Mental health issues have rightly dominated the health and social care agenda in the recent Scottish Parliament election and in debates in the new Parliament. There has been a severe under investment in mental health over recent years, as physical health has taken priority. Thankfully this is changing. We now have a dedicated minister for mental health and a commitment to a new ten year strategy both of which are very welcome.
However, there are a number of issues associated with mental health and support toward the end of life that need to be addressed in this strategy.
We need to look closer at how care is delivered for people with mental health issues arising from their terminal illness, and those with severe mental health conditions approaching the end of life.
For many people living with a terminal illness, their mental health issues can be very apparent but can often go untreated and unsupported. Access to support can depend very much on where they live, the disease and the practitioner delivering that care.
For people living with terminal illness, depression may occur anytime such as following diagnosis, as their disease advances and pain increases or their independence becomes more limited. It is more likely if a person experiences more symptoms of their disease, such as sickness or bladder and bowel problems.
At Marie Curie, many people we support experience anxiety which can lead to varied reactions such as insomnia, restlessness, being agitated, sweating, heart palpitations, panic, worry and tension. The fear of dying itself often creates anxiety and can lead to mental health issues.
There needs to be a range of support available. This can include access to psychiatrists and counsellors or other mental health practitioners, as well as support groups, and suitable medication.
As always, when dealing with terminal illness, speed is of the essence. Whether someone only has a few years or in many cases a matter of months to live, people cannot afford to wait to get the support they need.
Left unsupported, this can have very serious implications. Not only causing a detrimental impact on the quality of life a person has before they die, it can also see their condition worsen. It can even lead to suicide. According to research carried out by Demos, at least 10 per cent of suicides in Britain are linked to terminal or chronic illness however, owing to underreporting this may be a lot higher. This could mean up to 70 suicides in Scotland each year.
It is also vital to consider how palliative care might support someone approaching the end of life with severe mental health conditions such as schizophrenia, bi-polar disorder or clinical depression. This could be their main condition or alongside another physical condition. Nearly 500 people died in 2014 of a mental health or behavioural disorder (not including dementia or suicide). People with severe mental disorders tend to die earlier, mostly due to chronic physical medical conditions such as cardiovascular, respiratory and infectious diseases.
Disappointingly, there is a distinct lack of data available to show just how many people with severe mental health issues need palliative care. However, many will need support.
Treating the terminal condition of people with mental health problems can be problematic because they may not understand their diagnosis. It is possible that psychiatric symptoms could be made worse by a physical illness.
People with severe and chronic mental health problems approaching the end of life should have the same access to good quality palliative care as everyone else. There needs to be better communication and understanding between palliative care.
The new mental health strategy must consider the support needed for everyone living with mental health issues and where they have a terminal condition, cross reference the recently published Strategic Framework for Action on Palliative and End of Life Care. It is vital that everyone living with a terminal illness and at end of life have as good a quality of life as possible in the time that they have left. The only way to get this right is by properly supporting mental health, as well as physical health.
If you or someone you know is living with a terminal illness and looking for support call the Marie Curie Support Line on 0800 090 2309.
• Richard Meade is Marie Curie’s head of policy and public affairs Scotland www.mariecurie.org.uk/change