ABSTRACT
Adults with chronic mental disorders have at least double the risk of dying from natural causes at any age, compared with the general population. Chronic mental disorders may be fatal conditions. The natural history of these diseases, poor adherence to treatment regimes, metabolic adverse effects of medications, self-neglect, the perils of homelessness, substance abuse, violence and suicide may limit quality and quantity of life. There is a very limited literature on the palliative care needs or nature of care provided to persons with severe persistent mental illness. Individuals with severe mental illness have limited opportunities to engage in discussions about advance care planning. Street drug use by opioid-dependent and addicted cancer patients poses major difficulties in palliative care settings. A change from usual behaviour should alert the carers to the possibility of a psychological cause. Personality fragility compounds the intellectual limitations. Many intellectually disabled individuals are able to learn new information and from experience.
