Short Report National guidelines for psychological care in diabetes: how mindful have we been? T. R. J. Nicholson, J.-P. Taylor*, C. Gosden†, P. Trigwell‡ and K. Ismail Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London SE5 9RJ, UK, *Institute for Ageing and Health, Newcastle University, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK, †Diabetes UK, Macleod House, 10 Parkway, London NW1 7AA, UK and ‡Department of Liaison Psychiatry, Leeds General Infirmary / Leeds Partnerships Foundation NHS Trust, Leeds, Yorkshire, UK Accepted 10 February 2009 Abstract Aims To assess the availability and types of psychological services for people with diabetes in the UK, compliance with national guidelines and skills of the diabetes team in, and attitudes towards, psychological aspects of diabetes management. Methods Postal questionnaires to team leads (doctor and nurse) of all UK diabetes centres (n = 464) followed by semi- structured telephone interviews of expert providers of psychological services identified by team leads. Results Two hundred and sixty-seven centres (58%) returned postal questionnaires; 66 (25%) identified a named expert provider of psychological services, of whom 53 (80%) were interviewed by telephone. Less than one-third (n = 84) of responding centres had access to specialist psychological services and availability varied across the four UK nations (P = 0.02). Over two-thirds (n = 182) of centres had not implemented the majority of national guidelines and only 2.6% met all guidelines. Psychological input into teams was associated with improved training in psychological issues for team members (P < 0.001), perception of better skills in managing more complex psychological issues (P £ 0.01) and increased likelihood of having psychological care pathways (P £ 0.05). Most (81%) expert providers interviewed by telephone were under-resourced to meet the psychological needs of their population. Conclusions Expert psychological support is not available to the majority of diabetes centres and significant geographical variation indicates inequity of service provision. Only a minority of centres meet national guidelines. Skills and services within diabetes teams vary widely and are positively influenced by the presence of expert providers of psychological care. Lack of resources are a barrier to service provision. Diabet. Med. 26, 447–450 (2009) Keywords consultation–liaison psychiatry, diabetes, health services, psychology, survey Abbreviations NICE, National Institute for Health and Clinical Excellence; NSF, National Service Framework Introduction Psychiatric disorders and psychological problems are common in diabetes [1]. There is a twofold increase in depression [2–4] and eating problems [5] and these are associated with suboptimal glycaemic control [6,7]and increased mortality [8]. There are cost-effective treatments for depression in diabetes [9] and psychotherapeutic approaches to improve glycaemic control [10–13] but, despite this, the majority of psychological and psychiatric problems go undetected and untreated [2,14]. There are no formal clinical pathways for delivering expert psychological care in diabetes. The National Service Framework (NSF) has set standards to provide counselling (standard 3) and management of depression (standard 12) [15] and the National Institute for Health and Clinical Excellence (NICE) has also made explicit recommendations [16] (Table 1). The aim of this national survey was to describe and quantify the provision of psychological services for adults with diabetes and the extent to which national guidance was being met. Correspondence to: Khalida Ismail, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London SE5 9RJ, UK. E-mail: k.ismail@iop.kcl.ac.uk DIABETICMedicine DOI: 10.1111/j.1464-5491.2009.02701.x ª 2009 The Authors. Journal compilation ª 2009 Diabetes UK. Diabetic Medicine, 26, 447–450 447