Challenges in the End-of-Life Care for Patients With Severe Persistent Mental Illness: A Case Series

Despite reduced life expectancy and high rates of comorbidity, individuals with severe persistent mental illness (SPMI) face significant disparities in healthcare access and quality, which extends to palliative and end-of-life (EOL) care. Literature shows that this population is 3.5 times less likely to be referred to specialist palliative care services. Limited access to palliative and EOL care with suboptimal quality of care increases vulnerability and exacerbates suffering for both patients and their families.

This retrospective case series examines the challenges encountered by older adults with SPMI, upon transitioning from curative to palliative approaches of care.

Analysis of three cases using deductive thematic analysis revealed key themes: delayed recognition of psychiatric treatment futility, late or denied access to palliative care, fragmented models of service delivery and ethico-legal complexities. Referrals to palliative care occurred late-often days before death-thereby limiting opportunities for proactive care planning, caregiver support and preparation for EOL care.

Early recognition of treatment futility and poor prognosis could have prompted earlier palliative care involvement, enhancing patient comfort and family support. A dynamic interplay between multimorbidity, frailty and dementia in the context of SPMI is observed, with these co-occurring conditions collectively influencing clinical trajectories and service responses. This study emphasises the importance of improved clinician training, clearer referral pathways and integrated care models in addressing this disparity. Implementing these measures will aid in addressing longstanding inequalities and ensure individuals with SPMI receive appropriate and timely palliative and EOL care.