Download Co-morbidities: Diabetes/CVD and Mental Illness Workshop

Co-morbidities: Diabetes/CVD and Mental Illness Workshop
An evening of cross discipline discussion
Thursday 22 May 5.30 - 8.00pm
Sydney West Area Health Service
Facilitated by:
Prof Glen Maberly
Director of The Global Health Institute
Prof George Rubin
Director of I-Health
Mr Roy Laube
Research Coordinatorr, Diversity Health Institute
30 Phillip Street
Imagination will often carry us to worlds that never were. But without it we go nowhere. Carl Sagan
Create innovative ways to more effectively deliver health care to patients
with obesity, diabetes, cardiovascular disease and mental illness
An evening of cross discipline facilitated discussion
What to expect
5:30 – 6:00 Arrive meet, mingle and refresh
6:00 – 6:15 Recognizing the challenge – presented by our facilitators
6:15 – 6:45 Introductions and sharing our first thoughts in plenary
6:45 - 7:15 Generating some new ideas in small group discussion
7:15 – 7:45 Collecting our thoughts and developing a matrix of ideas
for cross discipline approaches to patient care
7:45 – 8:00 Making plans and seeking people to led the next steps
Why we are here: setting the stage
Who we are: GHI and you?
What’s the problem?
Obesity, Cardiovascular Disease and Diabetes
Mental Health
Overlap in patients
How can we improve the way we work?
When do we start?
Welcome GHI Council and Guests
GOALS: Forge strategic alliances among existing entities to overcome
important health problems and improve people’s health while reducing
inequity.
Reverse the trend of increasing obesity
and associated increasing cardio vascular
disease and diabetes
Lower the impact of poor mental health
on the health system and the community
VISION: Stimulate large scale, cross-discipline and cross sector
collaboration to create an environment where recognition and identity of
the individual units in SWAHS and other affiliated organizations
programs are preserved.
Diabetes/CVD and Mental Illness
Meeting of the Minds
Health Services Managers
Public Health Professionals
Directors of Clinical Services
Health Care Providers
Educators & Community Supporters
Our daily work
See big picture – cross boundaries
Diabetes Australia facts 2008
Diabetes is one of the leading chronic diseases affecting
Australians…
• An estimated 700,000 Australians - 3.6% of the
population had diagnosed diabetes in 2004–05.
• In addition, the most recent national data on this
indicate one undiagnosed case for every one
diagnosed case.
• In 2005, nearly 3% of deaths in Australia were
directly due to diabetes and it contributed to
another 6% of deaths—nearly 12,000 deaths in
total.
Burden of disease and injury in Australia
Cause
DALYs
% of Total
Diabetes
143,831
5.5
Ischemic HD
attributable to
diabetes
54,442
2.1
Stroke
attributable to
Diabetes
20,245
0.8
Total Burden
attributable to
diabetes
218,518
8.3
Begg S, Vos T, Barker B, Stevenson C, Stanley L & Lopez A. The burden of disease and injury in Australia
2003 http://www.aihw.gov.au/publications/hwe/bodaiia03/bodaiia03-c01.pdf
Mental Illness Australia facts
The impact of mental illness within the Australian population has
become increasingly apparent.
The 1997 National Survey of Mental Health and Wellbeing by the
Australian Bureau of Statistics found that 18% of adults in the
community had a mental disorder in the twelve months prior to the
survey.
The Burden of Disease and Injury in Australia study indicated that
mental disorders constitute the leading cause of disability burden in
Australia, accounting for an estimated 24% of the total years lost due
to disability.
http://www.aihw.gov.au/mentalhealth/index.cfm
Mental illness by age
Data source: Epidemiology, Population Health and Strategic Direction, SWAHS
Mental Disorder: SWAHS Hospital Separations
Schizophrenia Disorders: SWAHS Hospital Separations
Depressive Episodes: SWAHS Hospital Separations
Neurotic, Stress-related Disorders: SWAHS Hospital Separations
Population models
Server Disease: High burden
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes
Abnormal GTT
Lipid Disease
Obesity
Other Lifestyle Risks
Illicit drugs
Substance abuse
Alcohol abuse
Schizophrenia Disorders
Mood [affective] Disorders
Neurotic, stress-related Disorders
Adult Personality & Behavior
Emotional Disorders
Behavioral & emotional Disorders
Cultural beliefs & practices
Healthy: Preventable Risk Factors
What is the overlap – Diabetes & Mental Health
Overlap Ischemic heart disease, diabetes prevalence and mental illness
The five leading specific causes of burden of disease
and injury in men were: ischaemic heart disease
(11.1%), Type 2 diabetes (5.2%), anxiety & depression
(4.8%), lung cancer (4.0%) and stroke (3.9%).
