People experiencing homelessness often live with serious mental illness and face significant barriers to accessing psychiatric and palliative care. These unmet needs can lead to unnecessary suffering, especially near the end of life. This project looks at a new approach developed by the PEACH (Palliative Education and Care for the Homeless) program in Toronto: the integration of psychiatry directly into a mobile palliative care team.
The PEACH Psychiatry model of care brings specialized mental health support to people where they are—whether in shelters, drop-ins, rooming houses or on the street. Further, this model recognizes that people who are dying deserve the same access to dignity, compassion, and mental health care as anyone else, regardless of their housing status or life circumstances.
About the study
Traditional mental health and palliative care systems are not designed to meet the needs of people who are unhoused or precariously housed. This project provides early evidence that integrating psychiatry into community-based palliative care teams can help fill this gap. In addition, it shows how mental health care, when delivered with flexibility, cultural humility and respect for autonomy, can become more equitable—and more effective.
Methods
We reviewed the charts of everyone who received psychiatric support through the PEACH Psychiatry Program between 2020 and 2022. We collected information about who was served, why they were referred, what psychiatric care they received and where they died. This approach allowed us to better understand the role psychiatry can play in a team that provides both medical and social care at the end of life.
Impact
Traditional mental health and palliative care systems are not designed to meet the needs of people who are unhoused or precariously housed. This project provides early evidence that integrating psychiatry into community-based palliative care teams can help fill this gap. In addition, it shows how mental health care, when delivered with flexibility, cultural humility, and respect for autonomy, can become more equitable -and more effective.
We hope this work will inspire other communities to explore similar models of care. The findings of this study will be used to inform clinical practice and advocacy efforts in Toronto and beyond. Going forward, we will aim to share the lessons learned from this study with policymakers, researchers, and healthcare providers who are committed to health equity and systems transformation.
We hope this work will inspire other communities to explore similar models of care. The findings of this study will be used to inform clinical practice and advocacy efforts in Toronto and beyond. Going forward, we will aim to share the lessons learned from this study with policymakers, researchers, and healthcare providers who are committed to health equity and systems transformation.
