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Holistic Palliative Care Should Address Mental Health Issues

By Cameron Cucuzzella

Collage image - Hands touching, stethoscope, palliative care signPalliative care is designed to provide holistic care to people living with a life-threatening illness. But a team of researchers, including Duke Psychiatry’s Katherine Ramos, PhD, recently identified a notable shortcoming of the U.S. healthcare system: hospitals with palliative care programs tend to lack the resources, expertise and integration of social work, psychiatry and psychology providers needed to address their patients’ mental health challenges.

Mental health issues are prevalent among patients facing serious illness, and psychological symptoms can have a profound impact on quality of life, emotional well-being and adherence to medical treatment. While social workers have traditionally been at the forefront in providing psychosocial support for palliative care patients, only 10 percent of palliative care teams employ a full-time psychologist or psychiatrist. Ramos notes that psychologists, psychiatrists and social workers each bring unique psychosocial treatment orientations to palliative care teams. Their academic and clinical training, she says, prepares them to fill independent yet complementary roles in palliative care within the context of an interdisciplinary team.  

Research suggests that palliative care providers want greater access to psychiatric expertise, so what’s behind this serious shortcoming? Ramos and her collaborators identified multiple barriers to integrating psychological and palliative care. First, they noted a lack of palliative care training for interested psychologists. There are no psychological certification programs for palliative care, and psychologists traditionally do not receive training on providing end-of-life services. Additionally, current end-of-life reimbursement models would complicate billing for psychiatric services outside of the palliative care team.

The researchers argue that patient well-being would be meaningfully improved by greater integration of psychological services into palliative care programs. In addition to social workers, a psychologist or psychiatrist would be able to diagnosis and provide proper, evidence-based treatment for mental health disorders. Integrated care teams would allow for better access to mental health care, consistent psychological assessment of patients, and overall lower levels of patient distress.

To overcome barriers to providing integrated care, more targeted opportunities must be made available for psychologists and psychiatrists to be involved in palliative care. The Veterans Health Administration has begun to address this issue by creating a fellowship program designed to provide palliative care training to psychologists. Ramos and her colleagues suggest that this program could provide a model for other administrations and health care organizations to increase psychologists’ involvement in palliative care. 

The researchers also note that, without palliative care team members who are clinically trained in psychology or psychiatry, the mental health needs of patients may go unnoticed and undertreated because symptoms such as fluctuating anxiety, distress and feelings of sadness are expected in patients facing serious illness. The authors argue, though, that for care to be truly holistic and comprehensive, addressing patients’ psychological suffering must be a priority. 

“With the steady growth of hospital palliative care programs in the U.S., there is an incredible opportunity to directly impact the quality of life of seriously ill patients via increased access to mental health services,” says Ramos. “Better training and support for psychologists and psychiatrists is a must, and further research around the implementation of already existing psychological interventions in palliative care is greatly needed.”

Read the full article in BMJ Supportive & Palliative Care