Even before COVID-19 vaccines became widely available in the United States, conspiracy theories circulated. Some people were concerned that the vaccine could cause infertility — or that it carried tracking microchips that were implanted in those who received a dose.
While those theories and many others like them have been debunked, public health experts say that people with serious and persistent mental illness (SPMI) remain particularly vulnerable to these false claims, making them less likely to agree to get a dose of the vaccine.
Julie Bluhm, CEO of Guild, a St. Paul-based nonprofit providing support services to people experiencing serious mental illness and/or homelessness, said that it’s not uncommon for her organization’s clients to recite a litany of these same worries when offered a dose of the COVID vaccine.
“Among our client population, there’s still plenty of paranoia about injecting something into their bodies that could ‘track’ them,” Bluhm said. “It’s actually very common.” Part of this paranoia is a symptom of many mental illnesses, she continued: “Another part is related to past negative experiences with the mainstream medical system.”
Reservations about COVID vaccinations are particularly concerning among the population that Guild serves; people with severe and persistent mental illnesses like schizophrenia or bipolar disorder are at higher risk of serious illness or death when infected with the virus, and their vaccination rates appear to be lower than those of many other demographic groups. Other factors, including isolation or limited of access to health care providers, also play a role in lower rates of vaccination among individuals with SPMI.
Staff working at Guild have developed strategies to help their clients become more comfortable with the idea of getting the jab, Bluhm said.
“Our clients’ concerns are often something like, ’Isn’t this just the government forcing me to get vaccinated against my will, or some doctor who just wants me to do what he tells me to do?’”
To reduce those fears, Guild staffers work to educate clients about the truth behind the vaccines and the benefits they offer to those who receive them. “When they get their information from a Guild staff member, when the vaccine was administered at one of our sites by someone they know and trust,” Bluhm continued, “it feels that much better for them. They are much more relaxed and trusting.”
Natasha Hennessy, chief pharmacy officer at Genoa Healthcare, a provider of pharmacy services at behavioral health and addiction treatment facilities nationwide, including those inside Guild’s community mental health clinics, said that their staff take an understanding, informed approach when talking to patients with SPMI about COVID vaccines.
“Because we’re working with the behavioral health population, our pharmacists engage in a different approach than they would with a customer who walked into a Walgreens,” Hennessy said, explaining that Genoa pharmacists and pharmacy techs are trained in mental health first aid: “Having that training is important to understanding how to encourage those who suffer from mental illness to consider getting the vaccine.”
Bluhm believes that this informed approach to education around COVID vaccine safety and effectiveness can go a long way toward persuading more people to get a shot. “It’s an important thing for us all to do,” she said. “If we can explain that, and really get that message across to our client population, we’ll be able to make a lot of progress toward getting more vulnerable people vaccinated.”
In the comfort zone
Making COVID vaccination part of a person’s everyday routine is a key strategy for increasing vaccination rates in populations that have so far put off getting the shot, Hennessy said. Generally, most people who are strong vaccination supporters have already had their doses. The more reluctant segment of the population needs to be approached in ways that feel comfortable and non-threatening.
When the COVID vaccine was offered at Guild’s clinics, Hennessy said, clients felt better about signing up for a shot. It was also convenient, because clients could get their vaccine at their regular appointment.
“Access is a big thing,” she said. “If a client get access to a vaccination at the same time they are getting their mental health care, vaccination rates are up to 25 percent higher than they would be if they had to do it in a separate setting.”
Beyond convenience, the fact that the vaccine was offered at Guild clinics made many clients feel reassured about their safety, Bluhm said. Many clients have been coming to Guild for years, making the clinic a familiar and trustworthy space.
“The clients who came into our clinic for their vaccine felt more comfortable because they trust us,” she said. “A lot of them don’t have strong relationships with their primary medical providers: They feel marginalized. The idea that they could come here to get their vaccine really helped with some of that worry.”
Hennessy agreed. “We are uniquely positioned by being right there in the community and being able to team with our partner clinics,” she said. “With the behavioral health population, the trust factor can be a challenge. Having both the pharmacist and the health care provider be a united front really helps to make people feel comfortable about getting the vaccination.”
Genoa pharmacist Shannon Rudolph has given more than 800 doses to clients at Western Mental Health Center in Marshall, Hennessy said, explaining that Rudolph had taken a proactive approach her clients, working hard to educate them about the COVID vaccine and debunking myths.
