RESEARCH WEEKLY: 2021 Top 10 List of Severe Mental Illness Research  

By The Office of Research and Public Affairs

Reflecting on 2021, we at the Office of Research and Public Affairs (ORPA) have put together our top 10 list of the most important research published this year about severe mental illness. The list includes commentary on our favorite published research from each of the ORPA team members who brought Research Weekly to your inbox every week throughout 2021. Much like looking forward to 2022 after a year of innovation in COVID-19 research, this list focuses on the impact of the research findings for people with severe mental illness, their families and loved ones for the future.   

Here is our top 10: 

1. Schizophrenia is the second largest risk factor for COVID-19 mortality – Groundbreaking
research published in January 2021 found that people with schizophrenia who test positive for SARS-CoV2, the virus that causes COVID-19, have 2.7 times greater odds of dying from COVID-19 compared to the general population. When examining all risk factors for COVID-19 mortality, the researchers found that a schizophrenia diagnosis is the second largest predictor of mortality from COVID-19, second only to age. After sharing this research in ORPA’s Research Weekly blog as soon as it was published, this landmark study became the foundational evidence for our advocacy work to ensure people with serious mental illness are not left behind in the fight to combat the COVID-19 pandemic. – NR 

2. Failures at the NIMH – Spearheaded by Treatment Advocacy Center founder Dr. E. Fuller Torrey, ORPA continues to hold the National Institute of Mental Health (NIMH) accountable in their utilization of taxpayer dollars to fund research into psychiatric illnesses. In 2021, we submitted public comments to the NIMH Advisory Council urging them to insist NIMH leadership prioritizes research into severe mental illness. We wrote an article that was published in the academic journal Psychiatric Services, which found that the NIMH has shifted their funding to focus almost exclusively on basic science research, rather than clinical research that may have an impact on people currently living with severe mental illness. In addition to being published online, the article was featured on the cover of the November print edition of the journal. We also wrote a letter to the Office of Management and Budget regarding the inaccurate claims about schizophrenia prevalence made by the NIMH. We will continue to ensure the NIMH is living up to its mission to “transform the understanding and treatment of mental illnesses,” including severe mental illness such as schizophrenia and bipolar disorder. – ESH

3. COVID-19 vaccination for people with severe mental illness – The latest Treatment Advocacy Center report, COVID-19 Vaccination for People with Severe Mental Illness: An International Survey, released in September of this year, details results from an international survey of Clubhouses for people with severe mental illness. Conducted in partnership with Clubhouse International, the survey asked Clubhouses across the globe about the rates of vaccination among their members, barriers to receiving the vaccine and efforts by the Clubhouse to combat misinformation and increase vaccine uptake among members. The survey found that, compared to general county vaccination rates, vaccination rates were higher on average for Clubhouse members, likely due, in large part, to the efforts of Clubhouses to break down barriers to receiving the vaccine for their members. This finding, among others, points to the need for outreach and prioritization for people with severe mental illness, not only for the COVID-19 vaccine, but for other policy efforts that currently leave this population behind. – KS  

4. Outcomes of Assisted Outpatient Treatment – 2021 ORPA Research Summary compiled evidence of the beneficial outcomes associated with Assisted Outpatient Treatment (AOT). AOT is an organized, systematic effort within a mental health system to ensure that outpatient treatment will be made available to those who need it to live safely in the community. The studies evaluated in this report found that AOT can dramatically improve treatment outcomes and reduce the likelihood of repeated hospitalization and criminal justice involvement for program participants. In the upcoming year, ORPA will utilize the findings from existing research to generate educational materials on misconceptions around AOT, how AOT is compatible with recovery and cultural competency and AOT. – SA 

