Three dimensions of care for diabetes at King’s College Hospital, London

As the Mental Health Taskforce launches its strategy, King’s College Hospital reveals the results of its best practice physical and mental health model.

Hundreds of patients with diabetes who have mental health issues are getting quick bespoke treatment thanks to an innovative model of care in London.

The £190K a year King’s College Hospital London 3DFD scheme (3 Dimensions of care For Diabetes) sees around 300 patients a year with diabetes who also have mental health related-issues such as needle phobia, depression or anxiety.

The team set up the new service after noticing that some people, with problems like depression or isolation due to illiteracy or poverty, were not seeking help in parts of Lambeth and Southwark.

3DFD helps them get mental health care quickly with professionals who can work specifically on the diabetes aspect of their problems, integrated with their diabetes care issue instead of sending them to external services for these.

Since it launched in 2010/11 they have seen, among patients with diabetes, a 45% drop in A&E visits; 43% fewer hospital admissions; 22% fewer hospital bed days; a saving of £850 per patient in 12 months.

Now 60 per cent of patients referred received a new diagnosis of a psychiatric disorder, showing there were significant unmet health needs and they are on target to treble savings over the next three years.

Dr Anne Doherty, Consultant Liaison Psychiatrist for the service, said: “Being diagnosed with diabetes can be a big shock. People can often struggle to come to terms with how to cope with a new lifestyle particularly if they need insulin injections with the regular use of needles.

“People with diabetes can manage their conditions much better if they are well engaged with NHS services. But if someone develops severe depression or a phobia of needles, for example, then we can easily lose them and they don’t come back until their condition has worsened and they might have devastating complications.

“Amputation, blindness and kidney failure are the most common complications which are horrendous for the person and expensive for the NHS to treat. If we can help people early with a mental health condition then we can help them to stay well.”

There are currently 2.5 million people with Type 2 diabetes in England, a disease which is largely preventable through lifestyle changes, and it’s estimated that over five million people in England are at high risk of developing it.

The existing multi-disciplinary team is backed up with a psychiatrist, community support workers and psychologists to tackle such problems. Patients receive care as required by an assessment of their needs, and this is fed into the diabetes team.

It is only for people whose mental health condition is diabetes related. If not they are signposted to Improving Access to Psychological Therapies services (IAPT).

They are now aiming to train the area’s community mental health teams to spot the signs of diabetes in patients and act as an early warning system to stop more serious symptoms developing.

The team is now piloting an electronic register of patients with diabetes in South London and Maudsley NHS Trust to monitor and assess diabetes control and guide into the local diabetes care pathway when necessary, and plan to test a new e-learning model that will allow diabetes teams to manage the early symptoms of depression in their patients.