Working at the Intersection of Palliative End-of-Life and Mental Health Care: Provider Perspectives

Objective: Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort—particularly those with a comorbid, chronic and persistent mental illness (CPMI)—are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients. Method: Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis. Results: The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not. Significance of Results: Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers.

A relevant practical course for mental health care providers in South Africa

<p>The South African Mental Health Care Actdefines mental health care provider as a person providing mental health care services to mental health care users and includes mental health care practitioners. Mental health care practitioner means a nurse, psychiatrist or registered medical practitioner, psychologist, occupational therapist or social worker who has been trained at an accredited institution to provide prescribed mental health care, treatment and rehabilitation services. For a South African mental health provider to render high-quality mental health care, treatment and rehabilitation services, that mental health care provider should have been exposed to theory and practical teaching and learning in Intellectual Disability (ID). One of the most relevant practical courses for intellectual disability in South Africa is offered by the Sunshine Association.</p>

Biological Changes During Pregnancy and the Postpartum Period

Pregnancy and postpartum recovery involve profound changes that affect nearly every aspect of a woman’s life. This chapter reviews the physical, hormonal, and physiological changes that occur in the course of normal pregnancy and the postpartum period. It describes the common symptoms and sensations associated with these changes and their implications in contributing to behavioral changes and psychopathology. It is important for health care providers to realize that, for a majority of women, somatic symptoms and some psychological symptoms represent normal physiological changes. The symptoms and complaints engendered by the changes of pregnancy are, in most cases, the natural consequence of bringing new life into the world. A familiarity with routine pregnancy-related changes will aid the mental health care provider in recognizing when behavioral patterns deviate from what is expected. Such understanding is key to assessing when such symptoms demand treatment and when they only call for reassurance and legitimization.