Talking Type 1: Guided self-help to address unmet psychological need in people living with diabetes

Given the overwhelming lack of a specialist diabetes psychology workforce within the NHS, it is essential that steps are taken to develop specialist diabetes psychology resources and education that can be used in the absence of direct support from a diabetes psychologist. Bibliotherapy (also known as “book therapy”) represents one way of meeting some of the unmet need in diabetes psychology, and is already established throughout the UK via the Reading Well Books on Prescription Scheme (https://reading-well.org.uk). While initial phases of the scheme focussed on common mental health issues, like depression and anxiety, the scheme has now expanded to include titles centred on physical health issues, such as chronic pain, chronic fatigue, IBS and stroke. Titles focussed on diabetes are present in the scheme but, echoing the issues with services, the specific psychological issues related to diabetes are neglected.

Talking Type 1 – the world’s first bibliotherapy range for people with diabetes

The Talking Type 1 book range was developed in NHS Wales in 2018 to meet some of the unmet psychological need for people living with diabetes (see Box 1). Each book has been written by a specialist diabetes psychologist, in conjunction with individuals who have lived experience of the issues covered, to help support PWD and families who are experiencing common mild–moderate psychological issues in relation to their condition. These books are particularly helpful in instances where a person is starting to struggle, but referral to diabetes psychology may not be required or may not be practical (e.g. due to lack of staff, long waiting lists or the PWD being unable to attend appointments). By giving people access to these resources at an early stage, it is possible to reduce or entirely resolve distress before significant psychological or physical harm occurs. This may have the added benefit of reducing the burden on overstretched services.

The books use a guided self-help model, meaning that each can provide a basic-level psychological intervention on its own, but the impact can be reinforced and boosted by support from a member of the person’s diabetes team. Any professional with a relationship with the PWD will be able to provide effective support alongside the book.

Examples of the care team support around the book could include:

• Talking through the book and with the PWD as it is given out.
• Staying in touch with the PWD to find out how they are getting on with the book.
• Setting the PWD “homework” tasks (e.g. reading through particular pages or completing particular exercises) between support sessions.
• Keeping a note of any goals or plans that the PWD makes as a result of reading the book and reviewing these.
• Organising a review session with the PWD after they have read the book, to reflect on what they have learned and to set ongoing goals.

Each book contains a link to an online survey that is used for continual evaluation and improvement of the range. Anyone who has used the resources is welcome to complete the survey, be they PWD, staff or family members. Analysis of responses collected to date in Wales indicates that PWD felt significantly more confident to deal with the issues detailed in each book and, consequently, that these problems have significantly less negative impact in day-to-day life. As a result, the books have now become a mainstream part of the national Welsh diabetes programme.

Conclusion

While it is essential for diabetes services to continue to strive for an adequately staffed diabetes psychology workforce, realistically, addressing this issue will take significant time and service demand is likely to continue to outstrip capacity for the foreseeable future. The Talking Type 1 range uses specialist expertise to develop resources for common psychological issues faced by PWD on a mass level, and can help to begin addressing unmet psychological need.