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Published Online: 8 February 2023

Mobile Vaccine Clinics for Patients With Serious Mental Illness and Health Care Workers in Outpatient Mental Health Clinics

Abstract

Objective:

People with serious mental illness are particularly vulnerable to COVID-19 but face barriers to vaccinations. The authors describe the implementation of a mobile vaccine clinic at an outpatient mental health clinic for patients and health care workers to increase vaccination rates.

Methods:

In late 2021, mobile vaccine clinics were held in collaboration with a local pharmacy to provide COVID-19 and influenza vaccines to patients and health care workers. Participants in one clinic were asked to fill out a questionnaire about their experience.

Results:

Of 69 individuals who completed the questionnaire, 96% received the COVID-19 booster and 17% received the seasonal flu vaccine. Most patients and health care workers reported that the mobile vaccine clinic was easily accessible and preferable and that they would recommend it. Moreover, the mobile vaccine clinic was cost-effective.

Conclusions:

Mobile vaccine clinics can improve vaccine access for patients and health care workers in community mental health settings and can be cost-effective.

HIGHLIGHTS

Persons with serious mental illness have an increased risk of dying from COVID-19 and other vaccine-preventable, pulmonary infections, and they face numerous access barriers to vaccinations.
Community mental health settings can be leveraged for targeted outreach to vaccinate this group as part of a multipronged approach where mental health care providers encourage vaccinations and mobile vaccine clinics facilitate immediate follow-through.
Mobile vaccine clinics are a scalable and cost-effective intervention that can be targeted to patients but can also serve health care workers, leading to community protection from infections and reducing health disparities.
Individuals with serious mental illness, which includes schizophrenia, bipolar disorder, and persistent depression, are particularly vulnerable to COVID-19. Presence of schizophrenia spectrum disorders is associated with the highest risk of death from COVID-19 complications, second only to age, even after adjusting for comorbid conditions (1). Pulmonary infections are a leading cause of death among people with serious mental illness (2), highlighting the importance of preventing respiratory infections with vaccinations. However, people with serious mental illness are less likely to receive vaccinations because of vaccine hesitancy and barriers to access (3, 4), with influenza vaccination rates as low as 25% in this population. Furthermore, during COVID-19 vaccine rollouts, individuals with serious mental illness were undervaccinated compared with the general population, despite efforts to prioritize them given their high risk for severe COVID-19 outcomes (5).
Psychiatric providers can be leveraged for targeted outreach given their expertise in behavioral management skills and frequent contact with patients with serious mental illness (4). Previously, we conducted a pilot education intervention at a community mental health clinic in Boston, which involved training psychiatric providers to educate patients with serious mental illness about COVID-19 vaccinations and help them overcome barriers to getting vaccinated (5). Although the overall vaccination rate in this cohort increased compared with that of the general population in the area, some patients remained unvaccinated because they still faced barriers related to scheduling, transportation, and remembering appointments (5), a finding consistent with other literature (6).
Under current federal regulation, health care professionals at mental health clinics cannot administer vaccines. Vaccines, however, can be administered by mobile vaccine clinics—that is, when a mobile pharmacy travels to a site to administer vaccines. A mobile vaccine clinic providing multiple different vaccines (such as annual influenza, pneumococcal, hepatitis A, hepatitis B, and other vaccines), and set up at a mental health care site before the COVID-19 pandemic, increased vaccination rates by up to 25%, with most users of this service reporting high satisfaction with mobile vaccine clinics (7). In other medically vulnerable and underserved populations, mobile vaccine clinics providing COVID-19 vaccination have been effective in overcoming practical barriers to increase vaccination rates (8, 9). However, to our knowledge, no mobile clinics for the COVID-19 vaccine have been used in a mental health setting to target patients with serious mental illness.
When mobile vaccine clinics are deployed in mental health clinics, the ease of vaccination access can also benefit health care workers—which we define here to include staff at that clinic as well as other supporting staff from group homes or case management teams who often accompany patients with serious mental illness to their appointments. Vaccinated workers are less likely to get sick and miss work, to transmit viruses to patients and colleagues (10), and to negatively influence patients’ vaccine hesitancy (11). Additionally, health care workers belonging to racial and ethnic minority groups have been shown to have greater vaccine hesitancy and lower vaccination rates despite their increased risk for more severe COVID-19 outcomes (12, 13); thus, just like patients, health care workers could benefit from improved vaccine access.
In this report, we describe our experience of working with a pharmacy to set up mobile vaccine clinics for COVID-19 and influenza vaccinations in an outpatient mental health clinic and include a brief analysis of the cost-effectiveness of such clinics. Our findings support greater adoption of vaccine administration at mental health care sites.

