The way your patients live, work and play can have profound effects on their health.  This May, in honor of Mental Health Month, the California Medical Association checked in with Christopher Holliday, Ph.D., MPH, a community psychologist and director of clinical-community linkages for the American Medical Association’s (AMA) Improving Health Outcomes Group. Here’s why he says addressing mental health is one of the most critical aspects of preventing diabetes. Plus, his top tips for fostering physical and mental wellness among patients.

CMA: In 2016, CMA and AMA teamed up on a national campaign to prevent diabetes across the country. How does mental health intersect with this campaign? Why speak up about this issue?

Holliday: There are about 30 million people with diabetes in the country and another 86 million with prediabetes. These same 86 million people, if untreated, are at high risk of progressing to type 2 diabetes, which will absolutely put the healthcare system in a lurch. We will have an epidemic on our hands that we cannot solve, so part of our work in the Improving Health Outcomes Group is to not only think about the prevention of type 2 diabetes, but also the aspects—or comorbidities—that either create chronic disease or exacerbate it. Mental health is certainly one of them.  

CMA: How so? What mental health comorbidities create chronic disease?

Holliday: Science shows that there’s actually a bi-directional relationship between mental health and chronic disease: If a patient has mental health issues—like depression, stress, or anxiety—these issues can prevent the patient from engaging in the daily activities that support wellness and optimal health.

Taking care of oneself, exercising, eating right, taking time to enjoy the finer things in life and family, can become very hard. Each of these challenges can lead patients to poorer health outcomes. Mental health can affect obesity, weight gain, glycemic and glucose levels. So in effect, people with mental health issues are more prone to have chronic diseases like diabetes.

On the other side of this bi-directional relationship, people with diabetes or other chronic diseases often have comorbidities with a mental health issue that exacerbates their conditions. If a patient has anxiety and stresses about certain social determinants of health—where his next meal comes from, housing, transportation or safety—these stressors can actually worsen diabetes through reduced exercise, poor eating, insulin adherence, for example. The same mental health issues that cause patients to develop diabetes can also cause the health of patients with diabetes to worsen over time.

CMA: How do these linkages between diabetes and mental health affect communities of color?

Holliday: I’m a community psychologist, so I often think about mental health on a population-level. For instance, in my previous work at the Adler School of Professional Psychology in Chicago, I studied whole communities that grappled with depressed conditions such as high-crime activity, low access to healthy foods, low-income housing, poorly paved roads and a number of other infrastructural issues. We’re finding that in these communities, which are often communities of color, there is a certain population-level depression that looms over residents and prevents them from engaging in the daily activities that promote healthy outcomes.

These are the kinds of contextual factors that preclude living well that care teams have to consider. Patients can find a difference in life expectancy simply based on their zip code and unfortunately, this issue tends to pervade communities of color.

CMA: Is there any advice physicians can offer patients to help them self-actualize, especially if they live in areas where social determinants of health occur beyond their control?

Holliday: Patients can take control of their health and prevent diabetes by actively participating in team-based care. The best model for this type of care is the collaborative chronic care model, which allows patients to improve their self-management of type 2 diabetes or work with primary care physicians to prevent the onset of type 2 diabetes. Using this model, the patient connects to a health care family where each care team member provides insights to help the patient effectively self-manage. Imagine how empowering that can feel.

I also advise patients to take ownership of their health by joining or creating neighborhood efforts, like planting community gardens, and walking school buses, which can strengthen their sense of agency and safety.

CMA: What strategies can care teams implement to prevent chronic disease while caring for their patients’ mental health?

Holliday: The AMA Improving Health Outcomes Group especially this month, recommends one key strategy: Partner with a mental health professional. Currently, patients with comorbid diabetes and mental health are under-diagnosed. Of all the patients who have these two conditions, only about one-third of them are actually diagnosed and receive treatment for their diabetes and mental health disorders. And we know that patients who are commonly underserved tend to reside in communities of color, so can you imagine how many black and Latino people are struggling with diabetes and mental health but are still undiagnosed? So really, this is a call to action. As we think about diabetes treatment and prevention, we’re asking physicians to incorporate mental health into care and partner with a mental health professional as a core component of their care team treatment.

To fully foster wellness among patients and prevent diabetes, I also suggest care teams:

• Speak up. As physicians, we are in a unique position to affect policies and systems-based changes that alter the environments people live in. Tap into activism. Get involved with your state medical society to engage local elected officials, municipal leaders and state officials to build social capitol that will improve health outcomes in communities.
• Take advantage of vital resources. The Centers for Disease Control and Prevention and the AMA have been working together since 2014 to address diabetes prevention on a national level. This collaboration has included a national co-branded initiative, Prevent Diabetes STAT™, which offers a comprehensive toolkit featuring key resources—including patient handouts, questionnaires and step-by-step guidelines—on diabetes prevention. Download the complete toolkit today.
• Launch diabetes prevention programs that address mental health. Sign up with a CDC-approved training program to gain the resources you need to develop a DPP that incorporates mental health screening.
• Contact the AMA for consulting support, program expertise and education for implementing proven prevention strategies to reduce the incidence of type 2 diabetes. Learn how this physician developed his own successful program.​
  
  
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