Reflection is based within Dundee House, the Diabetes Centre of the City Hospital Campus, Nottingham University Hospitals Trust.
The Diabetes NSF Standards 3 & 5, NICE diabetes educational guidelines, IDF, and Diabetes UK have all identified the importance of emotional and psychological well-being.
Alan Archer, consultant diabetologist at Nottingham City Hospital set up the Reflection service. He is a registered psychotherapist, (MA UKCP), and identified that there was a need for a service that provides psychological support for people with diabetes. Initially on his own, the service has now expanded to himself and 4 other trainee counsellors completing their Masters in Humanistic psychotherapy.
The aim of Reflection is to enhance the psychological life of any person with diabetes who wishes to access both the physical and psychological care that the diabetes centre can offer.
People within the diabetes community can self refer themselves to Reflection. Awareness of the service is raised via leaflets and posters in the diabetes clinic reception area. This information is also available in the education packs given to all people with diabetes and is also available via the diabetes department’s Directory of Services accessible on the local web to all General Practitioners. Other staff within the diabetes team and diabetes community raise awareness of the service, and presentations have been made to GPs and the wider diabetes community beyond the team at the hospital. The counsellors providing the service ascertain whether an individual is already engaging in psychological services so that a decision can be reached together with the person and their existing mental health support team as to whether it would be appropriate for them to have Reflection counselling. Sessions are arranged on a weekly basis, they last for 50 minutes and on average are for a period of 8-10 weeks; this is flexible according to a person’s needs. The counselling approach is humanistic, reflecting the training of the counsellors presently providing the service.
By providing a counselling service, Reflection aims to improve the emotional and psychological well-being of people with diabetes. Counselling outcomes are currently assessed using 4 questionnaires: PAIDS - diabetes-related distress, HADS -depression/anxiety, W-BQ12 - well-being and ADDQoL - impact of diabetes on quality of life pre counselling and at 8 weekly stages throughout therapy. Comparison of these questionnaires pre and post counselling has indicated that counselling is of benefit, with significant improvements demonstrated in well-being and reductions in both diabetes-related distress and the negative impact of diabetes on quality of life. Accountability lies with the consultant who initiated the service, and he has responsibility within the Trust for the service.
1 counsellors have become increasingly welcomed by all staff working within the diabetes centre
2 there is an unmet need for such a service – there is currently a constant waiting list of approximately 15 clients, all self referred
3 Reflection extends the existing diabetes service that healthcare professionals can offer their patients; thus far >2% of the clinic patients have accessed the service
4 diabetes health care professionals are now introducing discussion around psychological issues in their consultations with their patients because they know that Reflection is there and available if counselling is desired; health care professionals have identified feeling more able to introduce this type of discussion as a result of being able to model learning they have acquired from the Reflection counselling team.
A ccess to Questionnaires: see http://www.healthpsychologyresearch.com for the W-BQ12 and ADDQoL
References for HADS: Zigmond AS & Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 1983; 67: 361-370 Bjelland I et al. The validity of the Hospital Anxiety and Depression Scale, an updated literature review. Journal of Psychosomatic Research 2002; 52: 69-77
References for PAIDS Polonsky WH et al. Assessment of diabetes-related distress. Diabetes Care 1995; 18: 754-760 Snoek FJ et al. Diabetes-related emotional distress in Dutch and US diabetic patients. Diabetes Care 2000; 23: 1305-1309