Mental illness and Palliative care: Care gaps and complexity

The talk will demonstrate that people with Severe Mental Illness (SMI) such as Schizophrenia, Psychosis and Bipolar Disorder, die on average 20 years younger than people without SMI. The prevalence of common morbidity and multi-morbidity (3+ physical conditions) under the age of 75 years is much higher than for people with SMI than for those without and this leads to much higher rates of premature deaths from common conditions such as cancer, cardiovascular disease, liver disease and respiratory disease. Premature mortality is very significantly higher in the most deprived 20% of people with SMI compared to the remaining 80%. The number and rate of people living with and dying with SMI prematurely is not evenly distributed across the country with a fourfold difference across Local Authority Geographies. Most people with SMI die with multiple psychological, physical and social problems, compounded by challenges accessing health and social services and therefore have complex palliative care needs. Preliminary data shows that people with SMI are half as likely as people without to die in Hospices. A cancer diagnosis may increase the chances of access to Palliative Care but only very late.

Professor Julia Verne, Consultant in Public Health Medicine

This will cover an overview of our NIHR-funded Menloc evidence synthesis with some updates from a HCRW funded study. The Menloc review was conducted in two parts, first focusing on published research evidence and second, published case studies. We assessed the strength of findings of studies and identified implications for services where there is a high degree of confidence. We identified challenges of living with severe mental illness with an additional end-of-life condition in the context of organisation and delivery of care arrangements and note the absence of intervention studies for this group. Our more recent HCRW funded review adds some updates which will be briefly mentioned. In addition the presentation will cover recently examined routinely collected data for last year of life for a cohort of people with severe mental illness diagnoses in Wales. These data give us a first look at variation across the system of care for people living and dying in the context of severe mental illness and have helped us identify additional data needs for service improvement initiatives. 

Professor Michael Coffey, Professor of Public Health, Swansea University

Look at the arguments for and against palliative care having a role in managing people with eating disorders (Clinically, Capacity to consent, Ethically). What does the evidence tell us? What are the controversies? Reflect on some cases (What is the same? What is different? What have we learnt?)

Dr Rob Freudenthal, Consultant Psychiatrist, Barnet, Enfield and Haringey Mental Health Trust and Dr Joanne Brady, Consultant in Palliative Care, Barnet Hospital and North London Hospice

This session will explore the relationship between mental health and palliative care services, and how the gap in care for people living with serious mental illness and a life limiting condition can be addressed. Dr Butler will highlight this using case-based examples from working in a Psychiatry service at St Christopher’s Hospice. Dr Shields will bring the perspective of a hospital-based Psychological Care Team working in cancer services, and hold a panel discussion where participants are encouraged to bring case or service examples for discussion.

Dr Greg Shields, Consultant Psychiatrist, King’s College Hospital Cancer Psychological Care Team and Dr Matt Butlers, Psychiatry Specialist Registrar, South London and Maudsley NHS Foundation Trust, St Christophers Hospice

The brain and body are intrinsically and dynamically coupled. Interoception is the process by which the nervous system senses, integrates and interprets internal bodily sensations, such as signals arising from the heart. Cognitive processing, pain experience and emotional feeling states are all influenced by different levels of interoceptive processing. These interoceptive levels encompass afferent, neural, behavioural accuracy and higher-order measures related to interoceptive judgments ascertained via subjective report. This talk will detail how these different interoceptive dimensions, at different levels of processing, can shape cognition, emotion and pain. These interoceptive mechanisms are selectively altered in different clinical conditions with implications for symptoms. The implications of interoceptive processing for palliative care will be addressed.

Professor Sarah Garfinkel, Professor of Cognitive Neuroscience, University College London