The American Diabetes Association recently issued guidelines for better addressing the psychosocial needs of persons with diabetes. The guidelines illustrate both opportunities for expanding health care psychology by collaborating with primary care physicians, and also some significant challenges. “Landmark psychosocial guidelines for diabetes spark debate over the ideal versus the practical” was published by MDEdge.com, an online news service, on 12-8-16. This article discusses these guidelines as “a state-of-the-art approach to delivering integrated mental health especially services to this patient population.”
People with diabetes are susceptible to significant mental health comorbidities, in part because of the stress of managing their care needs. For example, one study found that people diabetes have twice the risk of developing depression, while another study found that poor glycemic control is associated with increased risk of anxiety symptoms (citations in original article)
The new guidelines are thorough and informed by research about psychosocial factors for people diabetes, but also will be challenging for primary care providers to implement. They provide a strong case for collaboration between PCPs, and other medical providers such as endocrinologists, and mental health professionals. This will, however, require significant changes in how the medical professionals assess and respond to patients with mental health treatment needs. They already have “own crushing” demands on their time.
Medical providers are expected to respond to these guidelines with concern about whether they will have time and resources to do the activities required to comply with the guidelines. It will be necessary to educate them about options for screening for mental health conditions and making appropriate referrals. On the other hand, the guidelines encourage medical providers to view mental health professionals as partners in care, and to refer to them as promptly as they would for any other co-occurring medical condition that requires coordinated services. They can, and should, refer their patients for evaluations by mental health professionals “just like you would refer them for an EKG, blood test, or consultation to an endocrinologist.”
On the other hand, “An embrace of value-based care as envisioned by the guidelines’ authors is irrelevant, however, if qualified mental health specialists-particularly those trained specifically in the psychosocial needs of people with diabetes-are nowhere to be found.” One physician is quoted to illustrate a common concern: “I (practice) in the middle of Los Angeles, and I can tell you that in a 30-mile radius, there is not a psychologist anywhere that I can refer diabetes patient to.” (emphasis added)
The guidelines include the following recommendations that should be of interest to mental health professionals integrated in providing the service:
- Use of patient-appropriate standardized and validated mental health assessment tools at the initial visit and periodic follow-up interviews.
- Carefully monitoring the patient’s self-management behaviors and psychosocial factors affecting the person self-management as treatment progresses.
- Prompt referral to mental health professionals to help respond to self-management problems.
mhconcierge’s take: these guidelines, and the concerns documented in this article, support the benefits of developing healthcare psychology skills and networking with medical colleagues to help them respond to emerging pressures on them to address patient self-management and psychosocial problems.