Palliative Care Needs of Patients with Severe Mental Illness: Evidence from a Systematic Review of Nursing Interventions

Abstract

Severe mental illness (SMI), including schizophrenia, bipolar disorder, and severe major depressive disorder, is associated with significant physical, psychological, social, and spiritual burdens that adversely affect quality of life and life expectancy. Individuals with SMI experience higher rates of chronic physical illnesses, increased mortality, social exclusion, stigma, and reduced access to healthcare services compared with the general population. Despite these challenges, palliative care services for people living with severe mental illness remain underdeveloped and often overlooked. Nurses play a critical role in identifying palliative care needs, coordinating multidisciplinary services, managing symptoms, supporting families, and promoting holistic care. This systematic review aimed to examine the palliative care needs of patients with severe mental illness and evaluate the evidence regarding nursing interventions designed to address these needs. Electronic databases including PubMed, Scopus, Web of Science, CINAHL, and PsycINFO were reviewed to identify relevant studies published between 2010 and 2025. The findings demonstrate that patients with severe mental illness have extensive unmet palliative care needs across physical, psychological, social, and spiritual domains. Nursing interventions including symptom management, psychoeducation, advance care planning, case management, integrated care models, family support, and multidisciplinary coordination have shown positive outcomes in improving quality of life and patient-centered care. However, significant barriers persist, including stigma, fragmented healthcare systems, inadequate training, and limited integration between mental health and palliative care services. Strengthening nursing competencies and integrating palliative care principles into mental health services are essential for improving outcomes among individuals with severe mental illness.