Book Review

AIDS and People with Severe Mental Illness: A handbook for mental health professionals

N Engl J Med 1997; 336:1332-1333May 1, 1997

Article

AIDS and People with Severe Mental Illness: A handbook for mental health professionals
Edited by Francine Cournos and Nicholas Bakalar. 346 pp. New Haven, Conn., Yale University Press, 1996. $40. ISBN: 0-300-06757-7

The severely mentally ill are at risk for human immunodeficiency virus (HIV) infection, challenging mental health providers to develop new services for them. This book is a primer for the large number of providers who have not recognized the risk of HIV in the mentally ill or developed HIV-related programs for their patients or staff members. Short chapters review the issues that will emerge when clinicians in private practice, managed-care associations, and publicly funded settings discuss HIV with patients. The editors group the situations in which these issues arise into three categories: the identification and assessment of patients at risk; preventive interventions for patients with various backgrounds (such as those with dual diagnoses and the homeless) who receive care in disparate settings (such as prisons and mental hospitals); and legal and staffing policies that accompany all HIV-related programs. Mental health providers, public health administrators, and legislators who have not considered the impact of HIV on the delivery of mental health services must read this book. It will motivate them and provide basic background information.

Once the mental health provider, policy maker, or administrator is motivated to act, however, the book will need to be supplemented with substantially more detailed information. Implementing any HIV-related program is complex, and the problems are compounded for the mentally ill, whose rights to independent living and self-determination are often questioned. The authors keep the reader's interest with brief chapters and supporting clinical vignettes. However, the descriptions mask the problems that will be encountered. For example, the authors take a position against mandatory HIV testing, but they do not analyze the benefits and costs of HIV testing among the mentally ill or the effect of various strategies of testing (e.g., confidential or anonymous). This problem alone could occupy three to four chapters.

With increasing emphasis on the early detection of HIV, and as the rate of infection among the mentally ill becomes recognized, mental health providers will be pushed to institute programs of mandatory testing. To make decisions in this area, they will need detailed guidelines about medical charting procedures, staff training, emergency protocols, triage procedures, ethical issues of confidentiality, and legal obligations. The authors do not mention these issues.

The field of HIV prevention moves so quickly that it is difficult to publish timely guidelines for practitioners that incorporate the most current data. This book suffers from that problem. The dated information it contains reflects the challenge of diffusing information to health care providers across many fields.

Mary Jane Rotheram-Borus, Ph.D.
University of California at Los Angeles, Los Angeles, CA 90022

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