March 24 saw World TB Day commemorated globally. South Africa also saw the launch of the new National Strategic Plan (NSP) for HIV/TB/STIs 2023 – 2028. With this in mind, we wanted to share three Frequently Asked Questions (FAQs) on HIV/TB and Mental Health. Keep an eye out for our upcoming blog on the new NSP.
1) Why it is important for people living with HIV and/or TB to access mental health services?
From a health perspective, estimates show if mental health is integrated into HIV and TB programmes global HIV and TB infections can be reduced by up to 17% and 20%, respectively and as many as 14 million TB cases can be avoided. This would be more than the predicted number of cases for any year between now and 2030. Evidence supports providing integrated mental health interventions within TB services to boost the rates of TB treatment completion. We echo the words of Sarah Kline, CEO of United for Global Mental Health:
Addressing the mental health needs of people affected by TB will only add value to investments in ending the TB epidemic. Yes, we can stop TB, but we can stop it faster with an estimated 12.6-20% faster reduction in TB if mental health services are integrated into TB programming.”
From a human rights perspective, the right to health entails that every human being, without distinction of any kind, has the right to equitable access to the highest attainable standard of physical and mental health. We know that persons with HIV/TB remain marginalised and as such can find it difficult to access necessary services, including mental health services. We need work on strengthening health systems to ensure all marginalised or vulnerable groups can access the services they need.
2) Can people with HIV/TB easily access mental health services in the public health sector?
No. In general, people in South Africa cannot easily access mental health services in the public sector. It’s estimated, less than 1 in 10 people living with a mental health condition in our country receive the care they need.
It is encouraging to note that there is increased momentum globally and nationally to increase access to mental health care for people living with HIV/TB. Globally, we see organisations like UNAIDS and The Global Fund calling for easier access to mental health services and sharing practical models of integration. Nationally we see the National Strategic Plan for HIV 2023 – 2028 explicitly recognising the importance of mental health service integration into our HIV/TB care.
SAFMH highly commends this.
3) What is needed to integrate mental health services into HIV/TB services in the public sector?
- Provincial Departments of Health to set aside funds for integration: The new NSP calls for integration of mental health services into HIV/TB services. This can only happen if decision-makers at a provincial level allocate funds to make this happen in their province. Provinces should be briefed about the projected return on investments and equipped with knowledge regarding what mental health packages of care will yield the best outcomes for preventing or managing HIV in their province. Deciding on what packages of care should be funded within their province should be done in consultation with mental health experts, including mental health clinicians, academics, community-based organisations, people living with HIV and mental health conditions and their caregivers.
- More human resources to deliver mental health services : Mental health services in the public sector are already extremely overburdened. Training HIV/TB counsellors to also screen for poor mental health and provide referrals is crucial but without expanding the mental health workforce they are referring to; we’ll have a problem. We need more human resources to deliver mental health interventions and care, including in the community. Lay counsellors should be trained in accordance with evidence-based recommendations from the Adult Primary Care guide and the mhGap intervention training.
- Strengthening and scaling up community-based mental health care services, including community residential care (assisted living and group homes), day care services, and outpatient services: Mental health services must be available where people live: in the community. This provides mental health care users with opportunities for optimal recovery and reintegration. Across the country, community-based mental health organisations already play a significant role in the expansion and delivery of mental health services. This is mainly through providing counselling, life skills and financial independence building, and mental health promotion. Check out the work of community based organisations in Pietermaritzburg, Eastern Cape and the Northern Cape for examples of community-based care.
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If you have any other questions or want to find out more information, do not hesitate to get in touch with us via our Help Desk.