Covid 19: COVID-19 Rapid Response Project Proposal

Brief summary of description of project: People living with severe mental illness on average experience a 10-25 year life expectancy reduction compared to the general population1. A growing body of evidence suggests that disparities in the provision of healthcare plays a significant role in the reduction of this life-expectancy2. Health disparities experienced by people with serious mental illness may be due to a combination of overlapping societal, health system, health provider and patient level factors. It is almost certain that these factors may have an even greater impact on resource strapped rural settings where the effects of the social determinants may be felt the greatest. This is important as COVID-19 infections are increasingly occurring in rural and medium cities throughout the United States (Figure 1). Understanding the extent to which people with serious mental illness in rural areas are experiencing health care disparities during the COVID-19 pandemic is paramount and may prompt critical advocacy efforts to ensure equitable health care. Brief summary of goal of project: In partnership with the National Alliance of Mental Illness (NAMI) in Lexington, Kentucky, the goal of this project is to use a mixed-method approach to: 1) Document understanding and knowledge of COVID-19 symptoms, key COVID-19 prevention methods and access to key health care services among a community sample of people living with serious mental illness (n=150) using a standardized battery of questions (see appendix 1). These questions were previously used to gather similar data on a sample of people living with HIV (n=75). The sample of people living with HIV respondents will serve as a comparison sample. 2) Describe barriers and facilitators of COVID-19 related health care services through in-depth interviews of a purposive sample of people living with mental illness (n=20) 3) Disseminate findings and advocate with people living with serious mental illness to local health care entities, city, county and state level officials regarding resource reallocation and realignment to ensure healthcare equity during the COVID-19 pandemic. Brief summary of equity issue project is addressing: During the COVID-19 pandemic, health care disparities experienced by people living with serious mental illness may be worsened due to several synergistic health and societal related factors. First, people living with serious mental illness may be at greater risk of developing a COVID-19 infection due to a higher prevalence of unstable housing, homelessness and substance use which may make utilizing necessary public health precautions more difficult. Second, people living with serious mental illness may be at heightened risk for severest forms of COVID-19 due to a higher prevalence of tobacco use and chronic cardiovascular and respiratory illnesses compared to the general population3. Third, a financially strained health care system anticipating a third wave of COVID-19 infections, may be ill prepared to meet the complex health care needs of people living with serious mental illness. Geographic area or community(ies) targeted: Kentucky is one of the 10 unhealthiest states in America. Compared to the other the general US population, Kentucky has higher rates of cardiovascular disease, obesity, diabetes serious mental illness and substance abuse4. Of note, greater than 25% of the adult population in Kentucky (Figure 2) smoke cigarettes nearly twice that of the general US population. This is particularly relevant as the CDC now states that smoking is strongly associated with the severest forms of COVID-19 infection. The focus of this project will be on Central and Eastern Kentucky where the prevalence of smoking, heart disease and the risk of sever forms of COVID-19 may be the greatest.