Its an aspect - no bones about it- we in the NHS England diabetes team haven't focussed much on as regards diabetes care. . Yet.
Theres been a lot of work on prevention of type 2 diabetes, investment into safety in hospitals, improving foot care, treatment targets, education uptake, more of digital work being encouraged, encouraging use of modern technology such as Libre…but so far, cupboards a bit blank as regards mental health.
I suppose this is where social media has been good- you lurk, you listen, you engage- and you start to get a grasp as to how much mental health support is a key issue. You don't just ned to read papers to get policy direction, sometimes listening works too. As the national work has focussed on issues such as #LanguageMatters and then the Type 1 diabetes self-management platform- the feedback has been strong and equivocal- mental health support is patchy- or maybe I am being polite. Its actually not that good. Somehow it continues to be a cinderella service- and thinking of it, if we are doing work to relook at the contributions dieticians and pharmacists can make to diabetes care, mental health cant be glaring gap in the whole paradigm
Over the last few months, we have been working on gaining some information, talking to psychologists, psychiatrists- and boy, there are many things to cover. This sent simply about money or lack of support- theres a lot about which patients needs what support, where- and how. Juxtaposed in there is the ethos of digital- which needs a bit of tempering too. Digital IS important- but that shouldn't be at the expense of the value of face to face - so there needs to be a balance, a coherent strategy. Mental Health isn't just about "Phone IAPTs" either- we will likely need a varied options on the table- and more importantly, for health care professionals- the ability to recognise- and then be able to signpost to the right resource. What exactly is the point of raising awareness if there isn't an appropriate service to send to?
Having said all that, my approach to this is probably going to be the same as with what we have done with the Diabetes technology pathway- work on which is going through the final touches. Get the right cohort in the room- patients, psychologists, psychiatrists- and come up with a coherent strategy. There are- encouragingly- good examples of diabetes and mental health being tied in 1 strand- whether it be West Hertfordshire, parts of London, Cambridge- the key is too to see what we can learn from them, what stops us from adopting that as a national template- and what leeway we need to give for different economies
So we shall start the process- very soon. Diabetes UK have been doing some excellent work in this space- and as ever, will be a strong ally in this work- and invites will be out soon to some to contribute to this- who will then take things forward; ask for contributions etc as needed. The basic remit is very simple- for a population of say 10000 people living with diabetes- what does mental health support look like? How does it fit in with other chronic disease facilities around? What good practice can we encourage?
To the many who have helped- and made a few pointers along the way- thank you. We have focussed on some important things over the last few years- and proud too of whats been achieved. At the same time, no hesitation in saying this particular area needs its deserved focus too. So lets see where it takes us. As ever, if you live with diabetes or care for someone who has diabetes, your views are always welcome.
And oh…just in passing…there will be something called "Diabetes :Mind Over Matter" in the not too distant future- co-organised with Amanda Epps. Keep your eyes peeled- could be something of interest….