Individuals with serious mental illness (SMI) face an array of complicated barriers in accessing health care when they reach life’s final stages, leading to significant disparities. Inadequate collaboration among clinicians and lack of psychiatric-specific care are large contributing factors. The unique needs of people with SMI can add layers of complexity that are outside the scope of traditional end-of-life care providers. Individuals with SMI can have shortened life expectancy and increased risk of developing comorbid medical illnesses. People with SMI may not seek end-of-life care due to mistrust in the medical system based on negative past experiences. Many face a common barrier in a lack of psychosocial support among their families, friends or other trusted caregivers and they more likely to lack the same degree of support needed to help navigate end-of-life decisions. Roughly 5 to 8 million older adults in the United States have one or more mental health conditions with projections that this number will triple over the next three decades.
