Gabi Gubel

PUK Zurich, Switzerland

Palliative-psychological care for severe and persistent mental illness: a qualitative expert study toward an integrative, interdisciplinary model

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Biography

Gabi Gübel is a RN and APN with a BSc in Psychology and an MAS in Palliative Care. She is currently completing an MSc in Clinical and Forensic Psychology and is enrolled in a PhD programme. Her thesis investigated the integration of palliative-psychological approaches into inpatient psychiatry, focusing on quality of life, dignity and autonomy for people with severe and persistent mental illness, including dementia. Drawing on qualitative expert interviews with professionals from psychiatry, psychology, nursing and hospice care, she developed a seven-module integrative care concept that bridges psychiatric and psychological expertise. Her work supports a shift from a purely curative orientation toward a quality-of-life-centred model of psychiatric care.

Abstract

Inpatient psychiatry is largely oriented toward cure and symptom remission, yet for people with severe and persistent mental illness (SPMI), such as treatment-resistant schizophrenia, bipolar disorder, severe depression, personality disorders and dementia, this focus often falls short, and quality of life, dignity and autonomy receive too little attention. Palliative-psychological care prioritises these dimensions rather than cure and is well established in somatic medicine, but barely implemented in psychiatry. This study examined which contents, goals and limits such an approach could define for inpatient care, and how an integrative, interdisciplinary concept could be developed. A qualitative, exploratory design was used: eight semi-structured expert interviews with professionals from psychiatry, psychology, nursing and hospice care, together with a family caregiver, were analysed using Mayring's qualitative content analysis with combined deductive and inductive categories, intercoder checks and communicative validation. Palliative-psychological approaches were barely established, fragmented and conceptually unclear, as palliative was often equated with end-of-life care only. Barriers included staff shortages, placement and financing gaps, professional resistance, and ethical dilemmas around autonomy, advance directives and chronic suicidality. Success factors were interdisciplinary collaboration, continuity and relationship-based care, family integration, and psychosocial interventions such as biography work and music therapy. Findings informed a seven-module integrative concept spanning structured indication, existential support, family integration, continuity, spiritual and cultural support, interdisciplinary teamwork with supervision, and cross-sector transition management, supporting a shift toward quality-of-life-centred psychiatric care and a basis for participatory piloting and evaluation.