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How many of the 160 weekly diabetes-related amputations are carried out on patients with undiagnosed or unsupported mental health issues?

Posted on March 28, 2018
Archive : March 2018
Category : News

There is no diabetic foot health without mental health

I had the pleasure of attending the APPG for Diabetes meeting on diabetes and mental health at the House of Commons last week. It was a chance to see government ministers, mental health experts and members of the public with experience of diabetes and mental health, share experiences, knowledge and suggestions for improvement in this very important area.

If I am honest I hadn’t fully appreciated how important mental health was to the management of diabetes. I knew it was important but after listening to the speakers last week, it has really reinforced that without mental health there is no diabetic health, let alone diabetic foot health.

Listening to all the speakers talking about mental health issues and the interaction with diabetes added a new dimension to the way I think about diabetic foot health now.

At Solesee we spend time talking about the importance of daily foot checks if you have diabetes, as well as spreading awareness of our foot inspection mirror which makes these checks easier for the individual. We speak to groups of podiatrists around the country and there is a sense of frustration and disappointment about the number of patients who don’t check their feet regularly, and also a feeling of resignation that many of their patients never would. They love our product and are relieved that there is something that they can now recommend to patients instead of the ‘balancing a mirror against a wall’ option. As podiatrists, they know that if a patient checks their feet regularly they are more likely to spot a problem early enough to be able to deal with it, and hopefully prevent it from getting worse. Getting that message across to the patient is sometimes very difficult.

We have spoken about the apathy of certain patients to their own foot health. I am convinced that is still the case with a huge number of patients, drawing on my own experiences of interactions with people with diabetes. Prevention for many of us, until signs of imminent danger materialise, is something that we will put off until next week or next year, but not do anything about it now. These are the patients who need regular reinforcement of the importance of daily foot checks, so that eventually the message will be taken in and acted on.

This, in an ideal world, would be a different conversation to the one between a podiatrist/diabetes nurse/ wound care nurse with a patient who potentially has undiagnosed mental health issues. With the right amount of training and support this HPC would be able to broach the subject of mental health with their patient, assess, and then refer (if necessary) them to a psychologist who would be working alongside them within the multi-disciplinary team. Once this has been done and the patient has been given the appropriate support and treatment, in time they are much more likely to feel more in control of their diabetes and subsequently take control of their foot health.

Diabetes UK carried out a survey in 2015 and found that 76% of people with diabetes who needed emotional or psychological support from a specialist were not offered it*

So, three quarters of the diabetic population who need support to help them manage this highly self-managed disease with its relentless daily demands, were not getting any. Is it surprising then to hear that 7 out of 10 people don’t feel in control of their diabetes?

Listening to the discussions last week made me realise that there are a large proportion of the diabetic community, because of undiagnosed mental health issues, who are just not able to deal with yet another daily task. Their day is already full of relentless demands which are already making them feel overwhelmed and distressed. Those individuals are those, that even if they are made aware of Solesee and in an ideal world given one to use, would not be able to cope with yet another demand on them, and most likely not use it. Unless, that is, they are given emotional and psychological support to deal with their mental health issues, once these issues have been identified.

Mental health and diabetic foot health should be treated equally and in providing more support and training to those health professionals who deal with the feet of diabetic patients i.e. podiatrists, chiropodists, wound care nurses and diabetic nurses, could, I feel, only have a positive effect on reducing the incidence of diabetic foot. Patients whose mental health issues have been identified and have had the appropriate care and support, are more likely to be able to take responsibility for their foot health as they would feel more in control generally and empowered.

How many of the 160 amputations every week in England are carried out on patients with undiagnosed or unsupported mental health issues?

How many of these amputations could be prevented by better mental health awareness and enough psychological support for patients with diabetes?

I don’t know the answer to these questions but it is something to think about.

However, I do feel that improving the mental health of people with diabetes by providing better training and support for HPC’s, relieving the shortage of psychologists and improving the pathway of referral for specialist psychological treatment, would not only improve the quality of life of people with diabetes but allow them to be able to self-manage their diabetes better.

‘We need a health service where the physical and mental aspects of living with diabetes are treated equally and together, in every consultation. Where those who need it, get specialist mental health support from people who understand diabetes.’**

*Diabetes UK (2015). 15 Healthcare Essentials online survey 2015.

**The Final Report 2017 Diabetes UK

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