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

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.

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.

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.

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.

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).