Serious Illness at the Margins: Providing Palliative Care to People with Serious Mental Illnesses

Key Message: This session equips palliative care clinicians with practical tools to care for individuals with serious mental illness, focusing on symptom recognition, capacity assessment, and interprofessional collaboration. Attendees will gain strategies to deliver ethical, equitable, and integrated care for this underserved population facing structural vulnerability and serious illness.

Abstract:

Background: Individuals living with serious mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorders, and treatment-refractory mood disorders, experience significant disparities in serious illness care (1). Despite a high burden of serious illness-related suffering and significantly reduced life expectancies, they are less likely to access palliative care, have higher rates of institutionalization, lower rates of advance care planning, and are frequently undertreated for pain and other symptoms (2). Palliative care teams can play a pivotal role in addressing these inequities, but many clinicians feel underprepared to care for this population (3).
Approach: This session will provide interprofessional palliative care clinicians with evidence-informed strategies for delivering high-quality, patient-centered care to individuals with concurrent SMI and serious illness. Drawing on emerging evidence from palliative care and psychiatry, this interactive presentation will focus on three key areas: (1) understanding the manifestations and clinical implications of SMI in the palliative care setting; (2) assessing decision-making capacity through an ethically-attuned lens; and (3) leveraging the expertise of the interprofessional team for effective collaboration with mental health services aimed at optimizing continuity of care and outcomes.
The session will explore structural vulnerabilities experienced by this population, including homelessness, social isolation, and care fragmentation. Through case examples and practical tips, attendees will learn approaches for nuanced symptom assessment, communication, and proactive care coordination. The session will also highlight evolving workforce development efforts and integrated care models aimed at addressing barriers and bridging the gap between mental health and palliative care services.
Implications: By the end of the session, participants will be better equipped to identify and respond to the complex needs of patients with SMI, apply structured approaches to capacity assessment and communication, build collaborative partnerships across disciplines, and deliver equitable, compassionate care to a historically underserved population

References: 1. Shalev D, Fields L. Redressing disparities in end-of-life care and serious mental illness through models of care and workforce development. Int Psychogeriatr. 2021;33(2):109-112. doi:10.1017/S1041610220001519
2. Shalev D, Fields L, Shapiro PA. End-of-Life Care in Individuals With Serious Mental Illness. Psychosomatics. 2020;61(5):428-435. doi:10.1016/j.psym.2020.06.003
3. Shalev D, Ekwebelem M, Brody L, et al. Clinician Perspectives on Palliative Care for Older Adults With Serious Mental Illnesses: A Multisite Qualitative Study. Am J Geriatr Psychiatry. Published online September 3, 2024:S1064-7481(24)00441-X. doi:10.1016/j.jagp.2024.08.014