Open Access Government investigates the link between diabetes and mental health
People with diabetes suffer disproportionately high rates of mental health problems, such as depression, anxiety and eating disorders. But new approaches are being developed to integrate physical and psychological care.
Living with a long-term condition has an obvious physical cost but, in the past, the mental toll of living with the pain and stress has often been overlooked. Some 3.7 million people in the UK have been diagnosed with diabetes, according to the most recent figures from charity Diabetes UK. It estimates that another one million are living with the condition but have not yet been diagnosed – and a further 12.3 million are at heightened risk of Type 2 diabetes.
Research by the same body, published in November 2017, shows that three in five people with diabetes experience emotional or mental health problems because of their condition.
One in five of the 8,500 people surveyed had sought professional counselling or support to help them manage their diabetes. Only around one in three (30%) said they felt fully in control of their diabetes. “Diabetes affects more than 4.5 million people in the
UK and is the fastest-growing health crisis of our time. It can lead to heart disease, stroke, kidney failure and lower limb amputations”, says Chris Askew, Chief Executive of Diabetes UK.
“This research brings to light the isolation that can come from managing an invisible condition and how detrimental living with diabetes can be to a person’s emotional wellbeing without the right support. “Effective diabetes care requires that a person’s emotional needs are taken into account alongside their physical care needs.”1
The first model of care in the UK to integrate diabetes, psychological and social care for people with poor glycaemic control was launched in 2010. The Three Dimensions for Diabetes (3DFD) service, based at King’s College Hospital NHS Foundation Trust, was aimed at people living with complex psychological needs that could not be met by existing, generic psychological therapies.
It focused on the London boroughs of Lambeth and Southwark, which had some of the highest levels of deprivation in the capital and an estimated 28,000 people living with diabetes. Around one-third had psychological or social problems, such as homelessness, debt or unemployment, that affected their ability to self-manage their condition. As a result, they often failed to engage with regular health and social care services and made frequent visits to A&E. The 3DFD scheme found that patients valued being supported by a single team, with different skills allowing a faster, more integrated response to their needs.
It also found that for patients with regular hospital admissions and poor engagement with scheduled care, the time in the hospital provided a good opportunity to intervene in order to shorten admissions and enable engagement. Furthermore, it demonstrated that “hard to reach” groups were not necessarily so. Patients’ perceptions of the service were an important factor in their engagement and the team found that telephone contact, SMS
reminders, home visits and feedback to referrers improved attendance rates, particularly among Black, Asian and Minority Ethnic (BAME) communities. An evaluation of the programme in 2013 found significant improvements in psychological scores relating to
depression, anxiety and diabetes-specific distress. There were also improvements in measurements of social functioning across multiple categories, including personal responsibility, living skills, social networks, substance misuse, meaningful use of time and accommodation. Less than 10% of patients from phase one of 3DFD were referred back to the service in phase two, indicating the integration of patients back into routine care and low relapse rates.
In addition, the programme showed a saving of £56,700 for 119 patients during the first phase through a reduction in A&E and acute diabetes-related hospital admissions and re-admissions over a 12-month period. Analysis by the Diabetes Modernisation Initiative projected further savings of £102,000 per 120 patients, year-on-year, across Lambeth and Southwark in delaying or preventing diabetes complications.2 More recently, in 2016 NHS England began testing new services that integrated mental and physical treatments for long-term conditions under the Improving Access to Talking Therapies (IATT) programme. These services provide a “whole-person assessment” that focuses on the mental health care patients may need to manage their condition.
One scheme in Cambridgeshire and Peterborough showed that timely and effective mental health care for people with diabetes, cardiovascular or respiratory illness reduced inpatient hospital attendance by threequarters and A&E admissions by 61%, saving £200,000. Overall, the IATT service, which has been described as “the world’s most ambitious effort to treat depression”, delivered a record high recovery rate for patients of 51.9% earlier this year.
NHS England National Director of Mental Health, Claire Murdoch, says: “Effective NHS mental health care for people with long-term illness is a game-changer for our patients and good news for taxpayers. By integrating talking therapies with treatment for diabetes and heart conditions, NHS patients get care for mind and body at the same time.
“As the NHS turns 70, integrated talking therapy services are a big step forward for our patients and a crucial part of putting mental health at the centre of our plans for the future of the health service in England.”
The NHS has also announced that it will scale up the Diabetes Prevention Programme in 2017-18 and 2018-19.
Additionally, around £44 million a year has been allocated to a Diabetes Transformation Programme to improve treatment and care by promoting access to evidence-based interventions. Clinical commissioning groups (CCGs) can bid for the national funding to support the uptake of structured education; improve access to specialist inpatient support and to a multidisciplinary foot team for people with diabetic foot disease; and improve the achievement of treatment targets while reducing variations between CCGs.3
Open Access Government