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 To help you deal with and relate to people with specific emotional support needs

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

Activity GROUP CONTRACT OR LEARNING AGREEMENT

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

Think about… Two or three feelings or problems that living with HIV, or working with people with HIV, gives you

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

Four Primary Emotions Happiness Anger Fear Sadness… …and Confusion

Pair Exercise “My bad day, and what I did about it” Activity

Flipchart Exercise Dealing with stress is self-therapy. Sometimes it’s good therapy, sometimes not so good! Activity

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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

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

StressEvent value Death of spouse100 Divorce60 Menopause60 Separation from living partner60 Jail term or probation60 Death of close family member other than spouse60 Serious personal injury or illness45 Marriage or establishing life partnership45 Fired at work45 Marital or relationship reconciliation40 Stress Scale Top 10

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

How common? London 2002

Africans in England, 2003 Project Nasah Survey

Why do some people deal better with stress than others?

Symptom Cycle… (From Positive Self- Management Programme)

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

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

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

LUNCH

Quickfire list… Words or associations to do with mental illness

Put the emotions into the box 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 Activity

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

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)

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

Life scripts from 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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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)

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

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

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

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

EVALUATION