Palliative psychiatry: research, clinical, and educational priorities.
Sarah Levitt, Rachel B Cooper, Mona Gupta, Jeffrey Kirby, Lucy Panko, Daniel Rosenbaum, Kelli Stajduhar, Manuel Trachsel, Danusha Vinoraj, Anna Lisa Westermair, Anne Woods, Daniel Z Buchman
Author Information
Sarah Levitt: University Health Network, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Rachel B Cooper: Ontario Institute for Studies in Education (OISE), University of Toronto, Toronto, Canada.
Mona Gupta: Department of Psychiatry and Addictions, Universite de Montreal, Montreal, Canada.
Jeffrey Kirby: Department of Bioethics, Faculty of Medicine, Dalhousie University, Halifax, Canada.
Lucy Panko: Centre for Bioethics, Harvard Medical School, Boston, MA, USA; Centre for Addiction and Mental Health, Toronto, Canada.
Daniel Rosenbaum: University Health Network, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Kelli Stajduhar: School of Nursing and Institute on Aging & Lifelong Health, University of Victoria, Victoria, Canada.
Manuel Trachsel: Clinical Ethics Unit, University Hospital Basel (USB), University Psychiatric Clinics (UPK) Basel, University Children's Hospital Basel (UKBB), Geriatric University Hospital Felix Platter (UAFP), Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
Danusha Vinoraj: Faculty of Medicine, University of Ottawa, Ottawa, Canada.
Anna Lisa Westermair: Clinical Ethics Unit, University Hospital Basel (USB), University Psychiatric Clinics (UPK) Basel, University Children's Hospital Basel (UKBB), Geriatric University Hospital Felix Platter (UAFP), Basel, Switzerland; Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich (UZH), Zurich, Switzerland.
Anne Woods: Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Canada.
Daniel Z Buchman: Centre for Addiction and Mental Health, Toronto, Canada; University of Toronto Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
BACKGROUND: Palliative psychiatry has been proposed as a new clinical construct within mental health care and aims to improve quality of life (QoL) for individuals experiencing severe and persistent mental illness (SPMI). To date, explorations of palliative psychiatry have been largely theoretical, and more work is needed to develop its approaches into tangible clinical practice. METHODS: In this paper, we synthesize existing literature with discussions held at a one-day knowledge user meeting titled "A Community of Practice for Palliative Psychiatry" to generate priorities for research, clinical practice, and education that will help advance the development of palliative psychiatry. RESULTS: Palliative psychiatry will benefit from research that is co-produced by people with lived experience (PWLE) of mental illness, that clarifies contested concepts within mental health care and wider medicine, and that adapts existing interventions that have the potential to improve the QoL of individuals experiencing SPMI into the mental health care context. Specific methods and tools might be developed for use in clinical spaces taking a palliative psychiatry approach. More work must be done to understand the populations that might benefit from palliative psychiatry, and to mitigate mental health care providers' (MHCPs') anxieties about using these approaches in their work. As palliative psychiatry is developed, current MHCPs, trainees, individuals experiencing SPMI, and their loved ones will all require education about and orientation to this novel approach within mental health care. CONCLUSIONS: There are several priorities in research, clinical practice, and education that can help advance the development of palliative psychiatry. All future work must be considered through a human rights-based, anti-oppressive lens. Research projects, clinical models, and educational initiatives should all be developed in co-production with PWLE to mitigate the epistemic injustices common in mental health care.
