scholarly journals Ethico-legal issues in relation to end-of-life care and institutional mental health

2006 ◽  
Vol 30 (3) ◽  
pp. 286 ◽  
Author(s):  
Pam D McGrath ◽  
Kim Forrester
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Palliative Care ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Legal Issues ◽  
Life Care ◽  
Health Institution ◽  
Mental Health Institution

Objectives: In view of the fact that there is a higher mortality rate for individuals with serious mental illness and that people with mental illness suffer excess mortality due to physical illness, the lack of attention to end-of-life care for patients with a serious mental illness needs addressing. This article seeks to put these issues on the agenda by beginning to explore important ethico-legal issues at the interface of palliative care and institutional mental health. Methods: Data were collected from eight qualitative interviews conducted with mental health professionals at The Park, Centre for Mental Health, Queensland. The interviews were recorded verbatim, coded and thematically analysed. Results: The findings highlight the inherent tension at the interface of compassionate, patientcentred end-of-life care and the participants? perception of the legal restraints imposed by virtue of being in a mental health institution. This article examines the participants? perceptions of the legal restraints curtailing the provision of palliative care in a mental health institution and considers these findings within an understanding of the limitations imposed by law. Our hope and expectation in undertaking this exploration is to clarify the legal limitations that operate to restrict the type of end-of-life care that can be offered to mental health patients, in order to provide an informed basis for practice.

Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness

2021 ◽  
pp. 104990912110107
Author(s):  
Kate L. M. Hinrichs ◽  
Cindy B. Woolverton ◽  
Jordana L. Meyerson
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Psychosocial Support ◽  
Life Care ◽  
Case Examples ◽  
Increased Risk ◽  
Palliative Care Teams

Individuals with serious mental illness (SMI) have shortened life expectancy with increased risk of developing comorbid medical illnesses. They might have difficulty accessing care and can be lost to follow-up due to complex socioeconomic factors, placing them at greater risk of dying from chronic or undiagnosed conditions. This, in combination with stigma associated with SMI, can result in lower quality end-of-life care. Interdisciplinary palliative care teams are in a unique position to lend assistance to those with SMI given their expertise in serious illness communication, values-based care, and psychosocial support. However, palliative care teams might be unfamiliar with the hallmark features of the various SMI diagnoses. Consequently, recognizing and managing exacerbations of SMI while delivering concurrent palliative or end-of-life care can feel challenging. The goal of this narrative review is to describe the benefits of providing palliative care to individuals with SMI with concrete suggestions for communication and use of recovery-oriented language in the treatment of individuals with SMI. The salient features of 3 SMI diagnoses—Bipolar Disorders, Major Depressive Disorder, and Schizophrenia—are outlined through case examples. Recommendations for working with individuals who have SMI and other life-limiting illness are provided, including strategies to effectively manage SMI exacerbations.

End-of-life care for patients with mental illness and personality disorders

2015 ◽  
pp. 618-627 ◽  
Author(s):  
Betty D. Morgan
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Palliative Care ◽  
Personality Disorders ◽  
End Of Life ◽  
Serious Mental Illness ◽  
Mentally Ill ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Life Care

This chapter examines what is known about palliative care and the mentally ill, including those with serious mental illness (SMI) and personality disorders (PDs). Special issues related to communication and treatment are presented as well as strategies for care for this population. Ethical issues including capacity and competency for decision-making as it relates to those with SMI and end-of-life care are also discussed. Collaboration and consultation between providers is essential in providing end-of-life care for those with SMI.

scholarly journals End-of-Life Care in Individuals With Serious Mental Illness

2020 ◽  
Vol 61 (5) ◽  
pp. 428-435
Author(s):  
Daniel Shalev ◽  
Lauren Fields ◽  
Peter A. Shapiro
Keyword(s):  
Mental Illness ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Life Care

scholarly journals Development and evaluation of an LGBT+ education programme for palliative care interdisciplinary teams

