Palliative Care: Clients with Life-limiting Conditions and Mental Health Diagnoses
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1 Palliative Care: Clients with Life-limiting Conditions and Mental Health Diagnoses Robin Kimball, MS, APRN-CNS Wanda Robinson, PhD, APRN-CNS, CNE Palliative Care Summit Nov. 3, 2017
2 OBJECTIVES 2 At the end of the learning activities, participants will be able to: 1. Identify unique vulnerabilities and challenges for clients with mental health diagnoses who need palliative care. 2. Distinguish between grief and depression in clients receiving palliative care. 3. Formulate three strategies to enhance palliative caregiving for clients with mental health diagnoses.
3 DEMOGRAPHICS 56 million Americans with mental/sub abuse dx Clients with advanced illness = high rates of psychological symptoms: Anxiety Depression Limited literature on who, how, what & when of psychological care given (APNA, 2017; Rosenfeld, 2017) 3
4 4 Whole Health begins with Mental Health (APNA, 2017)
5 5 CLIENTS WITH MENTAL ILLNESS Higher rates of physical illness Die at earlier age Many, complex palliative & EOL care needs Less likely to receive palliative services Experience stigma Cognitive & capacity impairments r/t to illness Limited SES, support & proxies (APNA, 2017; APA, 2017; Butler & Obrien, 2017)
6 Aging populations: Lack social support Institutionalized Incarcerated (20+%) Homeless (46%) Needs: HOPE INCLUSIVITY QUALITY OF LIFE MENTALLY ILL IN DIVERSE SITUATIONS (APNA, 2017; Trachsel, Irwin, Biller-Andorno, Hoff, & Riese, 2016) 6
7 7 AND THE DYING Used with permission of Chato B. Stewart, 2009.
8 8 COMMON CONCERNS Anxiety about proper treatment & communication issues Unpleasant experiences with the health care system Stigmatization I worry about what kind of death I ll have. Will people know if I m psychotic or just think I m delirious? Who will know when I need my medications? I don t want to die alone. (Foti, Bartles, Merriman, Fletcher, & VanCitters, 2005)
9 9 Up to 80% of the psychological symptoms that occur in cancer patients go unrecognized and untreated. GRIEF VS. DEPRESSION One reason for this is the difficulty in diagnosing depression in patients receiving palliative care. (Arnold, 2015)
10 10 GRIEF No distorted sense of self Some fluctuations and variations in mood Able to respond to social support Guilt is related to loss Occasional thoughts or wishes to join deceased Hope is present, may shift (cure - prolonging life - dying well)
11 DEPRESSION 11 Worthless feeling Excessive guilt often related to personal inadequacy Pervasive hopelessness feelings Persistent flat affect and dysphoria Suicidal ideation and/or plan Self-pity and pessimism about the future Poor response to social support (Arnold, 2015; Periyakoil, 2015; Warm & Weissmam, 2015)
12 12 SIMPLE QUESTION SCREENING Are you feeling down, depressed or hopeless most of the time over the last 2 weeks? (Arnold, 2015; Warm & Weissmam, 2015)
13 ANXIETY 13 Component of pain, dyspnea, nausea & cardiac arrhythmias Adverse drug effect Drug withdrawal Metabolic causes Existential or psychosocial concerns about loss Symptom of psychiatric disorders Distinguish from agitated delirium & akathisia (Stoklosa, Patterson, Rosielle & Arnold, 2015)
14 RECOVERY: A process of change through which individuals improve their health and wellness, live a selfdirected life, and strive to reach their full potential. (SAMHSA, 2012) 14
15 15 RECOVERY & MENTAL HEALTH 1. Hope 2. Person-Driven 3. Many Pathways 4. Holistic 5. Peer Support 6. Relational 7. Culture 8. Addresses Trauma 9. Strengths /Responsibility 10. Respect (SAMHSA, 2012)
16 16 PALLIATIVE CARE-GIVING STRATEGIES What strategies can you apply to enhance palliative caregiving for your clients who have mental health needs? Cognitive Emotional Interpersonal Physical Spiritual/meaning
17 17 RECOMMENDATIONS Include & train for health and mental health care Identify emotional, cognitive & functional impairments Screen & treat depression, anxiety and dementia Explore unique client needs & situations Enhance palliative care services in varied settings Address aspects of recovery-oriented practice Partnerships with palliative & mental health care providers (APNA, 2017; Rosenfeld, 2017)
18 18 Cinquain Line 1 = Title Line 2 = 2 words (describe title) Line 3 = 3 words (action ing words) Line 4 = 4 words (sentence) Line 5 = 1 word (reflects title) Title Ideas: Homeless - Mental Prison Loss Grief - Depression - Anxiety - Recovery Ill - Life - Alone - Stigma Pain Comfort Care Palliative Incarcerated Psychopathology Respect
19 19 QUESTIONS?? Thank you
20 20 MENTAL HEALTH RESOURCES National Mental Health Association NAMI National Mental Health Alliance American Psychological Association American Psychiatric Association American Psychiatric Nursing Association ELNEC - End of Life Nursing Education Consortium SAMHSA Substance Abuse and Mental Health Services Administration
21 References American Psychiatric Nurse s Association. (2017, March 14). APNA Position Statement: Whole health begins with mental health. Retrieved from American Psychological Association. (2017). End-of-life care fact sheet. Retrieved from Butler, H. & O Brien, A. J. (2017). Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study. International Journal of Mental Health Nursing, 26. doi: /inm Foti, M.E., Bartles, S. J., Merriman, M.P., Fletcher, K. E. & VanCitters, A.D. (2005). Medical advance care planning for persons with serious mental illness. Psychiatric Services, 56(5), Howe, J.B. & Scott, G. (2012). Educating prison staff in the principles of end-of-life care. International Journal of Palliative Nursing, 18(8), Maschi, T., Marmo, S., & Han, J. (2014). Palliative and end-of life care in prisons: A content analysis of the literature. International Journal of Prison Health, 10(3), doi: /IJPH Rosenfeld, B. (2017). Relevant statistics- Mental health and end-of-life care talking points. American Psychological Association. Retrieved from Trachsel, M., Irwin, S.A., Biller-Andorno, N., Hoff, P. & Riese, F. (2016). Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks. BMC Psychiatry 16(260). Stoklosa, J., Patterson, K., Rosielle, D., & Arnold, R. (2015). Fast facts and concepts #186: Anxiety in palliative care-causes and diagnosis. Retireved from Substance Abuse and Mental Health Service Administration. (2012). SAMHSA s working definition of recovery. Retrieved from Warm, W., & Weissman, D. E. (2015). Fast facts and concepts #7: Assessing depression in advanced cancer. Palliative Care Network of Wisconsin. Retrieved from Waterman, L. Z., Denton, D., & Minton, O. (2016). End-of-life care in a psychiatric hospital. British Journal of Psychiatry, 40(3), Werth, J. L. (2013). Counseling clients near the end of life: A practical guide for mental health professionals. New York, NY: Springer Publishing. 21
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