By Ania Basiukiewicz

Diabetes mellitus, often referred to as Type 1 or juvenile diabetes, is the second most common chronic illness faced by children and youth. Research indicates that depression is three times higher in adolescents with Type 1 diabetes, yet when it comes to treating youth with diabetes, there is often no standard process in place to help identify mental health and quality of life issues they may be struggling with. As a result, young patients and families often do not have the opportunity to discuss this important aspect of treatment with their primary care providers, which poses a strong risk of leaving these issues unnoticed and untreated.

Trillium Health Partners in Mississauga sees nearly 600 young diabetes patients every year, and has launched a pilot program aiming to help treat young diabetes patients with co-occurring depression more holistically by blending physical and mental health goals right at the start of treatment. The pilot is supported by the Medical Psychiatry Alliance (MPA), a collaborative partnership between Trillium Health Partners, The Centre for Addiction and Mental Health (CAMH), The Hospital for Sick Children (SickKids), and the University of Toronto. The MPA is dedicated  to transforming  care for Ontarians living with coexisting physical and mental health conditions.

It is known that 20 to 40 per cent of children and youth with medical conditions have mental health concerns, but delivering the level of care these patients need can be challenging for health care providers. Trillium Health Partners’ new pilot program aims to improve the quality of care and life for young diabetes patients who are at increased risk for depression.

At their initial visit to Trillium Health Partners’ Paediatric Diabetes Education Program (PDEP), patients and families complete a quality of life questionnaire that helps their care team identify appropriate support. Questions aim to assess how teens may be feeling about their weight and body, how their diabetes impacts their experience at school and their social activities, relationships with friends and family, what they consider to be most difficult about living with diabetes, and how their condition affects their general mood.

“As a nurse in the Paediatric Diabetes Clinic, I have had the privilege of working with youth with diabetes. Coping with diabetes is stressful, and often impacts every aspect of our young patients’ lives. I have seen how challenging the struggles of  diabetes can be – the daily tasks needed to manage their condition can be not only physically exhausting, but can also overwhelm even the most resilient young patients. The most common challenges happen not because our young patients don’t know how to manage their blood sugars, but rather because they are unable to manage the mental and emotional burnout that is so often a part of living with diabetes. Successfully managing diabetes is so much more than simply checking blood sugar and taking insulin – it is also about the supportive mental health strategies that help my young patients cope with their condition. Integration of timely mental health supports into our program can truly make a difference,” says Elaine Wilson, Registered Nurse, Trillium Health Partners’ Paediatric Diabetes Clinic.

Through the innovative partnership with SickKids’ TeleLink Mental Health Program, Trillium Health Partners’ young diabetes patients displaying significant mental health symptoms are promptly linked to a psychiatric consultation –  a very convenient option for families living within Trillium Health Partners’ community, since it helps them cut down on time and travel cost to see a specialist at SickKids’ downtown location.  In this way, the new pilot program helps our PDEP interprofessional team provide holistic care to our patients and families at a level of integration not previously achieved.

“The MPA has a unique opportunity to more fully address the physical and emotional needs of children and adolescents with co-existing physical and mental health problems in more depth, and determine more innovative ways of meeting those needs. At Trillium Health Partners, we are excited to partner with SickKids on this innovative new program integrating medical and mental healthcare for our adolescents with diabetes. Together, we can all work toward improving health outcomes and quality of life for these youth and their families,” says Dr. Ian Zenlea, Physician Co-lead Medical Psychiatry Alliance Child & Youth Project.

“Our goal at Trillium Health Partners is to provide more holistic care to young patients facing the challenges of living with diabetes,” says Daphne Lok, Social Worker, Trillium Health Partners’ Paediatric Diabetes Clinic. “I’m excited to see mental health supports being integrated into the direct care setting through the use of easy to understand questionnaires. I feel this approach serves the youths’ mental and emotional needs in a more immediate and relevant way.  I believe that ultimately, treating the whole person enables our patients to live their lives fully and with an understanding that every aspect of their life is important, not just the medical diagnosis. Seeing children and youth living well with their diabetes is the ultimate reward for the work that our team does,” she says.

With 5,000 patient visits annually, Trillium Health Partners’ Paediatric Diabetes Clinic is among the largest in Ontario and the first to trial this new innovative model of including mental health screening as part of the treatment standard for all young diabetes patients between 13 and 18 years old. The pilot program began in September 2016 and runs to 2017 at its Mississauga Hospital site, with plans to expand in the near future.

Ania Basiukiewicz is a communications advisor at Trillium Health Partners.