Exploring barriers to the COVID-19 vaccine in people with psychoses in Western Australia

Objectives: We explored barriers to coronavirus (COVID-19) vaccination among people with psychoses and used these to propose expert recommendations to enhance vaccine uptake in this population. Methods: A mixed-methods, cross-sectional survey was conducted in Perth, Australia, between September 2022 and September 2023 with 233 adults with psychoses. Participants responded to a short telephone survey comprising questions regarding vaccination status, sources of health information, motivations for vaccine acceptance or refusal, and other factors influencing vaccination decisions. Results: Most respondents (217, 93.1 %) reported being fully vaccinated, however many described barriers to vaccination that reflected their experiences as people living with mental illness. Over half (126, 54.1 %) said they were not contacted by anyone about getting vaccinated for COVID-19. All participants refusing vaccination denied receiving information on vaccine safety, while almost half of those fully vaccinated had received such information. Unvaccinated participants reported lower levels of trust in general practitioners and psychiatrists compared to those who were vaccinated yet, simultaneously, reported higher levels of trust in other healthcare professionals. Vaccinated individuals cited preventing illness, following recommendations, and compliance with mandates as motivators, while reasons for refusal included vaccine efficacy and side-effect concerns. Conclusion: Despite limited outreach, participants overcame access barriers, with only those who deliberately sought to refuse the vaccines remaining unvaccinated. Mandates appear to have been a significant contributor to vaccine uptake. Recommendations for encouraging future pandemic and routine vaccinations include upskilling nurses and case managers to provide vaccine information and offering vaccination in mental health facilities and at routine clinical appointments.