The coronavirus disease 2019 (COVID-19) pandemic will present an unprecedented stressor to patients and health care systems across the globe. Because there is currently no vaccine or treatment for the underlying infection, current health efforts are focused on providing prevention and screening, maintaining continuity of treatment for other chronic conditions, and ensuring access to appropriately intensive services for those with the most severe symptoms.1
Disasters disproportionately affect poor and vulnerable populations, and patients with serious mental illness may be among the hardest hit. High rates of smoking in this population may raise the risk of infection and confer a worse prognosis among those who develop the illness.2 Residential instability and homelessness can raise the risk of infection and make it harder to identify, follow up, and treat those who are infected.3 Individuals with serious mental illnesses who are employed may have challenges taking time off from work and may lack sufficient insurance coverage to cover testing or treatment. Small social networks may limit opportunities to obtain support from friends and family members should individuals with serious mental illness become ill. Taken together, these factors may lead to elevated infection rates and worse prognoses in this population.
What strategies are available to mitigate the outcome of this epidemic among patients with serious mental illness? Federal preparedness policies developed in the wake of complex disasters have increasingly embraced the notion of whole community preparedness, which supports building and supporting structures at multiple levels to prepare and respond, particularly for vulnerable populations.4 Within the public mental health care system, this includes engagement with mental health service users, clinicians, and federal and state policies.
Author：Benjamin G. Druss