How important is mental health involvement in integrated diabetes care? The Inner North West London experience.

Supported self-management is key to good diabetes care, but the high rates of mental health difficulties in diabetes can hinder effective self-management. Depression, anxiety, eating disorders and cognitive impairment, as well as interpersonal difficulties and personality disorder are all known to have a detrimental effect on effective self-care and addressing these has been demonstrated to improve health and financial outcomes. We propose that integrating mental health into the core of diabetes care is vital to improve detection and effective treatment rates of these disorders as well as improving confidence of all professionals who support people living with diabetes. We found that in 81% of all cases brought to the multidisciplinary complex case conferences, mental health issues were discussed. The majority of these were regarding reasons for people not effectively self-managing their diabetes despite having education on diabetes. We found that there was a demand for our input in case conferences, educational sessions about self-management, cognition, capacity and mental illness, and a need and demand for a specialist mental health diabetes service.