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HIV and Mental Health

HIV and Mental Health. Gus Cairns, MA. 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

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HIV and Mental Health

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  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

  3. 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

  5. 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 it’s good therapy, sometimes not so good!

  11. BREAK BREAK

  12. 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

  13. What problems cause stress to people with HIV? • Flipchart exercise • Don’t have to be HIV-specific

  14. Stress Scale Top 10

  15. 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’: I’m 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

  16. How common? London 2002

  17. Africans in England, 2003Project Nasah Survey

  18. Why do some people deal better with stress than others?

  19. Symptom Cycle…(From Positive Self-Management Programme)

  20. Gestalt Cycle (Fritz Perls, 1951)A model for how we process experience: Mental ill-health is seen as an interruption/block in the cycle

  21. A model for how we deal with adaptation to loss and change On Death and Dying by Elisabeth Kübler-Ross

  22. 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 (“It’s not happening to me”) lies behind many adjustment disorders and ‘stuck’ states – see below. • It doesn’t take control of the threat; just protects bodily functions while it’s happening

  23. LUNCH LUNCH

  24. 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

  26. Definitions, Definitions… • Organic: Dementia • Psychosis • Neurosis • Personality Disorder • A note on misdiagnosis

  27. 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)

  28. Yes ,but why do some people deal better with stress than others?

  29. 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!

  30. BREAK BREAK

  31. 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)

  32. Depression and its Risk Factor, Suicide • A story…Mr P • Inner experience and meaning of depression: shutdown • Language to watch out for: overt/sleep/going away/switch off/can’t cope • Depressed people are helpless, hopeless…and annoying! • How NOT to help a depressed person

  33. Anger and its Risk Factor, Violence • A story…Dave • Inner meaning and experience: frustration and isolation • Language and behaviour to watch out for • How NOT to handle angry clients

  34. Bully/Victim/Rescuer • Looking after yourself… • The roles people play… • …and the roles they try to get you to play

  35. Boundaries and Confidentiality • The client who wants to be your friend • The client who tells you shocking things • When to break confidentiality

  36. EVALUATION www.restorego.cominfo@restorego.com0208 657 0555 0790 491 0894

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