fullest
• See which box is most empty
• You may have most problems with the emptiest box
• So may people with mental health problems

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Definitions, Definitions

• Organic Dementia
• Psychosis
• Neurosis
• Personality Disorder
• A note on misdiagnosis

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Five Primary Emotions - Stuck

• Happiness stuck ? manic defence, denial
• Anger stuck ? pathological rage, blame,
  self-harm, suicide
• Fear stuck ? anxiety disorder, panic attacks,
  phobias, PTSD, OCD
• Sadness stuck ? depression, dysthymia,
  irritability, physical symptoms
• Confusion stuck ? more confusion (compound
  dissociation, fugue, DID, amnesia)

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Yes ,but why do some people deal better with
stress than others?
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Life scriptsfrom Body Psychotherapy and
Transactional Analysis.Stories we tell
ourselves about life, gathered from early
experience. Different life scripts come from
different types of deprivation in infancy

• LIFE MEANS NOTHING/IS IMPOSSIBLE UNLESS
• I am in control Schizoid type Others
  control means death
• I please people Oral type endlessly seeks
  (never finds) love
• I and s/he are in love Symbiotic type
  Endlessly imagines love
• I am loved and adored Narcissistic type
  needs fame/adoration
• I do it all myself Masochistic type Help
  equals humiliation
• I am stimulated and excited Thrill-seeker
  Ordinary equals boring/alone
• I am a success Rigid type Failure equals
  failure for all time
• I win - Psychopathic type And others fail!

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BREAK
BREAK
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What We Notice

• Appearance/behaviour unkempt, restless,
  eccentric
• Rapport are they with you?
• Speech slow, fast, easy, reluctant,
  comprehensible
• Mood euphoric, depressed, anxious, irritable,
  labile, blunted, incongruent
• Thought block, incoherence, delusion, obsession
• Cognition ability to understand and have
  concepts
• Body and perception dizzy, spaced-out, cold
  sweat, heart, headache, noise
• Insight self-awareness, including the awareness
  that something is wrong (if it is)

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Depression and its Risk Factor, Suicide

• A storyMr P
• Inner experience and meaning of depression
  shutdown
• Language to watch out for overt/sleep/going
  away/switch off/cant cope
• Depressed people are helpless, hopelessand
  annoying!
• How NOT to help a depressed person

33
Anger and its Risk Factor, Violence

• A storyDave
• Inner meaning and experience frustration and
  isolation
• Language and behaviour to watch out for
• How NOT to handle angry clients

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Bully/Victim/Rescuer

• Looking after yourself
• The roles people play
• and the roles they try to get you to play

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Boundaries and Confidentiality

• The client who wants to be your friend
• The client who tells you shocking things
• When to break confidentiality

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EVALUATION
www.restorego.cominfo_at_restorego.com0208 657
0555 0790 491 0894