End-of-life care for people with severe mental illness: mixed methods systematic review and thematic synthesis of published case studies (the MENLOC study)

Michael Coffey,Paul Gill,Alan Meudell,Mala Mann,Sally Anstey,Ben Hannigan,Deborah Edwards

doi:10.1136/bmjopen-2021-053223

Michael Coffey, Paul Gill + Show 5 more

Open Access

https://doi.org/10.1136/bmjopen-2021-053223

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Journal: BMJ open	Publication Date: Feb 1, 2022
Citations: 3	License type: CC BY 4.0

Affiliation: Swansea University, Cardiff University

Abstract

ObjectivesPeople with severe mental illness (SMI) have significant comorbidities and reduced life expectancy. The objective of the review reported in this paper was to synthesise material from case studies relating...

Highlights

Mental ill health is the leading cause of years lived with disability in 56 countries and the second leading cause in a further 56.1 The wider economic costs of mental illness in England have been estimated at £105.2 billion each year[2] and £7.2 billion in Wales.[3]
Our work is distinguished from other work in this field as we adopt an inclusive approach to consider policy papers, primary research, and in this paper we report the inclusion of published case studies as a further part of our National Institute for Health Research (NIHR)-funded systematic review focused on published evidence for EoL care for people with severe mental illness (SMI).[35]
We focused on gathering evidence of EoL care for people with pre-existing SMI who would, broadly put, have used secondary mental health services

Summary

Objectives

People with severe mental illness (SMI) have significant comorbidities and reduced life expectancy. The objective of the review reported in this paper was to synthesise material from case studies relating to the organisation, provision and receipt of care for people with SMI who have an end-of-life (EoL) diagnosis. Twenty-five of the forty-two case study papers met seven, or more quality criteria, with eight meeting half or less. Attributes of case study subjects included that just over half were men, had a mean age of 55 years, psychotic illnesses dominated and the EoL condition was in most cases a cancer. Analysis generated themes as follows diagnostic delay and overshadowing, decision capacity and dilemmas, medical futility, individuals and their networks, care provision. The values and preferences of individuals with severe mental illness experiencing an end-of-life condition should be recognised.

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