An integrated care model for mental health in diabetes: Recommendations for local implementation by the Diabetes and Mental Health Expert Working Group in England

Abstract

Context: In 2019, NHS England and Diabetes UK convened an Expert Working Group (EWG) in order to develop a Model and recommendations to guide commissioning and provision of mental health care in diabetes pathways and diabetes care in mental health pathways. The recommendations are based on a combination of evidence, national guidance, case studies and expert opinion from across the UK and form other long term conditions. The case for integration: There is good the evidence around the high prevalence of co-morbidity between diabetes and mental illness of all severities and, the poorer diabetes and mental health outcomes for patients when this co-morbidity exists. Detecting and managing the mental health co-morbidity improves these outcomes, but the evidence suggests that detection of mental illness is poor in the context of diabetes care in community and acute care settings and that when it is detected, the access to appropriate mental health resource is variable and generally inadequate. The Model of integrated care for diabetes: The EWG developed a one-page Model with five core principles and five operational work-streams to support the delivery of integration, with examples of local case studies for local implementation. The five core principals are: Care for all—describing how care for all PWD needs to explore what matters to them and that emotional wellbeing is supported at diagnosis and beyond; Support and information—describing how HCPs should appropriately signpost to mental health support and the need for structured education programmes to include mental healthcare information; Needs identified–describing how PWD should have their mental health needs identified and acted on; Integrated care—describing how people with mental illness and diabetes should have their diabetes considered within their mental health care; Specialist care—describing how PWD should be able to access specialist diabetes mental health professionals. The five cross cutting work-streams for operationalising the principles are: Implementing training and upskilling of HCPs; Embedding mental health screening and assessment into diabetes pathways; Ensuring access to clear, integrated local pathways; Ensuring addressing health inequalities is incorporated at every stage of service development; Improving access to specialist mental health services through commissioning. Discussion and conclusions: The Model can be implemented in part or completely, at an individual level, all the way up to system level. It can be adapted across the life span and the UK, and having learnt from other long term conditions, there is a lot of transferability across all long term conditions There is an opportunity for ICBs to consider economies of scale across multiple long term conditions for which there will be a significant overlap of patients within the local population. Any local implementation should be in co-production with experts by experience and third sector providers.