Summary
Despite the prevalence of diabetes amongst individuals with Serious Mental Illness (SMI), diabetes care is not currently audited within mental health inpatient settings. It is audited in physical health settings. This project piloted an audit to assess the diabetes care within London NHS Mental Health Trusts.
"
“Good healthcare can significantly improve outcomes for people with diabetes, yet those with serious mental illness are more likely to miss out on this care. Despite great local initiatives there is no accepted standard for care of mental health inpatients who have diabetes. The London Physical Health Leads Network believes that this needs to change, and we are delighted to present this audit as the first step.”
Dr Ed Beveridge, Dr Kate Corlett – Co-Chairs, Pan-London Physical Health Leads’ Network
"
What the project involved
The Health Innovation Network in partnership with South London and Maudsley NHS Foundation Trust (SLaM) developed and piloted a diabetes audit. Following the SLaM pilot, the audit was completed by all nine London Mental Health Trusts.
A diverse approach was taken to spread and adoption. This included piloting the audit within one MH Trust, refining, and then rolling out the audit to eight London Mental Health Trusts.
The audit included:
- Questions on Trust diabetes policies and access to specialist diabetes advice
- Questions for the ward
- Interviews with multidisciplinary teams and inpatients.
A diverse approach was taken to spread and adoption which included, piloting the audit within one Mental Health Trust, refining, and then rolling out the audit to eight London Mental Health Trusts.
We also used networking opportunities with Key Stakeholders, e.g. London Diabetes Clinical Network and Diabetes Inpatient Network, the London Physical Health Leads Network and the Cavendish Square Group (Medical Directors and CEOs of all London MH Trusts). This approach led to over 7,000 stakeholders being made aware of the project findings.
Outcomes
The audit evidenced a need to improve:
- Access to diabetes specialists; no Mental Health Trust had access to consultant diabetologists. Seven out of nine Trusts had no access to Diabetes Specialist Nurses.
- Staff and patient education; Mental Health Trusts offered no or irregular education.
- Policy communication e.g. 76% of mental health wards stated they did not have or did not know of their Trust’s diabetes self-management policy.
- Patients rated diabetes care as 3.63 out of 5.
The audit evidenced the need to improve diabetes care. Since sharing the findings Mental Health Trusts have made improvements, these include:
- Recruiting Diabetes Specialist Nurses and Physicians Associates
- Sharing self-management policies
- Offering educational training
- Creating physical health forums.
We used networking opportunities with key stakeholders e.g. London Diabetes Clinical Network and Diabetes Inpatient Network and the London Physical Health Leads Network and the Cavendish Square Group (Medical Directors and CEOs of all London MH Trusts) to ensure more than 7,000 stakeholders were aware of the project findings.
The Health Innovation Network also produced a report and was successful in gaining both a poster and presentation at the 2023 Diabetes UK Conference which has a national and international audience.
Improving diabetes care in mental health settings remains a priority for London Mental Health Trusts and the London Diabetes Clinical Network.
Next steps
The audit tool has been made available to download with the report which can be downloaded here. Several Mental Health Trusts nationally have accessed this tool.
