Addressing the Diabetes Crisis Among People with Serious Mental Illness

Objective:- The Institute for Community Living (ICL) piloted the Diabetes Co-morbidity Initiative (DCI) to address the public health crisis among people with mental illness, who are 2-3 times more likely to develop diabetes, and die on average 25 years earlier than the general population.  The focus of DCI is promoting self-management and access to care for people with mental illness by training case managers to integrate diabetes care into mental health service settings. 

Methods:- A Diabetes Self-Management Workbook and Toolkit were piloted in 8 New York City mental health agencies, with over 200 case managers trained in supporting people with mental illness to self-manage co-morbid diabetes. Using motivational interviewing and psychoeducational techniques, the Workbook facilitates goal-setting and achievement to build momentum towards better diabetes care.

Results:- Outcomes from the first pilot reveal a significant increase in the proportion of A1c levels below 7 and significant improvements in diabetes health behaviors, including access to A1c, blood pressure, cholesterol, kidney, eye and foot examinations. In addition, significant decreases in emergency department and inpatient utilization were found, suggesting that self-management may produce cost savings to the health care system. 

Conclusion:- Community interventions that build on the strengths of mental health providers to address high diabetes-related risk among people with mental illness are urgently needed.  The DCI Toolkit holds promise as one solution to this public health crisis.