Mental health in diabetes: a response

Thank you for your letter and thoughts about the editorial.^1,2 I couldn’t agree more with all the points you make. The Cartesian split between mind and body means we are always playing catch-up on the issues mentioned in the article and your letter, and the issues are of course much broader than diabetes alone.

Our piece was written from the perspective of GP leaders in diabetes and a psychiatrist working in diabetes rather than a psychiatry focus, hence the diabetes lens. The same issues exist in all LTCs and multiple conditions, but the rich detail we were able to describe has come from our experience in the diabetes work we have been doing. I guess the point was to start to talk about whether this learning is transferable.

I sympathise with your view about this being back to front as an approach. My experience has been that it is easier to get the attention of people who hold the purse strings if the issue is aligned to one condition and relate it to their agenda, for example, some KPI that they are working towards, and then expand outwards. Mental health funding is getting more attention now than ever before, but we still don’t have parity of esteem for it and so the sad fact is that piggy-backing onto a physical health condition agenda gets it more attention.

I am pleased that many mental health providers are training their staff and looking at providing a much more trauma-focused approach to care delivery, but I think it will take time. The main point of this article was to highlight the service gap at what we call level 4, which is not diabetes specific at all, but needs addressing.

• © British Journal of General Practice 2020