When to start the conversation Talking about mental health should be part of every routine diabetes consultation, but there are times when it is extra important to get the conversation started: At diagnosis of diabetes During care planning appointments If you notice emotional distress When diabetes management is suboptimal How to start the conversation Start with a simple opening comment that normalises mental health challenges to build trust and rapport, such as: “Sometimes it can be stressful living with diabetes.” “Managing diabetes every day can make life a lot more challenging.” Use open questions to find out more, and show the person you are interested in their experiences: “How have you been feeling about managing your diabetes recently?” “Can you tell me about any challenges you’ve experienced while following your self-management plan?” “How do you feel about the support you’re receiving from your healthcare team in managing your diabetes?” “How do you think we can work together to overcome challenges you’re facing in managing your diabetes effectively?” What to do next: the 7 As model The 7 As model is a structured, flexible, seven-step process to identify and support people with diabetes who are experiencing mental health challenges. The solid arrows show the path you can follow if you are able to perform all seven steps. The dotted arrows show where you may diverge from the main path, for example by ASSIGNing to another health professional if extra support is required. Adapting the 7 As model for routine care See how to use a streamlined version of the 7 As model during routine consultations. Click the image to learn more. Learn more here How to use the 7 As model The steps below provide a general overview of how to use the 7 As model. Information on using the 7 As model for specific mental health conditions can be found in our toolkits. Step 1: Be Aware Be Aware that people with diabetes may experience emotional and mental health challenges. These include diabetes-related distress, depression, anxiety or eating problems. Look for signs of emotional or mental health challenges such as: skipping insulin or medication doses higher HbA1c or unstable blood glucose levels unhealthy or uncontrolled eating risk-taking behaviours missing clinic appointments. To learn more about signs of specific mental health conditions, visit the Questionnaires page or download the relevant toolkit. Step 2: Ask Ask about symptoms: as part of routine care when the person reports symptoms or when you have noted signs (see Aware) in periods of significant diabetes-related challenge or adjustment. Use open-ended questions or questionnaires. If you suspect the person may have a mental health condition, check whether they have a current diagnosis or are receiving treatment. If not, then further assessment is warranted (see Assess). Note: If you do not feel confident you have the capacity and relevant skills to assess the person for a mental health condition, skip now to Step 6: Assign. Step 3: Assess Assess the specific mental health condition you suspect using a validated questionnaire. When to assess: As part of routine care If Aware or Ask indicated symptoms of a mental health condition. Brief, validated mental health questionnaires are available here. Step 4: Advise Advise the person about their symptoms: Explain that their questionnaire responses indicate they are experiencing symptoms of depression or anxiety which you will need to confirm with a clinical interview Describe how it might impact on their life overall and their diabetes management Reassure them that experiencing mental health challenges is common, and their condition can be managed effectively. Make a joint plan about the ‘next steps’ (e.g. what needs to be achieved and who can help). Step 5: Assist Assist with developing an achievable action plan. Provide information about the specific mental health condition identified. Explain treatment/therapy options and assist the person to access them. Explain that a collaborative approach is needed, and who will be part of this multidisciplinary team and their roles. Agree on an action plan and achievable goals, and make sure the person feels comfortable with the approach. Step 6: Assign Assign to another health professional. If you do not feel comfortable or equipped to Assess or Assist, arrange a referral to a relevant health professional. Maintain ongoing communication with the health professional(s) to whom you made the referral. Step 7: Arrange Arrange a follow-up appointment to: ask about the person’s progress assess the potential need for revising the action plan. Be prepared to offer more support (e.g. through telephone reviews or more/extended consultations) during this time. The 7 As toolkits Learn how to use the 7 As model for specific mental health conditions with our range of toolkits. Diabetes distress Fear of hypoglycaemia Psychological barriers to insulin use Depression Anxiety disorders Eating problems
