How to Find Mental Health Help if You Have Diabetes
Your diabetes care team helps you manage your physical health. But you might be missing a key member: a professional who can help with your mental health, too.
Studies have long shown that people with diabetes are at higher risk for clinical depression than people without the condition. Recent research, including a study published in 2016 in the journal Diabetic Medicine, suggests that symptoms of depression, anxiety, and burnout can sometimes be attributed to a condition called diabetes distress. Nearly half of all people with diabetes experience diabetes distress, according to a study in a 2012 issue of Diabetes Care. Diabetes is also linked to eating disorders, including diabulimia (skipping or limiting insulin to lose weight) and, particularly among people with type 2, binge eating disorder and bulimia.
And then there’s the day-to-day emotions that come with managing a chronic illness: stress, guilt, fear, blame, anger—not to mention the mood swings that come with glucose fluctuations. In short: People with diabetes are dealing with extra emotional burdens.
Therapy can help, and the benefits don’t stop at your mental health. Studies have shown that people with diabetes who seek mental health treatment experience A1C improvements, too.
Call for Help
When is the right time to start therapy? Anytime. You can turn to a mental health professional for support when there are changes in your diabetes—a newly diagnosed complication, for instance. If you’re finding management difficult or burdensome, or if your feelings or thoughts about diabetes are getting in the way of your work and relationships, reach out, says Stacy Ogbeide, PsyD, MS, ABPP, a licensed psychologist who is part of the Mental Health Provider Directory Listing from the American Diabetes Association (ADA) and an assistant professor at the University of Texas Health Science Center San Antonio.
But you don’t need to be in crisis to benefit from therapy. “Everyone would benefit,” Ogbeide says. “Life is difficult and having diabetes is difficult.”
Someone on Your Side
There are many kinds of therapy, but they all have the same goal: providing a listening ear and tools to help you shift your perspective and change your behavior. “Therapy can provide a safe environment to share your tough feelings and experiences,” says Susan Guzman, PhD, a clinical psychologist and director of educational services at the Behavioral Diabetes Institute in San Diego. “Having someone to talk to helps you shift perspectives, and that’s true of almost every type of therapy. They can help you make peace with things that are bothering you and help you come up with solutions for your challenges.”
If you are overwhelmed or burned out by diabetes management tasks, a therapist can illuminate how your actions make a positive difference in your health. Through therapy, you can learn to break down big tasks into bite-size chunks and create a plan of action that fits into your life. The next time negative thinking patterns arise, you’ll be better equipped to substitute them with ones that are more helpful. “When you address those patterns, you can start to see shifts in your feelings and your behavior,” says Guzman.
Family therapy can help, too. If your child is asserting independence with his or her diabetes management, for instance, therapy can help you cope as a family. Or if you feel bad about a new diagnosis or a high A1C, a therapist can help you and your family deal with a diagnosis and dispel stigma. “Oftentimes with type 2, at diagnosis, people feel guilty because it’s involved with weight, and the community notion of it is, or can be, really negative,” says Ann Goebel-Fabbri, PhD, a licensed psychologist in the Boston area and author of Prevention and Recovery from Eating Disorders in Type 1 Diabetes: Injecting Hope. Therapists can provide recommendations to loved ones and family members about how to talk about diabetes in a way that’s open and nonjudgmental.
Finding a therapist can feel like the hardest part of a mental health journey. If you get your diabetes care from a hospital or community clinic, ask your provider for a referral to the behavioral or mental health department. They can often point you to someone they work with closely.
If you have insurance, call the number on the back of your insurance card to find out what kind of therapy is covered by your plan, what your share of the cost will be, and how many sessions are covered. Your insurance provider’s website should list in-network providers who are taking new patients. Look for someone who notes their experience working with people with chronic diseases or—even better—people with diabetes.
Someone who understands diabetes and the complexities of disease management can better understand your experiences and won’t unknowingly make harmful suggestions. (For instance, a therapist with diabetes know-how won’t tell a person with type 1 that skipping blood glucose checks is a good way to take a break.) To find a provider with specific diabetes expertise, check out the ADA’s Mental Health Provider Directory Listing, a collection of providers who have gone through diabetes training with the ADA and the American Psychological Association. If you think medication to improve your mental health is for you, consider psychiatrists, who can prescribe. Looking for a therapist of color? Check the listing here.
Once you have some names of providers, reach out to them to set up phone calls. Approach potential providers with questions such as how many clients with diabetes they’ve worked with or how they address diabetes distress. Listen to their responses. It’s important that you both click. “If you’re going to be in individual therapy, it’s going to be a very intimate relationship. You have to feel like you can open up and trust the therapist,” says Marisol Sanchez, MSW, LCSW, a licensed clinical social worker and psychotherapist in private practice in Washington, D.C. It might take a few tries before you find the right fit—even with phone introductions. But the calls can save you time and money by weeding out providers who don’t meet your needs.
Cost of Counseling
Therapy can be expensive. If you have insurance and have already called the number on the back of your card, you should know your portion of the cost of each appointment and how many appointments your plan will cover. On most plans, you won’t need a referral. Medicare also covers mental health care, as do many state Medicaid plans. Providers in private practice often do not take insurance, but some offer care on a sliding scale. When you reach out to a potential therapist, ask if paying on a sliding scale is a possibility.
If you don’t have insurance, or you cannot afford a therapist who does not accept insurance, you still have options. Community health centers serve low-income, underinsured communities and include lower-cost mental health care from licensed therapists (they take insurance, too). If there is a university near you, you may find cheaper therapy through graduate training programs. The student providers are under close supervision by licensed providers, so you can trust you’ll get good care. Sometimes, but not always, group-based therapy can be cheaper. “A lot of hospitals have diabetes support groups. Much of the time they’re free,” says Goebel-Fabbri. “That’s often a helpful thing.”
Trusting someone with your mental health can be a daunting step to take. But tackling emotional issues can help you do more than just live with diabetes. It can help you thrive.
If you are in crisis, contact the National Suicide Prevention Lifeline immediately at 800-273-8255.
Get the Behavioral Diabetes Institute’s free booklet, Breaking Free From Depression and Diabetes.
Who’s Who in Therapy
Psychotherapist: A general term for anyone providing mental health support.
Counselor: A general term that can refer to people providing mental health therapy and other kinds of support. Clinical mental health counselors typically have a master’s degree. Requirements vary by state.
Psychologist: A provider who can have a master’s degree or a PhD. They provide psychotherapy and do scientific research.
Psychiatrist: A provider with a medical degree (look for MD or DO after the name) who can write prescriptions for antidepressants and antianxiety medications. Some offer talk therapy; others do not. Psychiatric nurse practitioners can also write prescriptions.
Social Worker: A provider with a master’s degree who can help you navigate medical and financial needs, as well as school and work accommodations for your diabetes management.
Licensed Clinical Social Worker: A social worker who also has a license to provide psychotherapy.