BACKGROUND: Palliative care (PC) aims to improve quality of life for individuals with serious illness, yet mental health needs in this population often remain underaddressed. Currently, little is known about how patients and caregivers perceive the role of mental health services within PC.

OBJECTIVES: To explore patient and caregiver perspectives on 1) current delivery of mental health support in PC for serious medical illnesses and 2) preferences for integrated specialty mental health services.

METHODS: We conducted semistructured interviews with 23 patients receiving ambulatory PC and 11 caregivers at an academic medical center. Interviews explored experiences with mental health care, perceived roles of PC, and preferences for integration. Transcripts were analyzed using thematic analysis.

RESULTS: Participants described strong therapeutic relationships with PC clinicians, who offered informal mental health support through conversations, medication management, and referrals. However, many were uncertain whether mental health care formally fell within providers' roles. Both patients and caregivers expressed broad support for integrated mental health services, citing benefits such as improved care coordination, streamlined logistics, and access to clinicians with knowledge about serious illness. Caregivers emphasized their own emotional burdens and advocated for inclusion as recipients of mental health support.

CONCLUSION: Patients and caregivers view integrated mental healthcare as a valuable addition to PC. Integration models should include specialist mental health providers, address caregiver needs, and offer flexible delivery formats. PC's transdiagnostic scope, interdisciplinary structure, and psychosocial orientation make it a strategic site for integrated care.