Hepatitis C and mental health

A report back on Dr. Nada Andric's session: Treating hepatitis C in people with severe mental illness-challenges and victories in primary care delivered at the Hepatitis C in General Practice Forum.

I attended the pre-conference GP forum which was aimed at bringing GPs together to share strategies and local solutions for treating people living with hepatitis C. The speakers ranged from infectious disease specialists as well as GPs with varying levels of experience in the management of hepatitis C across different practice settings. There was also a presentation from a patient with a “lived” hepatitis C experience.

The key takeaways for me from this session include seeing the stigmatisation of patients with hepatitis C from a patient’s perspective and how this stigma impedes patients from checking their status or seeking treatment. It is interesting to note that patients may find clinician’s excessive focus of mode of infection with hepatitis C as judgemental. The forum agreed that while understanding how the patient may have contracted hepatitis C is important in terms of risk management, clinicians need to display tact, empathy and a non-judgemental attitude when exploring this. Patient’s stigma in the form of may persist through failure to achieve “sociological cure” despite “biological cure”. I will, therefore, be mindful of these points in my interactions with my patients.

Another interesting point from the forum is the high burden of hepatitis C among patients with enduring psychiatric illness. The speaker, who happened to be a GP working with homeless clients, highlighted the importance of integrating viral hepatitis screening/treatment into mental health services. This approach is in line with the National Strategy on the elimination of viral Hepatitis C in Australia which has identified mental health settings one of the priority areas to be targeted to achieve the country’s elimination targets. While acknowledging other potential causes of deranged liver function tests (such as psychotropic medications, non-alcoholic steatohepatitis, alcohol etc.) among patients within mental health settings, the speaker pointed out that the Royal Australian and New Zealand College of Psychiatrists recommends that patients with enduring mental illness should be screened for viral hepatitis as part of their baseline assessment. Obtaining informed consent for viral hepatitis testing in acute psychiatric settings as well as in patients with cognitive limitations might be a challenge. In my settings, however, my patients are more likely to be more stable or better supported and this may mitigate the ethical challenges and therefore offer more opportunities for testing and treatment for hepatitis C.