Diabetes and Mental Illness

Serious mental illness is a significant risk factor for the development of a number of chronic diseases including chronic obstructive pulmonary disease, breast cancer, colon cancer, lung cancer, stroke, heart disease and diabetes. This high risk of serious health conditions among people with serious mental illness means that prevention services, health screening and regular access to primary health care should be of high priority. Increased coordination, collaboration and shared care between health care sectors will increase the capacity of each sector and will improve health care outcomes for people with mental illness and chronic diseases.

It is important to add that underlying factors that put these individuals at high risk of chronic conditions and complicate their capacity to manage these illnesses must also be addressed. This is a population living with high rates of poverty. The impact of poverty on diabetes has been well‐documented (Health Council of Canada, 2007).

Diabetes rates are significantly elevated among people with mental illnesses. Both depression and schizophrenia are risk factors for the development of type 2 diabetes due to their impact on the body’s resistance to insulin. People with mental illnesses also experience many of the other risk factors for diabetes, such as obesity and high cholesterol levels. Antipsychotic medications have been shown to significantly impact weight gain; obesity rates are up to 3.5 times higher in people with serious mental illnesses in comparison to the general population.

Conversely, people with diabetes have nearly twice the rate of diagnosed mental illnesses as those without diabetes. Forty percent of people with diabetes also exhibit elevated symptoms of anxiety. People living with diabetes often experience significant emotional stress which can negatively affect an individual’s mental health. The biological impact of high blood sugar levels is also associated with the development of depression in people with diabetes. Left untreated, co-existing diabetes, poor mental health and mental illnesses can hinder self-care practices and increase blood sugar levels, contributing to worsening mental and physical health.

Physical and mental health are fundamentally linked, yet health systems tend to address them separately. Nowhere is this more evident a problem than in the area of chronic conditions. Poor mental health and mental illness are risk factors for chronic physical conditions and people living with chronic conditions often experience poor mental health.

Improving chronic disease prevention and management is a priority in Ontario’s current health care agenda. The Chronic Disease Prevention and Management (CDPM) framework, developed by the Ontario Ministry of Health and Long-Term Care (MOHLTC) in collaboration with the Ministry of Health Promotion, has been widely disseminated across the health system. An implementation strategy, beginning with diabetes prevention and management, is currently being developed.

The place of mental illnesses and mental health within the CDPM framework in Ontario has yet to be well-defined. In late 2008, the Government of Ontario announced the implementation of a Diabetes Strategy as the first phase of providing a comprehensive CDPM strategy for the province. Given that depression and schizophrenia are risk factors for the development of diabetes and people with diabetes have nearly twice the rate of diagnosed mental illnesses as those without diabetes, this is a timely opportunity to ensure that actions to address mental health and mental illness are incorporated in the Diabetes Strategy.

Related Resources

» Visit the CMHA Ontario website for more information about mental illness and chronic disease prevention and management.

Canadian Diabetes Association, “Diabetes and Mental Illness,” The Diabetes Communicator, September-October 2009.

World Federation for Mental Health, “Mental Health and Chronic Physical Illnesses: The Need for Continued and Integrated Care,” World Mental Health Day, October 10, 2010