Methods

This quality improvement project was part of an initiative of community mental health agencies (North Suffolk Mental Health Association, Massachusetts Department of Mental Health) in the Greater Boston metro area to set up mobile vaccine clinics in partnership with the agency’s in-house mental health specialty pharmacy. Mobile vaccine clinics were implemented in one outpatient mental health clinic, 42 residential treatment programs, and one shelter across the entire agency, serving 10,000 patients starting in February 2021 to offer COVID-19 and influenza vaccines.
Information about the mobile vaccine clinic was communicated via flyers across the agency and directly to patients and health care workers during routine outpatient visits. At the time of this initiative, no governmental or organizational mandates existed for COVID-19 vaccination of health care workers. Vaccines were administered free of charge for patients and health care workers associated with the site or the patient, regardless of insurance status. State and federal vaccine administration protocols were followed by pharmacists delivering vaccinations.
The survey data in this study focused on patients and health care workers who received a vaccine at one of the mobile vaccine clinics that was set up twice (in November and December 2021) for 4-hour-long sessions at one outpatient mental health clinic specializing in the treatment of patients with serious mental illness and where the abovementioned intervention was previously conducted (5). About 75% of patients receiving care at clinics run by this agency had a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder, and the clinic also hosted a large group of approximately 200 clozapine-treated patients with schizophrenia.
All patients and health care workers who were vaccinated on the two clinic days were invited to fill out a 12-item anonymous satisfaction questionnaire (created on the basis of a literature review of mobile vaccine clinics) in order to obtain feedback about their experience, assess whether they would prefer this model of receiving vaccines in the future, and determine whether they would recommend this mode of vaccine delivery to others. Basic demographic information and data related to vaccines received were also collected. No institutional review board or respective waiver was required from the compliance and quality assurance office of the mental health agency because the survey was collected anonymously without any identifiable information and was in line with other anonymous surveys of patients’ experience and satisfaction routinely administered by the organization.

