Remember caregivers are often managing the disease state called diabetes,  while also managing multiple other people, careers, and/or homes.

They are managing from outside someone else’s body which is infinitely more difficult!

They also place a great deal more shame and pressure on themselves when they feel they are harming someone else. And, of course, the judgement and pressure put on caregivers from other family members, media sources, and even so called “support groups” doesn’t help.

 

Exacerbation of Previous Behavioral/Mental Health Diagnosis

Of course, we have to be aware of any past history of a mental health/behavioral health diagnosis with regard to symptoms, and this should be included in intake assessments as diabetes diagnoses and management may exacerbate an underlying issue--or be a catalyst that kicks off an underlying issue.

Previous concerns may be perceived as having been “dealt with” but can reemerge with a diabetes focus, particularly anxiety disorders or compulsive disorders.

Coping strategies that were effective in the past, or in other areas of life, may be detrimental in diabetes management. For example, someone with a compulsive disorder may be highly successful as an analyst because they can focus their intense need for order and precision on their work and it makes them very good at their job, but that same need for perfection and order, applied to human physiology (which is never going to be perfect and rarely is ordered) can quickly spiral out of control and lead to a complete mental health break down for the individual, their family, and their career.

 

Past history of any mental health struggles may be an indicator of higher risk of future exacerbation with diabetes diagnosis. May present with diabetes focus. “Effective” coping strategies in the past may be destructive in diabetes management. (hypervigilance, avoidance, perfectionism).

Assist - Assign - Arrange!

Note that in the 7As the last three As are Assist, Assign and Arrange!

We cannot drop the ball on Mental health.

Simply suggesting someone see a therapist is not sufficient!

Simply prescribing an antidepressant is not even sufficient!

Follow through! And Follow UP! This is KEY.

Set a plan for follow-through and be sure to follow-up, set specific referrals and a plan to help the patient make contact, a date by which contact will be made, and when follow-up will happen

 

What is the plan to proactively reach out to patients who become clinically avoidant?

Identifying a problem is not enough. We have to be Aware, then Ask, Assess, Assist, Assign, and Arrange. Support the whole person through their entire diabetes journey with warm handoffs and solid plans, all the while providing them with a place where they can find a sure footing and some stability. So, to reiterate:

 

Do not just “pass the buck” with a vague referral. Give them a referral to a specific care provider. Ideally have someone available to assist the patient and support them in making that appointment. Arrange to check back in with the patient to see how that appointment went and answer any questions they may have (i.e. how any medications might impact their diabetes management).   Remember, patients will avoid getting ANOTHER diagnosis on top of the one that is currently overwhelming them. They are compromised and cannot see that getting treatment can help make their diabetes management better and easier to live with, too!

 

Screening tools:

https://professional.diabetes.org/meetings/mentalhealthworkbook

https://www.ismanet.org/doctoryourspirit/pdfs/Beck-Depression-Inventory-BDI.pdf

http://www.chcr.brown.edu/pcoc/cesdscale.pdf

https://www.nedc.com.au/assets/files/Resources/NEDC-Video-Handout.pdf

 

Listing of Diabetes knowledgeable mental health providers:

https://diabetes.org/healthy-living/mental-health

 

Additional learning and support resources:

https://professional.diabetes.org/meetings/mentalhealthworkbook