# Integrating psychiatry into a community based palliative care team for structurally vulnerable populations: a descriptive retrospective cohort study of the PEACH psychiatry program model

## TL;DR

This study describes a new model combining psychiatric care with palliative care for vulnerable populations facing serious illness and mental health challenges.

## Contribution

The paper introduces a novel integrated psychiatric-palliative care model for structurally vulnerable populations.

## Key findings

- Most patients referred to PEACH psychiatry were male and aged 50–70.
- Common reasons for referral included psychiatric symptom management and coping with life-threatening illness.
- Substance use disorder was the most common diagnosis after psychiatric assessment.

## Abstract

Structurally vulnerable populations have higher morbidity rates and lower life expectancy than the general population. Additionally, there is a high prevalence of mental illness and substance use disorders within this group, which compounds their health issues and adds complexity to providing palliative care. The Palliative Education and Care for the Homeless (PEACH) program in Toronto provides palliative care to this population, and includes an integrated psychiatry service to support patients with mental illness. The aim of this paper is to describe a novel model of integrated psychiatric care and palliative care for structurally vulnerable populations living with life-threatening illness and complex mental health needs.

We conducted a retrospective cohort study, collecting data from all patients referred to the PEACH psychiatry service in Toronto, Ontario, Canada from 2019 to 2023. The study included patients currently followed by PEACH Psychiatry, those deceased or discharged, and those referred but not assessed. Descriptive statistics were used to analyze the data.

Out of 62 patients referred to PEACH psychiatry, 48 were included in the analysis. The majority were male (77.1%) and were aged 50–70 (68.7%). Referrals were primarily for psychiatric symptom management (45.8%) and support around coping with life-threatening illness (22.9%). Half of the patients had two or more psychiatric diagnoses, with depressive disorders, substance use disorder, and psychotic disorders being most common. Substance use disorder was the most common diagnostic impression post-assessment by psychiatry (25.0%). Therapies provided included medication management, psychotherapy, and diagnostic clarification.

This study outlines a model of integrated psychiatric care within a community-based palliative team serving structurally vulnerable populations. This kind of integrated care represents an important service to improve delivery of both palliative care and psychiatric support for structurally vulnerable populations.

The online version contains supplementary material available at 10.1186/s12904-026-01996-3.