Canadian Journal of Public Health

, Volume 104, Issue 4, pp e330–e334 | Cite as

Diabetes Care and Mental Illness: The Social Organization of Food in a Residential Care Facility

  • Ruth H. Lowndes
  • Jan E. Angus
  • Elizabeth Peter
Qualitative Research


OBJECTIVE: To explore the social organization of food provision and dietary intake in seriously mentally ill people with diabetes who reside in a forprofit group home.

METHODS: Institutional ethnography was used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were conducted with residents with diabetes, care providers, field workers, and health professionals. Observations and document analysis were also used to understand the lack of congruence between diabetes guidelines and the possibilities for diabetes management within the confines of group home care.

RESULTS: Although it was mandated in group home guidelines that “Health Canada’s Eating Well with Canada’s Food Guide” (2007) be followed, menus were planned within the context of a limited food budget of approximately $1.91 per day per resident. Group home policies regulated systems of safety, reporting, and financial accountability, but not health promotion. Inspections carried out by the Public Health Department focused primarily on food safety during handling, preparation, and storage, and compliance to regulations regarding environmental cleanliness and infection control.

CONCLUSION: Resource rationing found in group home care exacerbates illness in an already marginalized group. Financial support is required to enable provision of healthy food choices, including dairy products, fresh fruits, and vegetables. Additional support is required for care of co-morbid conditions such as diabetes for associated food costs and education to improve outcomes. Group home policies must take into consideration health threats to this population and give primacy to health promotion and illness prevention.

Key Words

Diabetes dietary intake serious mental illness group home care institutional ethnography 


OBJECTIF: Explorer l’organisation sociale de l’approvisionnement en aliments et les apports alimentaires de personnes diabétiques gravement atteintes de maladies mentales vivant dans un foyer de groupe à but lucratif.

MÉTHODE: Nous avons utilisé l’ethnographie institutionnelle pour explorer les pratiques de soins du diabète chez 26 femmes vivant dans un établissement de soins résidentiels en milieu rural dans le sud de l’Ontario. Nous avons mené des entretiens semi-directifs approfondis avec des résidentes diabétiques, des fournisseurs de soins, du personnel de terrain et des professionnels de la santé. Nous avons aussi eu recours à l’observation et à l’analyse documentaire pour comprendre le manque de concordance entre les lignes directrices sur le diabète et les possibilités de prise en charge de cette maladie dans le cadre des soins en foyer de groupe.

RÉSULTATS: Malgré les lignes directrices des foyers de groupe, qui doivent suivre les directives de l’ouvrage Bien manger avec le Guide alimentaire canadien de Santé Canada (2007), les menus étaient planifiés dans le contexte d’un budget alimentaire limité (environ 1,91 $ par jour par résidente). Les politiques du foyer abordaient les systèmes de sécurité, de production de rapports et de responsabilité financière, mais pas la promotion de la santé. Les inspections menées par le Service de santé publique étaient axées principalement sur la salubrité des aliments durant leur manipulation, leur préparation et leur entreposage et sur la conformité aux règlements de propreté de l’environnement et de contrôle des infections.

CONCLUSIONS: Le rationnement des ressources observé dans les soins en foyer de groupe exacerbe les maladies au sein d’un groupe déjà marginalisé. Une aide financière est nécessaire à un approvisionnement en aliments sains, notamment en produits laitiers et en fruits et légumes frais. Un soutien supplémentaire est également nécessaire pour le soin des comorbidités comme le diabète, afin de couvrir les coûts des aliments et de la sensibilisation connexes afin d’améliorer les résultats. Les politiques des foyers de groupe doivent prendre en considération les menaces pour la santé dans cette population et accorder la priorité à la promotion de la santé et à la prévention de la maladie.

Mots Clés

diabète apport alimentaire maladie mentale grave soins en foyer de groupe ethnographie institutionnelle 


