Patrick is a Mental Health Nurse who took an interest in immunisation before the pandemic by running drop in influenza vaccine clinics in an inpatient mental health service. During the pandemic, Patrick used his experience from running the influenza clinics to rapidly set up a co-designed COVID-19 vaccine clinic to improve vaccine equity for people who access mental health services, who experience a wide range of barriers in accessing conventional vaccination services. The clinic has since been funded as a pilot, and to expand to two more sites and covering all vaccines. Patrick is currently on a research scholarship working with the NSW Ministry of Health InforMH team to analyse data around vaccine equity for mental health service users. Patrick is also mid-way through completing a research Master’s degree on vaccine equity in people with severe mental illness.
Title: Vaccine-preventable hospitalisations in adult mental health service users: A population study
Author(s): Grant Sara, Patrick Gould
Introduction: Mental health service users experience significant health inequalities, including less access to preventative care and higher rates of physical health conditions. This study investigates the risks of hospitalisation for vaccine-preventable conditions among mental health service users in New South Wales, Australia.
Method: Using linked population data, we identified all hospitalisations for 19 vaccine-preventable conditions between 2015 and 2020 for adult mental health service users and other NSW residents. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated to determine the relative risks of VPH, after standardising for age and sex. A secondary analysis examined admissions including the NSW COVID-19 delta wave up to September 2021.
Results & Findings: We identified 94,180 vaccine preventable hospitalisations. Mental health service users had more than three times the rate of vaccine-preventable hospitalisations compared to other NSW residents (aIRR 3.2, 95% CI 3.1 - 3.3). Risks were highest for hepatitis B (aIRR 4.4, 95% CI 4.3 – 4.6) but elevated for all conditions, including influenza, herpes zoster and COVID-19 (aIRR 2.0, 95% CI 1.9 – 2.2). Mental health service users were younger at the time of their first VPH admission, with the largest age gap observed for vaccine-preventable pneumonias (11-13 years younger).
Discussion: High VPH rates may reflect lower vaccination rates, greater risk of severe illness, or barriers in accessing community care. The findings highlight the importance of vaccine-preventable illness as a contributor to health inequalities. MH service users need equal access and prioritisation in vaccination policies and strategies. Collaborative approaches, with mental health services, physical health services and lived experience experts working together, are crucial if we are to succeed in "Becoming an Equally Well Country”.
Title: Improving immunisation coverage with keeping the body in mind – vaccines. A co-designed vaccination service for mental health consumers
Author(s): Patrick Gould , Ken Murray, Liana Lapuz, Hamish Fibbins, Catherine O’Donnell, Philip Ward
Introduction: Mental health consumers face significant systemic barriers in accessing primary health services and have higher rates of hospitalisation and mortality from vaccine-preventable diseases. This project codesigned and implemented a vaccination service for mental health consumers with the aim of promoting fair and equitable access to vaccinations.
Method: A co-design workshop was run with consumers and clinicians to ensure that the service would best meet the needs of those who accessed it, with decisions on the clinic model and processed being decided by the co-design group. From the co-design, a roving vaccine clinic was set up to provide immunisation coverage to two community mental health centres and six inpatient units within a metropolitan mental health service. Attendees of the co-design later attended the operating clinic to assist in ensuring the clinic was running in accordance with the co-design.
Results & Findings: Since the service began, 468 vaccines have been administered, including 343 COVID-19 vaccines, 120 influenza vaccines, and 5 other vaccines. Of the 522 consumers in the community mental health service, as of 5 December 2022, 80% have received at least 1 dose of a COVID-19 vaccine, 78% have received at least 2 doses, 57% have received at least 3 doses, and 20% have received at least 4 doses.
Discussion: By providing targeted vaccination services to people who access mental health services, it is possible to improve vaccination rates, literacy and access and contribute to ensuring vaccine equity. Co-designing the service was vital in ensuring the service met the needs of those who will use the service. The project's results and findings highlight the potential for this approach to be replicated in other contexts. The service is currently undergoing an expansion to two more sites and to include drug and alcohol services and will undergo further evaluation.