The importance of mental health in palliative care

In recent years awareness surrounding mental health issues and their impact on overall health has increased. The latest studies suggest that one in four people will suffer a mental health issue at some point in their lives. Despite this, decreased funding for mental health services has caused these individuals to seek treatment from alternative sources. Increasingly, responsibility is falling on charities to offer support where previously this would have been provided by the NHS. Our services in particular have seen a marked increase in the number of patients with both diagnosed and undiagnosed mental illnesses and this can be linked to two clear causes.

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Firstly, chronic and terminal illnesses are highly triggering and often cause the development of mental illnesses. In fact, over 10% of suicides in Britain are linked to a chronic or terminal illness. St John’s Hospice has not escaped the impact of this; recently a patient, upon receiving his palliative diagnosis, went into a psychotic episode, attacked a member of staff and attempted to leave our Inpatient Unit.

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Secondly, those with diagnosed mental illnesses tend to die earlier and are more likely to develop terminal and chronic Illnesses. They tend to suffer from isolation and loneliness which increases the likelihood of mortality by 26%, poor diet and exercise which increases the likelihood of heart and lung problems, and an increase in impulsivity which can increase the likelihood of substance misuse, and resulting long-term health problems such as cancer.

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At the hospice

There has been a definitive increase in the number of patients that we see who are suffering from a mental illness. In the last year alone we have helped over 50 patients with diagnosed mental illnesses:

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• Five out of 11 patients currently in our Inpatient Unit have a diagnosed mental illness.
• Approximately half of the patients we treat have some form of cognitive impairment or learning disorder.
• Approximately one patient a month has a developmental disorder (e.g. autism).
• Five patients in the last three years have had personality disorders.
• Almost all patients deal with some level of depression or anxiety.
• We have tackled this issue in a multi-faceted approach, which has sought to maintain our high level of care for each and every patient.

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Training

One of the basic principles of hospice care is holistic medicine, it’s therefore very important to make sure that when we get a referral we are appropriately equipped. Too often patients are referred to providers that do not have the training to treat all the patients’ needs. With this in mind, all our members of staff have received training for:

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• Advanced Communication Skills
• Conflict Resolution
• Dementia Patient Support
• Level Two Mental Health Conditions (i.e. providing emotional support)

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We have also provided Cognitive Behavioral Therapy (CBT) training to those staff members who tend to take care of long-term patients. These techniques are used in conjunction with holistic emotional support.

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Treatment Planning

Given the fact that mental illnesses manifests itself in a highly individual manner, we make sure that all of our treatment plans are just as bespoke.

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Learning and Developmental Disorders

It is incredibly important in these circumstances to ensure that the patient is aware of all aspects of their illness. J was an IPU patient who was dually diagnosed with Asperger’s and colon cancer. J was obsessed with cop shows and convinced that dying meant being shot. He was truly terrified and couldn’t accept the terminal nature of the illness. Our Head of Department worked individually with him on a daily basis to teach him about his illness and how it would manifest itself so that he could approach it with peace. She used bespoke leaflets with specific language and made sure that all the nurses were aware of how to appropriately communicate with him. After several weeks of work, J was able to pass away without fear.

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Personality Disorders

One-to-one nursing is vital in these kinds of situations in order to build trust and rapport with the patients. Mrs R had a dual diagnosis of borderline personality disorder and curable breast cancer. Due to a childhood trauma involving surgery, she was refusing all treatment. Our occupational therapy nurses worked with her for weeks to build up her trust in our services and managed to get her to agree to chemotherapy. After personally escorting her to twenty chemotherapy appointments, her cancer was deemed to be in remission and she was provided with access to the appropriate mental health services.

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Resources

We provide every patient with a Holistic Assessment and a “What Matters to Me” questionnaire. The Holistic Assessment will ascertain a person’s emotional and cognitive well being while the “What Matters to Me” questionnaire allows us to hear from the patient about how we can adjust their treatment to suit their needs.  These are reviewed and updated every 3 months. It’s all about adapting to each individual’s needs.

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We also endeavour to learn from experts in the field which is why we are members of the Palliative Care for People with Learning Disorders Network, and are working on creating a borough-wide support network for healthcare services to provide more comprehensive plans going forward.

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Ultimately we want to be patient-led in designing the treatment and support packages needed. The goal always is to alleviate anxiety by empowering patients to set their own values and priorities for end of life, and avoid creating stressful power dynamics where they do not feel listened to.