Masel et al.

BMC Palliative Care (2023) 22:31 BMC Palliative Care

https://doi.org/10.1186/s12904-023-01152-1

E D I TO R I A L Open Access

Palliative care in severe mental illnesses

Eva Katharina Masel1*, Bárbara Antunes2 and Christian Schulz-Quach3,4,5

Abstract
In this editorial, we highlight the interaction between patients who are diagnosed with severe mental illness and
their treatment within palliative care, a clinical area of specialized focus which has a multitude of complex impacts
on affected patients, their (chosen) family members and caregivers, as well as the healthcare professionals who are
caring for them.
Keywords Hospice and Palliative Care Nursing, Mental Health, Palliative Care, Psychiatry, Psychosocial Functioning

It cannot be denied that there is a stigma associated with palliative care frame. Indeed, palliative psychiatry is an
both mental illness and palliative care. While palliative evolving field which focuses on mental illnesses that are
care is less often understood within the continuum of severe, refractory, and often unresponsive to conven-
care it provides and is sometimes perceived as “the last tional psychiatric and psychosocial treatments.
resort when there is nothing more to be done”, mental Palliative psychiatry encompasses a wide range of
health issues are often underdiagnosed, minimized or not issues, including widely-known mental health conditions,
treated with a sufficient degree of interprofessional col- like anxiety or depression, treatment-refractory serious
laboration. Indeed, universal access to palliative care and mental illnesses, neuropalliative care and symptom bur-
end-of-life care for patients suffering from serious mental den at various levels. Additionally, it addresses ethics and
illnesses remains an unmet goal [1]. psychosocial problems, psychological distress, person-
Although most healthcare systems separate mental hood, the wish and will to die, dignity, loneliness, social
health from physical health services, creating systemic isolation, as well as psychopharmacology. Furthermore,
barriers to integrated palliative care for patients with the “3 Ds” of palliative psychiatry include depression,
severe mental illnesses, some medical fields, such as dementia, and delirium [2] and it is worth mentioning
clinical psychiatry, are reversely providing care within a that psychiatric comorbidities are common in patients
receiving palliative care.
While palliative care generally attempts to improve
*Correspondence: quality of life at any stage along the disease trajectory and
Eva Katharina Masel
[email protected] to reduce symptom burden, palliative psychiatry focuses
1
Division of Palliative Medicine, Department of Medicine I, Medical on mental health rather than physical issues [3]. How-
University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
2
ever, quality of life is a broad concept which needs to be
Primary Care Unit, Department of Public Health and Primary care,
Palliative and End of Life Care Research Group, University of Cambridge, redefined in the face of severe mental illness. In order
Cambridge, UK to provide a patient with the best care possible, mental
3
4
Centre for Mental Health, University Health Network, Toronto, Canada health aspects should not be outsourced but be part of a
Division of Psychosocial Oncology, Department of Supportive Care,
Princess Margaret Cancer Centre, University Health Network, Toronto, comprehensive assessment [4].
Canada This raises the question of whether the (repeated)
5
Division of Consultation and Liaison Psychiatry, Department of failure of various therapy attempts could lead to a shift
Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto,
Canada in therapy goals. This question is critical in palliative

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and
the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included
in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The
Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available
in this article, unless otherwise stated in a credit line to the data.
Masel et al. BMC Palliative Care (2023) 22:31 Page 2 of 2

Data availability
psychiatry, where therapy attempts may involve freedom not applicable.
constraints. Considering ethical implications, defining
realistic therapy goals and weighing a benefit-harm ratio Declarations
seem all essential elements, especially after numerous
failed therapy [5]. Ethics approval and consent to participate
Not applicable.
This is where palliative care’s core competencies come
into play, through the assessment of distressing circum- Consent for publication
stances and the development of an individual-focused Not applicable.

