Massachusetts Department of Mental Health

Project Overview

Nationwide, people with profound psychiatric illness who are facing life's end are often forgotten. Even most hospice providers have scant experience with these patients, and few protocols exist for helping those with mental illness through the last days of their lives.

The Massachusetts Department of Mental Health in Medfield, MA, established an innovative mental health-hospice partnership to integrate end-of-life care planning into the mental health planning process. End of Life Care for Persons with Serious Mental Illness was a partnership between the Massachusetts Department of Mental Health's MetroSuburban Area, the state's Medicaid Bureau, Emerson Hospital's Hospice Program and Hospice of the South Shore to reach out to people suffering from longstanding, serious mental illness who were dying.

This innovative program developed tools to assess competence to select a health care proxy and elicit information about care preferences among patients with serious mental illness who suffer from progressive, incurable illness.

The program also taught hospice workers about mental illness and mental health care workers about hospice, creating a bridge between hospice and mental health providers to improve care for dying people with mental illness. The project trained mental health care providers to clarify patients' preferences for care, within the setting of ongoing mental health care. Project Director Mary Ellen Foti, M.D., explained that the project's goal was to develop "best practices" in end-of-life care for people with serious and persistent mental illness.

Tools

• Do It Your Way: End-of-Life Care for Persons with Serious Mental Illness
  An online resource for mental health administrators and clinicians complete with evaluation tools, policies and guidelines to support excellence in end-of-life care for their patients.

Resources

• Bibliography (PDF 102 KB / 2 pages)
  Download Acrobat Reader
• The Journal of Palliative Medicine (August 2003: Volume 6, No. 4) features an article about this demonstration project titled "'Do It Your Way': A Demonstration Project on End-of-Life Care for Persons with Serious Mental Illness".
• This demonstration project was featured at the 2003 NHPCO 5th Clinical Team Conference:
  • Session 3: Tailoring Hospice Care for the Patient with Serious Mental Illness

After the Grant

Because of this project, the Massachusetts Department of Mental Health adopted statewide policies on end-of-life care and advance directives.

Contact Information

Principal Investigator:
Mary Ellen Foti, M.D.
State Medical Director
Massachusetts Department of Mental Health
25 Staniford St.
Boston, MA 02114
Phone: 617.626.8116

Return to top

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.