Mental health and palliative care patients: the “treatment gap”
Sadness, social withdrawal, depression, loss of hope; if a non-palliative person experiences any of these feelings, the health care system has well established processes and services to treat them. Why then do we accept this as ‘normal’ and ‘to be expected’ for those facing the end of life? Why does the system hesitate to ‘label’ these vulnerable people with a mental illness tag?
Mental illness in the terminally ill is too often underdiagnosed and undertreated. It’s frequently ignored – “well of course you’re having trouble coping, you’re dying,” – or pushed aside in favour of addressing clinical symptoms. While existential and psychological care is acknowledged as being crucial to providing quality end of life care, people continually report that theirs, their families and care givers needs in this domain are not addressed.
So if we have the evidence that mental health significantly impacts on outcomes for those living with dying, why aren’t we addressing it properly? Because too often we think it’s too hard. Having a terminal illness and a coexisting mental illness is a very complex situation. It requires a specialised knowledge and skill base, both in the diagnosis and treatment of mental illness and in understanding the interaction of physical symptoms and psychological reactions or disorders for each disease trajectory. Traditional mental health responses don’t adequately address the overarching issues relating to their terminal or life threatening illness. In the face of not knowing what to do, healthcare professionals focus on what they do best and emphasise the physical needs of patients with a terminal disease; their psychosocial and mental health needs often go undiagnosed and untreated.
This gap was highlighted in findings from a previous study which we undertook called ‘Your Mind does Matter’, in which health professionals indicated there is “an apparent lack of knowledge of appropriate screening tools for psychological distress or mental health issues” as well as a lack of understanding of the “unique circumstances of people with life limiting or terminal illnesses and appropriate mental health responses”.
Closing the treatment gap: the Listen, Acknowledge, Respond (LAR) project
Responding appropriately to the complex mental health needs of terminally ill patients, their families and care givers requires healthcare professionals to have a unique mix of competencies, knowledge, skills and attitudes, and we believe these can be developed with adequate training. The LAR project was designed to close this treatment gap by developing and delivering specialist training for healthcare professionals to address the mental health needs of those living with dying.
The LAR project goes a step further than delivering training for the specialist and generalist palliative and health care workforce; a significant research component of the project will investigate the efficacy of this approach to end of life care and test our hypothesis that patient outcomes will improve and the overall cost of care for those living with an advanced chronic or terminal illness will decrease, or at least remain the same, if they receive appropriate screening and treatment for mental health issues. Healthcare professionals who participate in the training workshops are also invited to contribute to the project research.
Get involved: “Mind the Gap” free professional development workshops
The LAR project is delivering two-day professional development workshops nationally between now and June 2017. The “Mind the Gap” professional development workshops have been designed to close the treatment and knowledge gap and will cover how to effectively acknowledge and respond to the complex mental health needs of people living with an advanced chronic and terminal illness, and that of their family and caregivers. Included in the workshop content is how to screen and assess for psychological distress or mental health issues, and use evidence-based therapeutic skills and knowledge to respond appropriately and in a timely, patient-centred manner.
We are excited to be delivering these free workshops around the country, especially in rural and regional communities where services and resources aren’t always as readily available as in metropolitan areas. Our first workshop is being held in Wagga this week, and further workshops are scheduled in all Australian states and territories.
If you’re ready to address the Treatment Gap for your patients, visit the Listen Acknowledge Respond website and find a professional development workshop near you or call 1800 70 10 22 for more information.
The LAR project is a collaboration between Charles Sturt University, Amaranth Foundation and integratedliving Australia, and is funded by the Commonwealth Department of Health.
Connect with us;
LAR Facebook https://www.facebook.com/listenacknowledgerespond/
LAR Twitter https://twitter.com/larproject
Julianne Whyte is CEO of the Amaranth Foundation
Associate Professor Janelle Wheat is Associate Dean Academic at Charles Sturt University
Kirsty Smith is the Listen Acknowledge Respond Project Manager at Charles Sturt University
Dr Janelle Thomas is the Listen Acknowledge Respond Research Officer at Charles Sturt University