interprofessional treatment plan. A palliative service cer- Competing interests

tainly goes beyond pharmacology and it is essential to Eva Katharina Masel, Bárbara Antunes and Christian Schulz-Quach are Guest
never forget the ABCDs of caring: attitude, behaviour, Editors of the Collection ‘Palliative care in severe mental illnesses’ and editorial
board members of BMC Palliative Care.
compassion and dialogue [6]. In both psychiatry and pal-
liative care, holistic approaches are paramount to allevi- Received: 21 March 2023 / Accepted: 24 March 2023
ate symptoms, whether visible or invisible. However, new
exciting pharmacological approaches to severe mental
illness are also in place, such as psychedelics, psyche-
delic-associated psychotherapy [7, 8] and ketamine for
suicidality [9]. References
We are now welcoming submissions to our Collec- 1. Shalev D, Fields L, Shapiro PA. End-of-life care in individuals with Serious
Mental illness. Psychosomatics. 2020;61(5):428–35.
tion of articles titled “Palliative Care in Severe Mental 2. Weng CF, Lin KP, Lu FP, Chen JH, Wen CJ, Peng JH. u. a. Effects of depression,
Illnesses”. More details can be found here: https://www. dementia and delirium on activities of daily living in elderly patients after
biomedcentral.com/collections/PCSMI. We would like to discharge. BMC Geriatr 11 Oktober. 2019;19:261.
3. Trachsel M, Irwin SA, Biller-Andorno N, Hoff P, Riese F. Palliative psychiatry for
invite you to contribute and illuminate the many points severe persistent mental illness as a new approach to psychiatry? Definition,
of contact between serious mental health issues and pal- scope, benefits, and risks. BMC Psychiatry 22 Juli. 2016;16:260.
liative care so that the bio-psycho-socio-spiritual model 4. Hadler RA, Goldshore M, Rosa WE, Nelson J. What do I need to know about
you?”: the patient dignity question, age, and proximity to death among
that constitutes comprehensive care can be made accessi- patients with cancer. Support Care Cancer. 2022;30(6):5175–86.
ble and mapped. Barriers, contradictions, burning issues 5. Westermair AL, Buchman DZ, Levitt S, Perrar KM, Trachsel M. Palliative psy-
and deficits should also find a place, as we do not live in chiatry in a narrow and in a broad sense: a concept clarification. Aust N Z J
Psychiatry Dezember. 2022;56(12):1535–41.
an ideal world [10]. 6. Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of
We hope that this Collection will inspire you to recog- dignity conserving care. BMJ 28 Juli. 2007;335(7612):184–7.
nize the versatility of palliative care. Cicely Saunders said, 7. Yaden DB, Nayak SM, Gukasyan N, Anderson BT, Griffiths RR. The potential
of Psychedelics for End of Life and Palliative Care. Curr Top Behav Neurosci.
“Good care can reach the most hidden places”. This also 2022;56:169–84.
means listening, asking, allowing for the full spectrum of 8. Reiff CM, Richman EE, Nemeroff CB, Carpenter LL, Widge AS, Rodriguez CI. u.
human emotion to be safely experienced and addressed a. psychedelics and psychedelic-assisted psychotherapy. Am J Psychiatry 1
Mai. 2020;177(5):391–410.
by all involved, educating oneself and giving mental 9. Shamabadi A, Ahmadzade A, Hasanzadeh A. Ketamine for suicidality: an
health issues the necessary space they need. umbrella review. Br J Clin Pharmacol September. 2022;88(9):3990–4018.
10. O’Malley K, Blakley L, Ramos K, Torrence N, Sager Z. Mental healthcare and
Acknowledgements palliative care: barriers. BMJ Support Palliat Care 1 Juni. 2021;11(2):138–44.
not applicable.

Authors’ contributions Publisher’s note

EKM,BA, CSQ conceived and drafted the manuscript. EKM, BA searched the Springer Nature remains neutral with regard to jurisdictional claims in
literature. All authors read and approved the final manuscript. published maps and institutional affiliations.
Funding
not applicable.