User accounts on received diabetes and mental health care in a Danish setting – An interview study

Abstract

People with coexisting type 1 and 2 diabetes and mental illness have a higher mortality rate compared to the general population, among other reasons due to unregulated diabetes. One explanation might be the complexity of managing both conditions. In this interview study, we explored the accounts of delivered diabetes and mental health care of 16 individuals living with coexisting diabetes and mental illness in Denmark. A thematic analysis by Braun and Clarke was applied in the analysis. Some of the participants described the care for diabetes and mental illness to be inextricably linked to each other. Therefore, health care providers ought to focus and knowledge of both conditions as essential components in the care provided. The participants accounted for support needs in other settings beyond diabetes and mental health outpatient clinics, such as the family doctor, residential institutions, and community care. However, the inefficient collaboration between these health care settings is one of the barriers to supporting the participants' self‐management.

A systematic review of barriers and enablers that health professionals experience to the delivery of type 2 diabetes care for adults with severe mental illness

“…Focussing on these aspects of care delivery may also improve service user perceptions of care as previous literature has identified a need for increased diabetes knowledge in health professionals. 23 This has been further described as a poor understanding of type 2 diabetes (in mental health professionals) and suboptimal 'interaction' with people with an SMI (in physical health professionals) that leads to perceived poor care by people with an SMI. 21 Thus a multi-skill intervention that is sensitive to the needs of the different professionals involved in type 2 diabetes care, and cognisant of service user experience and perceptions, has the potential to be beneficial in improving delivery of type 2 diabetes care.…”

“…The findings from this review however suggest that whilst the need to acquire knowledge and skills is important, without the confidence and intention to put these into practice this may be insufficient. Focussing on these aspects of care delivery may also improve service user perceptions of care as previous literature has identified a need for increased diabetes knowledge in health professionals 23 . This has been further described as a poor understanding of type 2 diabetes (in mental health professionals) and suboptimal ‘interaction’ with people with an SMI (in physical health professionals) that leads to perceived poor care by people with an SMI 21 .…”

“…Challenges reported by service users such as the overshadowing of type 2 diabetes in the context of an SMI and difficulties in self‐management of type 2 diabetes and an SMI, particularly when physical or mental health deteriorates, illustrate the potential for improving outcomes by targeting health professionals 22 . This is also pertinent given the suggested links between meeting the support needs of service users with coexisting type 2 diabetes and how individuals can manage their conditions in everyday life 23 . Additionally, reviews of service user involvement in intervention planning for type 2 diabetes and an SMI highlight the difficulties in combined care including unequal attention to both conditions, challenges in communication, and care coordination 24 .…”

“…22 This is also pertinent given the suggested links between meeting the support needs of service users with coexisting type 2 diabetes and how individuals can manage their conditions in everyday life. 23 Additionally, reviews of service user involvement in intervention planning for type 2 diabetes and an SMI highlight the difficulties in combined care including unequal attention to both conditions, challenges in communication, and care coordination. 24 Given the need to improve outcomes for people with type 2 diabetes, evidence 12,15,21 suggests that targeting healthcare provision is one avenue that could provide a meaningful change in these outcomes.…”

Combining diabetes and mental health care: An ethnographic exploration of user involvement in combined care

“…Poor mental health status among people with severe mental illness is noted to be a justification for healthcare providers to decline to intervene on risky health behaviour and physical health conditions such as diabetes (Bellass et al, 2021; Zabell et al, 2021). The ability to self‐care is influenced by separate diabetes and mental health care, where healthcare providers have specialised skills limited to one of the conditions (Zabell et al, 2022). However, self‐care among users can be improved by cultivating the understanding that diabetes and severe mental illness are more than two separate conditions.…”