People with unbearable psychiatric suffering and a chronic death wish: Who are they and what changes do they experience in the care and expertise centre Reakiro? A Belgian cross-sectional study

Introduction People with unbearable psychiatric suffering and a chronic death wish are a subgroup of patients with Severe and Persistent Mental Illness (SPMI; Moureau et al. , FiP 2023; 14:1094038). They suffer from at least one, but usually multiple psychiatric disorders, in a chronic course, resulting in severe limitations in psychosocial functioning (Woods et al. , CJP 2008; 53 725-736.). Their chronic death wish is rooted in their struggle with life and death and diminished perspective on the alleviation of their suffering. They are at risk for suicide and/or are eligible to request euthanasia as legislated in Belgium. Reakiro is a Belgian pilot project and a drop-in, care and expertise centre developing tailored mental healthcare for this target population in addition to continued care as usual. Objectives To describe psychological and existential characteristics, care needs, experienced changes and the correlations between these variables in 107 consecutive Reakiro patients who agreed to participate in this study. Methods The Beck Scale for Suicide Ideation (BSSI), Dutch Empowerment Scale (DES), Herth Hope Index (HHI), Meaning In Life Measure (MILM), Existential Concerns Questionnaire (ECQ), Outcome Questionnaire-45 (OQ-45) and the Change Questionnaire (CQ) were administered combined with an assessment of their life and death wish and of how they experience the care in Reakiro. Results The BSSI (M = 21.78, SD = 8.48), DES (M = 113.39, SD = 20.42), HHI (M = 24.15, SD = 5.40), MILM (M = 5.39, SD = 1.50), ECQ (M = 62.13, SD = 12.10) and OQ-45 (M = 98.93, SD = 20.50) show heightened levels of suicidality, existential anxiety and symptomatology and lowered levels of hope, meaning in life and empowerment, compared to other psychiatric and non-clinical samples. Longer trajectories in Reakiro were correlated with heightened hope and lowered symptomatology, but not with suicidality. The preliminary CQ-analysis revealed 31 participants reporting positive changes in their relation to life and death, to self and others and to hope and future; 8 participants reported negative changes in their relation to life and death. Conclusions The results depict a concrete profile of the severity of the suffering and suicidality in these patients. The mixed-methods design reveals a major group that does not report any change and suffers greatly, but also a minor group that reports positive changes and even lowered suicidality. Clinical implications for psychiatric healthcare professionals will be discussed. Disclosure of Interest None Declared