Report on the Regional Roundtable Discussions on Diabetes and Mental Health

Between December 2011 and February 2012, the DMHPS project held eight regional roundtables across Ontario. The purpose was to bring together the mental health and diabetes/primary health care sectors in each region to discuss how to improve diabetes prevention and self-management for people with mental illness, particularly involving the role of peer support. The roundtables were meant to be a catalyst for local action.

This report describes some current initiatives underway that were shared at the roundtables and some of the ideas people came up with that they will explore in future. These are grouped under eight themes that emerged from the discussions. Recommendations for planners and policy makers to support both current and future initiatives follow.

» Download the complete DMHPS Roundtable Report (PDF)

» Download Appendix 2: Regional Roundtable Presentation (PPT)

Recommendations for Planners and Policy Makers

  1. Clarify mandates and reduce conflicts between catchment areas and funding requirements to enable referrals and outreach.

    Different funding rules and catchment areas prevent professionals from accessing resources in other agencies. In addition, some regional diabetes programs are providing outreach and off-site services while others feel that their funding requirements restrict them. Diabetes Regional Coordination Centres could support information sharing across the province so that diabetes service providers that are doing outreach can share with other diabetes service providers how they are able to do this. Catchment and funding barriers to referrals could be addressed through the LHIN and through cross-LHIN discussion where organizations provide services across LHINs.

  2. Create a system-level role for peer supporters, provide funding for positions, and educate health professionals about how to work with them as a team.

    Health professionals and funders often perceive peer support as something that belongs in the realm of volunteers. There are two issues: One is resistance to inclusion of peers in interprofessional teams. The other is paying for what has been understood as a volunteer role. Funding models for paid qualified peer support workers for diabetes should be developed and funded. Education should be provided to health care providers to raise awareness of the training, role and impact of peer support and how to work with peer supporters as part of a professional team. System-level recognition and inclusion of the role of peer support is also needed.

  3. Hire peer support workers on diabetes and primary health care teams, ensuring they are supported by CSIs.

    Diabetes and mental health peer supporters are seeking employment and can complement the work of health professionals. For this reason, the DMHPS project recommends a partnership between CSIs and diabetes providers, so that where a peer support worker is working in a diabetes organization they remain connected to a CSI.

  4. Provide self-management support programs within hospital psychiatric services.

    The current focus within many psychiatric services to address mental health alone is changing in some regions. It is important to reinforce this so that the mental and physical health of people using these services are addressed together. Hospital patient councils who provide peer support could be trained in diabetes peer support and offer self-management groups. In order to do this effectively, the hospital psychiatric services must make this a priority and fund it appropriately.

  5. Create more metabolic clinics and include mental health peer support.

    It was recommended that the metabolic clinic at Waypoint Centre for Mental Health Care in Penetanguishene, which was created from within existing resources, be replicated in other communities. Metabolic clinics may not necessarily have to be within a hospital setting but could be based in community health organizations.

  6. Provide diabetes and mental health peer support through home care.

    Community Care Access Centres and their contracted home care service providers see people with mental health problems and diabetes but are not funded or trained to address the two health problems together. Personal support workers in at least one community provide services to an inner-city population, including homeless people, many of whom have diabetes and mental illness and who may not be receiving care elsewhere. Personal support workers are not trained to address diabetes. Peer support workers could play a role.

  7. In planning and funding for diabetes/physical health care in mental health organizations, include qualified peer supporters on the team.

    Where diabetes is being addressed within mental health organizations, peer support is not always offered as part of diabetes prevention and management.

  8. Improve access to primary health care and improve monitoring of diabetes by family physicians when care is provided.

    Many people with mental illnesses do not have primary health care physicians or nurse practitioners. Some of these people are getting their primary health care needs addressed through a mental health organization but in many communities mental health services cannot provide this care. Where people have family doctors, the latter are often not providing comprehensive monitoring of diabetes.

  9. Address the lack of access to care and to peer support in rural communities.

    Most CSIs across the province serve the community in which they are located, and do not have the means to travel. Some CSIs are providing access to information and support electronically. Peer support via telehealth could be explored. Some rural communities have a shortage of mental health services. Many lack adequate services generally.

  10. Improve access to medication for people on low incomes.

    Poverty forces people with diabetes and mental illnesses to choose between paying for diabetes or mental health medications.

  11. Train more mental health peer supporters in the diabetes module.

    Not all LHIN regions have people who were trained in diabetes and mental health peer support, and in those that do, more are needed.

  12. Provide diabetes education to mental health professionals.

    There is a need for mental health professionals to have a better understanding of how to address diabetes. Specifically, mental health nurses expressed a desire to receive diabetes training. Diabetes training for mental health professionals was developed in London, Ontario, some years ago. A diabetes “boot camp” for family health team nurses is also available in Ontario. These resources could be made available to the mental health sector.

  13. Evaluate the outcomes of diabetes and mental health peer support for people receiving peer support.

    The DMHPS project does not have funding at this point to do so.