RESEARCH WEEKLY: Special Edition in This Time of Uncertainty    

In times of uncertainty, it can be challenging to maintain normalcy while worrying about the potentials of the crisis ahead. With the situation rapidly evolving, vital decisions need to be made constantly as to how to ensure the health and safety of yourself, your loved ones, and those around you.  
 
This is not new to many family members with loved ones with severe mental illness. However, the events happening around the world as a result of this novel virus may disproportionately impact the most vulnerable residents, including those with severe mental illness. With that in mind, I have decided to take a break from the usual  Research Weekly  blog to address the current crisis facing many people with severe mental illness and their loved ones, including personal stories of those affected. 
 
While we recognize that such measures are necessary during a public health crisis, the Treatment Advocacy Center believes it is important to highlight the disproportionate strain COVID-19 puts on those already struggling with severe mental illness and their loved ones.   
 
COVID-19 and severe mental illness  
As one family member said to me “our loved ones have been suffering already. Now they are suffering even more.” Below are just a few examples of how this pandemic is affecting people with severe mental illness and their loved ones:  
 
Panic   
People with underlying mental health conditions, including a severe mental illness, may be at increased risk of worsening symptoms due to the stress and panic of the current events. As one family member said to me, “my loved one is just now starting to have some progress towards recovery. I worry that she is at risk of severely decompensating and experiencing extreme paranoia if exposed to too much information about what is going on.” 
 
Smoking  
People with severe mental illness smoke tobacco at rates significantly higher than the general population. For example,  research estimates  that between 60% and 80% of people with schizophrenia are current smokers. Chronic tobacco use is known to cause respiratory illnesses such as lung cancer or chronic obstructive pulmonary disease (COPD). Therefore, individuals with severe mental illness who smoke are a high-risk population for contracting COVID-19 and experiencing significant respiratory distress due to the virus.  
 
With no home to ‘hunker down’ in 
As a result of an inadequate mental illness treatment system and lack of community supports for people with severe mental illness, many have no home to ‘hunker down’ in for protection or to self-quarantine. 
 
It is estimated that a  minimum of one-third of people  who are currently homeless have a severe mental illness. Estimates of serious mental illness among the homeless are even higher among women, people who are unsheltered living on the streets, or those who have experienced homelessness for a year or more.  
 
“People experiencing homelessness live in environments that are conducive to a disease epidemic,” writes Jack Tsai in a  Lancet Public Health  article  last week. “Many people experiencing homelessness live in congregate living settings—be it formal (ie, shelters or halfway houses) or informal (ie, encampments or abandoned buildings)—and might not have regular access to basic hygiene supplies or showering facilities, all of which could facilitate virus transmission.” 

Here is one family member's story: 
"While the whole country is focused on ‘sheltering in place’ to avoid the consequences of the coronavirus, my mind still is focused on my brother who suffers from paranoid schizophrenia, anosognosia, a traumatic brain injury, and is blind.  
 
Up until a little more than a month ago, he was living on the streets, unsheltered and abandoned due to archaic mental health laws. The only reason that he is sheltered now is because he was struck by a vehicle that put him in critical condition for the second time in five months. But, with the current crisis, we are restricted from visiting him. Because he is blind, sending him cards, letters, or expecting an internet presence is not helpful. So, he is again feeling that he has been abandoned... and indeed he has been. 
 
Suddenly, policymakers have been pushing to procure motels and hotels to house the unsheltered homeless to try to curb the spread of the virus. While this seems like a great idea, one has to wonder why the 13 years my brother spent on the streets in mortal and grave danger with no thought to his safety was ever addressed before in this manner? Only when the homeless population suddenly presents a possible effect on the general population do new ideas suddenly spring up with urgency, under the guise of helping a population at risk. And once this crisis abates, will the response to people with serious mental illness still be a priority or will they all sink back into obscurity once again?” 
Mental illness and COVID-19 behind bars    
 
Many family members have loved ones with a severe mental illness who are incarcerated in a local jail or prison. Due to their low sanitary conditions and confinement practices, correctional institutions are known  “ incubators and amplifiers of infectious diseases. ”   
 
If COVID-19 were to get into a correctional setting, the spread to other inmates and staff is almost inevitable. The chairman of the House judiciary committee recently sent a  letter  to the Department of Justice requesting information on their plans to address the health and safety of those in federal prisons. 
 
To prevent the spread of the virus, many correctional settings are implementing new policies to mitigate the risk. These include limiting recreational time for inmates and suspending visits from the public. Meaningful contact between inmates and loved ones is important to maintain connections and boost morale, not to mention the oversight and accountability family members can provide to correctional staff around the care and treatment of their loved ones.  
 
Advocates are seeking increased telephone access and video conferencing with loved ones who are incarcerated. For more information, see  here .   
 
Inpatient psychiatric care 
 
Inpatient psychiatric hospitals are also limiting visitors in attempts to prevent the transmission of the virus to patients. A family member below shares her story: 
“My family member has been in an inpatient hospital since July 2019. Last week, due to COVID 19 concerns, visiting is no longer allowed. A patient they received was exposed to someone with the virus in the ER. So far, she’s not showing symptoms. 
 
There are no visits. They are not accepting new patients and not discharging patients who no longer meet inpatient criteria. Most are happy to stay since they’re homeless and it’s been raining. 
 
My family member calls me each day to see if I’m visiting. Each day I tell him visits are not allowed, due to a bad cold going around. I say they want to protect the patients. He doesn’t retain or understand that information. 
 
It’s so hard. Not having family contact makes the distance seem so much more. I worry that staff will talk about the deaths and contribute to paranoia in the patients. I worry that he’ll be exposed.” 
We are all a community and must take care of our most vulnerable. Please take care of yourself, your loved ones, and those around you. Wishing everyone good health,  


Elizabeth Sinclair Hancq
Director of Research
Treatment Advocacy Center
COVID-19 
 
Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by a novel coronavirus called severe acute respiratory syndrome (SARS)-Cov2. The virus was first identified in December 2019 and has now become a global pandemic.  
 
Because it is a respiratory illness, symptoms include a fever, dry cough, and shortness of breath. Although many people may show no symptoms or experience mild symptoms and recover at home, some require hospitalization and others may require intensive respiratory interventions such as a ventilator to assist with breathing. Throughout the world as of this morning, there are more than 8,000 reported deaths due to the virus and more than 200,000 cases, although due to testing restrictions that number is likely an underestimate.  
 
Although there are many unknowns as to who may die as a result of the virus, as reported by  The   New York Times ,   there are some factors known to put an individual at risk. These include older age, also having another illness that weakens the immune system such as cancer, a reduced lung capacity, unsanitary conditions, or not having access to needed health interventions.  

Questions? Contact us at  [email protected]  

Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.  

The Treatment Advocacy Center does not solicit or accept funds from pharmaceutical companies.