Undoing Descartes: integrating diabetes care for those with mental illness

Diabetes UK has supported the concept of integrated diabetes care to ensure that the person with diabetes is seen by the right professional at the right time in the right place. At a time when diabetes teams are threatened by changes in the NHS, the division between mental and physical health services makes those with mental illness particularly vulnerable. The association between diabetes and mental illness has been recognised for over 350 years. The prevalence of diabetes in people with depression and severe mental illness (schizophrenia and bipolar illness) is increased two-to three-fold. Furthermore, the proportion of people with undiagnosed diabetes is considerably higher than in the general population. The risk of complications and diabetes related mortality is higher in those with co-morbid mental illness. Currently, diabetes services for people with severe mental illness lag behind those for people without mental illness; patients are less likely to be examined for eye or foot complications, less likely to be screened for glycated haemoglobin or cholesterol, and less likely to receive education. Integration of care between mental and physical health services, whether in primary or secondary care, is essential if this health inequality is to be overcome. Perhaps only then can we bring body, mind and soul back together. Copyright (C) 2011 John Wiley & Sons.