We need to treat long-term illness and mental health together

It’s diabetes clinic day and I’m literally being examined from head to toe – a blood test, weigh in, blood pressure check, an eye exam and a foot sensitivity check.

I’ve been through this routine hundreds of times but it’s always focused on what is going on with my physical wellbeing. I can count on one hand the number of times someone has asked me about what is going on with my mental health.

Like many long-term illnesses, a diagnosis of type one diabetes made me much more likely to have mental health problems – two to three times more likely in fact – but very few people have talked to me about it.

When I started suffering from depression, anxiety and panic attacks, I don’t think I saw the association. In my mind, I was just unlucky to have these things – but they are so intertwined.

Through writing a series about invisible illness and disability, You Don’t Look Sick, I see the same problem in so many people dealing with a chronic condition.

Living with a long-term illness puts a huge amount of stress on your brain. I’m constantly trying to process what my blood sugar levels are, how much insulin that means I can inject, what I’m are eating for that meal and what I might eat between that meal and the next.

It is a relentless condition that controls my life every single day, and always will.

Some days, I’m just tired of dealing with it and constantly having to be on the ball.

There’s the guilt when it’s not quite under control and the sadness of not being able to eat what you want without circumstances.

There’s the days where I’m struggling with my mental health and give in and eat what I want because planning healthy meals is too much but it makes me physically feel incredibly unwell and makes my mood sink further.

There’s the fear of what it might mean in the future, not to mention the fact my severe anxiety attacks have an impact on my blood sugars levels, sometimes making them quickly fall. Not knowing when or if I might have a panic attack makes it pretty hard to plan.

And just having a day with low blood sugar levels triggers my anxiety. After one incident on the tube when my blood sugar levels fell low unexpectedly, I am incredibly anxious about it happening again in public. Feeling pretty lightheaded, I asked someone for a seat but they refused because I apparently ‘didn’t look like I needed it’.’

It was embarrassing and frightening. Luckily someone else helped out, I found some glucose tablets in my bag and I was ok.

Sometimes my anxiety about that happening again makes me overcompensate and my blood sugar levels end up higher than they should be.

It’s a cycle – dealing with the illness leads to depression but depression makes the illness much harder to manage, making me more feel worse. Both the physical illness and mental illness just feed off each other.

Research by Diabetes UK released this week shows that seven out of 10 people with diabetes feel overwhelmed by the condition but three quarters of those surveyed who needed mental health support said they could not access it.

Despite the strong links between diabetes and mental health problems, 70 per cent said that their diabetes team did not talk to them about their emotional wellbeing.

When I went to my GP for the first time to talk about my low moods and crippling panic attacks almost two years ago (and several times since), my long term health condition wasn’t mentioned.

The survey also revealed 40 per cent of GPs say they are not likely to ask about emotional wellbeing and mental health in routine diabetes appointments. While only 30 per cent feel there is enough emotional and psychological support for people living with diabetes when needed.

And I know when I do eventually get off the waiting list for therapy, the counsellor I speak to is pretty unlikely to have any specialist knowledge of my condition so really breaking down how to manage both anxiety and diabetes side by side seems unrealistic.

I know mental health services are already overstretched but these figures are poor and not supporting the mental health of people with long term conditions has an impact in the long run.

Poor mental health can lead to bad diabetes management, hospital stays and the need for increased support. Tackling it and talking about it from the minute of diagnosis makes people aware of the connection.

Diabetes UK are calling for more to be done. The #ItsMissing campaign and petition highlights their report into care and mental health services.

They want to see the emotional and psychological impact of diabetes recognised and for patients to have systematic care and better conversations.

Everyone should be provided with peer support, education and self-help resources so they have something in place if they do struggle with mental health problems.

The system is not set up for integration of both mental and physical treatment but it is time it was.

We need diabetes teams to be supported by specialist mental health professionals, for healthcare professionals providing diabetes care to have training in helping patients with mental health and for mental health professionals to have knowledge and understanding about the condition.

Every year I’m treated and checked for other long term affects like eye problems and circulation problems. Mental health problems should be discussed in the same way.

For people with diabetes and other long term health conditions, we need to treat the whole person, not just the bits we can see.

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