Quality Standards for Diabetes Care Toolkit

Mental health or cognitive problems

Mental health

Mental health is defined as a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (World Health Organization 2013). Mental illness refers to a wide range of mental health conditions affecting mood, thinking and behaviour (such as depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviours) (Mayo Foundation for Medical Education and Research 1998–2014).

Cognitive problems

Cognition relates to or involves conscious mental activities (such as thinking, understanding, learning and remembering) (Merriam-Webster 2014). Cognitive impairment or disability is difficult to define but the implication is that persons with cognitive impairment or disability may have difficulty with various types of mental tasks (Center for Persons with Disabilities nd; Disabled World nd). Cognitive impairment or disability arises from physiological or biological processes (genetic disorder, traumatic brain injury). Cognitive disability may be described as a clinical diagnosis (eg, Down syndrome, traumatic brain injury, autism, dementia, dyslexia, Attention Deficit Disorder, dyscalculia) or from a functional perspective (eg, difficulties or deficits involving problem solving, attention, memory, math comprehension, visual comprehension, reading, linguistic and verbal comprehension) (Center for Persons with Disabilities nd; Disabled World nd).
The literature suggests there is evidence to support the view that people with diabetes have increased risk of developing cognitive impairment (Allen et al 2004; McCrimmon et al 2012) and that cognitive impairment is associated with poor diabetes control (Munshi et al 2006).
Documents relating to mental/cognitive health have a focus on mental health (Ministry of Health 2009) or disability (Te Pou o Te Whakaaro Nu: The National Centre of Mental Health Research Information and Workforce Development 2013). However, it appears that for both broad groups there is a common theme that suggests closer alignment of physical/mental services is required because mental health issues are often missed or treated inadequately in these groups of people.
The Ministry of Health (2009) document ‘Towards optimal primary mental health care in the new primary care environment: A draft guidance paper’ is a guidance document which addresses vulnerable populations with mental health conditions. The key message relates to primary mental health services taking a targeted approach to meeting the needs of these groups and highlights ‘that there are currently major gaps in primary mental health service provision for children and youth, Pacific peoples, migrant and refugee peoples, and patients with alcohol and/or other drug problems. These gaps, along with sustained effort on meeting the mental health needs of Māori, should be priority areas for future service development’ (Ministry of Health 2009, p 76).
It is also suggested that comorbid health problems are being missed or not treated adequately (ie, depression, metabolic syndrome resulting from treatment with antipsychotic medication) (Ministry of Health 2009). The Ministry of Health highlights that for older adults mental health and addiction problems are often undetected, untreated and individuals are not referred to appropriate services. This often leads to poly-pharmacy which is problematic because of drug interactions arising from physiological changes in the elderly.