Patterns of healthcare including palliative care in the last year of life for people with mental illness and/or addiction: An intersectional cohort study
Helen Butler, Jackie Robinson, Merryn GottBackground
People with mental illness and/or addiction experience persistent inequities in physical healthcare, multimorbidity and premature mortality. Little is known about how healthcare responds to this group across intersecting identities in the last year of life.
Objectives
To describe healthcare access and utilisation in the last year of life for people with a diagnosis of mental illness and/or addiction in two Aotearoa NZ regions and examine variation across intersecting identities.
Methods
A retrospective cohort study using linked national datasets to identify adults with sustained contact with publicly funded mental health and/or addiction services who died between 2015–2020 integrating last year of life health service use. Analysis was intersectionality-informed.
Results
The cohort included 475 people. Most lived in areas of socioeconomic deprivation and had at least one recorded physical illness. Heart-related conditions were the leading cause of death. Although most had contact with at least one health service in their last year of life, fewer than 10% accessed specialist palliative care. Descriptive differences were observed across intersections.
Conclusion
Descriptive patterns of end-of-life healthcare varied across the intersecting physical, mental and social characteristics, indicating that diagnosis alone does not capture the complexity observed within this population. Embedding inclusive, culturally grounded and trauma-informed palliative approaches within generalist settings may address current disparities.