  1. 1.
    Canadian Diabetes Association. The prevalence and costs of diabetes. 2006. Available at: (Accessed January 2, 2007).Google Scholar
  2. 2.
    Dombrovski A, Rosenstock J. Bridging general medicine and psychiatry: Providing general medical and preventive care for the severely mentally ill. Curr Opin Psychiatr 2004;17:523–29.CrossRefGoogle Scholar
  3. 3.
    American Diabetes Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004;27(2):596–601.CrossRefGoogle Scholar
  4. 4.
    Daumit GL, Goldberg RW, Anthony C, Dickerson F, Brown CH, Kreyenbuhl J, et, al. Physical activity patterns in adults with severe mental illness. J Nerv Ment Dis 2005;193:641–46.CrossRefGoogle Scholar
  5. 5.
    Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2003;27(Suppl 2).Google Scholar
  6. 6.
    Teachout A, Kaiser S, Wilkniss S, Moore H. Paxton House: Integrating mental health and diabetes care for people with serious mental illnesses in a residential setting. Psychiat Rehab J 2011;34(4):324–27.CrossRefGoogle Scholar
  7. 7.
    National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. Morbidity and Mortality in People With Serious Mental Illness. 2006. Available at: morbidity_nasmhpd.pdf (Accessed October 25, 2012).Google Scholar
  8. 8.
    Voruganti LP, Punthakee Z, Van Lieshout RJ, MacCrimmon D, Parker G, Awad AG, Gerstein, HC. Dysglycemia in a community sample of people treated for schizophrenia: The Diabetes in Schizophrenia in Central-south Ontario (DiSCO) study. Schiz Res 2007;96(1–3):215–22.CrossRefGoogle Scholar
  9. 9.
    Ontario Ministry of Health and Long-Term Care website. Diabetes Facts. Available at: html (Accessed September 13, 2009).Google Scholar
  10. 10.
    Smith D. Institutional Ethnography: A Sociology for People. Lanham, MD: Altamira Press, 2005.Google Scholar
  11. 11.
    Smith DE (Ed). Institutional Ethnography as Practice. Oxford, UK: Rowman and Littlefield, 2006.Google Scholar
  12. 12.
    Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2008;27(Suppl 2):S1-S201.Google Scholar
  13. 13.
    Ministry of Health and Long-Term Care. Operating Guidelines for Homes for Special Care. 2003. Available at: providers/pub/hsc/hsc_manual (Accessed September 24, 2009).Google Scholar
  14. 14.
    DeVault M, McCoy L. Institutional Ethnography: Using interviews to investigate ruling relations. In: Gubrium JF, Holstein JA (Eds.), Handbook of Interview Research: Context and Method. Thousand Oaks, CA: Sage Publications, 2002;751–76.Google Scholar
  15. 15.
    Spradley J. Participant Observation. New York, NY: Holt, Rinehart and Winston, 1980;73–88.Google Scholar
  16. 16.
    Diamond T. Where did you get the fur coat, Fern? Participant observation in institutional ethnography. In: Smith D (Ed.), Institutional Ethnography as Practice. Lanham, MD: Rowman & Littlefield, 2006;45–64.Google Scholar
  17. 17.
    Emerson R, Fretz R, Shaw L. Writing Ethnographic Fieldnotes. Chicago, IL: University of Chicago Press, 1995.CrossRefGoogle Scholar
  18. 18.
    Campbell M, Gregor F. Mapping Social Relations: A Primer in Doing Institutional Ethnography. Aurora, ON: Garamond Press, 2002.Google Scholar
  19. 19.
    McCoy L. Keeping the institution in view: Working with interview accounts of everyday experience. In: Smith D (Ed.), Institutional Ethnography as Practice. Lanham, MD: Rowman & Littlefield, 2006;109–25.Google Scholar
  20. 20.
    Smith D. Texts, text-reader conversations, and institutional discourse. In: Smith D, Institutional Ethnography: A Sociology for People. Lanham, MD: Altamira Press, 2005;101–22.Google Scholar
  21. 21.
    Ministry of Health and Long-Term Care, Government of Ontario. Residential Home Report. 2007. Available at: forms/ssbforms.nsf/GetFileAttach/014-382941~2/$File/3829-41_.pdf (Accessed March 20, 2009).Google Scholar
  22. 22.
    Community and Health Services Department, Social Services Branch. Hostel Compliance Checklist. 2008.Google Scholar
  23. 23.
    Henderson DC, Cagliero E, Gray C, Nasrallah RA, Hayden DL, Schoenfeld DA, Goff, DC. Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: A five-year naturalistic study. Am J Psychiat 2000;157:975–81.CrossRefGoogle Scholar
  24. 24.
    Lowndes R, Angus J, Peter E. Diabetes care and mental illness: Constraining elements to physical activity and social participation in a residential care facility. Can J Diabetes 2013;37:220–25.CrossRefGoogle Scholar
  25. 25.
    Health Canada. Eating Well with Canada’s Food Guide. 2007. Available at: (Accessed November 4, 2012).Google Scholar
  26. 26.
    Ministry of Health Promotion. Government of Ontario. Nutritious Food Basket Guidance Document. Available at: healthy-communities/public-health/guidance-docs/NutritiousFoodBasket.PDF (Accessed March 28, 2012).Google Scholar
  27. 27.
    Gucciardi E, Vogt JA, DeMelo M, Stewart, DE. Exploration of the relationship between household food insecurity and diabetes in Canada. Diabetes Care 2009;32(12):2218–24.CrossRefGoogle Scholar
  28. 28.
    Ministry of Health and Long-Term Care. Ontario Public Health Standards. Ontario Public Health Standards and Protocols: Documents. Queen’s Printer for Ontario, 2008. Available at: oph_standards/ophs/index.html (Accessed November 16, 2012).Google Scholar
  29. 29.
    Strassnig M, Brar JS, Ganguli R. Dietary intake of patients with schizophrenia. Psychiatry 2005;2:31–35.PubMedGoogle Scholar
  30. 30.
    Daumit G, Dalcin A, Jerome G, Young D, Charleston J, Crum R, et al. A behavioural weight-loss intervention for persons with serious mental illness in psychiatric rehabilitation centers. Int J Obes 2011;35:1114–23.CrossRefGoogle Scholar
  31. 31.
    Xiong G, Ziegahn L, Schuyler B, Rowlett A, Cassady D. Improving dietary and physical activity practices in group homes serving residents with severe mental illness. Progress in Community Health Partnerships 2010;4(4):279–88.PubMedPubMedCentralGoogle Scholar
  32. 32.
    McDevitt J, Snyder M, Miller A, Wilbur J. Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation. J Nurs Scholarsh 2006;38(1):50–55.CrossRefGoogle Scholar
  33. 33.
    Vancampfort D, De Hert M, Skjerven LH, Gyllensten AL, Parker A, Mulders N, et al. International organization of physical therapy in mental health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia. Disabil Rehabil 2012;34(1):1–22.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2013

Authors and Affiliations

  • Ruth H. Lowndes
    • 1
  • Jan E. Angus
    • 1
  • Elizabeth Peter
    • 1
  1. 1.Lawrence S. Bloomberg School of NursingUniversity of TorontoNewmarketCanada

Personalised recommendations