“She talks to anybody that comes up to the pharmacy,” Hennessy said. “She’s engaging hem in a conversation about vaccination, saying things like, ‘Have you been vaccinated or not? If not, what are your reasons?’”
One couple visited the clinic, but told Rudolph that they were nervous about getting the COVID vaccine, Hennessy said. “They had a lot of questions around it, like, ‘It was approved so quickly. I’m not sure I would be OK with getting it.’”
Because this couple had a history with the clinic and Rudolph, they considered her a trusted health care professional: “She was able to talk to them, get their fears addressed,” Hennessy said. “The next day, they called and said they wanted to come in for a vaccination.”
Real reason for concern
The drive to vaccinate people with SPMI is serious because this is a population that carries high risk of negative outcomes from COVID infection.
“In general, those that suffer from serious mental illness often have other chronic health conditions and social issues they live with that make them more vulnerable to severe illness from COVID,” Hennessy said.
Bluhm added that Guild’s client population is also more likely to live in poverty with fewer social supports. They are also older — another risk factor: “Our biggest patient demographic is over 50.”
When the COVID vaccine first became available, some Guild staff members expressed concern about its safety. But it was also clear that if the organization, which also operates group housing programs and a long-term care facility, was going to keep clients safe and keep running, as many people as possible had to get vaccinated.
“Even I was a little concerned about getting the vaccine too quickly,” Bluhm admitted. “I was worried about the quality of what I was going to put in my body.” But she did get the vaccine in March — and encouraged others in her organization to do the same.
“There are a lot of reasons why people are nervous about getting the vaccine,” she said. “I didn’t want to take a hard-line position like, ‘You have to get vaccinated,’ but I also wanted to say, ‘Please educate yourself. Make the best decision for you and your family, but know that vaccination is how we get back to work.’”
Side effects of success
Bluhm said that vaccinating staff and clients has made it possible for Guild to keep running.
While clients in the organization’s residential facilities are still wearing masks in common areas, life is slowly returning to normal. The organization, whose new St. Paul headquarters (constructed during the pandemic) will be open for business starting July 6, began offering vaccines to staff as early as January. Bluhm said she didn’t conduct “heavy-handed” promotion campaigns, but she made it clear that the vaccine was available to everyone, and so far she’s proud to say that there hasn’t been any COVID outbreaks in Guild programs.
“I trust my staff to do what’s right,” Bluhm said. “Looking at our anecdotal experience, I want to say that at least 70 percent of our staff are now vaccinated.”
Last month, as the opening date for the new building approached, Bluhm decided to launch what she called a “third phase” of the nonprofit’s vaccine push. She scheduled a Genoa-run vaccine clinic in the new building, making the shots available to just about anyone who wanted them.
“We made the decision to open it up to anyone related to Guild in any way,” Bluhm said. “We have staff who have partners, family members, friends who were uninsured. We said, ‘Sign up anybody you know that needs a vaccine that hasn’t been able to access one. They can just come to this clinic.’”
Genoa was more than happy to staff the vaccination clinic, Hennessy said.
“Vaccinating staff and clients makes it easier for us to keep serving our client population,” Hennessy said. The company is committed to vaccinating as many people as possible, she added: “To date we have administered just over 100,000 vaccinations nationwide. In Minnesota alone, given 5,500 vaccines.”
This commitment goes back to the early days of the pandemic, Hennessy said, when Genoa leadership met to brainstorm about what they could do to help. “We knew we wanted to be part of the solution. We made sure we had vaccinations in our clinics as soon as they were available. Our pharmacists are doing vaccinations after hours or on weekends. They are using local churches or schools to be able to offer immunization clinics to everyone.”
Bluhm said that her work with Guild’s client base makes her intimately aware of the challenges that many face when it comes to vaccinations and health care. This knowledge informs her approach to her organization’s vaccination campaigns.
“I want to support public health,” Bluhm said, “but I also know that with all the racial and social disparities, a lack of trust for the health care system is understandable. I’m leaving it up to our communities to make their own decisions. I don’t feel like it’s our place to demand that people do as we say. But honestly, the message I want to deliver is, ‘We’re here with your vaccine when you’re ready.’”