Reakiro: a care model for people with a well-considered death wish due to unbearable psychiatric suffering

Reakiro is a walk-in house where people with a death wish due to unbearable mental suffering caused by psychiatric illnesses are welcome to gather information on psychiatric euthanasia (PE) or seek support, shelter, recovery-oriented care and existential counselling when struggling with the life-or-death dilemma. The aim of Reakiro is to create tailored mental healthcare attuned to this target population with a central focus on facing the death wish together to arrive at well-considered, authentic decision making. The scientific evidence exploring the care needs of the target population is scarce. This doctoral project wishes to address this hiatus. Complementary to preliminary qualitative findings that are already available, a quantitative research design was developed to inquire into existential, palliative and recovery-oriented topics of interest such as hope-hopelessness, meaning-meaninglessness, suicidality, empowerment, demoralisation, existential anxiety and quality of mental health care. These variables were selected as meaningful targets of research by reviewing the available literature concerning end-of-life care, cross-referenced with the experiential expertise of a multidisciplinary team of caregivers in this novel field of mental healthcare. A cross-sectional study will describe the target population and explore how the target population relates to the above mentioned key concepts, with the use of psychometrically validated, as well as our own developed self-report questionnaires. Bivariate associations between the key variables will be explored and the target population will be tested on its homogeneity in relation to those variables. In a subsequent longitudinal study we will explore how the key variables change over time for the group of people visiting Reakiro and if these key variables can predict whether people will initiate the formal euthanasia procedure. The data collection for these studies is ongoing. In a second phase of the doctoral project, comparative studies will be set up to test whether the population of Reakiro can be distinguished from other populations with similar characteristics, such as a population requesting psychiatric euthanasia without calling on the care of Reakiro or a population of patients with severe and persistent mental illness who do not hold a death wish.