2021 ◽  
Vol 15 ◽  
pp. 263235242110513
Author(s):  
Claude Chidiac ◽  
Kate Grayson ◽  
Kathryn Almack
Keyword(s):  
Mental Health ◽  
Palliative Care ◽  
End Of Life ◽  
Cultural Change ◽  
End Of Life Care ◽  
Healthcare Access ◽  
Interdisciplinary Teams ◽  
Life Care ◽  
Educational Work ◽  
Health And Social Care

Background: Despite national policy recommendations to enhance healthcare access for LGBT+ (lesbian, gay, bisexual, transgender, and those who do not identify as cisgender heterosexual) people, education on LGBT+ issues and needs is still lacking in health and social care curricula. Most of the available resources are focused on primary care, mental health, and sexual health, with little consideration to broader LGBT+ health issues and needs. The limited available educational programmes pertaining to LGBT+ individuals outside the context of sexual or mental health have mainly focused on cancer care or older adults. Aim: To support palliative care interdisciplinary teams to provide LGBT+ affirmative care for people receiving and needing palliative and end-of-life care. Methods: A 1½-h workshop was developed and evaluated using Kotter’s eight-step process for leading change. Across four hospices, 145 health and social professionals participated in the training. A quasi-experimental non-equivalent groups pre–post-test design was used to measure self-reported levels of knowledge, confidence, and comfort with issues, and needs and terminology related to LGBT+ and palliative care. Results: There was a significant increase in the reported levels of knowledge, confidence, and comfort with issues, needs, and terminology related to LGBT+ and palliative care after attending the training. Most participants reported that they would be interested in further training, that the training is useful for their practice, and that they would recommend it to colleagues. Conclusion: The project illustrates the importance of such programmes and recommends that such educational work is situated alongside wider cultural change to embed LGBT+-inclusive approaches within palliative and end-of-life care services.

scholarly journals 458 - End-of-life decision-making capacity in an elderly patient with schizophrenia and terminal cancer

2020 ◽  
Vol 32 (S1) ◽  
pp. 179-179
Author(s):  
C Kotzé ◽  
JL Roos
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Decision Making Capacity ◽  
Advance Care ◽  
End Of Life Decision

Medical practitioners are confronted on a daily basis with decisions about patients’ capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end -of-life decision-making capacity in a 72-year old lady with treatment resistant schizophrenia and terminal cancer will be discussed.In the case discussed there were differences in opinion about the patients decision-making capacity. In light of this, the role of the treating clinician and importance of health-related values in capacity assessment are highlighted. It is recommended that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient’s wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient’s capacity will change the treatment approach.Compared to the general population, people with serious mental illness have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services and are rarely engaged in end-of-life care discussions. Older people with serious mental illness can engage in advance care planning. Conversations about end -of-life care can occur without fear that a person’s psychiatric symptoms or related vulnerabilities will undermine the process. Clinicians are also advised to attend to any possible underlying issues, instead of focusing strictly on capacity. Routine documentation of end-of-life care preferences can support future decision making for family and clinicians at a time when patients are unable to express their decisions.More research about palliative care and advance care planning for people with serious mental illness is needed. This is even more urgent in light of the COVID-2019 pandemic, as there are potential needs for rationing of health care in the context of scarce resources. Health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with serious mental illness.

scholarly journals End of life care in a secure hospital setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S96-S96
Author(s):  
Owen Obasohan ◽  
Deepak Tokas ◽  
Mamta Kumari
Keyword(s):  
Mental Health ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospital Setting ◽  
Care Plan ◽  
Psychiatric Ward ◽  
Life Care ◽  
Individualised Care ◽  
Care Of The Dying

