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Trust paper highlights inequalities for secure inpatients with diabetes

23 February 2017

WLMHT’s Ignazio Puzzo and Alan Cohen are joint authors with Imperial College’s David Gable on an important paper recently published in the Journal of Forensic Psychiatry and Psychology.

The paper, entitled ‘Using the National Diabetes Audit to improve the care of diabetes in secure hospital in-patient settings in the UK‘, highlights new data showing that high-quality diabetic care can be provided to inpatient forensic service users in high, medium and low secure units.

The paper also provides an evidence base for discussions with commissioners by raising the following concerns:

  • Current UK statistics show that diabetes appears in 6% of the population but likely to be prevalent in 25-30% of those diagnosed with a psychotic illness.
  • Service standards for patients with diabetes placed in a secure setting are not audited, in contrast to those in general health settings.
  • Patients in all mental health trusts are currently excluded from the National Diabetes Audit.
  • Although standards of care for those with diabetes in secure settings is likely to be the same as those in a community setting, the outcomes are likely to be worse.
  • Poorer outcomes are likely to be reflective of the side effects of anti-psychotic medications; a more sedentary lifestyles and the effect of smoking.
  • People in a mental health secure setting who have diabetes are unlikely to be cared for by a general practitioner but are dependent on mental health professionals untrained in specialist diabetes management.

In addition, the paper illustrates the importance of having a pharmacy database which allows analysis over time of the burden of antipsychotic medication and the interaction with diabetes.

It is important to note that this lack of parity does not just apply to diabetic patients but also patients in secure units who suffer from other long-term conditions.

Mortality rates for patients with both a long-term condition well as a mental health diagnosis show that they are at much more risk of dying younger than those without a mental health condition.

It is hoped that the paper will raise these issues at a national level and be used as an evidence base for jointly commissioning services more effectively, thereby demonstrating parity between physical and mental health care.