(021) Motivating and mobilizing: Leveraging psychiatric providers and settings to maximize vaccinations among individuals with serious mental illness

Abstract: Background
Individuals with serious mental illness(SMI) are at increased risk of hospitalization and mortality from respiratory infections, including COVID19, influenza, and pneumonia(1,2). Nonetheless, they are less likely to utilize vaccinations partly due to low health literacy, attitudinal hesitancy, and practical barriers(2,3). A multipronged approach is needed to address these barriers. Psychiatric clinics where patients are seen frequently and longitudinally provide an ideal venue for this approach with psychiatric providers being best positioned to promote healthy behavior of vaccination given their expertise in motivational interviewing and nudging(3). Mobile Vaccine Clinics(MVCs) in psychiatric settings can remove practical barriers to accessing vaccines.

Methods
Using a three pronged approach, we first mobilized psychiatric providers at a community mental health center through in-service education to identify and address barriers to COVID19 vaccination in a cohort of 193 clozapine-treated patients from February to June 2021. Secondly, a vaccination monitoring tool was created in electronic medical records (EMR) to track vaccination intention, hesitancy, and uptake at each outpatient visit. We replicated the intervention in a neighboring psychiatric clinic not only to encourage COVID19 vaccines, but also influenza and pneumococcal vaccines. Finally, in collaboration with a pharmacy, we set up MVCs in psychiatric settings, offering COVID19 and influenza vaccines.

Results
By June 30, 2021, the COVID19 vaccination rate in our pilot cohort was 84.5%, higher than the Massachusetts rate estimated to be between 62.5% and 77% at the time. While attitudinal hesitancy seemed to decrease over visits, practical barriers (scheduling, transportation, remembering appointments) commonly remained. Setting up MVCs subsequently increased the COVID19 vaccination rate to 93%, with many patients receiving the influenza vaccine simultaneously. In a short questionnaire about the MVC experience, nearly all participants reported it was easy accessing vaccines, with most preferring MVCs for future vaccinations.

Discussion
When psychiatric providers were empowered to lead vaccine discussions with patients using a standardized vaccine monitoring tool in EMR, their patients had high COVID19 vaccination rates. Embedding MVCs in psychiatric settings was preferred and cost-effective (pharmacy was reimbursed by insurance), and removed practical barriers, particularly for those who may have cognitive limitations associated with SMI.

Conclusion/Implications
This multi-pronged approach of integrating preventive care and mental health care in psychiatric settings was highly effective in maximizing vaccine uptake in people with SMI. Leveraging psychiatric providers and settings can help protect people with SMI against vaccine-preventable respiratory diseases, reduce health disparities, and benefit public health.

References

1. Olfson M, Gerhard T, Huang C, et al. Premature mortality among adults with schizophrenia in the United States. JAMA psychiatry. 2015;72(12):1172-81.

2. Siva N. Severe mental illness: reassessing COVID-19 vaccine priorities. The Lancet. 2021;397(10275):657.

3. Lim C, Van Alphen M, Freudenreich O. Becoming vaccine ambassadors: A new role for psychiatrists. Curr Psychiatry. 2021;20(8):10-1.