Patients with serious mental illnesses (SMI) have a range of complex needs that greater integration of psychiatry into palliative care could help address.
A large issue preventing stronger collaborations is a lack of clearly defined patient eligibility criteria for palliative care delivery, according to Dr. Danielle Chammas, palliative care physician and psychiatrist at University California, San Francisco’s (UCSF) School of Medicine.
Without this clarification, it can be difficult for behavioral health professionals to determine when a patient may qualify to receive palliative care services, Chammas said. Palliative care also is often conflated with hospice even among health care providers, and the misconceptions pose barriers for patients who could benefit from these services, she stated.
“How do we treat the mental health needs of patients with serious medical illness?” Chammas said in a recent GeriPal podcast. “Some [people] are conceptualizing a trade off between the standard of care and a more palliative approach … It’s very hard to define the lines of this. We don’t have a way of operationalizing which patients qualify. The system isn’t always great at meeting people’s needs.”
Breaking down the barriers
SMI conditions include bipolar disorder, dissociative identity disorder, psychotic disorder, major depressive disorder and post-traumatic stress disorder (PTSD), among others.
Seriously ill patients with SMIs face many challenges as their conditions progress, often navigating a complicated and fragmented health system, Chammas said. This can make it difficult to address their physical, emotional, psychosocial and spiritual needs, she indicated.
Palliative care providers can help manage seriously ill SMI patients’ nonmedical symptoms and offer diverse interdisciplinary services that can support their psychiatric treatments, according to Chammas. Adopting an approach to mental health care that includes palliative care involves a primary focus on quality of life for patients and their families, a model that could vastly improve outcomes in more ways than one, she stated.
“If we added palliative care philosophies to all of psychiatry alongside the standard of care, that could be beautiful for everybody because we’re going to take in the patient’s perspective maybe more than we were trained to,” Chammas said. “This is a really vulnerable patient population.
Addressing the interdisciplinary challenges
A common thread in both palliative and psychiatric care delivery is an aim to provide symptom management and relief while addressing patients’ goals of care and values, according to Dr. Brent Kious, psychiatrist and associate professor at the University of Utah Health’s Huntsman Mental Health Institute.
Understanding this common goal could open doorways for more collaborative partnerships among behavioral health and palliative care providers, Kious indicated.
“There is a way in which everything we do in psychiatry is palliative with the respect to the fact that it’s aimed at improving symptoms,” Kious said during the podcast. “I can’t actually think of a single psychiatric illness that I can cure. What I can do is achieve enough symptom improvement in some of these symptoms.”
Greater integrative palliative care psychiatry collaborations could help SMI patients with more severe symptoms and mental health challenges, Kious stated. These collaborative care approaches focus on harm reduction and reducing “unhelpful treatments” for patients that have exhausted other avenues, he added.
Among the keys to greater behavioral health and palliative care collaboration is developing more training pathways that intersect these fields, according to Chammas.
Medical students largely lack exposure to palliative care services throughout the course of their clinical education, leaving significant gaps of knowledge as they enter their respective fields, she said. If more palliative care components were brought into medical education for psychiatry professionals, it could go a long way to establishing guidelines that help providers identify patients that could benefit from these services, Chammas said.
“[It’s having] a palliative care curriculum for psychiatrists, and this is one of our recognized subspecialties,” Chammas said. “We can teach this to psychiatrists so they can synergize these principles. There’s a lot of work to do to create models that operationalize [this] to have safeguards in place to try to help people.”
