adult vaccinations, immunizations, severe mental illness, health disparities, improvement project


Background: Adults who suffer with severe and persistent mental illness (SPMI) rarely access medical care to address basic medical needs, so they are subsequently less likely to receive preventive vaccines. The aim of this project was to increase the rate of vaccines among the SPMI population. This project started in 2011 and still is ongoing. It took place in an outpatient community mental health center (CMHC) which serves about 4,200 SPMI clients. Personnel managing the project included registered nurses from the local health department, staff from the CMHC, and volunteer nursing students.

Methods: A review of the literature identified a gap between the general population and SPMI clients in preventive vaccinations. Researchers conducted an initial mixed-method convenience survey at Wasatch Mental Health (WMH), an outpatient CMHC in Utah County. SPMI clients who participated (n=392), provided information on current vaccination status, demographics, beliefs, and interest in receiving vaccines. After review of the data, a vaccination program was developed to address identified barriers and increase vaccination rates in the target population. Finally, post-intervention data were collected through a mixed method convenience survey of SPMI clients (n= 60) who participated in immunizations clinics to evaluate client satisfaction with the program.

Interventions: An intervention program was designed that included a collaborative partnership between the local health department and WMH, to deliver a vaccination program in non-traditional sites tailored to the target SPMI population. Vaccines administered included: annual influenza; hepatitis A; hepatitis B; herpes zoster; measles, mumps, and rubella (MMR); pneumococcal; and tetanus, diphtheria, and pertussis (Tdap).

Results: Eight months after the non-traditional site vaccination program was implemented over 1,000 vaccines were administered. Overall there was a significant increase in vaccination rates for individual vaccines ranging from 18.75% to 83% when compared to baseline. Herpes zoster vaccines were inconsistently available to participants at no cost, so these vaccines were not actively promoted. The post-intervention survey found a subject satisfaction rate of 95% with the program.

Conclusion: Implementation of a vaccination program in a non-traditional site that facilitates access for SPMI clients to vaccines can promote an overwhelming increase in the vaccination rates for this underserved population. It is expected that this increase will ultimately decrease the occurrence of preventable communicable diseases in the target population. The results from this project suggests that the integration of mental health and primary care services can have a profound positive effect on the health of the SPMI population.

Document Type

Peer-Reviewed Article

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University Standing at Time of Publication

Graduate Student


Nursing 698R

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Nursing Commons