Changing the Conversation: a Critical Ethnography of Diabetes Care in People with Mental Illnesses

Chronic illnesses pose a large public health threat. Diabetes mellitus type II accounts for about 90% of cases, is largely considered preventable by health providers, but continues to be among one of the most debilitating chronic conditions in Canada, and around the world. The co-occurrence of severe mental illnesses and diabetes is well documented, with diabetes being two to three times more prevalent among individuals with severe mental illnesses, compared to the general population. In clinical practices, diabetes management for people with mental illnesses and diabetes continues to operate on the premise of chronic disease model with an understanding of diabetes as a physiological and behavioral deficiency. Therefore, clinical and policy efforts are directed toward the enhancement of patient self-management techniques through patient compliance with pharmaceutical and lifestyle behavior recommendations. Self-management continues to be an important mandate in clinical practice and public health policies, where its biomedical understanding continues to prevail. Nonetheless, relatively little attention has been given to the exploration of how well the biomedical model aligns with peopleâ s everyday experiences. This project explored everyday experiences of diabetes self-management and biomedical compliance among those diagnosed with severe mental illnesses through the lens of critical ethnography. This work demonstrated discordance between biomedical perspectives on diabetes management and the lived experiences of those with mental illness. I identified an alternative conceptualization of diabetes management that moved beyond idealized concepts of self-care in order to introduce the social realities of people with severe mental illnesses as they attempt to enact and negotiate around medical directives. This new understanding encourages a shift towards broader social and contextual understandings of the lived realities of individuals with severe mental illness, and their resourcefulness, competence, persistence, and capabilities. Attention to how social context informs patientsâ realities may assist in the development of new context-sensitive and patient-oriented grounds for public health strategies and clinical practices associated with diabetes care, and challenge traditional understandings of compliance and noncompliance with diabetic self-management.Ph.D