Place of Death for People with Schizophrenia and Bipolar Disorder in New Zealand: A National Retrospective Cohort Study

Objectives: Inequities in access to physical health care for those with mental health conditions and substance use disorders are well recognised, and evidence of unequal access to palliative care is emerging. This study uses complete national data to examine the place of death for those with specific mental health conditions in Aotearoa New Zealand. Methods: Mortality data between 2013 and 2018 was linked to secondary mental health service usage. Place and cause of death were compared between those with diagnoses of bipolar affective disorder or schizophrenia and those without, stratified by ethnicity. Results: A cohort of 498,293 individuals was identified. People diagnosed with bipolar disorder and schizophrenia had different patterns of cause and place of death from other New Zealanders. This group was less likely to die in hospices, even after adjustment for differences in cause of death and age (adjusted OR 0.59, CI 0.52-0.68). Patterns of place of death differed by ethnicity. Conclusions: Inequities in healthcare provision for those diagnosed with psychotic disorders continue at the end of life, with reduced access to hospice facilities. Further research is needed to understand the quality of healthcare provision and wishes of those with mental health conditions in end-of-life care.