Palliative Care Considerations for Patients Living with Severe Mental Illness

In Canada it is estimated that 25% of the population will experience mental illness during their lifetime1. Within this population, a portion of individuals live with serious and persistent mental illnesses (SPMI) characterized by the Government of Canada as “changes in an individual’s thinking, mood, or behaviour and is usually associated with significant distress or impaired functioning in social, occupational and other activities”2.

Several studies have investigated the barriers that individuals with SPMI encounter when accessing palliative care services. These barriers to palliative care include the negative symptoms of mental illness3, the stigmatization of mental illness3 difficulties being understood by healthcare providers4, and lack of social support from family members or friends5. In addition, people with SPMI are disproportionately affected by poverty, homelessness, and substance abuse among other social and health disparities 6,7.

To address these barriers researchers, recommend collaboration among local health care providers and mental health services8. The establishment of interdisciplinary and intersectional palliative care This interdisciplinary approach creates more opportunities for individuals with SPMI to access care and broadens the resources available to both patients and providers.

Alongside the barriers to accessible palliative care, there are numerous barriers and unique challenges associated with providing palliative care to patients with SPMI. These barriers and challenges include communication between patient and provider, difficulties managing symptoms of SMI, complex co-morbidities associated with SPMI, and patient mistrust in medical system4.

A recent review by Hinrichs et al. published in 2021 emphasizes patient-centered communication that preserves patient dignity and acknowledges patient strengths as a best practice4.The review also identifies shared-decision making, communication between staff members to provide consistent care, and a flexible and comprehensive care plan that provides opportunities for socialization, physical activity, and psychiatric services as important considerations4. The need to advanced care planning and open discussions about end-of-life care with patients living with SPMI is also encouraged9. Finally, provision of specialized training for providers to better understand the needs of patients with SPMI can improve the experiences of those receiving and providing palliative care.

The Canadian Mental Health Association estimates that 1% of Canadians experience bipolar disorder, 1% experience schizophrenia or other psychotic disorders, and 8% will experience a major depressive disorder in their lifetime6. Individuals living with SPMI are often marginalized and as a result, experience social and health disparities. The systemic inequities affecting marginalized populations also extends to palliative care services. In the pursuit of equitable healthcare, interdisciplinary and intersectional approaches to palliative care can extend the reach of palliative care services with the goal of providing comprehensive care that best addresses the needs of patients living with SPMI.

Citations:

  1. Centre for Addiction and Mental Health. (n.d). Mental Illness and Addiction: Facts and Statistics. Retrieved from: https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics

  2. Government of Canada. (2020) Mental Illness in Canada- Infographic. Public Health Agency of Canada. Retrived from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/mental-illness-canada-infographic.html

  3. Shalev, D., Fields, L., & Shapiro, P. A. (2020). End-of-Life Care in Individuals With Serious Mental Illness. Psychosomatics, 61(5), 428–435. https://doi.org/10.1016/j.psym.2020.06.003

  4. Hinrichs, K. L., Woolverton, C. B., & Meyerson, J. L. (2021). Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness. American Journal of Hospice and Palliative Medicine®, 10499091211010722.

  5. McNamara, B., Same, A., Rosenwax, L., & Kelly, B. (2018). Palliative care for people with schizophrenia: a qualitative study of an under-serviced group in need. BMC palliative care, 17(1), 1-11.
  6. Canadian Mental Health Association. (n.d). Fast Facts about Mental Illness. Retrieved from: https://cmha.ca/fast-facts-about-mental-illness#.Uw0Eo3lupg0

  7. Sylvestre, J., Notten, G., Kerman, N., Polillo, A., & Czechowki, K. (2018). Poverty and serious mental illness: Toward action on a seemingly intractable problem. American Journal of Community Psychology, 61(1-2), 153-165.

  8. Bloomer, M. J., & O’Brien, A. P. (2013). Palliative care for the person with a serious mental illness: The need for a partnership approach to care in Australia. Progress in palliative care, 21(1), 27-31.

  9. Knippenberg, I., Zaghouli, N., Engels, Y., Vissers, K. C., & Groot, M. M. (2020). Severe mental illness and palliative care: patient semi-structured interviews. BMJ Supportive & Palliative Care.