Coordinating Care For Dual Diagnosis : Diabetes And Mental Illness

The DOH (2001) suggests that approximately 90% of adults in the UK that have Diabetes have Type 2, and that this condition can have a significant effect on the psychological well-being of these people and their families.

People with mental illness often go undetected, undiagnosed, and untreated in primary care settings. The mental health stigma contributes to how primary care decisions exclude and overlook mental health as an integral part of patient care (Corrigan, P. et al., 2014). Past research revealed that at least one third of primary care patients with psychiatric disorders escape detection (Jones, Badger, Ficken, Leeper, & Anderson, 1987). As a result, current researchers assert there are increasing concerns about how behavior health contributes to the physical health of people. Alarming figures indicate that people with serious mental illness have two to two and a half times higher mortality rate than the general population (Iyer & Young, 2015).

Lack of health insurance is a barrier to medical care, which may increase the risk of diabetes complications and costs. The objective of this study was to assess the potential of the Affordable Care Act (ACA) of 2010 to improve diabetes care through increased health care access by comparing health care and health outcomes of insured and uninsured people with diabetes. Uninsured adults with diabetes had less access to health care and lower levels of preventive care, health care use, and expenditures than insured adults. To the extent that the ACA increases access and coverage, uninsured people with diabetes are likely to significantly increase their health care use, which may lead to reduce incidence of diabetes. Mental Health issues that can develop with people with diabetes are diabetes distress, anger, denial and depression.

It's been found that most people with diabetes are also more likely to face depression. Unfortunately, this may affect a diabetic's ability to manage their own

Schmutte et al. (2009) concluded that patients diagnosed as having a psychotic disorder have significantly more inpatient admissions than those with “other” disorders. According to Hunter, Yoon, Blonigen, Asch, & Zulman (2015), individuals with severe mental illness and substance abuse disorders were younger and had fewer chronic medical conditions. The same individuals also had a greater proportion of their healthcare costs generated by mental healthcare (41%).

The ‘medical model’ (Beecher, 2009), also called the ‘biomedical model’ (Germov, 2009), basis its beliefs on the theory that there is not a connection between the mind and the body (Sarafino & Smith, 2014) and illness is caused by ‘biological’ (Germov, 2009) factors that can be diagnosed and treated with medications (Germov, 2009). The biomedical model becomes problematic when applied to the treatment of mental health illness due to the cause being widely unknown and so how can mental illness be successfully treated using this model? Social factors that may have a contributory effect or allowance for preventative measures to be implemented are also not taken into consideration with the ‘medical model’ (Germov,

Over the years, “the importance of the mental health expert in the management of medically ill individuals has grown with the proliferation of information linking health and behavior”. (Harris & Lustman, 1998) Receiving a diagnosis such as Diabetes Mellitus has been linked to psychological disorders that affect the way an individual copes with this disorder. We will identify treatments, controlled and uncontrolled factors, and the approach used by mental health professional to help these patients replace unhealthful behaviors in the midst of emotional distress. With years of

Brown, et al. (2005) found that depression appears to increase the threat of developing diabetes by roughly 23% in younger adults. De Groot (2010) agrees saying studies in which people were tracked down for more that 10 to 20 years, instituted that people with a history of high depression are at an increased risk of developing type 2 diabetes later in on life. (Mann, 2010) also showed that depression amplified the risk for diabetes, and diabetes amplified the risk for depression. Particularly, depressed women were 17% more prone to develop diabetes even after the researchers considered other risk factors like weight and irregular exercise. (Nordqvist, 2010) also concluded that women with depression had a 17% higher danger of developing diabetes. Finally, Pouwer et al. (2010) suggested that it is not only depression but also general emotional stress, anxiety, anger, sleeping problems and resentment are associated with an amplified risk for the development of type 2 diabetes.It is therefore evident from all these studies, that depression can lead to diabetis within a span of ten years or less as was evidenced in Mr. Banks

