EPP490
Diabetes Management in Severe Mental Illness: An Audit at Broadmoor Hospital
S. Olotu 1,*, I. Hussein 1, S. Jyoti 1
1Broadmoor Hospital, West London NHS, Berkshire, United Kingdom
Introduction: Individuals with severe mental illness (SMI) face a 13–30 year mortality gap, with type 2 diabetes contributing significantly due to lifestyle, antipsychotic medication use, and limited access to equitable physical healthcare. At Broadmoor Hospital, concerns about diabetes complications and an emergency hyperglycaemic episode prompted this audit. Raising awareness about diabetes education among mental health professionals and patients is a top priority
Objectives: Determine the prevalence of type 2 diabetes and related complications in Broadmoor Hospital
- Evaluate the education and knowledge of diabetes among the patients and nursing staff
- Gaps in current care and recommendations in line with the National Institute of Clinical Excellence (NICE) guideline and the Public Health guideline [PH38] Type 2 diabetes: prevention in people at high risk
Methods: Data collection (Oct 2024–Mar 2025) included review of patient health records and HbA1c monitoring
Evidence-based surveys were distributed to 106 nursing staff (20.7% response rate) and 21 inpatients with type 2 diabetes
Quantitative and qualitative data analysis, incorporating the Theoretical Domains Framework (TDF), was used to interpret the findings (Image 3)
Results: Staff survey: 54% of nurses had received diabetes training; only 21% within the past year. Nearly half were unsure of guidelines, with 43% citing lack of training as a barrier. Patient compliance (84.9%) was the most reported challenge, followed by workload pressures and limited resources. Nurses strongly supported structured training and better patient education resources (Image 1&2)
Patient survey: Most patients felt knowledgeable and motivated to manage diabetes, yet 71% reported never being offered a structured education course. Exercise (61%) and diet adherence (22%) were the greatest challenges. Mental health significantly influenced self-management—75% reported poor mental health worsened diabetes control. While most patients were confident and optimistic, gaps between confidence and routine adherence persisted (Image 1)
Significant correlation was observed between patient confidence and optimism (r ≈ 0.68, p < 0.01). Lack of structured education was statistically linked to unmet educational needs (p < 0.05)
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Conclusions: This audit highlights major gaps in structured diabetes education for both staff and patients in a secure forensic setting. Despite good awareness and motivation, barriers such as limited training, patient compliance, mental health challenges, and lack of structured support hinder effective management
Recommendations:
- Implement mandatory diabetes training and refresher courses for nurses
- Develop structured patient education programmes (e.g., DESMOND model)
- Enhance collaboration within the multidisciplinary team
Impact: Embedding the recommended approaches could improve diabetes outcomes, reduce complications, and address health inequalities for individuals with SMI in secure settings
Disclosure of Interest: None Declared