Palliative Care for Patients With Mental Illness

Betty R. Ferrell, PhD, RN


March 16, 2015

Palliative Care and Mental Illness

Palliative care has much to offer patients with both serious disease and chronic mental illness. Although patients with mental illness and a history of substance abuse will require extra attention if opioids are used, they still deserve relief of pain. Coordination of care will be essential, but palliative care clinicians, working closely with the patient's mental health and primary providers, can provide attention to the needs of this patient with advanced liver failure. As with all illnesses, patient care should be individualized. In Jolene's case, attention must be given to issues of adherence, but palliative care should not be excluded.

Mental illness is common. Approximately 2% of people in the United States over age 18 years are diagnosed with a mental illness each year, representing 57 million people.[1] One in seventeen Americans (6% of the population) suffers from such serious mental illnesses as schizophrenia, bipolar disease, and depression.[1,2]

Those living with serious mental illness are very likely to have extensive comorbid illnesses and to die 20-25 years sooner than those without mental illness; they are more often homeless as well.[3] People with mental illness often have delayed access to primary healthcare, late diagnosis of disease, difficulty with complex decision-making about treatment options, and much higher frequency of substance abuse.

There is great opportunity for collaboration between mental health and palliative care providers.[4,5,6] Shared evaluation is needed to determine the patient's capacity for healthcare treatment decisions, devise goals of care, and prepare advanced directives.[2] Careful monitoring of the often numerous psychiatric medications, plus those taken for symptom relief, must be ongoing. Palliative care providers need the direction of their mental health colleagues to plan for disease progression, the impact of the advanced disease on the patient's comorbid conditions, integration of cognitive-behavioral therapies, and planning for the end of life and place of death.

Mental illness continues to be a major factor in the overall challenges of healthcare delivery, an aging population, care of veterans, and the transition to outpatient care. There are many challenges, but also potentially significant benefits to patients and society, of having coordinated palliative and mental health care.

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