Mental Health Support in a Paediatric Diabetes Clinic

Hetashi Bawa


Hetashi Bawa is an aspiring clinical psychologist who graduated from the University of Roehampton with a BSc in Psychology. She has worked in the NHS for over a year in both clinical and corporate roles. Most recently, Hetashi has been working in the Children and Young People's Division of CAMHS in a mental health trust and will now continue to broaden her experience in this area alongside starting her Masters in Health Psychology.

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Physical health conditions which are life changing for a child can have a significant impact not only upon their management of the condition, but also on emotional well-being. This blog will cover the importance of supporting children and young people with their mental health, in addition to their physical health condition.

One of my placements as an Honorary Assistant Psychologist has been within a paediatric diabetes clinic. My role has been a part of the psychology team with a clinical psychologist and a family therapist to help support the mental health and well-being of children in this physical health setting.

Type 1 diabetes is a physical health diagnosis that is characterised by the pancreas not being able to produce enough insulin, a hormone which controls levels of blood glucose (NHS, 2018). This differs from type 2 diabetes which is caused by problems with insulin resistance or lowered levels of insulin production and are often linked to being overweight and inactive (NHS, 2017).

I mainly worked with children who had type 1 diabetes. Both diagnoses can impact an individual’s mental health given the amount of changes that are required to adjust to such a life changing condition. This can be particularly difficult when an individual also has a comorbid mental health diagnosis. The prevalence of psychological conditions such as anxiety, depression and eating disorders are significantly higher in people with diabetes (Diabetes, 2010). Furthermore, poor emotional well-being has been associated with poor glycemic control. This creates increased risks of diabetes-related complications.

As a result, NICE guidelines have suggested that children and young people who have a diagnosis of type 1 or 2 diabetes, should have access to mental health professionals who explicitly understand their condition (NICE, 2016). It is essential to have clinical staff who understand the physical and psychological complications that can arise alongside a diagnosis in order to provide beneficial psychological support and interventions.

We worked with children and their families to help support longstanding conditions that interact with their diabetes diagnosis. This could be where an individual’s diagnosis of depression is having an impact on their diabetes control, or when systemic family work is required to appropriately support a family to adjust to the changes that come with a diagnosis.

The biopsychosocical model was a main model that was referred to when working with this population as it could be easily applied to the setting, enabling us to examine a broad range of factors when considering a formulation (Polonsky, 2002). For example, when parents reported behavioural and developmental concerns for their children. Key questions that we tried to answer were:

  • Whether these were behavioural outcomes as a result of a child’s diabetes (Biological):
    • Was the child exhibiting alternate behaviours when their blood glucose was too high or low?
    • Was the child fearful of taking blood for blood glucose measurement?
  • Was this a longstanding behavioural concern (Psychological):
    • Did the parents have this concern prior to a diagnosis?
    • What were the child’s developmental milestones and could this reflect behaviours observed?
  • When were these behaviours observed (Social):
    • Were they only observed by the parents?
    • Were these behaviours only seen in one setting?

The use of the biopsychosocial model meant that as an Honorary Assistant Psychologist I could formulate with the Clinical Psychologist about what the main concerns were and the next steps to take in a holistic way.

I observed that having a psychology team within a paediatric diabetes setting has had a lot of benefit to the children and young people that we see. There are still many stigmas attached with accessing mental health services, however this particular service is very lucky to have dedicated staff whom are on hand and part of the diabetes team.

But, you may ask, how do we help those who may need support, but may be worried to reach out? At this paediatric service, there are many ways to reach a member of the psychology team. Luckily, as we work as a multi-disciplinary team, one of the easiest ways to catch the psychologist will be at the multidisciplinary appointment that children have on a quarterly basis. Another way that we offer support for mental health is through the monthly parent support groups. This allows the team to work systemically and with the families of children with diabetes. Each month there will be a theme that helps support parents which offers skills and further understanding about their child’s diagnosis. This can range from sessions regarding what it is like to be a parent of a child with diabetes, understanding emotions and even mindfulness! Whilst the caseloads may continue to grow, another way that the psychologist will be in touch with all children with a diagnosis is through their annual mandatory reviews.

Integrated Bio-psycho-social support is essential for this group of vulnerable children. From my experience of working in this unique area, it is evident to see that the requirement for mental health services is one that is expanding. Furthermore, I can see how it should also be important across many physical health care services, divisions and disciplines. The psychological support team can offer alternative approaches when working with individuals to ensure that emotional well-being is supported alongside one’s physical health complications. I think it is essential to ensure that this guidance and support is available to people with other long-term health conditions, and that this support is not taken away as children when they transition from paediatric to adult healthcare provisions.

Conflict of interest statement

The author declares no conflicts of interest in relation to this blog on clinical experience.

Correspondence

Hetashi Bawa by email

References

Diabetes, N. H. S. (2010). Emotional and psychological support and care in diabetes. Report from the emotional and psychological support working group of NHS Diabetes and Diabetes UK.

National Institute for Health and Care Excellence. (2016). Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Retrieved from https://www.nice.org.uk/guidance/ng18

National Institute for Health and Care Excellence. (2016). Quality statement 6: Access to mental health professionals with an understanding of type 1 or type 2 diabetes. Retrieved from https://www.nice.org.uk/guidance/qs125/chapter/Quality-statement-6-Access-to-mental-health-professionals-with-an-understanding-of-type-1-or-type-2-diabetes

NHS (2017). What is type 2 diabetes? Retrieved from https://www.nhs.uk/conditions/type-2-diabetes/

NHS (2018). Symptoms and getting diagnosed. Retrieved from https://www.nhs.uk/conditions/type-1-diabetes/symptoms-and-getting-diagnosed/

Polonsky, W. H. (2002). Emotional and quality-of-life aspects of diabetes management. Current diabetes reports, 2(2), 153-159.

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