A new report by Dr Sarah Yardley (Marie Curie Palliative Care Research Department, UCL Division of Psychiatry) calls for a major rethink of how palliative care is designed and delivered for people with complex mental health conditions.
The report, Rewilding healthcare by cultivating relational systems to reimagine palliative care, argues that current systems are failing some of the most marginalised individuals due to structural, relational and cultural gaps across health and social care services.
Dr Yardley was awarded a Churchill Fellowship in 2024 funding her to travel to learn from global innovators how palliative care can be reimagined for people with severe mental illness. The resulting Churchill Fellowship report, highlights that people with advanced, incurable physical illness already face multiple decision points within fragmented systems, but when layered with complex mental health conditions, these individuals often encounter inconsistent care, stigma, and systemic blind spots. Dr Yardley asks how health and social care can better respond to the realities of those whose needs do not neatly fit existing service boundaries.
Dr Yardley said: “Healthcare systems around the world are grappling with a challenge: everybody dies but not everyone gets the palliative care that they need. This is a World Health Organization priority, and it has the greatest impact on people with the most complex needs, including those already living with significant mental health challenges.”
“This report presents a substantial new finding with real‑world consequences: when relationship, not structure, becomes the organising principle of care, systems can be transformed to meet these needs more effectively, more humanely, and with better use of resources. The evidence gathered across three continents shows that relational models are not only possible, but are already delivering measurable improvements in the experience of care and effective use of system resources.”
Drawing on international case studies from Australia, Canada, USA, and Finland the report identifies global models that place relationships between professionals, patients, families, and wider communities at the centre of care. These include innovative place‑based systems such as the Southcentral Foundation Nuka System of Care in Alaska and relational, community‑embedded palliative care approaches in Toronto and Melbourne. Dr Yardley argues these examples demonstrate how relational thinking can drive resilience, equity, and more humane system design.
The report sets out a vision for systemic change, calling for new approaches to inclusion, equity, risk, and resource stewardship, as well as practical recommendations to reshape UK palliative care so that people living with complex mental health conditions are no longer left out. It concludes with a call to build a movement for change that redefines care ecosystems, emphasising that meaningful relationships are essential to improving outcomes.
“People living with complex mental health conditions often fall through the gaps when they develop serious physical illness, and as a result, they are only half as likely to receive the palliative care they need,” Dr Yardley said, “This report shows that it doesn’t have to be this way. By redesigning healthcare so that relationships, not rigid structures, guide decisions, services can respond earlier, reduce avoidable crises, and offer care that feels humane, safe, and joined‑up. The findings speak to anyone shaping or delivering health and social care: policymakers, clinicians, service planners, charities, community organisations, and the wider public. This is a call to rethink how we design care, and to build a system where no one is seen as ‘too complex’ to deserve it.”