According to research, depression in adolescents is up to three times higher in those who also have type 1 diabetes mellitus. When it comes to treating adolescents with diabetes, however, there is often no standard process in place to help health professionals identify mental health and quality of life issues their patients may be struggling with.
“It’s very busy caring for diabetes patients in general,” says Elaine Wilson, Registered Nurse, Trillium Health Partners (THP) Paediatric Diabetes Clinic (PDEP). “We are assessing their symptom management, downloading critical health information from their blood glucose meters, looking at blood sugars and discussing strategies for their care. But who’s talking to the kids?”
Elaine says that by focusing only on the physical challenges of diabetes management, clinicians often don’t address the deeper reasons behind why a patient is missing insulin injections or forgetting blood sugar checks.
But for the past year, patients between the ages of 13 and 18 who visit THP’s innovative
PDEP clinic have experienced a different kind of care, designed to take into account the close link between mental health and physical outcomes. The program is one of several new MPA initiatives aimed at improving care and quality of life for the more than 1.3 million people in Ontario who live with both mental and physical illness.
“Before this program existed, care for the young patient was typically discussed with their parents,” says Elaine. “Now our young diabetes patients are being empowered to have these conversations themselves with the support of their parents or caregivers and their health-care team, keeping their feelings and choices at the forefront.”
Under the program, patients complete a quality-of-life questionnaire to help their care team identify any barriers the patient is facing. The questions are designed to assess how adolescents are feeling about a range of issues: weight and body image; relationships with friends and family; diabetes’ impact on their social lives, school experiences and recreational activities; and how diabetes affects their general mood.
Elaine says the questionnaire is a conversation starter. “For the ones who are struggling, who need the conversation, they really appreciate it,” she says. “As a result, we have a way of comparing and quantifying their progress from one appointment to the next.”
In addition to Elaine, a mental health professional—usually a social worker—is present during the patient’s initial clinic visit. At each subsequent visit, the patient sees the same two providers, improving continuity of care and allowing a collaborative, trusting relationship to develop between the patient and healthcare provider.
Another innovative component of the program is THP’s partnership with SickKids’ TeleLink Mental Health Program. It enables young diabetes patients with mental health symptoms to be linked to a psychiatrist by videoconference. If any mental health issues are identified during the consultation, the patient is then referred to the PDEP clinic where a treatment plan is created in collaboration with the primary care provider and the psychiatrist, all via TeleLink.
“It’s easy to get focused on the diabetes care ‘tasks’, but we also need to give our patients the opportunity to talk about how they are coping,” says Elaine. “By integrating mental health support as part of the care of our adolescent patients, we hope to improve their emotional wellbeing, quality of life and their diabetes management,” says project lead Sheryl Parks, who is also a social worker with the new program. “That’s why this is a game changer.”
As of Summer 2017, approximately 135 teens and their families have been screened through this MPA initiative at THP, which is the first of its kind in Canada.