Palliative psychiatry care approaches can be key to improving quality of life among patients with severe and persisting mental illness (SPMI). However, a lack of standardized quality measures for these care models is challenging the ability to measure efficacy.
Widespread misconceptions about palliative care are a larger hurdle preventing greater collaborations with behavioral health providers, said Dr. Anna Westermair, psychiatrist and senior research assistant at the University of Zurich’s Institute of Biomedical Ethics and History of Medicine (IBME). Westermair is board certified in psychosomatic medicine and psychotherapy, psycho-oncology and palliative care.
Behavioral health providers can often conflate palliative care with hospice, Westermair said during a recent American Psychiatric Association podcast. Having more solidified quality measurement tools in place could aid in building stronger collaborative relationships that ease some of the biggest challenges that patients with SPMIs face, she stated.
“We don’t have, as of yet, validated instruments to really measure quality of life in our patients,” Westermair said during the podcast. “At the moment, palliative psychiatry is an idea. It’s the idea that it might be beneficial for our patients to introduce the general approach of palliative care to mental health care. I think this is definitely something that we need to develop with palliative psychiatry, to become a part of more conventional mental health care.”
Roughly 6.0% of adults across the United States had some type of serious mental illness in 2022, reported the National Institute of Mental Health. An SMI includes mental, behavioral or emotional disorders resulting in serious functional impairment, and substantial interference or limitation with major life activities.
Developing successful palliative psychiatry models that go beyond addressing symptom burden and into quality improvement is key to helping patients with an SPMI, according to Westermair.
Severe and persistent mental health conditions can lead to debilitating circumstances for some patients, particularly those who lack sufficient caregiver and family support. But not all SPMI patients fall into this scope, even if their symptoms are burdensome, making it challenging to determine appropriateness for palliative psychiatric care, Westermair said. Having guidelines around eligibility could lay the groundwork for measuring quality of life among these individuals, she stated.
Providers lack a defined framework to decipher when a palliative psychiatry intervention may be appropriate for an individual with an SPMI, Westermair said. Patients who are symptomatic for several years often have little recourse for relief as a result, as well as individuals who have not experienced symptom relief from traditional treatments. This trend trickles impacts into quality, she stated.
Individuals with a severe or persisting mental illness can have a different outlook on quality of life compared to others due to their unique practical, physical, emotional and psychosocial burdens, she stated.
An overall is needed to better ensure person-centered care delivery among patients with SPMIs, Westermair indicated. Consistent assessment is key to understanding what is most important to these patients, with interdisciplinary collaboration and goal-setting large components, she added.
Palliative care providers can leverage advance care planning services to improve goal-concordant care, according to Westermair.
“The idea of palliative psychiatry is maybe we can increase quality of life by means other than reducing the core symptoms that define the mental illness,” Westermair said. “Whereas by default, the goal of care in standard mental health care is symptom remission and improvement of psychosocial functioning. In a nutshell, this is the difference — a shift in the primary goal of care.”