AimsTo measure the standard of care provided to patients who had a natural and expected death whilst in secure care at Roseberry Park Hospital, Middlesbrough.Mallard ward is a low secure psychiatric ward for older aged men suffering from cognitive difficulties and significant physical comorbidity in addition to a severe and enduring mental illness. The patient population is such that it will remain the most appropriate placement for some patients until their death. It is vital that staff members on Mallard ward and indeed all parts of the Trust are aware of the priorities for care of the dying person and ensure that care is provided in accordance with these priorities.The Leadership Alliance for the Care of Dying People (LACDP), a coalition of 21 national organisations, published One Chance to get it Right – Improving people's experience of care in the last few days and hours of life in June 2014. This document laid out five priorities for care of the dying person focussing on sensitive communication, involvement of the person and relevant others in decisions and compassionately delivering an individualised care plan.MethodThe data collection tool was adapted from End of Life Care Audit: Dying in Hospital, a national clinical audit commissioned by Healthcare Quality Improvement Partnership (HQIP) and run by the Royal College of Physicians. Data were collected from both electronic and paper records. There were three natural and expected deaths in the last two years.ResultFor all three patients, there was documented evidence that they were likely to die in the coming hours or days.End of life care discussion was held with the nominated persons and not with the patients due to their lack of mental capacity.The needs of the patients and their nominated persons were explored in all three cases.All patients had an individualised care plan which was followed.The palliative care team supported the staff with the care of these patients.The care provided was largely consistent with the priorities listed.ConclusionThe national audit compares performance of only acute NHS Trusts with no data to reflect the performance of mental health hospitals. It is imperative that mental health services work in collaboration with physical health and palliative care services so they are able to continue providing a high level of care to this patient group. Clinicians and staff involved in the care of dying patients also need to be adequately trained.

scholarly journals End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis

2019 ◽  
Vol 34 (1) ◽  
pp. 49-68 ◽  
Author(s):  
Rebecca Wilson ◽  
Nilay Hepgul ◽  
Irene J Higginson ◽  
Wei Gao
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Mental Illness ◽  
General Population ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Place Of Death ◽  
Narrative Synthesis ◽  
Life Care

Background: People with serious mental illness have greater mortality risk than the general population. They experience health care inequalities throughout life; it is not clear if this persists to end of life. Aim: Assess the empirical evidence describing end-of-life care and place of death for people with serious mental illness. Design: A systematic review of original, peer-reviewed research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analysed using a narrative synthesis approach. Data sources: Five online databases (Embase, PsycArticles, PsycINFO, Medline, PubMed) and additional sources were searched (without time restriction) for primary research reporting health care utilisation in the last year of life or place of death in adults with serious mental illness. Results: After full-text screening, 23 studies were included. We found studies reporting hospital admissions, emergency department care, palliative care, and general practitioner (GP) visits at end of life. We found conflicting evidence for the association between serious mental illness and end-of-life care, although different patient groups, settings and measures were used across studies. People with serious mental illness were more likely to die in care homes than the general population. There were no patterns for other places of death. Conclusions: The evidence was sparse and heterogeneous, demonstrating variability in patterns and reporting of health care use and with little consensus on where people with serious mental illness are likely to die. Given that people with serious mental illness have increased mortality risk, this gap in the knowledge around end-of-life care outcomes is concerning; this area of research needs further development.

scholarly journals Honoring Preferences—The Consistency Between End-of-Life Care and a Veteran’s Goal for Comfort Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 752-752
Author(s):  
Joan Carpenter ◽  
Winifred Scott ◽  
Mary Ersek ◽  
Cari Levy ◽  
Jennifer Cohen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Multivariate Logistic Regression ◽  
Comfort Care ◽  
Lower Odds ◽  
Medicare Data ◽  
Life Sustaining Treatment

Abstract This study examined the alignment between Veterans’ end-of-life care and a Life-Sustaining Treatment (LST) goal “to be comfortable.” It includes Veterans with VA inpatient or community living center stays overlapping July 2018--January 2019, with a LST template documented by January 31, 2019, and who died by April 30, 2019 (N = 18,163). Using VA and Medicare data, we found 80% of decedents with a comfort care goal received hospice and 57% a palliative care consult (compared to 57% and 46%, respectively, of decedents without a comfort care goal). Using multivariate logistic regression, a comfort care goal was associated with significantly lower odds of EOL hospital or ICU use. In the last 30 days of life, Veterans with a comfort care goal had 43% lower odds (AOR 0.57; 95% CI: 0.51, 0.64) of hospitalization and 46% lower odds of ICU use (AOR 0.54; 95% CI: 0.48, 0.61).

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