Most European countries ignore patients with severe mental illness in COVID-19 vaccine strategy

A survey by Europe's main psychiatric and mental health patient organizations shows that only 4 out of 20 European countries prioritize COVID vaccinations for individuals with severe mental disorders (such as psychosis and mood problems), despite a wealth of scientific evidence showing that these patients are amongst the most at risk. This is published today in the peer-reviewed journal Lancet Psychiatry.

The authors of the paper, and the major European mental health organizations, call for the European Union, as well as national health authorities to take concerted action to protect these vulnerable patients.

The authors reviewed official publicly available vaccine deployment plans and contacted clinicians in 20 European countries to confirm national vaccination policies. They found that only the Netherlands, Germany, Denmark, and the UK recognize severe mental illness as a high-risk medical condition eligible for early vaccination. Strikingly, the majority of countries surveyed do not make any mention of mental health in their vaccination priority guidance (see map and table) Some countries prioritize treatment for those in mental health institutions, but most patients with severe mental illness are now living and receiving treatment in the community, and thus are not covered by vaccination plans.

Lead author, Dr. Livia De Picker (from the University Psychiatric Hospital Campus Duffel, Belgium) said:"Everyone is concerned about the mental health problems which will follow the COVID epidemic. But many of those who already have severe mental health issues will face these problems earlier and probably more seriously. Research also clearly indicates that their risk of severe complications or dying of COVID is as high if not higher than those with physical conditions. Recent work shows that if you have a psychiatric disorder your risk of COVID infection rises by 65%, and severely mentally ill patients are between 1.5 and 2 times more likely to die.

Early vaccination is needed to protect them from severe or even fatal COVID infection; they need to be prioritized in the same way that at-risk patients with physical conditions are prioritized. Most countries are giving priority to people living in institutions, but this is not good enough. Most people with severe mental disorders are now living and being treated in the community, these patients are completely disregarded in most vaccination plans, and this needs to change. We are glad to see that more and more countries are changing their policy to include patients with severe mental illness, but vaccination is happening now, so we can't delay."

Up to 1 person in 20 in Europe will suffer from a severe mental health problem at some point.

The survey was initiated by the ImmunoNeuroPsychiatry Thematic Working Group of the European College of Neuropsychopharmacology; this was prompted by a recent article, on the neuroscientific reasons why individuals with severe mental illness are at increased risk of COVID infection in the journal Brain, Behavior and Immunity. Following this paper, the Lancet Psychiatry paper was developed in collaboration with the Europe's main clinical and patient mental health organizations.

• European College of Neuropsychopharmacology (ECNP)
• European Psychiatric Association (EPA)
• European Federation of Associations of Families of People with Mental Illness (EUFAMI)
• Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe)
• European Union of Medical Specialists Section of Psychiatry (UEMS-Psychiatry).

These bodies endorse the call for the European Union to take a lead in setting standards, and for national health and scientific bodies to ensure that vulnerable mental health patients are prioritized in vaccine strategy.

Author and director of the working group, Professor Marion Leboyer (University of Paris Est Créteil, France) said, "Patients with severe mental disorders are again neglected, despite suffering great risks. There is substantial evidence of the harm mental health patients suffer due to the pandemic. For example, recent work has shown that schizophrenia is second only to age as a risk for death due to COVID. Countries often look to what's happening elsewhere when setting vaccine priorities, and given how few countries prioritize mental health this risks perpetuating the neglect of mental health issues. This is a huge problem in Europe, and will continue unless action is taken. I am therefore pleased that the French scientific advisory committee on vaccines has just announced that it will recommend a change in policy for schizophrenia patients."

ECNP President, Professor Gitte Moos Knudsen (Righospitalet, Copenhagen) said:"This work reveals an intolerable lack of consideration for mental health patients. If you want to 'follow the science," then these at-risk patients should be prioritized. Further, as COVID does not respect national borders, we need European-level strategies to contain the virus."

Speaking for the mental health patient community, Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe), President Hilkka Kärkkäinen said, "Society needs to prioritize at-risk groups, but it is dispiriting to see that even during the pandemic, mental health is an afterthought—if that—for many countries. The scientific evidence is clear that COVID and the resulting lockdown is causing significant harm to people with serious mental health problems, but very few countries are addressing this. This needs to change."