Integrating Psychiatry into a Community Based Palliative Care Team for People Experiencing Homelessness: A Descriptive Retrospective Cohort Study of the PEACH Psychiatry Program Model

Background People experiencing homelessness have higher morbidity rates and lower life expectancy than the general population. Additionally, there is a high prevalence of mental illness and substance use disorders within this group, which compounds their health issues and adds complexity to providing palliative care. The Palliative Education and Care for the Homeless (PEACH) program in Toronto provides palliative care to this population, and includes an integrated psychiatry service to support clients with mental illness. The aim of this paper is to describe a novel model of integrated psychiatric care and palliative care for structurally vulnerable people living with life-threatening illness and complex mental health needs. Methods We conducted a cross-sectional retrospective cohort study, collecting data from all patients referred to the PEACH psychiatry service in Toronto, Ontario, Canada from 2019 to 2023. The study included patients currently followed by PEACH Psychiatry, those deceased or discharged, and those referred but not assessed. Descriptive statistics were used to analyze the data. Results Out of 62 clients referred to PEACH psychiatry, 48 were included in the analysis. The majority were male (77.1%) and were aged 50–70 (68.7%). Referrals were primarily for psychiatric symptom management (45.8%) and support around coping with life-threatening illness (22.9%). Half of the clients had two or more psychiatric diagnoses, with depressive disorders, substance use disorder, and psychotic disorders being most common. Substance use disorder was the most common diagnostic impression post-assessment by psychiatry (25%). Therapies provided included medication management, psychotherapy, and diagnostic clarification. Conclusions This study outlines a model of integrated psychiatric care within a community-based palliative team serving structurally vulnerable populations. This kind of integrated care represents an important service to improve delivery of both palliative care and psychiatric support for structurally vulnerable populations.