Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks


As a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry does not currently explicitly provide palliative care for patients with mental illness outside the context of terminal medical illness.

Based on the WHO definition of palliative care, a, a working definition of palliative psychiatry is proposed. Palliative psychiatry focuses on mental health rather than medical/physical issues. We propose that the beneficiaries of palliative psychiatry are patients with severe persistent mental illness, who are at risk of therapeutic neglect and/or overly aggressive care within current paradigms. These include long-term residential care patients with severe chronic schizophrenia and insufficient quality of life, those with therapy-refractory depressions and repeated suicide attempts, and those with severe long-standing therapy-refractory anorexia nervosa. An explicitly palliative approach within psychiatry has the potential to improve quality of care, person-centredness, outcomes, and autonomy for patients with severe persistent mental illness.

The first step towards a palliative psychiatry is to acknowledge those palliative approaches that already exist implicitly in psychiatry. Basic skills for a palliative psychiatry include communication of diagnosis and prognosis, symptom assessment and management, support for advance (mental health) care planning, assessment of caregiver needs, and referral to specialized services. Some of these may already be considered core skills of psychiatrists, but for a truly palliative approach they should be exercised guided by an awareness of the limited functional prognosis and lifespan of patients with severe persistent mental illness.

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Wake me up when they find an effective approach to treat negative symptoms!


I don’t understand this - palliative is treatment with meds - how is that new. That’s all they do now.

When I first read the headline I immediately had this thought that they’re getting ready to start euthanizing those of us with “refractory illnesses”. Or maybe that’s just my refractory paranoia.

I always viewed the approach of modern psychiatry to mental illness as a de facto palliative approach.

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Palliative care is the humane way to treat people who are ill. Nothing wrong with finding out the best way to make people comfortable, meds or not.
Sometimes just having someone listen without judgement but actually listen takes a great weight off your shoulders.
Bonus if they actually resolve what makes you feel terrible.

Ack! how did this post 23 days later?
A resurrected thread whilst everyone is on summer vacation?