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Paula Trief Part 5, Should Mental Health Be Part Of Diabetes Care?

In part 5, the conclusion of this Exclusive Interview, Paula Trief talks with Diabetes in Control Publisher Steve Freed about the necessity of including mental health care in overall diabetes care, but also the need to show insurance companies how mental health services can contribute.

Paula Trief, PhD is a Patrick A. Lehan Professor of Physiology and Biophysics and Chairman of the Department of Medicine Department at University of Mississippi.


Transcript of this video segment:

Steve Freed:  This year you’re the third psychologist we’ve talked to. We’ve talked about distress, we’ve talked about emotions, we’ve talked about depression. Which basically is saying that there’s a lot involved in the mind when it comes to diabetes. It’s not like cancer where you know, you hope you’ve got a smart doctor. Even though there’s other things you can do. With diabetes, this can be more of an emotional disease with all the response and the education and the trials that are going on. You find that also there’s more concern and that physicians really need to team up. So we know that the doctor’s part of the team, we know the cardiologist is part of the team. Dentists should be part of the team. Foot doctors should be part of the team. But there was never a mention of the psychologist being part of the team until now where I start to see that you know, maybe this should be part of the team.

Paula Trief:   I mean we psychologists all think that and there’s definitely a movement in that direction; ADA just came out with psychosocial guidelines, the first guideline statement around psychosocial issues and diabetes, so that was really really big that that’s been addressed. I think in general, even with other diseases, there’s a growing recognition of the role of emotions and relationships and coping styles and all those, you know, squishy things play in illness and in managing illness. The difficulty is one, it’s hard to find mental health people who are focused on diabetes. It’s not just the physicians who are not looking for the mental health people, but the mental health people are not necessarily focusing on this. So now the ADA and the APA, which is the American Psychological Association, are doing a training program where they’re training mental health people in diabetes, and that’s a beginning. But it’s a small number of people, and a big country. So yes there’s definitely a growing recognition that those things play a role and really you know we’re talking about well-being. So it’s not only about glycemic control, it’s about how you feel about your life.

Steve Freed: What are some research things you feel that we need to do in the future in this area?

Paula Trief:   Well actually I think that the issue that you raise is a really good one. I think we still we still don’t have a lot of good data that shows that that bringing mental health into primary care or into diabetes care translates into things that we can measure. We have to be able to show that something changes in order to get insurance companies to pay for it. Medicare, Medicaid, all that. We have some data on that but we’re just beginning to; the same thing with these telephone interventions. That hasn’t been picked up because nobody pays for telephone interventions. They’re starting to pay for online interventions; we are starting to see a little bit of that, but they don’t pay for telephone at this point. So if I’m a provider I don’t want to talk to somebody on the phone because I don’t get paid, or my boss won’t get paid. So I think looking at ways to get reimbursement for mental health services and more accessibility is definitely something we need to keep working on.


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