When watching the news or reading articles about COVID-19, the physicians who contribute are often in internal medicine, epidemiology, emergency medicine, etc. You do not typically see psychiatrists contributing to discussions on the virus itself but more about the mental health ramifications of COVID-19.
Psychiatrists are also not often considered integral in the role of vaccine educators. But I argue that they, in fact, play a vital role in educating a large group of our patient population that is not getting vaccinated. Psychiatrists see the patients that are the most hesitant and skeptical about receiving the COVID-19 vaccine. Patients with severe mental illness (SMI) already have a reduced lifespan compared to the general population for various reasons and social determinants.
Rates low in the mentally ill
Rates of vaccination are much lower than the general population as well. Studies show vaccination rates as low as 25 percent amongst those with severe mental illness. Outside of physical determinants making getting the vaccine harder, many of these patients have underlying paranoia as part of their illness. There have been so many conspiracy theories about this virus that have only propagated the paranoia in this population.
A common theme amongst those with paranoia and delusions is the thought that chips are being implanted inside their bodies. Sadly, this is also one of the main conspiracy theories about the vaccine that are circulating right now. These distorted thoughts only add to the barriers that cause vaccination rates to be so low in this population. But poor vaccination rates are not just limited to those with SMI. Those with persistent mental illness or chronic mental illness are also among those refusing to get vaccinated.
I am a psychiatrist in Mississippi. I was born and raised in Mississippi and love practicing here. I truly consider it an honor. But sadly, we are the state with the lowest vaccination rates. This has been disappointing, but with the new Delta variant, it is disappointing and scary. All physicians must make a concerted effort to reach the nonvaccinated population.
Open conversation about safety
I make it a point to reserve time at the end of every appointment to talk about the COVID vaccine and to hear their thoughts or hesitation about the vaccine. These patients are often treated for anxiety and are naturally more anxious and worried about receiving the vaccine. By and large, these patients are most worried about how quickly the vaccine was produced and not knowing the long-term side effects. However, most of these patients are open to conversation and want to learn more about the vaccine.
Empathy and understanding are huge in these discussions. Lead with facts but go easy on the medical jargon. Medical terms in themselves can sound very scary. Put it in terms that non-medical patients can understand easily. I have seen the most success when discussing the vaccine in terms of risk vs. benefit because you can also include the patient in making the list of risks vs. benefits. It gives them a sense of reaching the decision by themselves and not being told what to do.
We all like to have control of things happening to us and in our lives. Control reduces anxiety. In addition to empathy and engagement, trust is essential in these conversations. I have treated most of my patients for years now. They have told me their deepest thoughts, and I have gained their trust over time. Use your patient’s trust in you to show them that they can trust you about the vaccine. One of the easiest ways to keep their trust and encourage them to get the vaccine is to tell them about your own vaccine experience.
Good or bad, be honest
Tell them about your vaccine experience and what they may experience, even with the negatives. Be truthful. They will appreciate your truthfulness and continue to trust you. Another way psychiatrists can educate about vaccinations is via social media. Social media has exploded with pictures of physicians getting their vaccines and I highly encourage psychiatrists to put your post out there so that those with mental illness can see that psychiatrists trust the science. I have had many patients tell me that “if their doctor is getting the vaccine, then they must need to as well.”
But getting your patients to agree to the vaccination is just one part of the equation when looking at ways to increase rates of vaccinations amongst those with mental illness. Removing the social/physical determinants that prevent these patients from physically getting the vaccine is the hard part. We need to have an ongoing dialogue, not just when there is a pandemic and need this population to get vaccinated. We need to be actively and constantly searching for solutions to address health care needs in this vulnerable population.