Palliative care providers have opportunities to bridge gaps of unmet needs among patients who have serious mental illnesses (SMIs) and their families.
People with SMIs navigate a complicated mental health care system that can become even more challenging when they have a serious or chronic physical illness. Breakdowns in a fragmented health system have frayed lines of communication and collaboration among providers, representing a big hurdle for patient access and quality.
Staffing shortages are also playing a role in the quality of care received, according to Dr. Andrew Esch, palliative care physician and senior education advisor at the Center to Advance Palliative Care (CAPC).
Building up community-based palliative and mental health care collaborations will be crucial to supporting a growing population of seniors with SMIs with complex needs, he said.
“It’s recognizing that the health care system is all equally under-resourced and needs to collaborate together to find ways to meet the needs of patients with serious mental illnesses and other conditions — that’s a really big challenge,” Esch told Palliative Care News. “The element of collaboration is so important to link them up to community resources, clinicians and other support services. For those that do palliative care, a lot of us make it a priority to get training in chronic conditions and mental health illnesses that coexist in patients. That really plays into pain, symptom and medication management in these patients’ experiences.”
Roughly 5 to 8 million older adults nationwide have one or more mental health conditions, according to research from the supplement Journal of the American Geriatrics Society (JAGS). This number is projected to triple over the next three decades.
Some of the most common SMIs among seniors include bipolar disorder, schizophrenia, borderline personality disorder and post traumatic stress (PTSD) and major depression, among others.
These individuals often lack supportive services as they get older and sicker, research shows.
Cancer patients and those with other serious chronic illnesses often experience higher rates of mental health comorbidity that is “under-diagnosed, under-treated and under-studied,” a 2021 study from the Cambridge University Press found.
This negatively impacts health outcomes among SMI patient populations, with negative effects tied to lagging access to specialized care, pain and symptom management, mental health utilization and advance care planning services, the researchers indicated.
Building stronger collaborative models between community-based palliative care providers and mental health professionals could help improve quality and health disparities, according to Julie Turner, a licensed mental health counselor based in South Carolina.
“A lot of burden falls on palliative and hospice workers to manage serious, persistent mental health concerns that might be beyond their scope of knowledge,” Turner told Palliative Care News. “Gaps in services could be filled if we collaborate and consult more with psychiatrists, community mental health centers and other programs that can keep patients more stable. Collaborations with mental health organizations that touch these patients’ lives will be pivotal for those who could potentially reach palliative care. It’s an area for growth on both sides to become more aware of so that we don’t miss serving this population.”
Seniors with SMIs often face uniquely difficult challenges compared to others with chronic and terminal conditions, including the ability to age in place.
Much of the supportive care for these seniors has historically been in facility-based settings, but increasing demand and patient preferences has been fueling growth of community-based mental health services, Turner stated.
“It’s a huge problem to have to go to an inpatient psychiatric center for a terminally or seriously ill person,” Turner said. “That can create stress on the patient and a challenge on these centers in staffing crisis. Mental health services in general are trying to be a lot more encompassing of community-based services, whether that’s having a mobile division, a triage to de-escalate emergency situations or having relationships with community-based providers like palliative care.”
Palliative providers seeking to construct community-based care models with mental health professionals can take a strategic “mapping” approach around building up support resources and services for patients with SMIs, according to Esch. For example, some of these patients may need additional support when it comes to housing, drug and substance abuse treatment and caregiving needs compared to others, he stated.
“There’s so much complexity to the range of issues that you really need to be able to map and know what services are available in your community and how to plug these patients into the help they need,” Esch said. “It’s community mapping, and that takes getting to know who the other clinicians are and what community organizations offer things like housing and caregiving support. It’s working collaboratively with them to make sure we are able to deliver the services needed.”