People with severe mental illness (SMI) die approximately 20 years earlier than the general population. People with diabetes also die earlier. A 60-year old male newly diagnosed with type 2 diabetes without pre-existing cardiovascular disease can expect to lose 8 to 10 years of life if his diabetes is poorly controlled. Having diabetes & SMI compounds problems of both. Diabetes is more than twice as prevalent in people who suffer from SMI and have poorer outcomes compared to people without. Reasons for this are poorly understood, but are probably related to a combination of features of the mental illness, metabolic side effects of psychotropic medication and the organisation of health services.
The DIAMONDS programme will be delivered in three phases:
Phase One: The researchers will concentrate on developing an in- depth picture of people with SMI and diabetes, describing their health status and the care they receive. They will also look at the barriers and facilitators to good healthcare for people with SMI and diabetes, and what types of care have been tested in this area. This will be done by conducting three studies:
· Interrogation of large health service datasets in primary and secondary care
· Comprehensive and Systematic reviews of the literature
· Qualitative interviews with patients, carers and healthcare providers
Phase Two: These three strands of work will inform the development of better care for people with SMI and diabetes in the future. The team will then test whether this is feasible to trial and implement.
Phase Three: To evaluate a newly developed method of healthcare for people with SMI and diabetes. This will result in a full multi-centred Randomised controlled trial with a process evaluation and evaluation of the effectiveness and cost effectiveness of a new method of care.