Results

Nearly two-thirds (63%, N=43 patients and 26 health care workers) of the 110 individuals receiving vaccines during the two dates at the mental health clinic completed the questionnaire. Table 1 summarizes the responses of these 69 participants. Patients were on average about a decade older than the health care workers, with slightly more men among the patients (55%) and an even gender split among the health care workers. Roughly half of all participants were White, with a larger percentage of Black or African Americans among the patients. Of note, 72% of patients and 85% of health care workers reported having received the flu vaccine in the previous year.
TABLE 1. Demographic data and satisfaction with mobile vaccine clinics among patients and health care workers, questionnaire resultsa
 PatientsHealth care workersTotal
Characteristic or responseN%N%N%
N of participants4362263869100
M age in years (range)5328–824322–664922–82
Gender      
 Female184213503145
 Male245513503754
Race      
 White214914543552
 Black or African American17407272435
 Other race, ethnicity, or origin2531257
 American Indian or Alaska Native121423
 Asian12012
Answered yes to, Did you get the seasonal flu shot the previous year?317222855377
Vaccines administeredb      
 COVID-19 vaccine booster4093261006696
 Seasonal flu vaccine7165191217
 Both5125191015
How easy was it for you accessing the vaccine(s) today?      
 Very easy368420775681
 Easy6144151015
 Difficult000
How does today compare to previous times when accessing the vaccine at your PCP’s [primary care physician’s] office, employee health, or pharmacy?      
 Much easier214911423246
 Easier9217271623
 Same12288312029
 More difficult or much more difficult000
Would you prefer a mobile clinic like the one today versus other settings for future vaccinations?      
 Yes358125966087
 No25023
 Maybe or not sure5121469
Would you recommend mobile clinics to others (peers, family members, friends, etc.)?      
 Yes409325966594
 No12012
 Maybe or not sure121423
a
A few participants did not answer some questions, and therefore some variables do not add up to 100%. Seven participants did not report their age; all other questions had between no and three missing responses.
b
Included in the COVID-19 and flu vaccine counts are participants who received both; therefore, percentages exceed 100%.
In total, 96% of all participants received the COVID-19 booster, and 17% received the seasonal flu vaccine. Among the patients surveyed, 93% received the COVID-19 booster vaccine, 16% received the seasonal flu vaccine, and 12% received both. All health care workers surveyed received the COVID-19 booster, and 19% also received the seasonal flu vaccine. None of the participants completing the questionnaire reported receiving their first or second COVID-19 vaccine dose at the mobile vaccine clinic; all received COVID-19 boosters, and some also received influenza vaccines.
Among the patients, most (98%) found it “very easy” or “easy” to access the vaccines through the mobile vaccine clinic, and more than two-thirds (70%) reported that access to the clinic was “much easier” or “easier” than access to previous immunization venues (i.e., primary care office, pharmacy, or employee health office). Most patients (81%) preferred future access to vaccines via a mobile vaccine clinic in a community mental health clinic versus more traditional settings, and 93% affirmed that they would recommend the mobile vaccine clinic to others. As shown in Table 1, health care workers had very similar patterns of responses, finding the mobile vaccine clinic easy to use and at least as good as if not better than previous methods of accessing vaccines, and most workers said they would prefer it in the future and would recommend it to others.
The in-house specialty pharmacy recorded a 40% profit when considering the costs associated with the mobile vaccine clinics’ provision (i.e., expenses arising from pharmacists' salaries, cost of vaccines, supplies, travel expenses, and other costs) and the revenue per vaccine dose generated (i.e., administrative fee paid to the pharmacy by the government; in this case, fees were $25 per seasonal flu vaccine dose and $40 per COVID-19 vaccine dose). Thus, the pharmacy staff found this effort to be cost-effective. The pharmacy noted that of all the mobile vaccine clinics conducted by this agency, the outpatient clinics had the highest volume compared with other community settings, thereby increasing the pharmacy’s overall profit margin. Staff from the outpatient mental health clinic and health care workers helped with the logistics of getting patients to the mobile vaccine clinic, and vaccine costs were covered by insurance or federal programs, pharmacy staffing costs by the in-house specialty pharmacy, and nonpharmacy staffing by the respective agency.

