A new VA study suggests that bringing palliative care into the mix can make a big difference for veterans living with serious mental illness (SMI) and heart failure at the end of life. Among 9,369 deceased veterans with both conditions (2011–2020), those who received a palliative‑care consult in the year before death had about sixfold higher odds of enrolling in hospice during their final six months, compared with peers who had neither palliative nor mental‑health care. By contrast, veterans engaged only in mental‑health care were less likely to enter hospice.
What the study looked at
Researchers grouped veterans with SMI (schizophrenia‑spectrum or bipolar‑spectrum disorders) and heart failure into four categories based on care received 6–18 months before death:
- Neither mental‑health nor palliative care (reference group)
- Mental‑health only (≥3 mental‑health visits)
- Palliative care only
- Both mental‑health and palliative care
The main outcome was hospice use in the last 6 months of life.
Key findings
- Hospice enrollment rates: ~24% with neither service; ~18% with mental‑health care only; ~60% with palliative care (with or without mental‑health care).
- Adjusted odds: Mental‑health care alone was linked to lower odds of hospice use (aOR 0.74, 95% CI 0.62–0.87). Adding palliative care was linked to much higher odds (aOR 5.96 for palliative‑only; 6.67 for both services).
Why it matters
People with SMI face higher rates of cardiovascular illness and often receive less end‑of‑life support. Hospice—specialized care focused on comfort when life expectancy is about six months—can reduce hospital visits, manage symptoms, and support families. The study points to stronger collaboration and cross‑training between mental‑health and palliative‑care teams as a practical way to close hospice gaps for this group.
Caveats
This was a retrospective analysis of VA data, largely male patients with heart failure, so results may not generalize beyond the VA or to other illnesses. Observational studies can’t prove cause and effect, and some barriers to hospice (for example, severity of psychiatric symptoms or how terminal heart failure is recognized) weren’t fully captured.
Source
Boozalis J, Perreault J, Turner HI, et al. A retrospective study of deceased veterans with serious mental illness and heart failure: Analysis of palliative care and mental health collaboration on hospice utilization. General Hospital Psychiatry.2025;96:151–155. doi:10.1016/j.genhosppsych.2025.07.009.