Diabetes and liaison psychiatry: what about transition?

There are very few diabetes centres in the UK with a psychiatrist as part of the team (Dalvi et al, 2008). Our service in Leeds is one of those few and has been in existence since 1998. Prompted by the Dalvi 12-month case-note review describing a service in London (Chelsea and Westminster) (Dalvi et al, 2008), we compared it with our service (for 2008).

There were several similarities, including the number of patients referred, their gender split, rates of non-attendance and range of interventions offered. The differences included referral source (usually consultant diabetologists in Leeds but diabetes nurse specialists in London), presenting complaints (broadly coping difficulties in Leeds, low mood in London) and who provides the various interventions (liaison psychiatrists in Leeds but, apart from initial assessment, the majority in London are seen by a clinical psychologist). The most striking difference, however, is with regard to the type of diabetes diagnosed in those referred and their age. In Leeds, 84% of referred individuals have type I diabetes, across a total patient age range of 18–74 years, whereas in London, 44% of those referred have type I diabetes and the age range is much more limited (31–71 years). There is great disparity between the two services as regards the percentage of younger people (age 30 years and younger) referred from the diabetes service to liaison psychiatry – 64% in Leeds, none in London. The fact that none of the patients seen in London are in their teens or twenties is surprising to us, particularly given the increasing focus nationally upon the relatively high prevalence of psychological and psychosocial difficulties experienced by people with diabetes in the stage of ‘transition’ (i.e. moving from childhood to adulthood with diabetes). National and regional working groups are calling for the provision of specific physical and mental health services for people aged 16–25 years, to come in line with existing requirements within the National Institute for Health and Clinical Excellence diabetes guidance (National Institute for Health and Clinical Excellence, 2004) and National Service Framework (Department of Health, 2001; 2007). Dalvi et al (2008) do not mention any separate service for the psychological needs of younger people with diabetes in their centre – either they are not being identified as requiring specialist psychological help or they are not referred on for that help. If this is the case, and given the increasing recognition of the particular needs of this group, we would wish to raise the issue of this apparent gap in service provision.