Discussion

To our knowledge, our effort represents the first implementation and assessment of an intervention administering COVID-19 and influenza vaccines via a mobile vaccine clinic to patients with serious mental illness and to health care workers in an outpatient mental health clinic. Nearly all the patients and health care workers who completed the questionnaire reported that it was easy to access vaccines through the mobile clinic, with most preferring mobile vaccine clinics for future vaccinations. The mobile vaccine clinic was profitable for the pharmacy because of reimbursement by insurance providers and additional financial support from the federal government.
In this intervention, most people received COVID-19 boosters, whereas the influenza vaccine was administered at lower rates. This difference could be explained by the timing of the intervention, conducted on two dates in November and December; most individuals may have received their influenza vaccine before these dates. We believe mobile vaccine clinics could be effective for other vaccination campaigns when timed appropriately.
Bringing mobile vaccine clinics to mental health settings such as psychiatric outpatient clinics can be a critical component of a multipronged approach to improve the overall health of people with serious mental illness. Particularly clinicians can play an important role during outpatient visits in encouraging patients to get vaccinated (4), but current policies do not allow vaccine administration in mental health clinics. Given the challenges for patients with serious mental illness in scheduling and remembering appointments and accessing transportation, an onsite mobile vaccine clinic would enable providers to direct patients to immediately walk in to receive a vaccine, and patients can easily be assisted by support staff who are often involved in helping the patients navigate appointments. To this end, we note a follow-up observation with the sample from the pilot intervention previously conducted at the same mental health outpatient clinic (5), indicating that more than half of those who were unvaccinated in the previous intervention became fully vaccinated at the mobile vaccine clinics.
Moreover, we have shown that mobile vaccine clinics are feasible and financially sustainable and thus make pharmacies willing partners in setting them up. We also note additional cost savings in overall patient care to patients’ insurers or Medicaid. Patients who remain unvaccinated are more vulnerable to serious illness, necessitating a greater number of primary care physician visits and increased engagement with urgent care, adding cost to the health care system. Health care workers, alongside patients with serious mental illness, can benefit from the support and ongoing education from the clinic as well as pharmacy staff during visits to mobile vaccine clinics—particularly as health care workers move into a new phase of this pandemic where the benefits of vaccinations may no longer be emphasized.
Racial and ethnic minority groups tend to have greater vaccine hesitancy despite higher rates of complications and death from COVID-19 at younger ages, even among health care workers (14). Although we did not have information about the base rates of racial and ethnic minority representation among our patients and health care workers, 23.5% of people in the Boston metro area were Black in 2021, according to U.S. Census Bureau data (15). A larger proportion of our sample of patients and health care workers who received vaccines and completed questionnaires were Black (40% of patients and 27% of health care workers). Therefore, mobile vaccine clinics may effectively target otherwise underserved or potentially vaccine-hesitant groups. Of note, because of an error in the questionnaire, Latino ethnicity data were not collected properly and were therefore not reported.
We note some limitations to what can be concluded from our experience with mobile vaccine clinics. We had no information about patients and health care workers who did not participate in mobile vaccine clinics or any information about who may have already received vaccines and boosters elsewhere; therefore, we were unable to calculate overall vaccination rates at these sites or understand how they may have changed because of the mobile vaccine clinics. In addition, we did not know whether the mobile vaccine clinics served only patients and health care workers who may have otherwise gotten vaccinated elsewhere if the mobile vaccine clinics were not available. Our sample was small because it comprised individuals visiting on only two of the days a mobile vaccine clinic was onsite.

Conclusions

Mobile vaccine clinics provide a low-threshold, sustainable, and scalable alternative to traditional immunization venues for hard-to-reach clinical populations and health care workers. Making vaccine access as easy as possible and available in mental health settings within current federal policy limitations may reduce health disparities because such access removes barriers that may reduce vaccination rates among patients with serious mental illness. In addition, the ease of access to mobile vaccine clinics may address disparities associated with race and ethnicity, including among health care workers belonging to racial and ethnic minority groups who may have greater vaccine hesitancy. Further, extending vaccine access to health care workers helps foster community protection.
Mobile vaccine clinics were preferred by both patients and health care workers because of their ease of use and were cost-effective in our locale where insurance and federal programs reimbursed the pharmacy for administering vaccinations, demonstrating the sustainability and efficiency of mobile vaccine programs. Moreover, mobile vaccine clinics may help reduce overall costs in patient care. We recommend that future efforts using mobile vaccine clinics move beyond COVID-19 vaccinations to include immunizations for other vaccine-preventable illnesses such as influenza and pneumococcal disease (2).

