Severe mental illness and type 2 diabetes

KHP Diabetes, Endocrinology and Obesity recently conducted a health needs assessment to better understand the needs of people living with both a severe mental illness and type 2 diabetes.

People with mental health disorders such as psychosis and schizophrenia are two to three times more likely to develop diabetes, but care for these two long term conditions are often coordinated in isolation, with little integration of mental and physical healthcare. This assessment has included reviewing local data on the demographics of this group, as well as patient and service provider interviews, and a rapid literature review and aims to inform a better care model for the future that meets the needs of this population. 

We spoke to Jennie Crossan from the KHP DEO team to find out more. 

Can you tell us a little about your background and role?

I’m a Project Manager in the King’s Health Partners Diabetes, Endocrinology and Obesity Clinical Academic Partnership and lead on our Integrating Mental and Physical Health workstream. I’m a dietitian by background and have previously worked in both mental health and obesity services so have first-hand experience in treating patients with these conditions. 

What is severe mental illness and what are some of the health impacts? 

Severe mental illness (SMI) is defined as schizophrenia, non-affective psychosis, bipolar disorder, major depression, and other affective disorders.

People with SMI die 15-20 years earlier than the general population due to a greater risk of poor physical health, including diabetes – the prevalence of diabetes is 2-3 higher in people living with SMI than in the general population. People with SMI often face additional challenges such as higher rates of unemployment, poor accommodation, the burden of managing multiple conditions as well as dealing with the obesogenic and diabetogenic effect of antipsychotics they may be taking for their SMI. 

Why did you conduct a Health Needs Assessment for SMI and type 2 diabetes?

Given these health inequalities, there is pressing need to understand the evidence that currently exists around interventions for this population including capturing the experiences of both service users and service providers, and local demographics.

Conducting a Health Needs Assessment helped us to understand the needs of people with living with these two conditions with will help us inform future care models and reduce the health inequalities experienced by this population. 

What did you find?

In terms of our local population the prevalence of those living with an SMI and Type 2 diabetes is increasing and black populations are disproportionately represented.

People living with these two conditions are more likely to be prescribed a glucose lowering medication than those with just Type 2 diabetes and medication adherence is often better, with patients stating they found this was one of the most helpful elements in controlling their diabetes.

Patient education was highlighted as a point for improvement with goals being tailored to the patient’s situation along with a need for a better uptake of the adapted patient education group on offer. Staff education was also highlighted as an important factor in driving up care for this population in terms cross partner working and sharing of knowledge to better facilitate integrated care as well as a robust training off for staff. 

The creation of patient champions was a theme that emerged from both service provide and patient interviews to better engage patients in their care which was backed up by evidence found in the literature.

What are the recommendations of the HNA?

An action plan has been devised to take forward with our partners to address each of these findings, linking into existing forums and forming working groups where appropriate.

New proposed workstreams include:

• engaging with GPs and primary care;
• working with the South East London Diabetes Delivery Board to improve data quality;
• feeding into the new Diabetes, Endocrinology and Obesity Research Strategy theme of Metabolic Complications of Major Mental Illness to inform research and funding opportunities;
• developing a champions network;
• engaging with the Maudsley Recovery College to further develop patient education
• continuing to develop staff education in diabetes across all disciplines and working to develop and integrate patient pathways across South London and Maudsley NHS Foundation Trust and acute and community services for diabetes. 

Read the full Health Needs Assessment.

Find out more about the work of KHP Diabetes, Endocrinology and Obesity.