Carol Lim, MD, MPH Fellow in Public and Community Psychiatry Massachusetts General Hospital Harvard Medical School Boston, Massachusetts
Manjola U. Van Alphen, MD, PhD, MBA Chief Medical Officer North Suffolk Mental Health Association Instructor in Psychiatry MGH Schizophrenia Clinical and Research Program Harvard Medical School Boston, Massachusetts
Oliver Freudenreich, MD, FACLP Co-Director MGH Schizophrenia Clinical and Research Program Director MGH Fellowship in Public and Community Psychiatry Massachusetts General Hospital Associate Professor of Psychiatry Harvard Medical School Boston, Massachusetts
Disclosures Dr. Freudenreich has received research grants (to institution) and consultant honoraria (advisory board) from Janssen (area: schizophrenia, long-acting injectable antipsychotics). Drs. Lim and Van Alphen report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
First, a strong recommendation should be made using the presumptive approach.40 If vaccine hesitancy is detected, psychiatrists should next attempt to understand patients’ reasoning with open-ended questions to probe vaccine-related concerns. Motivational interviewing can then be used to target the fence sitters (rather than anti-vaxxers).6 Psychiatrists can also communicate with therapists about the need for further follow up on patients’ hesitancies.
When assuring patients of vaccine safety and efficacy, it is helpful to explain the vaccine development process, including FDA approval, extensive clinical trials, monitoring, and the distribution process. Providing clear, transparent, accurate information about the risks and benefits of the vaccines is important, as well as monitoring misinformation and developing convincing counter messages that elicit positive emotions toward the vaccines.41 Examples of messages to counter common vaccine-related concerns and misinformation are shown in Table 3.42-44
Know the barriers to vaccination. The role of the psychiatrist is to help patients, particularly those with SMIs, overcome logistical barriers and address hesitancy, which are both essential for vaccine uptake. Psychiatrists can help identify actual barriers (eg, transportation, digital access for information and scheduling) and perceived barriers, improve information access, and help patients obtain self-efficacy to take the actions needed to get vaccinated, particularly by collaborating with and communicating these concerns to other social services (Table 4).41
Monitor for vaccination series completion. Especially for vaccines that require more than a single dose over time, patients need more reminders, nudges, practical support, and encouragement to complete vaccination. A surprising degree of confusion regarding the timing of protection and benefit from the second COVID-19 injection (for the 2-injection vaccines) was uncovered in a recent survey of >1,000 US adults who had received their vaccinations in February 2021.45 Attentive monitoring of vaccination series completion by psychiatrists can thus increase the likelihood that a patient will follow through (Table 4).41 This can be as simple as asking about completion of the series during appointments, but further aided by communicating to the larger care team (social workers, care managers, care coordinators) when identifying that the patient may need further assistance.
The Figure2,6,7,19,40 summarizes the steps that psychiatrists can take to help patients get vaccinated by assessing attitudes towards vaccination (vaccine hesitancy), helping to remove barriers to vaccination, and ensuring via patient follow-up that a vaccine series is completed.