The five leading specific causes of burden in women
were: anxiety & depression (10.0%), ischaemic heart
disease (8.9%), stroke (5.1%), Type 2 diabetes (4.9%)
and dementia (4.8%).
Begg S, Vos T, Barker B, Stevenson C, Stanley L & Lopez A. The burden of disease and injury in Australia
2003 http://www.aihw.gov.au/publications/hwe/bodaiia03/bodaiia03-c01.pdf
Diabetes prevalence and mental illness
• Diabetes prevalence in patients with mental illness is 2
to 3 times greater than in the general population.
• Some atypical antipsychotics have been shown to
increase risk for new-onset diabetes.
• Before prescribing an atypical antipsychotic, assess the
patient's glucose tolerance.
• The combination of diabetes and depression has the
most negative impact on health among a dozen serious
medical conditions.
• People with mental illness die younger (25 years
younger in US)
• CVD is the biggest cause of premature death for people
with mental illness, not suicide
Mental Illness & Diabetes
 Incidence reported to be elevated compared to general
population 'Schizophrenia and Diabetes 2003' Expert Consensus
Meeting, Dublin, 3-4 October 2003: consensus summary. 2004. British
Journal of Psychiatry
 Impaired learning for diet and control Dickinson et al, 2008.
Psychosomatics
 US NIMH CATIE trials with 1460 enrolled patients: 45%
had untreated diabetes, 89% had untreated
hyperlipidemias and 62% had untreated hypertension.
Bick, Knoesen, Castle. 2007. Australasian Psychiatry
 Good diabetes management can be achieved across
the mental illness population [11 043 diabetes patients in UK].
Whyte et al. 2008 Psychosomatics
What difficulties do overlap patients face?
Stigma and discrimination
Sickness label
Low self-confidence and self reliance
Difficulties with work, family and other social relations
Low motivation to employ and maintaining needed lifestyle
habits
Lack of receptivity to education
Poor compliance with medications, diet and exercise program
Difficulty attaining a more ideal body weight
Inappropriate self-management
Side effects from medications exacerbating diseases
Tobacco, drugs, alcohol and other substance abuse
Study: disease-specific knowledge about diabetes in a sample of
201 psychiatric outpatients with a diagnosis of schizophrenia or
major mood disorders, all of whom had type 2 diabetes.
Findings: knowledge was associated with higher cognitive
functioning, higher level of education, and recent receipt of diabetes
education
Findings: disease-specific diabetes knowledge predicted lower
levels of perceived barriers to diabetes care
Conclusion: Gaps in diabetes knowledge may be reduced by
specialized interventions that take into account the cognitive deficits
of persons with serious mental illness
Diabetes Knowledge Among Persons With Serious Mental Illness and Type 2
Diabetes - Faith B. Dickerson, et al, Psychosomatics 46:418-424, October 2005
What is the overlap – Diabetes & Mental Health
Psychological distress with diabetes
• According to the 2004–05 NHS, 18% of people with diabetes
had high or very high levels of psychological distress compared
with 12% of people without diabetes, as measured by the
Kesslar-10 scale
• More females (22%) than males (15%) with diabetes had high or
very high levels of psychological distress
How can we design our health care systems to better manage this overlap?
Challenges of dual responsibility management
Mental Illness Teams
Hospital admissions
Specialty Clinics &
Rooms
GP Rooms
Ancillary & Community
Services
Other Community
facilities and socioeconomic support
systems e.g. schools,
media, sports, religious
institutions, transport
systems, food outlets,
work, culture & lifestyle
environments
Chronic Disease Teams
Shared Complex
Case Management
Diagnosis
Disease Containment
Monitoring
Screening
Lifestyle Adjustment
Prevention
Shared medical
record &
management
Shared disease
registers
Screening tools &
management
algorithms
New & old media
Education systems
cultural, social &
religious influencers
Mental Health
Diabetes
Cardiology
GP
Opening up horizontal channels of
communication between units (silos)
to share information and responsibility for
management
 What’s in it for me? – Redefine the reward systems to favor
shared care behavior by health professionals and patients
 Who’s responsible? - Define the ground rules for
responsibility of all aspects of shared care
 But the system won’t let me - Design systems that supports
shared information and more comprehensive management
approaches
 How do we do this? - Clinical education (medical, nursing
and ancillary) and workforce training to support integrated
comprehensive services
 Will it work? – Build evaluation systems designed for
continued feedback and improvement