Advocates have increasingly emphasized the importance of integrating behavioral health into hospice care, pointing out that mental health conditions and substance use disorders (SUDs) often complicate the end-of-life journey. Addressing these issues can greatly improve the quality of care for patients and families, yet hospices continue to face significant barriers when it comes to weaving psychiatric services into their models. From limited funding and research to reimbursement challenges, providers are struggling to meet the rising demand.
The Growing Need for Behavioral Health in Hospice Care
According to the Journal of the American Geriatrics Society, between 5 to 8 million older adults in the United States currently live with at least one mental health condition. That figure is expected to triple in the next three decades. As the population ages and more patients enter hospice care, these behavioral health challenges cannot be ignored.
Patients with depression, anxiety, or substance misuse often experience unique complications at the end of life. Their care needs differ from patients without behavioral health conditions, and without proper support, families and providers may struggle to manage symptoms effectively. Advocates argue that improved access to behavioral health specialists and targeted interventions will help patients navigate both physical decline and mental or emotional distress.
The Role of Behavioral Health in Hospice
Behavioral and mental health services have long been recognized as core components of hospice and palliative care. As Cameron Muir, M.D., chief innovation officer for the National Partnership for Healthcare and Hospice Innovation (NPHI), explained, mental health is “front and center every single day with patients and families.” Hospice is not solely about treating physical pain—it also involves addressing emotional, spiritual, and psychological well-being.
Despite this, hospices often find themselves constrained by limited reimbursement opportunities and insufficient regulatory support. While hospice benefits include services such as chaplains, social work, and bereavement care, sustainable funding for psychiatric care has lagged behind. As a result, many providers cannot fully support patients with more complex mental health or substance use issues.
Barriers to Integration
A key challenge facing hospice providers is the disconnect between everyday patient needs and the available resources to address them. Muir and others point out that while hospices are required to provide emotional support to families, there is little guidance—or funding—for how to effectively sustain psychiatric and substance use disorder treatment within the hospice model.
Research into mental health and SUDs in hospice is also underfunded, leaving providers without clear best practices. Much of the exploration to date comes from academic institutions rather than clinical settings, and the lack of robust data makes it difficult to secure support for widespread integration of behavioral health.
What the Research Shows
Although limited, existing research has shed light on pressing behavioral health issues among hospice patients. For instance, a University of Maryland study analyzed data from the U.S. Health and Retirement Study, which surveyed over 20,000 older Americans. Researchers found a significant prevalence of depression and alcohol misuse in aging populations nearing the end of life.
The study did not establish a strong connection with other mental health conditions such as anxiety or bipolar disorder, but it did highlight areas where further research is needed. According to Todd Becker, a doctoral student and research assistant involved in the study, these findings reinforce the need for hospices to prepare for patients’ complex psychiatric and substance-related needs.
Challenges for Families and Caregivers
Mental health concerns in hospice extend beyond patients. Families and caregivers also struggle with grief, anger, and stress, particularly when long-standing mental illness or substance misuse is involved. As Claudia Fine of eFamilyCare noted, it is critical for providers to view patients holistically, taking into account both physical and behavioral health, while also supporting family members.
Hospices that fail to address behavioral health issues risk leaving families with unresolved trauma, which can complicate bereavement and affect long-term well-being. Offering integrated support for both patients and loved ones is essential for improving overall outcomes.
Collaborative Care as a Path Forward
One of the most promising solutions for integrating behavioral health into hospice care is collaborative care. This approach involves close partnerships between hospice teams and psychiatric providers to ensure that mental health needs are identified and addressed in real time.
Rebecca Bauer, M.D., of the Medical College of Wisconsin, emphasized the importance of this model in an article for The American Journal of Psychiatry. She noted that while research on end-of-life psychiatric care remains limited, collaborative care has proven effective in helping patients with serious mental illness navigate hospice.
Building Sustainable Models
For hospices to truly integrate behavioral health, sustainable business models must be developed. Muir suggests several key steps: expanding billing and coding practices to support behavioral health services, training hospice staff to recognize and manage mental health conditions, and incorporating standard screening tools into care workflows.
By systematically tracking mental health outcomes—such as depression, anxiety, and insomnia—hospices can demonstrate the value of these interventions. Improved data collection could also help secure funding and expand reimbursement opportunities.
Signs of Progress
Despite barriers, there are encouraging signs that hospices are beginning to prioritize behavioral health. Providers are increasingly aware of the unmet needs in their communities, and some are implementing targeted programs and partnerships with behavioral health providers.
At the same time, digital tools and caregiver support platforms like eFamilyCare are emerging to bridge gaps in access. These innovations, coupled with greater awareness, may help hospices make incremental progress toward comprehensive, integrated care models.
Looking Ahead
The path forward requires stronger collaboration between hospice providers, behavioral health specialists, policymakers, and researchers. Greater investment in research and funding will be critical to overcoming barriers and developing best practices.
Ultimately, addressing behavioral health in hospice care is about improving quality of life. Patients facing terminal illness deserve compassionate, holistic support that recognizes the connections between mind and body. Families need guidance and resources to cope with both loss and the mental health challenges that may come with it.
As the aging population grows, hospices that prioritize behavioral health will not only meet an urgent need but also position themselves as leaders in compassionate, whole-person care. By continuing to advocate for change, the hospice field can move closer to a future where mental and emotional well-being are seamlessly integrated into end-of-life care.
