May is mental health awareness month. Many people with diabetes and many people with disability deal with diabetes distress, depression, anxiety, or other mental health challenges. I have learned that I must ask questions and often build a different self-care plan for when their mental illness is most impacting them. I cannot have the same expectations as when they are feeling like themselves. Yet other times I must accept that the individual identifies with their disability and that they see their diagnosis as a big part of who they are. In those cases, I try to see how they identify with diabetes and how they can implement healthy behaviors.
When working with someone, the typical questions I ask are:
What does (anxiety/depression/other) look like for you? What is the longest the episodes have lasted? What is the shortest? What has helped you recover? How long between episodes? Are there things that trigger the episodes?
Do you sleep more or less during those times? What is your activity level like when you are not experiencing (depression)? What is it like when you are (depressed)?
Are you able to eat? What kinds of foods? Do you binge or do you skip eating?
Do you take your medications when you are experiencing the (depression)? How often do you miss taking the medication? In what ways do you find that skipping the medication impacts your physical or mental health? What do you do if you run out of medication during those times? Have there been consequences from not renewing or taking your medications? If so, what consequences and how did you deal with that? (Please note that sometimes the consequences have been implemented by health professionals because the individual has been “non-adherent”. That’s a whole other blog post.)
What does monitoring look like when you are experiencing (depression)? What blood sugar goals are reasonable to you during those times?
What self-care or coping skills work for you? What health professionals do you work with? Has your doctor recommended treatments for you? Have you tried them, and which ones work or don’t work for you? Why? Are you open to other strategies?
Who is most supportive of your mental health? Your diabetes? What do they do that makes you feel supported? Is there anyone/anything that is done that keeps you from being your healthiest?
The biggest thing for me is to accept what the individual can or cannot do due to their mental health. That often means different goals at different times. When I try to push for my goals, which they know they will not accomplish, then they tend to drop everything. So, I try to get agreement on what they are willing/able to do when they are at various stages.
For the people I work with who live with mental health difficulties, it helps me to get to know how the individual experiences their disability. Is it new or have they had it for decades? What is negative and what is positive about that diagnosis? How does diabetes impact their mental health? How does mental health impact their diabetes? Working together, we can find a self-care plan that may not be perfect but may be agreeable to both of us.
While I find a one-on-one discussion to be highly effective, I understand that you might not have the time/opportunity. There are a variety of screening tools for diabetes and various mental health conditions that you may employ. Here are a few resources for mental health research:
Psychiatry.org - Home
SAMHSA - Substance Abuse and Mental Health Services Administration
Anxiety Disorders and Depression Research & Treatment | Anxiety and Depression Association of America, ADAA
Mental Health, Depression, Anxiety, Wellness, Family & Relationship Issues, Sexual Disorders & ADHD Medications (mentalhelp.net)
Search for your local mental or behavioral health authority
What questions do you ask to find out about the person’s mental health challenges? What tools do you find most useful?