The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 10: Psychiatric ProblemsPermanency placement evokes powerful feelings in parents who fear abandoning their children,and who grieve the probability that they will not see their children grow up. Accepting thatpermanency placement is necessary means accepting one’s inevitable death, a problem for boththe patient26andpicashis or her health care providers. Guilt and shame inevitably emerge as parentsget sick and face the possibility that they will die, leaving others to care for their offspring.Particularly in cases where there are difficult family relationships, many parents feel ambivalentabout having to place their children with family members they don’t like or don’t trust withtheir children.Providers can support parents with HIV by acknowledging that permanency placement planningis a very painful process that takes time and continued reflection and consideration, andoften involves wavering back and forth from one decision to another. Helping parents to establisha working relationship with a mental health provider before permanency planning issuesmust be addressed can make it easier for them to deal with such powerful concerns when theydo arise. For patients, trying to establish a strong, trusting relationship with a provider broughtin during a crisis is very difficult. With a relationship built early in the care of the infectedparent, a skilled mental health clinician can raise issues of permanency placement before theacute fears and denial set in when a medical crisis occurs.Another difficult issue for HIV-infected people is the establishment of advance directives. (SeeChapter 18: Legal and Financial Issues.) Psychologically this requires the patient to acknowledgethat life is finite and death may be imminent. Again, a relationship with a mental healthprovider can provide a safe place for the patient to explore fears of dying, and of death. Helpinga patient to think about the quality of life near the end of life is best done in the context ofongoing relationships with both a primary provider and a mental health clinician, working togetherto explain the medical details and the emotional components of the decisionmakingprocess.XU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 247