References

1.
Nemani K, Li C, Olfson M, et al: Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry 2021; 78:380–386
2.
Olfson M, Gerhard T, Huang C, et al: Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry 2015; 72:1172–1181
3.
Warren N, Kisely S, Siskind D: Maximizing the uptake of a COVID-19 vaccine in people with severe mental illness: a public health priority. JAMA Psychiatry 2021; 78:589–590
4.
Lim C, Van Alphen MU, Freudenreich O: Becoming vaccine ambassadors: a new role for psychiatrists. Curr Psychiatry 2021; 20:11
5.
Lim C, Van Alphen MU, Maclaurin S, et al: Increasing COVID-19 vaccination rates among patients with serious mental illness: a pilot intervention study. Psychiatr Serv 2022; 73:1274–1277
6.
COVID-19 Vaccination for People With Severe Mental Illness: An International Survey of Clubhouses. Arlington, VA, Treatment Advocacy Center, Office of Research and Public Affairs, 2021. www.treatmentadvocacycenter.org/storage/documents/COVIDVaccine_FINAL.pdf
7.
Miles LW, Williams N, Luthy KE, et al: Adult vaccination rates in the mentally ill population: an outpatient improvement project. J Am Psychiatr Nurses Assoc 2020; 26:172–180
8.
Hill CF, Powers BW, Jain SH, et al: Mobile health clinics in the era of reform. Am J Manag Care 2014; 20:261–264
9.
Leibowitz A, Livaditis L, Daftary G, et al: Using mobile clinics to deliver care to difficult-to-reach populations: a COVID-19 practice we should keep. Prev Med Rep 2021; 24:101551
10.
Abbas M, Robalo Nunes T, Martischang R, et al: Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers. Antimicrob Resist Infect Control 2021; 10:7
11.
Factors Influencing COVID-19 Vaccine Uptake Among Minority Ethnic Groups. London, Government Office of Science, Scientific Advisory Group for Emergencies, 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/952716/s0979-factors-influencing-vaccine-uptake-minority-ethnic-groups.pdf
12.
Momplaisir FM, Kuter BJ, Ghadimi F, et al: Racial/ethnic differences in COVID-19 vaccine hesitancy among health care workers in 2 large academic hospitals. JAMA Netw Open 2021; 4:e2121931
13.
Gagneux-Brunon A, Detoc M, Bruel S, et al: Intention to get vaccinations against COVID-19 in French healthcare workers during the first pandemic wave: a cross-sectional survey. J Hosp Infect 2021; 108:168–173
14.
Health Disparities—Provisional Death Counts for Coronavirus Disease 2019 (COVID-19): County-Level Data on Race and Hispanic Origin. Atlanta, Centers for Disease Control and Prevention, 2020. https://www.cdc.gov/nchs/nvss/vsrr/covid19/health_disparities.htm#CountyRaceHispanicOrigin. Accessed Aug 31, 2022
15.
QuickFacts—Boston City, Massachusetts. Suitland, MD, US Census Bureau, 2021. https://www.census.gov/quickfacts/fact/table/bostoncitymassachusetts/PST045222#PST045222. Accessed Jan 24, 2023

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 982 - 986
PubMed: 36751907

History

Received: 8 September 2022
Revision received: 8 January 2023
Accepted: 12 January 2023
Published online: 8 February 2023
Published in print: September 01, 2023

Keywords

  1. Covid-19
  2. Mobile vaccine clinic
  3. Serious mental illness
  4. Health disparity
  5. Outpatient mental health clinic
  6. Prevention

Authors

Details

Manjola U. Van Alphen, M.D., Ph.D. [email protected]
Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston.
Carol Lim, M.D., M.P.H.
Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston.
Oliver Freudenreich, M.D., F.A.C.L.P.
Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston.

Notes

Send correspondence to Dr. Van Alphen ([email protected]).
The findings of this intervention were presented at the 10th Annual Massachusetts General Hospital Public and Community Psychiatry Spring Symposium, March 23, 2022, Boston.

Author Contributions

Drs. Van Alphen and Lim contributed equally to this report.

Funding Information

Dr. Freudenreich reports receiving research grants from Alkermes, Janssen, and Otsuka; consultant honoraria from Janssen, Integral, and American Psychiatric Association; medical honoraria from Elsevier and Medscape; and royalties from Wolters Kluwer, Springer Verlag, and UpToDate. The other authors report no financial relationships with commercial interests.

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