Researchers have long known that people with serious mental illnesses (SMI) tend to die at younger ages than those who do not have these conditions—likely due to their higher risk of chronic illnesses that tend to be more severe and diagnosed later in life. A recent article in JAMA Psychiatry examines why these patients may have been overlooked for palliative care and a few simple steps that psychiatrists can take to help connect patients to end of life care when needed.
“A distinguishing feature of palliative care in SMI is that unlike patients with fatal illnesses, such as cancer or heart disease, patients with SMI must cope with 2 distinct issues: lifelong SMI treatments and management of fatal medical conditions,” wrote Kwok Ying Chan, M.D., of the Palliative Medical Unit at Grantham Hospital in Hong Kong and colleagues. Additionally, “This population faces disparities at the patient, health care professional, and system levels, which are worsened by the prevalent stigma associated with major mental illness. The ensuing fragmentation impedes care integration and raises the likelihood of poor health outcomes.”
By learning more about general and specialized palliative care, including those with whom to collaborate on palliative care needs for patients, psychiatrists can help patients with SMI overcome barriers to this care, Chan and colleagues wrote. Some psychiatrists, such as those in consultation-liaison psychiatry and geriatric psychiatry, receive some training in palliative care as part of fellowship programs, they added.
“Understanding good palliative care practices is not the same as coping with common ailments,” they wrote. “As with many serious medical conditions, the best course of action for a patient with SMI should be determined in addition to the most effective disease-specific treatment. Close collaboration between psychiatrists and palliative care professionals can gradually improve patients’ quality of life.”
For related information, see the Psychiatric Services article “Future Care Planning: Concerns of Elderly Parents Caring for a Person With Serious Mental Illness.”
(Image: iStock/michellegibson)
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