Summary

It is estimated that people from Black and Minority Ethic (BME) communities are up to six times more likely to develop diabetes, according to NSF Diabetes 2007.

One in five people with severe mental heath issues have diabetes and people with a diagnosis of schizophrenia or bipolar illness are more than twice as likely to have diabetes and a range of other related physical illnesses, eg, stroke, heart disease (Choosing Health 2006).

The risk of developing diabetes accumulates when individuals belong to more than 1 risk group, eg, South Asian and having mental health problems (NSF Diabetes 2007). 

Results

The project was developed with mental health service user and carer input. This ensured their full engagement and participation in the development, production and delivery of the project, and resulted in breaking into a market not previously reached by diabetes services in this region.

The project was completed at the end of summer 2011 and a full evaluation will take place in spring 2012. Some of the areas that will be evaluated include staff’s self-reported knowledge/awareness/confidence levels compared to the baseline questionnaire, self-reported user/carer levels of satisfaction, knowledge, confidence and control of own care and acute hospital emergency admission rates of people with diabetes who are mental health users.

In the short term the feedback from both mental health staff and service users/carers has been very positive.

Staff have reported that the e-learning programme and aide-memoir will help them to provide better care and service users have said how they have gained confidence, improved their self esteem and lost weight as a direct result of their increased knowledge of better management of their diabetes.

Challenge

Leicester City has a diverse population with a high percentage of which originate from South Asia. In a survey in 2007, almost 5 per cent of the city population was registered as diabetic (16,844) with an anticipated growth of 3,000 new cases per year.

Research revealed that there are several issues to consider for individuals with severe mental illness and diabetes who are of South Asian origin:

• Individuals may not be able to make informed choices about their diabetes due to impaired judgment
• There may be lack of trust towards healthcare professionals
• Lack of social skills may mean that communication around medical problems is poor
• Language and literacy barriers may exist, which hinder education and discussion about issues related to self management of the illness
• Lack of information in appropriate formats for service users and carers
• Lack of understanding for acute and primary care re: impact of mental health on medical conditions such as diabetes
• Lack of up to date training of mental health clinicians re: management of diabetes and limitations in their knowledge about dietary issues relating to diabetes in particular the cultural factors in relation to food and lifestyle for service users from BME communities.

The City PCT has developed diabetic services, which generally meet the needs of the population. However because of the issues identified above, there is a gap in the care pathway for mental health services users with diabetes.

The aim of the project was twofold. Firstly, to work with mental health service users with diabetes from the South Asian community to better help them understand the implications of diabetes on their general health and wellbeing. Secondly, to ensure clinical staff in Leicestershire Partnership Trust (LPT) have the appropriate skills and knowledge to support individuals in self caring of their diabetes through the development of an e-learning programme and an aide-memoir document.

Solution

Firstly the team gathered baseline information about mental health staff’s confidence/knowledge levels about diabetes. This showed few staff had had appropriate diabetes training and many did not feel confident in their ability to give support to patient with diabetes.

Additionally, the team gathered baseline information from service users/carers. This showed: 

• User/carer isolation
• Poor experience of services (eg, from GPs)
• Inability to challenge services
• Impact of the stigma of their mental health problems on the level of practical support/sympathy received for their diabetes.

In order to develop the work further focus groups were held where participants discussed their views on cultural barriers, and possible ideas to overcome them. The focus group allowed the collection of rich qualitative data regarding people’s experiences and opinions.

Clinicians were engaged throughout the whole programme, including representation from health, modern matrons and Wellbeing Link Nurses.

The information collated through the engagement process informed the development of a self care DVD for service users and e-learning module and aide-memoire document for mental health professionals, both of which highlight specific issues for people from the South Asian community who have mental health problems and diabetes.