06 April, 2016

What can diabetes epidemic tell us about the challenge of mental healthcare?

This year’s World Health Organisation (WHO) Annual World Health Day focuses our attention on the global health challenge of diabetes (1). The intention of World Health Day is to highlight issues of major significance for population health and especially this year the diabetes epidemic that is surely one of the most pressing of today’s health challenges.

Diabetes has rapidly become a major contributor to the global burden of disease even though it is both a preventable and treatable problem. Unfortunately at least 347 million people world-wide suffer from Diabetes and the disease is the direct cause of 1.5 million deaths each year. By increasing public awareness World Health Day highlights the need for effective public health measures and for interventions that could benefit many millions of people.

These measures include a greater recognition of the coexistence of diabetes (as well as other enduring physical illnesses) with mental health problems. Diabetes increases the risk of mental health disorders including depressive disorders, anxiety disorders and psychotic disorders (2). At the same time mental health disorders greatly increase the risk of developing diabetes. Depression presents in nearly 20% of people with diabetes leading to a significant adverse effect on quality of life and treatment outcome. Until recently the confluence of physical and mental health problems was under-estimated, under-recognised and under-treated.

Mental health phenomena associated with chronic disease defy a single explanation, but the stress and human burden of living with an enduring illness is an important part of the understanding (3). Other associations between chronic enduring physical illness and poor mental health are also important. Untreated physical illness including diabetes is a perpetuating factor for mental distress, and the coexistence of physical and mental illness can frustrate attempts at rehabilitation and recovery.

Patients with severe and enduring mental health challenge have a shorter life expectancy, not only because of the risk of suicide, but because of the unmet needs arising from the co-existence of enduring physical health problems. Some estimates suggest that life expectancy of those with enduring mental health problems is reduced by as much as 20 years and this jeopardy is largely explained by untreated poor physical health. Endemic stigma leads to the exclusion of the mentally ill from most of the agenda around physical health. This exclusion is the largest contributory factor underlying the unacceptably high death rate seen in those with enduring mental health problems.

Population health is the area of health care where the greatest good can be achieved for the greatest number of people. As life goes on this need will include more and more people with physical and mental illness, as well as increasing numbers of those experiencing both of these challenges. Societal change in health status will only be achieved if mental health needs are included in this agenda. Public health interventions will succeed if they are combined with coherent mental health commitments. The integration of measures to enhance physical health and mental health can be postponed no longer.

The truth is “there is no health without mental health” (4). Public health measures acknowledging the co-existing needs of physical and mental illness are not just pie in the sky, they are essential, and they are more likely to be effective. Mental healthcare can no longer remain on the margins of our initiatives if we are to succeed in increasing the health status of our population.


  1. World Health Day 2016 (WHO) www.who.int/campaigns
  2. Diabetes and mental health disorders. Snoek et al 2015 The Lancet / Diabetes and Endocrinology Vol 3 pp 450-460
  3. Depression and diabetes Moulton et al, 2015. The Lancet / Diabetes and Endocrinology Vol 3 pp 461-471
  4. Global Health 1 No health without Mental Health Prince et al 2007 Lancet 2007, 370, 859-877