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Palliative Care Psychiatry Programs


Winner of the 2009 American Psychiatric Association’s Psychiatric Services Gold Achievement Award

The Palliative Care Psychiatry Programs at San Diego Hospice and The Institute for Palliative Medicine combine clinical innovation, applied research, and professional education to improve mental health care for a seriously-ill and highly-vulnerable population at a highly significant time for both patients and families. Located on the campus of a large hospice organization with an average daily census of over 1,000 patients, the program is unique in its exclusive focus on the mental health needs of hospice and palliative care patients, their loved ones, and their informal caregivers.

These programs address the under-recognition and under-treatment of psychiatric symptoms when the end of life is near. Standard pharmacologic treatments are frequently not appropriate for these patients, but we are showing that rapid screening, identification, and treatment of psychiatric symptoms – often within hours of initiating hospice care – can make a drastic difference in the lives of our patients and the lives of their loved ones.

There are multiple complex medical and psychosocial issues faced at the end-of-life. These issues constitute a major impact on the individual as well as family members, and often result in financial costs for these families, as well as society. These issues create both a substantial burden to and a tremendous opportunity for our healthcare system as a whole. Palliative care aims to relieve suffering and improve quality of life throughout an illness and bereavement experience, so that patients and families can realize their full potential to live, even when someone is dying. The need for psychiatrists to work with patients and families living with life-limiting illnesses in support of this aim has never been greater. The Palliative Care Psychiatry Programs at San Diego Hospice and The Institute for Palliative Medicine are setting a new standard of whole-person care for dying patients and their families.

Featured In

Dr. Irwin discusses the benefits of the palliative care model when used within the existing healthcare system on the recent UCSDTV segment: Research on Aging: The Opportunity for Health Care via Hospice and Palliative Care.

Palliative Care Psychiatry: What Is It and Does It Work? An interview with Dr. Irwin by Medscape Psychiatry & Mental Heath

“San Diego Hospice Offers Psychiatric Care To Ease Suffering” as heard on KPBS San Diego, to listen to radio broadcast. Dr. Irwin discusses the opportunity for psychiatry in palliative care.

An Expert Interview With Jeremy M. Hirst, MD by Medscape Medical News on The Challenge of Psychopharmacology for Children With Advanced Illnesses a Challenge.

Gift Giving

The Palliative Care Psychiatry Programs are primarily supported by donations from the generous benefactors of the education and research programs at The Institute for Palliative Medicine at San Diego Hospice.


The Palliative Care Psychiatry Clinical Programs are staffed by five psychiatrists, a psychologist, and a hypnotherapist. The psychiatrists are available 24 hours a day for on-call services within the inpatient, home, clinic, and long-term-care hospice care settings as requested by hospice team members. In addition, they provide psychiatry consults to the community in support of providing palliative care. Our psychologist provides psychotherapy for hospice patients, largely through the use of Dignity Therapy.

The hypnotherapist provides therapy for hospice patients upon request from any of the staff, primarily for symptom management, such as those of pain and anxiety.

Educational Programs

The Palliative Care Psychiatry Educational Programs provides education on palliative care psychiatry to hospice staff, institutional partners, and to many of the 1,700+ healthcare students who rotate through The Institute for Palliative Medicine each year. We are also proud to announce the inaugural year of fellowship training in Palliative Care Psychiatry (click here for more information). In addition, this program supports:

  • Week-long required palliative care psychiatry rotations for psychiatry residents from the University of California, San Diego (approximately 9/year).
  • Year-long elective palliative psychiatry rotations for senior psychiatry residents from the University of California, San Diego (approximately 2/year).
  • Ongoing palliative care psychiatry interactive lectures and grand-round education for every 3rd-year UCSD medical student (124/year), and for family practice and internal medicine residents from 8 different residency programs operating in San Diego County (approximately 80/year).
  • Research mentoring for trainees (11 to date ranging from undergraduate nursing and BS students to psychiatry residents, as well as geropsychiatry and psychopharmacology fellows).
  • Training in basic palliative care psychiatry for palliative medicine fellows from across the US and from developing countries such as Mongolia, Vietnam, Jordan, the Republic of Georgia, and Pakistan (approximately 15/year).

Research Programs

The Palliative Care Psychiatry Research Programs currently has over 6 studies that are currently active or under development.

Research topics include:

  • Rapid pharmacologic treatment of depression
  • Rapid management of agitation
  • Decision-making capacity and levels of unrecognized cognitive impairment in hospice patients
  • Caregiver stress and burden
  • Dignity Therapy


As Director, Dr. Irwin provides overall administration for the program, is the educational and clinical leader in addition to providing direct clinical services, and is the Principal Investigator for all current Palliative Care Psychiatry Programs research.

The program is currently staffed by five psychiatrists, a psychologist, a hypnotherapist, and two volunteers.

Scott A. Irwin, M.D., Ph.D.
Chief of Psychiatry & Psychosocial Services

Jeremy M. Hirst, M.D.
Assistant Director, Palliative Care Psychiatry Clinical and Educational Programs

Lori Montross, Ph.D.
Assistant Director, Palliative Care Psychiatry Research Program

Michelle Lemarie
Assistant Director, Palliative Care Psychiatry Hypnotherapy Program

Julie Le, D.O.
Psychiatric Consultant

Alana Iglewicz, M.D.
Psychiatric Consultant

Steve Koh, M.D.
Psychiatric Consultant

Laura Chambers

Karen Lamphere

Palliative Care Psychiatry Fellowship

The Institute for Palliative Medicine (IPM) is proud to offer the first palliative care psychiatry fellowship training program in the United States. This training program is designed for psychiatrists who wish to become sub-specialists and pursue a long-term career as a clinician or academician in palliative care psychiatry. The program’s educational objectives are to help each trainee:

  • Become an expert in palliative care psychiatry
  • Obtain intermediate knowledge of palliative medicine
  • Demonstrate communication and collaboration skills
  • Exemplify professionalism
  • Demonstrate clinical scholarship and improvement
  • Advocate for patients and families
  • Fellows will gain experience in a variety of settings, including hospice inpatient/acute care centers, patients’ homes, long-term care, or as a consultant at an acute care hospital. These experiences will prepare fellows to become leader in palliative care psychiatry, education, advocacy and/ or research.

Some of the most widely-recognized physicians and researchers in palliative medicine from places as far away as Maine and as near as local medical schools come to teach and learn.

Fellows are expected become leaders and leave ready to infuse the special insights of palliative care psychiatry, palliative medicine, and whole-patient/family approaches into their own communities and/or institutions.

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