6.5.0.0 Re­fer­ral to a Men­tal Health Spe­cialist

In­di­ca­tions for re­fer­ral to a men­tal health spe­cialist fa­mil­iar with di­a­betes man­age­ment may in­clude pos­i­tive screen­ing for over­all stress re­lat­ed to work-‍life bal­ance, DD, di­a­betes man­age­ment difficul­ties, de­pres­sion, anx­i­ety, dis­or­dered eat­ing, and cog­ni­tive dys­func­tion (see Table 5.2 for a com­plete list). It is prefer­able to in­cor­po­rate psy­choso­cial as­sess­ment and treat­ment into rou­tine care rather than wait­ing for a specific prob­lem or de­te­ri­o­ra­tion in metabol­ic or psy­cho­log­i­cal sta­tus to occur (26,193). Providers should iden­ti­fy be­hav­ioral and men­tal health pro­viders, ide­al­ly those who are knowl­edgeable about di­a­betes treat­ment and the psy­choso­cial as­pects of di­a­betes, to whom they can refer pa­tients. The ADA pro­vides a list of men­tal health pro­viders who have re­ceived ad­di­tional ed­u­ca­tion in di­a­betes at the ADA Men­tal Health Provider Di­rec­to­ry (pro­fes­sion­al. di­a­betes.org/ada-men­tal-health-pro­vider-directory). Ide­al­ly, psy­choso­cial care pro­viders should be em­bed­ded in di­a­betes care set­tings. Al­though the clin­i­cian may not feel qualified to treat psy­cho­log­i­cal prob­lems (200), op­ti­miz­ing the pa­tient-pro­vider re­la­tion­ship as a foun­da­tion may in­crease the like­li­hood of the pa­tient ac­cept­ing re­fer­ral for other ser­vices. Col­lab­o­ra­tive care in­ter­ven­tions and a team ap­proach have demon­strat­ed efficacy in di­a­betes self-‍man­age­ment, out­comes of de­pres­sion, and psy­choso­cial func­tion­ing (17,201).

Table 5.2—Sit­u­a­tions that war­rant re­fer­ral of a per­son with di­a­betes to a men­tal health pro­vider for eval­u­a­tion and treat­ment