Aristotle stated “the whole is greater than the sum of its parts”, the same applies in the care of the dual diagnosis of diabetes and mental illness, the intertwining of the two chronic illness increases the blurring the lines of cause and effect, patients diagnosed with serious mental illness are at greater risk for the development of diabetes due and diabetics are at increased risk for depression due to the chronic nature of diabetes. Numerous studies have delved into the health disparities of mental illness and diabetes contributes to the detrimental outcome for physical and mental health. Diabetes and mental illness do not afflict in a vacuum, through addressing the dual diagnosis the quality of health for other at risk groups in the Hispanic, African American, Native American and impoverished communities, results in decreased comorbidities associated with the dual diagnosis . ADD STATS FOR THE other groups.

Aristotle stated “the whole is greater than the sum of its parts”, the same applies in the care of the dual diagnosis of diabetes and mental illness, the intertwining of the two chronic illness increases the blurring the lines of cause and effect, patients diagnosed with serious mental illness are at greater risk for the development of diabetes due to prescribed psychiatrist medications. Inversely diabetics are at increased risk for depression due to the chronic nature of diabetes. Despite numerous studies that have delved into the health disparities of mental illness and diabetes dual diagnosis few have addressed the provider patient relationship. Diabetes and mental illness crosses racial, cultural, ethnic and social boundaries, through

This article discusses the different populations of people living with behavioral health conditions and separates them into different populations. The first population deals with anxiety and depression; the second population deals with behavioral health conditions that are moderate and the third population deals with serious conditions. Behavioral health conditions including bi-polar disorder and schizophrenia are serious conditions when it comes to behavioral health and these conditions are not being managed properly by behavioral health

Carper, M., Traeger, L., Gonzalez, J., Wexler, D., Psaros, C., Safren, S. (2013). The differential associations of depression and diabetes distress with quality of life domains in type 2 diabetes. Journal of Behavioral Medicine, 37, 501-510.

One possible link that explains why depressive symptoms are related to poorer diabetes health outcomes is through self-efficacy. Those with higher depressive symptoms have lower self-efficacy, or the belief that they cannot control their diabetes. If you feel a lack of control it can lead to making unhealthy decisions because you feel that whatever you do, it will not change the outcome. Finally, depression and depressive symptoms not only relate to negative disease outcomes, but are also related to poor overall functioning and low perceived quality of life. Signs

This is even more important as a high proportion of people with physical health conditions also have co-morbid mental health problems, many of these problems go undiagnosed and untreated leading to poorer health outcomes and higher costs of care. In addition, mental health co-morbidities increase hospital costs by 45- 75% per case, the extra costs of physical health care associated with mental health co-morbidities and medically unexplained symptoms amount to around £13.5 billion a year(11). Across a range of conditions, each patient with co-morbid depression costs health services between 30 and 140 per cent more than equivalent patients without depression (4).

En este estudio vinculado directamente con efectos que pueden ser causados por el diagnóstico y afrontamiento de la enfermedad Diabetes Mellitus (DM) tipo 1 es esencial hacer notar que por su magnitud y trascendencia es considerada un problema de salud público a nivel mundial. Según Moreno, 2001 ̈En 1955 existían 135 millones de pacientes diabéticos, se esperan alrededor de 300 millones para el año 2025 ̈ (p.35). Es importante considerar que por esta gran población que padece de esta condición, es relevante tomar medidas que prometan brindar calidad de vida a estos seres humanos, lo cual incluye un balance psico emocional y físico. Estas consideraciones son validadas por Martinez, Lastra & Luzuriaga (2002), donde revelan que ̈La aproximación terapéutica debe incluir la comprensión de las ramificaciones sociales, psicológicas y psiquiátricas de la diabetes mellitus tipo 1 si se desea alcanzar la meta de lograr el bienestar del paciente a la vez que la prevención de las complicaciones ̈(p.114).