Blue Monday, commemorated in January, centres on the idea that the third Monday of that month has been calculated to be the most depressing day of the year, associated with post-Christmas financial hardship, foul weather and increasingly failing new year's resolutions. The idea of a specific day of amplified low mood, and its empirical evidence base, has been debunked both as pseudoscience and mathematically unsound, and possibly a marketing ploy to promote winter sales to sunnier climates. All these arguments notwithstanding, the awareness of personal difficulties and a desire to be helpful is noteworthy and shows a professional and personal insight into helping people over a period that has connotations of austerity and cheerlessness.
Evidence, even though it may be uncomfortable, provides the impetus to review practices. For many people, patients, their families or carers, the experience of severe mental illness, such as depression, can be a significant, distressing and debilitating burden. It is also associated with poorer physical health and inequitable healthcare experiences. This is particularly relevant for palliative and end-of-life care.
While mental health and psychological concerns are common among patients with malignant disease (Sewtz et al, 2021), these may be underdiagnosed and untreated. As such, there is a need to better integrate specialist mental healthcare with palliative care services to provide effective, holistic care and treatment patients with cancer or other chronic illnesses (Wozniak et al, 2021).
Patients with severe, serious and enduring mental illnesses, such as bipolar affective disorder, severe personality disorder or schizophrenia report significant differences and discrimination in their healthcare experiences, with underuse or suboptimal incorporation of palliative and end-of-life care (Shalev et al, 2021; Riley et al, 2022).
Stigma related to mental illness, whether in an individual provider or a healthcare system, may be a serious obstacle to accessing services (Knaak et al, 2017) and societal and media depictions of people living with mental illness can perpetuate undesirable, inaccurate and negative representations and connotations (Compotiello et al, 2023). The complexities of the symptom experience or inability to communicate effectively about physical or mental health needs can be diagnostically challenging which, when compounded by lack of specialist training, makes screening, assessment and treatment difficult (Wozniak et al, 2021). Many patients may subsequently be denied the opportunity to anticipate, discuss or plan their end-of-life care needs and may be forced to receive only crisis intervention (Knippenberg et al, 2023). As care is increasingly scrutinised in an ethical and legal milieu, where issues such as capacity and autonomy are difficult to determine, collaboration between psychiatry and palliative care may help to relieve suffering, reduce risk of harm and promote a focus on quality of life (Trachsel et al, 2016; Westermair et al, 2022).
The need for more awareness, better training and up to date evidence and guidelines to support the nonspecialist caring for people living with mental ill health is progressively being addressed and made available, such as the updated version of the Handbook of Palliative Care available as part of the NHS England e-learning for healthcare platform (Faull et al, 2024).