Introduction Do individuals with severe mental illness receive equitable care in the last year of life? People living with severe mental illness (SMI) have higher morbidity rates compared to general population. This is partly explained by lifestyle factors; however there is emerging evidence that the increased prevalence rates of cancer and infectious diseases are also attributable to the lack of appropriate healthcare provision, including in the last year of life. For these patients, tasks to quantify the degree of under-use of medical care, as well as to draw health economic implications have been challenging for researchers.

Aim(s) and method(s) To estimate whether people with SMI in the UK have poorer access to healthcare services in the last year of life. The analysis utilises the Heath Improvement Network, a UK primary care database with over 450 General practices. In the cohort study, we identify patients with and without SMI deceased due to cancers and infectious diseases and estimate the reduced likelihood of receiving adequate medical attention for patients with SMI, adjusting for various factors such as race and deprivation area. Patient, provider, and system-level factors are integrated to consider health outcomes in people with SMI.

Results Compared to demographically similar general practice patients, people with SMI diagnosis have fewer recorded screening tests, lifestyle counselling and referrals for treatments. Furthermore, they frequently receive inadequate advice from healthcare professionals regarding modifiable risk factors. Disparities are also seen after medical hospitalizations.

Conclusion(s) Fragmentation of healthcare produces poor outcomes for individuals with SMI. Health economic, clinical and research implications are drawn.