End-of-Life Care in Individuals With Serious Mental Illness

Abstract

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Disparities and inequalities in cancer care and outcomes in patients with severe mental illness: Call to action

“…It has also been reported that patients with SMI do not see specialists other than psychiatrists, do not correctly receive analgesics when needed, and do not have optimal levels of palliative care. [14][15][16] A further issue relates to problems that oncology teams have in caring for people with SMI and cancer, since the patient's unusual behavior, inappropriate affect, presence of psychosis (e.g., delusions and hallucinations), or cognitive symptoms (e.g., impaired attention, reducing the patient capacity to understand the meaning of medical and surgical procedures), dysfunctional coping (e.g., pathological denial) and behavioral problems (e.g., poor adherence), often contribute to difficulties in communication and management. 17…”

“…Therefore, and not surprisingly, patients with SMI and cancer live fewer years than patients without SMI and die in an advanced phase of the disease. It has also been reported that patients with SMI do not see specialists other than psychiatrists, do not correctly receive analgesics when needed, and do not have optimal levels of palliative care 14‐16 …”

Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness

“…Similarly, it has been noted that “words, language, and labels can create and maintain embedded stigma, prejudice, and disrespect, or conversely promote functionality, healing, compassion and caring, while assisting individuals to reach their full potential in a self-directed life.” 29 Individuals with SMI may have had experiences in their life where autonomy and engagement in conversations about medical care were limited which perpetuates the stigmatizing view that individuals with SMI are incapable or lack capacity. 4 Including patients in open discussions about their care may provide them with autonomy. Further, concepts such as sharing power and supported decision-making can be highly relevant in HPC conversations.…”

“…3 Most of us have not been taught how to work effectively with people with SMI and can become overwhelmed by the challenges we assume will come with caring for these supposedly “difficult” patients. Sadly, individuals with SMI are at greater risk of receiving low quality end-of-life care, 4 are less likely to have access to palliative care, 5 and may simultaneously be more likely to require inpatient hospice care than those without SMI. Understanding more about serious mental illnesses, and the barriers to accessing quality end-of-life care for individuals with SMI, is important for providing wholistic patient-centered care and can help HPC teams approach their care with more confidence and empathy.…”

Redressing disparities in end-of-life care and serious mental illness through models of care and workforce development

“…Because patients with serious medical illness experience such a high degree of behavioral health (BH) comorbidity (Garrido et al, 2014;Schuyler, 2010), siloing of mental and physical health in serious illness care (SIC) is especially problematic. This is particularly true with respect to the care of patients with SMI or dementia and comorbid life-limiting medical illness as such patients are likely to require intensive mental health and SIC longitudinally (Lloyd-Williams et al, 2014;Shalev et al, 2020a).…”