You are a counsellor working at a mental health service. Tony a 35 year old man presents to you as a client. He has a history of mental health problems and has just received a letter in the mail from a Blood Donation service claiming that he may have been exposed to hepatitis C over 15 years ago from a blood transfusion. He is clinically depressed and claims he will commit suicide if his young children (5 and 7 years old) are positive. He says he would rather die than tell his wife or be tested. What do you do?
Issues for discussion
- Tony may have cleared the virus, approximately up to ~25% of people clear the virus following exposure, but still carry antibodies.
- Even if he is positive, hepatitis C is not classified as a Sexually Transmitted Infection (only transmitted blood to blood) therefore it is highly unlikely that he has transmitted hepatitis C either sexually or in a household setting to his partner or children.
- A father cannot transmit hep C to his unborn child while in the womb.
- The mother would have to be hep C positive for the children to have acquired hepatitis C, even then there is a low likelihood (2-5%) chance of transmission when detectable levels of HCV is in the mothers blood (when the mother is HCV PCR+).
- The priority issue is to provide Tony with support
- How does Tony’s mental health status affect the decision to test for hepatitis C?
- Discuss whether testing may or may not be the most effective strategy to begin with; waiting until Tony has stabilised and been given more information may be a better time to organise testing.
- Tony’s anxiety may be lessened by some factual information (above) and emotional support.
- Encouraging support from his family rather than feeling he has to hide his possible illness may help with his isolation.
- Supply resource information and family referral support
- Take care with the messages conveyed about hepatitis C; experiences surrounding diagnosis often impact a person’s sense of empowerment or powerlessness
- Supply information on local support group and Hepatitis C Council.
- It is also important to offer Tony referral to a relevant General Practitioner or a counselling service.
- Training for staff within the organisation would help in providing a higher quality of service delivery when dealing with the psychosocial issues relating to hepatitis C.