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The STIRR Model of Best Practices for Blood-Borne Diseases Among Clients With Serious Mental Illness

OBJECTIVE: Persons with severe mental illness have a markedly elevated risk of several blood-borne infections, including HIV, hepatitis B, and hepatitis C. Prevention, early detection, and treatment of these disorders are crucial interventions for high-risk populations. However, because of a number of barriers, most clients with severe mental illness do not receive these basic best-practice services. The authors describe a public health model intervention designed to deliver basic best-practice services for blood-borne diseases, as specified by the Centers for Disease Control and Prevention, to clients with severe mental illness and co-occurring substance use disorders. METHODS: The intervention, called STIRR (for screen, test, immunize, reduce risk, and refer), is brief (requiring approximately one hour per client) and is delivered at the site of mental health care by a mobile team of specialists. Clients are provided with risk screening, testing for HIV and hepatitis, immunization for hepatitis A and B, risk-reduction counseling, and treatment referral for blood-borne infections. Also described is a pilot study to evaluate this model in two publicly funded community mental health centers. RESULTS: At the first site, 137 (79 percent) of clients with severe mental illness were tested and immunized. At the second site, more than two-thirds of the clients of a dual diagnosis team participated (67 clients, or 68 percent). Intervention costs per client ranged from $194 to $262. CONCLUSIONS: The STIRR approach has the potential to provide a basic, best-practice package of interventions for high-risk clients with severe mental illness.

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