Do we manage our patients’ mental health needs effectively in palliative care?

Following the government’s recent pledge of an extra billion pounds for mental health services across the country, the media continues to highlight stories of individuals ‘failed’ by the system in relation to accessing and receiving adequate treatment for their psychological needs.

With mental health charity Mind suggesting that 1 in 4 people in the UK experience mental health problems, this area is one which is likely to affect us all as a society and particularly within healthcare.

Within palliative care, the concept of holism lends itself to robust assessment of not only the physical and social needs of our patients, and those important to them, but the psychological issues arising too. The question is, do we always do this effectively for the people we care for, and are we confident at managing situations where our patients access our services at a point when they have pre-existing mental health issues?

In a meeting some time ago, one of our hospice physicians commented that she was frustrated at not being able to find a conference focusing on mental health and palliative care. This prompted a discussion about ‘difficult’ cases, where the concept of a ‘seamless’ service had been challenged and staff had felt uncertain and anxious about the best course of action or treatment plan.

Within this forum, the consensus was that more education was needed to ensure that local knowledge of support services was increased, and to provide the opportunity to appraise the evidence base for both pharmacological and non-pharmacological intervention for mental health needs.

It is clear that palliative care goes beyond just encountering patients developing anxiety and depression as a result of their life-limiting diagnosis; it is an area where this diagnosis can exacerbate existing mental health issues which may involve things such as complex substance misuse to schizophrenia and psychosis.

Ellison (1) concurs with this and reminds us that there is an increased prevalence of terminal illness in those with mental health conditions yet, despite this, there appears to be a gap in the psychological support for those receiving palliative care and the provision of specific mental health support in hospices is scarce in some areas (2).

It has also been suggested that individuals with pre-existing mental health problems, who go on to develop a life-limiting illness, are among the most underrepresented and deprived populations in our society (3).

These facts are the main driving force for the forthcoming conference facilitated by Wigan and Leigh Hospice.

The conference aims to equip health and social care professionals with increased knowledge on the management of severe and enduring mental health problems, while examining depression in palliative care and best practice for end of life care for patients with dementia.

The day will explore decision making processes and the relationship between mental health services and palliative care teams, and how these can be strengthened to ensure the patient and those important to them receive timely, appropriate intervention which will improve their quality of life.

The conference will conclude by looking at what needs to be achieved both locally and nationally, with delegates highlighting their own priorities and ongoing learning needs and possible areas for future research.

It is intended that the key note speakers will provide more detailed guidance in relation to treatment plan options for prescribers within generalist and specialist palliative care, and examine alternative approaches to management which consider the needs of families and carers.

Our patients need support to be able to live well until they die and a crucial ingredient for success is a skilled workforce who are responsive to the mental health needs of patients under their care.

Garrido et al (4) believe that while psychological assessment may be integrated well into daily care routines, this doesn’t always lead to receipt of optimum care. If we, as professionals, can find out more about this area of palliative care we can empower our patients to discuss all their concerns, however difficult, and promote the true essence of person-centred care.

Wigan & Leigh Hospice’s Mental Health in Palliative Care Conference takes place on Wednesday 3 February 2016 from 9.15am to 4pm at Leigh Sports Village, Leigh. A standard fee of £100 will apply per delegate. Booking forms can be downloaded from Wigan & Leigh Hospice’s website.

References

1. Ellison N. Mental Health and Palliative Care. Literature Review. Mental Health Foundation; 2008.
2. Price A, Hotopf M, Higginson J, Monroe B and Henderson M. Psychological services in hospices in the UK and Republic of Ireland. Journal of the Royal Society of Medicine. 2006; 99:637-639.
3. Davie E. A social work perspective on palliative care for people with mental health problems. European Journal of Palliative Care. 2006; 13(1):26-28.
4. Garrido M, Penrod J and Prigerson H. Unmet need for mental health care among veterans receiving palliative care: Assessment is not enough. The American Journal of Geriatric Psychiatry. 2014; 22(6):540 – 544.