Rethinking Palliative Care in Psychiatry

Abstract

<p>Severe mental illnesses (SMI) are long-term and recurring conditions that interfere with daily activities and demand long-term therapy. Schizophrenia, bipolar disorder, and severe depression are the most common diagnoses. In the US, the prevalence of SMI is estimated to be 4.2%.^{<a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2809646#yvp230026r1">1</a>}^{,<a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2809646#yvp230026r2">2</a>} People with SMI have a higher risk of chronic illnesses that are more severe and are discovered later in life (including 2 to 3 times the risk of diabetes and 5 times the risk of metabolic syndrome compared with the general population).^{<a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2809646#yvp230026r3">3</a>} The prevalence of antipsychotic-related metabolic syndrome has been shown to range between 23% and 50% in various samples.^{<a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2809646#yvp230026r3">3</a>} Compared with the general population, patients with SMI have nearly twice the risk of dying from cardiovascular disease and have a 15 to 25 year shorter life expectancy.^{<a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2809646#yvp230026r1">1</a>} In addition, schizophrenia was the second most important risk factor for dying from COVID-19, trailing only age.^{<a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2809646#yvp230026r2">2</a>} Palliative care is regarded as appropriate for this population due to the care complexity associated with SMI along the illness trajectory and toward the end of life. However, the rate of receipt of palliative care in patients with SMI was only 0.5%, compared with 1.72% of the general population.^{<a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2809646#yvp230026r4">4</a>} In this Viewpoint, we focus on the specific issues related to SMI for palliative care and highlight a more sustainable model for the collaboration between palliative care and psychiatric teams.</p>