Give Psych Patients the COVID Vaccination Now, Experts Say

Megan Brooks

December 17, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

With COVID-19 vaccinations now underway, mental health experts around the world continue to push for patients with serious mental illness (SMI) to be considered a high priority group for the vaccine.

Research shows that patients with SMI are at increased risk of being infected with SARS-CoV-2 and have higher rates of hospitalization and poor outcomes, Nicola Warren, MBBS, University of Queensland, Brisbane, Australia and coauthors write in a viewpoint published online December 15 in JAMA Psychiatry  

Factors behind the worse outcomes in individuals with SMI include concomitant medications, poorer premorbid general health, physical comorbidity, reduced access to medical care, and environmental and lifestyle factors such as lower socioeconomic status, overcrowding, smoking, and obesity.

"In light of these vulnerabilities, it is important that people with SMI are a priority group to receive a vaccination," Warren and colleagues say.

Yet there are challenges at the individual and public health level in getting people with SMI vaccinated against COVID-19, they point out.

Challenges at the individual level include getting people with SMI to recognize the importance of the vaccine and combating negative beliefs about safety and misconceptions that the vaccine itself can make them sick with COVID-19.

Mental health professionals are "uniquely skilled" to deliver vaccine education, "being able to adapt for those with communication difficulties and balance factors influencing decision-making," Warren and colleagues write. 

System-level barriers to vaccine uptake in people with SMI include access, awareness of services, cost, and other practical considerations, like getting to a vaccination clinic.

Research has shown that running vaccination clinics parallel to mental health services can boost vaccination rates by 25%, the authors note.  Therefore, one solution may be to embed vaccination clinics within mental health services, Warren and colleagues suggest.

Join the Chorus

Plans and policies to ensure rapid delivery of the COVID-19 vaccine is "vital," they conclude. "Mental health clinicians have a key role in advocating for priority access to a COVID-19 vaccination for those with SMI, as well as facilitating its uptake," they add.

Warren and her colleagues join a chorus of other mental health care providers who have sounded the alarm on the risks of COVID-19 for patients with SMI and the need to get them vaccinated early.

In a perspective article published last month in World Psychiatry, Marc De Hert, MD, PhD, professor of psychiatry at KU Leuven in Leuven, Belgium, and coauthors called for individuals with SMI to have priority status for any COVID-19 vaccine, as reported by Medscape Medical News.

De Hert and colleagues noted that there is an ethical duty to prioritize vaccination for people with SMI given their increased risk of worse outcomes following COVID-19 infection and the structural barriers faced by people with SMI in accessing a vaccine.

Joining the chorus, Benjamin Druss, MD, MPH, from Emory University, Atlanta, Georgia, warned in a JAMA Psychiatry viewpoint in April that the COVID-19 pandemic represents a looming crisis for patients with SMI and the healthcare systems that serve them. 

"Careful planning and execution at multiple levels will be essential for minimizing the adverse outcomes of this pandemic for this vulnerable population," Druss wrote.

The authors have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online December 15, 2020. Viewpoint

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