Oyster Care: An Innovative Palliative Approach towards SPMI Patients

Abstract

Oyster Care is the result of the search by caregivers in Flanders, Belgium, to develop quality care for patients with a Severe and Persistent Mental Illness (SPMI). This article offers a conceptual analysis of the Oyster Care model, based on experiences, analysis, and reflection of the authors, and on several examples. The starting point of the development of this new care model is the complex and difficult context of the care for SPMI patients. Their needs and suffering are very challenging on account of a wide variety of causes. At the same time they are in danger of being neglected by the care system. Paradoxically, the development and implementation of psychosocial rehabilitation in Belgian mental health care puts the care for these patients under pressure. In practice, they are often exposed to over-or undertreatment. Another aspect that has influenced the search for more qualitative care in cases of severe psychological suffering in general and palliative approaches in particular is the background of the legal regulation of euthanasia in Belgium. Oyster Care is an innovative form of the palliative approach and philosophy, tailored to the specific target group of SPMI patients. The caregivers create an "exoskeleton" or "shell" in which SPMI patients can "come to life": they are mainly dependent on the "external structure" they receive in order to function, rather than on the "internal structure" of their abilities. It is a dynamic approach that responds to the needs, possibilities and pace of each patient: within this safety, people can fold back or take new steps. Oyster Care is also a holistic care approach, based on four pillars: physical care adequately responding to the somatic impairments of these patients; psychological care changing the scope of therapy by focusing on mental comfort and wellbeing; social care providing a structure of daily activities and contacts; existential care enhancing the experience of life as valuable and meaningful. The wellbeing of patients is paramount and requires a range of interventions, such as a highly personal approach, a flexible dealing with rules, a great dose of creativity in everyday life, extensive expertise in somatic care, and specific attention to existential needs and the search for meaning. The development of this care model in a number of care units in Flanders increases the wellbeing of the patients and creates a significant positive dynamic among caregivers. However, more research and resources are needed to further develop and integrate this model.

Defining Severe and Persistent Mental Illness—A Pragmatic Utility Concept Analysis

“…In other words, SPMI is considered the target population of palliative psychiatry, and palliative psychiatry attempts to promote person-centeredness and patient autonomy. As to be expected from our concept analysis, a recent article on a novel therapeutic approach to SPMI had to further specify its intended target population as “most serious forms of SPMI, for instance, when the quality of life is seriously compromised” ( 55 ). We ultimately believe that a definition of SPMI true to a palliative ethos of care will necessarily have to take the perspectives of the affected persons into account.…”

Palliative Psychiatry for Patients With Severe and Persistent Mental Illness: A Survey on the Attitudes of Psychiatrists in India Compared to Psychiatrists in Switzerland

“…Thereby, palliative psychiatry is a genuine biopsychosocio-existential approach [see ( 12 , 13 )] that includes but is not limited to end-of-life care for persons with SPMI. For detailed case examples of palliative psychiatry, please see ( 7 , 14 , 15 ).…”

Nurses' views on palliative care for those diagnosed with severe persistent mental illness: A Pilot Survey Study in Switzerland

“…It is suggested that some mental illness should be understood as treatment resistant or treatment refractory if patients do not improve despite varied treatment efforts and adequate medication trials. Those who believe futility is a concept that should be defined and applied to certain mental illnesses believe psychiatric care would improve if clinicians acknowledged that curative treatment is not always possible (Decorte et al., 2020; Eisenmann et al., 2020). In such cases, patients might benefit from care that prioritizes symptom reduction and quality of life even in the face of a potentially life‐threatening psychiatric condition (Decorte et al., 2020; Strand et al., 2020).…”

“…Those who believe futility is a concept that should be defined and applied to certain mental illnesses believe psychiatric care would improve if clinicians acknowledged that curative treatment is not always possible (Decorte et al., 2020; Eisenmann et al., 2020). In such cases, patients might benefit from care that prioritizes symptom reduction and quality of life even in the face of a potentially life‐threatening psychiatric condition (Decorte et al., 2020; Strand et al., 2020). Here, the values of autonomy and beneficence must be carefully weighed.…”