Abstract Background Approximately 4.5% of the population live with serious mental illness (SMI), a term referring to mental health disorders that are chronic, impair function, and require ongoing treatment. People living with SMI are at risk of premature mortality relative to people without SMI. Chronic medical illnesses contribute significantly to mortality among individuals with SMI. The standard of care for individuals with serious medical illnesses includes palliative care. However, the provision of palliative care has not been operationalized for individuals with SMI. Objective/Methods This narrative review presents existing epidemiologic data on end-of-life (EOL) care and palliative care for individuals with comorbid serious medical illness and SMI. Challenges in the care of such patients are discussed. The role of the consultation-liaison psychiatrist in providing EOL care for individuals with SMI is delineated with an eye towards redressing disparities. Results Individuals with SMI are at risk of sub-optimal end-of-life care. Patient, clinician, and system-level factors all contribute to disparities including decreased access to palliative care, uneven continued engagement with mental health services, and low rates of advance care planning. CL psychiatrists can use their expertise at the intersection of medicine and psychiatry to address such disparities by (1) correcting misassumptions, (2) promoting advance care planning, (3) engaging long-term caregivers, (4) recognizing social needs, (5) ensuring ongoing access to psychiatric treatment, and (6) addressing suffering. Conclusions There are significant disparities in the end-of-life care of individuals with SMI. CL psychiatrists have expertise to ally with medical providers and redress these disparities.

中文翻译：

---

严重精神疾病患者的临终关怀

摘要 背景 大约 4.5% 的人口患有严重的精神疾病 (SMI)，该术语指的是慢性、损害功能并需要持续治疗的精神健康障碍。与没有 SMI 的人相比，患有 SMI 的人有过早死亡的风险。慢性疾病对 SMI 患者的死亡率有显着影响。对患有严重疾病的个人的护理标准包括姑息治疗。但是，尚未为 SMI 患者提供姑息治疗。目的/方法 本叙述性综述介绍了有关患有严重疾病和 SMI 的个体的临终（EOL）护理和姑息治疗的现有流行病学数据。讨论了此类患者护理方面的挑战。咨询联络精神科医生在为 SMI 患者提供 EOL 护理方面的作用被描述为着眼于纠正差异。结果 患有 SMI 的个体处于次优临终关怀的风险中。患者、临床医生和系统层面的因素都会导致差异，包括获得姑息治疗的机会减少、与精神卫生服务的持续参与不均以及预先护理计划率低。CL 精神科医生可以利用他们在医学和精神病学交叉领域的专业知识，通过 (1) 纠正错误假设，(2) 促进预先护理计划，(3) 聘请长期护理人员，(4) 认识到社会需求，(5) ) 确保持续获得精神病治疗，以及 (6) 解决痛苦。结论 SMI 个体的临终关怀存在显着差异。CL 精神科医生拥有与医疗提供者结盟并纠正这些差异的专业知识。