A new vision for palliative care and psychiatry in South Africa

This weekend I’m preparing to head down to Cape Town to teach at the University of Cape Town for the Postgraduate Diploma in Palliative Medicine. It’s always a highlight of my year. The students in this program are a diverse, deeply committed group of professionals who bring such richness and humanity to the work of palliative care. Teaching here never feels like a one-way lecture—it’s a dialogue.  I’ll be speaking on Neuropathic Pain and Central Sensitisation on Monday, and on Tuesday, sharing a topic especially close to my heart: Psychiatry and Palliative Care.

Getting to teach on subjects I care so deeply about—and having that passion reflected back by others—is such a powerful experience. I always leave UCT feeling energised, full of new ideas, and with new professional connections that often turn into enduring collaborations.

As I prepare, I keep wondering what the barriers are to collaboration between psychiatry and palliative medicine in South Africa? And most importantly, how do we dissolve these barriers?

Is it a lack of awareness? Perhaps many don’t know the profound impact psychiatric input can have—supporting patients through depression, anxiety, delirium, existential distress, and complex grief.

Or maybe people simply don’t know who to call. Psychiatric care in palliative medicine demands a specific kind of expertise—someone who not only understands mental health but can approach it with gentleness, nuance, and a respect for the person’s values, stage of illness, and goals of care.

Could it be an outdated institutional culture—one that still sees psychiatrists as only relevant in crisis: psychosis, suicidality, agitation?

Or is it the persistent stigma around mental health? That unspoken fear that asking for psychiatric help somehow implies weakness, or shame, or failure?
I don’t know the full answer yet. But I do know this: we need to start changing the culture.

This week, I had the immense privilege of a Zoom coffee with two leaders in the field—Dr Keri Brenner and Dr Danielle Chammas, pioneers in integrating psychiatry and palliative care in the United States.

It was humbling to be included in their community, to be part of a global conversation that is slowly but steadily reshaping how we think about suffering, healing, and presence.

How do we translate this global conversation and make it relevant to our cultural landscape in South Africa? These questions fill me with hope. Because if we start now—if we begin to shift attitudes, and open space for collaboration—just imagine where we could be in 10 years.

by Dr Michelle Beukes-King