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The views and opinions expressed in our blog series are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health.
I remember a patient some years ago. I’ll call her Maria. She was a lovely Italian woman, in her late 80’s, with a very supportive family.
Maria had developed very complex medical problems. She had heart issues, kidney problems and quite severe diabetes. In the last year of her life she had recurring kidney failure and breathing difficulties. She was going in and out of hospital every three or four weeks.
The medical team did their very best for her – they were very focused on her medical issues and her symptoms, and she received excellent medical care. A lot of focus was given to how best to look after her kidneys, her heart, her pain and her difficulty with breathing. As her problems multiplied and her needs became increasingly complex, the care she received continued to be excellent.
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.
“Palliative care is everyone’s business”
This was the theme of Palliative Care Australia’s advocacy in 2013. While this message aimed primarily to promote understanding at the wider community level, it is important for all health care providers to recognise the role they play in palliative care. All health disciplines, in specialist and non-specialist roles, in acute, community and aged care settings, cross paths with people affected by life-limiting illnesses. To provide care reflecting the values and principles of palliative care, the health workforce needs to be appropriately prepared and updated through postgraduate learning, professional experience, and ongoing professional development.
With 52% of Australians dying in acute hospitals, end-of-life care is essential knowledge for health care professionals.
However, health care professionals working in acute hospitals can find themselves challenged by patients with end-of-life care needs. Doctors, nurses and allied health professionals can be in a situation where they do not know how to best respond to a patient with end-of-life needs. Appropriate end-of-life interventions can be missed.