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Mental healthcare and palliative care: barriers
  1. Kelly O'Malley1,2,3,
  2. Laura Blakley4,
  3. Katherine Ramos5,6,7,8,
  4. Nicole Torrence9,10 and
  5. Zachary Sager1,11
  1. 1 New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, Massachusetts, USA
  2. 2 Department of Psychiatry, Harvard Medical School, Boston, MA, USA
  3. 3 Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
  4. 4 Psychology Service, VA Connecticut Health System West Haven Campus, West Haven, Connecticut, USA
  5. 5 Geriatric Research, Education, and Clinical Center (GRECC), Durham VA Healthcare System, Durham, NC, USA
  6. 6 Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
  7. 7 Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
  8. 8 Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
  9. 9 Geriatrics and Extended Care Service, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
  10. 10 Department of Psychiatry and Behavioural Sciences, University of Washington School of Medicine, Seattle, WA, USA
  11. 11 Division of Geriatrics and Palliative Care, VA Boston Health Care System, Boston, Massachusetts, USA
  1. Correspondence to Dr Kelly O'Malley, New England GRECC, VA Boston Health Care System Jamaica Plain Campus, Boston, MA 02130, USA; kelly.omalley{at}


Context Psychological symptoms are common among palliative care patients with advanced illness, and their effect on quality of life can be as significant as physical illness. The demand to address these issues in palliative care is evident, yet barriers exist to adequately meet patients’ psychological needs.

Objectives This article provides an overview of mental health issues encountered in palliative care, highlights the ways psychologists and psychiatrists care for these issues, describes current approaches to mental health services in palliative care, and reviews barriers and facilitators to psychology and psychiatry services in palliative care, along with recommendations to overcome barriers.

Results Patients in palliative care can present with specific mental health concerns that may exceed palliative care teams’ available resources. Palliative care teams in the USA typically do not include psychologists or psychiatrists, but in palliative care teams where psychologists and psychiatrists are core members of the treatment team, patient well-being is improved.

Conclusion Psychologists and psychiatrists can help meet the complex mental health needs of palliative care patients, reduce demands on treatment teams to meet these needs and are interested in doing so; however, barriers to providing this care exist. The focus on integrated care teams, changing attitudes about mental health, and increasing interest and training opportunities for psychologists and psychiatrists to be involved in palliative care, may help facilitate the integration of psychology and psychiatry into palliative care teams.

  • mental health integration
  • hospice and palliative care
  • mental healthcare policy

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  • Contributors KOM contributed to the conceptualisation, planning and reporting of the material described in this work in addition to acquiring and reporting data on policy issues and barriers and facilitators for psychologists and psychiatrists interested in palliative care. LB contributed to structuring the work and acquiring and reporting on international approaches. KR contributed to acquiring and reporting on veterans' palliative care needs and common mental health concerns frequently seen in palliative care settings. NT contributed to acquiring and reporting on VHA palliative care programmes. ZS contributed to acquiring and reporting on psychiatrists in palliative care, palliative care training for psychiatrists and factors related to upscaling training of palliative care providers. All authors contributed to the writing of the manuscript and subsequent revisions thereof.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The contents do not represent the views of the US Department of Veterans Affairs or the US Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.