When people think of “hospice,” they often picture caring for the physical needs of a terminally ill patient in their final months of life. But compassionate hospice care improves a patient’s quality of life — no matter the quantity — and that includes their mental health. 

April is Counseling Awareness Month, serving as the perfect time to highlight the importance of counseling in hospice care and recognize the compassionate professionals who provide counseling and other mental health services. According to the National Institute of Aging, the four psychological needs of dying patients are: physical comfort, mental and emotional needs, spiritual needs, and practical tasks. Counseling and mental health care are a vital part of hospice for both the patient and their families.

Unique Care for End-of-Life Mental Health

Beyond pain and symptom management, addressing the understandably difficult emotional and mental needs guides patients through a more peaceful journey. As patients face their mortality, they may feel fear, regret, denial, anger, sadness, depression, anxiety, withdrawal, and a range of other emotions.

Heart to Heart Hospice provides team members who specialize in mental health, spiritual care, or counseling: social workers, spiritual care coordinators/chaplains and bereavement coordinators who offer grief counseling. Adam Hollenbacher, a licensed medical social worker with Heart to Heart Hospice in Indiana, notes that all team members help observe and address mental health concerns and communicate those to the medical director, nurses, and other hospice caregivers. 

With death and grief, counseling can help families find acceptance, help, and hope. Safety risk assessments also help identify deeper mental health issues.

Many hospice families have never walked through the dying process so intimately before. Feelings of helplessness and uncertainty are met by professionals who can walk them through this unique journey. Many families wonder if they’re doing the right thing for their loved one.

“Normalizing how they feel then letting them know they’re not alone is a big help with patients and their families,” says Hollenbacher. “Frequently, they just need a place where they can vent their emotions and their feelings with somebody who will listen to them. The key is being present and listening, not so much providing all the answers.”

Chaplains help families reconnect with their religious traditions and questions. They offer counseling, prayer, guidance in spiritual traditions, connection to online services or sacred music. Social workers provide relationship mediation, coordination with the medical team, emotional support, and assistance with end-of-life plans like advanced directives and funeral planning. They can also connect families to community resources like counseling or grief support groups. 

Hospice nurses can also address the medical side of depression and anxiety, such as needed medications to help patients cope. Additionally, many of our hospice professionals are trained for special considerations for veterans (via the We Honor Veterans program) and cancer, Alzheimer’s, and dementia patients. Addressing mental health disorders is also part of the whole-health approach to hospice care, including mood disorders (bipolar, depression), psychotic disorders (hallucinations, schizophrenia), addiction (alcohol or drug abuse), eating disorders, and personality disorders (OCD, paranoia). 

Offering Compassionate Hope

Sometimes hospice is called in as the result of a sudden, unexpected accident or illness, other times the cause is a long-term illness where treatments are no longer effective or a condition that results from aging, like dementia or heart failure. 

Every hospice family outlines their care plan, including wishes about dying at home, pain management, and other comfort measures. Mental health needs are as unique as each individual patient, including identifying if their medications or disease are contributing to their mental health challenges.

Hospice professionals support patients’ and families’ mental health in a variety of ways:

  • Presence and connection — Listening to patients without judgment and providing coverage to give caregivers a break.
  • Counseling and spiritual support — Prayer, meditation, guided imagery, and other coping method techniques.
  • Leading in important conversations — From mediating family conflicts to recording special memories for families.
  • Specialized therapies — Coordinating or providing pet therapy, music therapy, massage, or other support.
  • Medications and further resources — Clinical solutions are agreed upon by the hospice team, patient, and family, plus referrals to outside resources.
  • Grief support — Guiding families through funeral planning, grief of dealing with illness and impending death, and bereavement counseling 13 months after the patient passes.

Challenges of Hospice and Mental Health Support

Some hospice patients suffer from mental health challenges directly related to end of life, such as situational depression or anxiety, while others suffer from chronic or recurrent mental health issues (sometimes severe) throughout their life, such as bipolar or schizophrenia. Veterans can also face unique issues from their service, such as post-traumatic stress disorder (PTSD). 

Hospice and mental health are inextricably linked, but face ongoing challenges such as:

  • Integrating mental health care and hospice, especially for those with severe mental illness, with gaps between regulations and funding.
  • Lack of social support or cognitive skills for proper disease management before hospice, such as a patient without familial support or a healthcare proxy designated for decision-making, resulting in inconsistent management for their disorders or incongruent care (missing medications, deciding to go in and out of hospice, etc.).
  • Extreme symptoms like violence or self-harm and lack of resources for in-home caregivers or hospice professionals.
  • Limited availability of outside resources, such as the need for a geropsychologist, a psychologist trained to support older adults and their families.

Setting mental health goals with families, along with further education and training for the entire hospice team, can help overcome some of these barriers. Well-trained, non-judgemental communication helps families be more open with a therapist, psychiatrist, social worker, and the potential need for medications or other therapies.

Benefits of Hospice Counseling Programs

“What I love about hospice is we look at the mental, physical, and spiritual aspect of the person. It is a holistic approach, and mental health is very important to address,” says Hollenbacher. “Our goal is to help provide comfort in those last stages of life, and identifying mental health needs are a critical part in that.”

Most people wish their final days are filled with comfort and peace, and the benefits of hospice counseling and mental health support are many. Heart to Heart Hospice helps hospice families and patients finish well, as many wish to die at home surrounded by the people and things they love. 

Thank you to Heart to Heart Hospice counselors and mental health professionals who serve our families!