Search

Long-acting injectable antiretroviral medications are new to HIV treatment. People with HIV may benefit from a treatment option that better aligns with their preferences, but could also face new challenges and barriers. Authors from the fields of HIV, substance use treatment, and mental health collaborated on this commentary on the issues surrounding equitable implementation and uptake of LAI ART by drawing lessons from all three fields. We employ a socio-ecological framework beginning at the policy level and moving through the community, organizational, interpersonal, and patient levels. We look at extant literature on the topic as well as draw from the direct experience of our clinician-authors.

OBJECTIVE: The purpose of this study was to examine associations between homelessness and length of psychiatric hospitalization and to explore the role of mental health conservatorship in determining discharge location for patients who are homeless and have a grave disability from serious mental illness. METHODS: This observational study used administrative data from a safety-net psychiatric hospital in Los Angeles. The sample included 795 adults (≥18 years) who were hospitalized on an involuntary psychiatric hold between 2016 and 2018. The outcome variables were length of stay (days) and discharge location (home, locked psychiatric facility, unlocked psychiatric facility, unhoused). The predictor variables were homelessness status and whether a mental health conservatorship was initiated during hospitalization. Multiple regression models were used to estimate associations between variables. RESULTS: Homelessness status was associated with 27.5 additional days (SE=3.5 days) of hospitalization in adjusted models. Homeless patients for whom conservatorship was initiated comprised 6% of the sample but 41% of total inpatient days. Among people who were homeless, initiation of a conservatorship was associated with significantly longer length of inpatient stay (mean=154.8 days versus 25.6 days for the whole sample) but also with lower odds of being unhoused at the time of discharge (risk ratio=0.19, 95% confidence interval=0.09-0.34). CONCLUSIONS: A mental health conservatorship can be a mechanism for helping homeless people with a grave disability from mental illness to transition from the streets to residential psychiatric treatment, but it requires substantial resources from facilities that initiate such conservatorships and does not guarantee resolution of long-term supportive housing needs.

PURPOSE OF REVIEW:We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. RECENT FINDINGS:There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.

PURPOSE OF REVIEW:We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. RECENT FINDINGS:There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.

Antiretroviral (ARV) treatment first became publicly available in Mozambique in June of 2004. The steadily rising count of "lives saved" seems to represent a success story of high-tech treatment being provided in one of the poorest contexts in the world, and in some ways it does, as people with AIDS are experiencing dramatic recoveries and living longer. But the numbers say little about how life has changed for people with the disease. This ethnographic study uses participant observation and in-depth interviews to offer accounts of people living with HIV/AIDS at the start of the "treatment era" in central Mozambique. In a context of chronic underemployment and threadbare public infrastructure, the HIV positive status offered eligibility for free medical care and other material benefits. The number of those eligible for benefits far outnumbered availability, however, triggering intense competition amongst the HIV positive and widespread cynicism about the entire AIDS effort. Extraordinary practices of solidarity did emerge within local organizations, churches, and homes, yet these spaces were fundamentally shaped by scarcity and exclusion. In the AIDS clinic, patients were counseled to "live positively" and maintain a strict lifestyle that included a lifetime of ARV treatment, renouncing the herbal medications of traditional healers, and consenting to voluntary infertility. From their perspective, ARV treatment represented an ambivalent proposition. This dissertation argues that these individually targeted treatment programs have dehumanizing and sociopathic effects, as the broader structures that contribute to suffering and impoverishment remain hidden and intact while the victims of the epidemic are consigned to a social death. By targeting a biological condition, political and economic x concerns are sidelined. These dynamics are crystallized in the hunger that plagues those on ARV treatment. Hunger has both a physiological basis and an existential dimension, as t

Antiretroviral (ARV) treatment first became publicly available in Mozambique in June of 2004. The steadily rising count of "lives saved" seems to represent a success story of high-tech treatment being provided in one of the poorest contexts in the world, and in some ways it does, as people with AIDS are experiencing dramatic recoveries and living longer. But the numbers say little about how life has changed for people with the disease. This ethnographic study uses participant observation and in-depth interviews to offer accounts of people living with HIV/AIDS at the start of the "treatment era" in central Mozambique. In a context of chronic underemployment and threadbare public infrastructure, the HIV positive status offered eligibility for free medical care and other material benefits. The number of those eligible for benefits far outnumbered availability, however, triggering intense competition amongst the HIV positive and widespread cynicism about the entire AIDS effort. Extraordinary practices of solidarity did emerge within local organizations, churches, and homes, yet these spaces were fundamentally shaped by scarcity and exclusion. In the AIDS clinic, patients were counseled to "live positively" and maintain a strict lifestyle that included a lifetime of ARV treatment, renouncing the herbal medications of traditional healers, and consenting to voluntary infertility. From their perspective, ARV treatment represented an ambivalent proposition. This dissertation argues that these individually targeted treatment programs have dehumanizing and sociopathic effects, as the broader structures that contribute to suffering and impoverishment remain hidden and intact while the victims of the epidemic are consigned to a social death. By targeting a biological condition, political and economic x concerns are sidelined. These dynamics are crystallized in the hunger that plagues those on ARV treatment. Hunger has both a physiological basis and an existential dimension, as t