RESEARCH WEEKLY: COVID-19 Vaccination and Severe Mental Illness
By Elizabeth Sinclair Hancq
Today, just over 18% of the United States population have received at least one dose of a COVID-19 vaccine and 9.4% are fully vaccinated. While the vaccines will not eliminate COVID-19 entirely, they are very effective in reducing serious illness and death from COVID-19 infection.
People with severe mental illness are at significantly higher risk for developing serious complications from contracting COVID-19. As we wrote earlier this year, new data suggests schizophrenia is the second largest risk factor for death from COVID-19, second only to age. Therefore, vaccinating this vulnerable population is critical.
There are multiple barriers to ensuring vaccination among people with severe mental illness, even beyond the limited availability of the COVID-19 vaccine itself and state variation for its distribution. Vaccine hesitancy, limited access to preventative health services and overall lack of resources all contribute to the challenge of vaccinating this population.
Public health experts have looked to research about the influenza vaccine to inform best practices to establishing a COVID-19 vaccine program. Previous research indicates that only 25% of adults with severe mental illness receive the annual flu vaccine, compared to almost 50% of adults in the general population. However, previously published research studies that aim to understand flu vaccination willingness and barriers to access in people with severe mental illness may help in filling knowledge gaps around COVID-19 vaccination in this population.
Vaccination barriers in severe mental illness
Research first published in March 2019 in the Journal of American Psychiatric Nurses Association found significant barriers to receiving immunizations among people with serious mental illness. The researchers from Brigham Young University surveyed individuals with serious mental illness to understand their perceptions of vaccinations and barriers to receiving them. Of the 392 people with serious mental illness who participated in the survey, the following barriers to vaccination were found, in order of significance:
- lack of awareness and knowledge,
- accessibility,
- costs, and
- fears about vaccinations.
They used the results of this survey to inform a vaccination program targeted to this population that included a partnership between a county health department and community mental health center. Because accessibility and costs were both significant barriers people with severe mental illness reported in receiving immunizations, the study leaders developed mobile vaccination clinics at outpatient mental health clinics. Simple and low-cost marketing strategies were used to provide education on the importance of immunization to address lack of awareness and knowledge. Of the 85 people who participated in a survey after receiving the immunization, 94% of participants responded saying they would like to receive future vaccinations at their community mental health center.
Another study published in 2018 in Australasian Psychiatry examined the willingness of people with schizophrenia to adopt protective behaviors in response to the swine influenza pandemic of 2009 in Australia. The study authors, from the Australian National University Medical School, surveyed 71 adults with schizophrenia and 238 without, all in a general primary care practice setting. Almost three-quarters of individuals with schizophrenia reported they would be willing to isolate themselves to stop the spread of the swine flu, while only 55% of participants reported a willingness to wear a face mask. Although 74% of people reported they were “at least moderately willing” to be vaccinated, 72% of participants reported they thought they would get the flu from vaccination, indicating a high-level of misconceptions and lack of knowledge about how vaccines work to protect individuals from illness in people with schizophrenia.
Establishing a COVID-19 vaccination program
Nicola Warren and colleagues from the University of Queensland in Brisbane Australia discussed strategies to increase the uptake of the COVID-19 vaccine in people with severe mental illness in an article published in JAMA Psychiatry late last year. Education about the importance of vaccination and directly addressing negative beliefs about the safety of the vaccine was chief among their recommendations. They suggest that mental health professionals may be in the best position to deliver this education due to the level of trust among people with severe mental illness and experience in adapting communications to this population to assist in their decision making.
References:
