NHS England has also recognised the importance of good mental health, advocating a holistic approach to care for people with diabetes which includes consideration of mental and emotional well-being as well as physical health (NHS England 2018). Diabetes UK has recommended that ever person with diabetes should be in receipt of 15 healthcare essentials - including getting psychological and emotional support, and that receiving more integrated care would improve outcomes and quality of life. This, they say, would also subsequently reduce healthcare costs.
A ‘stepped care’ approach to treating depression has been recommended by NICE which organises provision according to what is seen as the patient’s specific needs.
Identifying the symptoms
When someone goes to their GP to discuss feeling depressed or anxious, identification of symptoms starts with two questions:
1. During the last month, have you often been bothered by feeling down, depressed or hopeless?
2. During the last month, have you often been bothered by having little interest or pleasure in doing things?
If the answer is ‘yes’ to either of these questions, then further questions are asked in order to decide on the next step, and this is usually based on the severity of symptoms.
What support is available?
A service available to all those identified as having depressive symptoms is the Improving Access to Psychological Therapies (IAPT) service. GPs usually make the referral, however self-referral is also an option. The IAPT service consists of talking therapies such as cognitive behavioural therapy.
NICE guidelines, based on existing evidence, also recommend the use of physical activity groups, motivational interviewing, and group or family therapy.
Some people prefer group rather than individual support as it can promote a sense of belonging, sharing stories and feeling less isolated.
A recent systematic review of studies investigating the impact of different treatments in people with diabetes found that both psychological and pharmacological interventions had a moderate effect on depressive symptoms, but had no impact on quality of life. NICE are currently updating their guidance and evaluating the evidence which can inform their recommendations.
Specific guidelines for supporting people with long-term conditions (including diabetes) have only very recently (April 2018) been developed and are yet to be widely available. At the same time, direct access to psychological support in primary or secondary diabetes clinics remains scarce.
There is often a lack of confidence in talking about depression or other psychological and emotional problems, on the part of both the GP and the person with diabetes.
The treatment of diabetes and its physiological consequences is often seen as the main priority of care, with psychological well-being further down the list, and worries about the most appropriate service to offer or receive are common.