Pandemic increases mortality risk for people with mental health issues

The study’s analysis found an increased likelihood of dying among people with mental health issues and intellectual disabilities in the U.K. during the first COVID-19 lockdown compared with the general population.

Specifically, they found that:

• People with intellectual disabilities were 9.24 times more likely to die of COVID-19.
• People with eating disorders were 4.81 times more likely to die of COVID-19.
• People with dementia were 3.82 times more likely to die of COVID-19.
• People with personality disorders were 4.58 times more likely to die of COVID-19.
• People with schizophrenia spectrum disorders were 3.26 times more likely to die of COVID-19.

These groups experienced a brief respite, relatively speaking, from July to September 2020 during a temporary drop in COVID-19 cases. During these months, their risk returned to the pre-pandemic, already doubled, chances of mortality.

MNT asked Holly Kathryn Tabor, Ph.D., an associate professor of medicine at Stanford University, California — who was not involved in the study — why this disparity occurs. She replied that there are likely several reasons.

“It’s very hard for adults with intellectual disabilities to get access to basic healthcare and to other things that are social determinants of health, and they have much poorer health overall,” said Dr. Tabor.

Dr. Tabor also explained that the conditions cited by the study:

“All require you to be able to have a care provider and go get help from them, and also have a safety net. Your care provider isn’t going to do everything for you. You have to have people taking care of you and looking in on you. Health is more than just getting a prescription. Health is more than going to the doctor when you have a heart attack. Health is a lot of other things, and […] because of those conditions, all those people need help getting to a doctor.”

Dr. Betzler pointed out that these groups often experience “medical comorbidities, delayed or poor access to healthcare, living in a group or congregate care setting, and psychiatric hospitalizations.”

Joseph A. Stramondo, Ph.D., another expert not involved in the study, focuses on the intersection of the philosophy of disability and bioethics at San Diego State University.

Dr. Stramondo told MNT about the often damaging effect of institutionalization on some people in these groups. He recalled the 1972 TV exposé of the Willowbrook State School on New York’s Staten Island.

In that coverage, he said, “you just saw horrifying living conditions, and so it’s no wonder that there’s going to be increased mortality for disabled people living in these places.”

An additional factor may be triage decisions regarding who doctors treat. Early in the pandemic, hospitals in the United States had to devise “crisis standards of care.”

A number of these policies contained language that either overtly or indirectly excluded people with mental health issues or intellectual disabilities, leaving disability advocates “completely justifiably” angry, said Dr. Tabor.

Dr. Stramondo told MNT that the attitudes embodied in discriminatory policies “are fundamentally about disvaluing disabled lives.”

He explained: ”There is this presumption that they have a lower quality of life – that there ought to be less effort put into preserving their lives. And I think that we see that over and over again in various contexts.”

However, according to Dr. Tabor, “The advocacy groups and the attorneys generally succeeded in getting most crisis standards of care policies to have at least the explicit and very often the implicit discriminatory language taken out.”

“But,” she cautioned, “a policy is only as good as the people who are implementing it and hopefully doing it right.” So far, only a few states have officially implemented their crisis standards of care policies.

The disparities before and during the pandemic are “a judgment on our society,” Dr. Tabor said. “And the fact that the people who are the least well-off in our society also have the poorest health [is] just magnified with COVID-19.”

Dr. Tabor noted that “the ways in which our society is ableist and discriminatory against people with disabilities — that those [biases] existed in the first place pre-pandemic — is a sign and symptom of what already exists in society. And it’s appalling and needs to change, absolutely.”