Providing Palliative Care to Patients and Families with Pre-Existing Mental Health and Substance Use Issues (P07)

Abstract

•Assess how mental health issues and substance use may be impacting patients' and families' ability to cope with serious illness.•Identify which areas of concern may be reasonable to address in the limited time available for assessment and intervention.•Develop and advocate for an Integrative Behavioral Health model that incorporates mental health and addiction issues, effective program models and policies, and evidence-based assessment and treatment strategies Managing mental health and addiction in hospice and palliative care is a critical component of quality care for patients facing serious illness who also have pre-existing behavioral and/or substance use issues. Reports underscore the high prevalence and burden of behavioral health disorders, particularly in the presence of other physical health conditions. Despite this concern, patients can experience fragmented care that leads to suboptimal services and outcomes, including poor patient and family satisfaction, and higher costs. While effective integrated care models have been described and tested, very few integrated models have adequately been described in the context of serious illness care. Some of the challenges are: how to assess and define interventions that work with existing mental health and substance issues that present as barriers to patient, family, or team goals; how to support the most functional aspect of behaviors, while tending to the goals of palliative care; how to interpret trusted therapeutic interventions to fit what are often very time- and access-limited situations; and how to assist other providers in managing reasonable expectations and goals with patients and families with pre-existing mental health and substance problems. The clinical social worker on the interdisciplinary palliative care team has the mental health expertise, and skill set, to provide these services. First, we will provide an overview of the existing landscape, including historical and epidemiological background, and current service models. An Integrated Behavioral Health model will consider strategies for promoting mental health and addiction care in palliative care settings. Opportunities and challenges for improving care will be considered. Second, we will assess how mental health and substance abuse may be impacting the patient and family's abilities to cope. This includes identifying what areas of concern are reasonable to address in light of the limited time to assess the situation and effectively intervene. Provider education will be considered to help avoid labelling and stereotypes. Third, we will consider how mental health and substance use issues can impact the provision of pediatric palliative care. This includes concerns about addiction when strong opioids are needed. We will discuss family dynamics, implications for interprofessional team practice, adapting best practices in addictions treatment to a palliative setting, and ethical issues.