5. CDC recognizes COVID-19 risk for people with SMI – The largest success for ORPA in 2021 was our role in ensuring severe mental illness is prioritized in our nation’s response to the COVID-19 pandemic. After we called attention to the impacts of COVID-19 on people with severe mental illness and their loved ones in March 2020 and pursued subsequent research, education and advocacy efforts around the issue, the Centers for Disease Control and Prevention (CDC) finally recognized that people with mental illness are at higher risk of severe illness or death from COVID-19 and need to be prioritized in preventative efforts. This has enormous implications for the protection and prioritization of people with severe mental illness and their loved ones, especially as we continue to combat the pandemic into 2022. See what the addition of mental illness to the CDC high priority list means on our COVID-19 resources page. – ESH 

6. ORPA team guest lectures at university – ORPA team members Elizabeth Sinclair Hancq and Kelli South lectured at a Catholic University senior seminar class this April, discussing criminal justice and women-specific issues for people with severe mental illness. The presentation focused on the many ways in which severe mental illness is criminalized in this country, starting with the deinstitutionalization
efforts of the second half of the 20th century, which forced more and more people with serious
mental illness into jails and prisons instead of treatment. There are an estimated 10 times more
people with severe mental illness in prisons than in state hospitals and those with a serious mental
illness have longer lengths of stay once in prison compared to those without. After their lecture,
the ORPA team had a robust discussion with the soon-to-be-graduating seniors at Catholic University. If you or someone you know would like to request a guest lecture from the research team, please email – KS
7. Co-occurring SMI and substance use disorders – Earlier this year, ORPA released our latest evidence brief, Dual Diagnosis: Serious Mental Illness and Co-occurring Substance Use Disorders. A history of substance use disorder is more of the rule than the exception among people with serious mental illness and we created a resource with relevant research and data to help inform and understand the complexities of their intersection. For example, we found that a dual diagnosis can have a multitude of consequences on an individual’s life: people with co-occurring disorders are more vulnerable to becoming involved with the criminal justice system and experiencing homelessness compared to those with one or none of these illnesses, and it is very difficult for them to access the necessary treatment that addresses both disorders simultaneously. ORPA also released a fact sheet in 2021 about racial disparities in co-occurring serious mental illness and substance use disorder treatment, which was also translated into Spanish. – ESH 

8. Suicide prevention in people with severe mental illness – People with severe mental illness are at a much higher risk of suicide compared to the general population, indicating the need for specialized suicide prevention policies for this population. This year, ORPA wrote about the importance of suicide risk prediction for women, as well as the importance of psychiatric bed availability to reduce suicides. Furthermore, Treatment Advocacy Center, along with 14 of the leading mental health organizations in the country, released a joint policy recommendation to guide the 988 crisis hotline enactment, which is set to begin in July 2022. The 988 hotline is another important tool to aid in suicide prevention and is part of the continuum of care necessary for treating those with severe mental illness. – KS  

9. Digital health and SMI treatment – The ongoing COVID-19 pandemic has shown the importance of digital health services in both physical and mental healthcare. The application of digital health services to serious mental illness treatment is an ongoing process and includes both mobile health and telehealth interventions. Mobile apps in particular have been used widely to help manage the occurrence of physical conditions with severe mental illness, with a recent study concluding that mHealth coaching may be a scalable intervention for reducing cardiovascular risk factors for young adults in community mental health settings. In addition, The Journal of Nervous and Mental Disease published a review of the benefits and challenges of telemedicine for individuals with severe mental illness and its role after the pandemic. We look forward to seeing the progression of current efforts to integrate digital health services and severe mental illness treatment in 2022. – SA 

10. Women with severe mental illness experience psychosis differently than men – Women with severe mental illness are overrepresented in the criminal justice system and underserved in society, as reported in a research summary published by ORPA in 2016. Much progress was made in this past year on research into women and mental illness, including an entire edition of the Health Affairs journal dedicated to perinatal mental health, including postpartum psychosis care. Also published in 2021 was an article highlighting how gender influences psychosis-related interruptions and the roles and relationships that shape individuals’ identities. Look for more on this topic from Treatment Advocacy Center in 2022, as we continue to be one of the few organizations that focuses on women with severe mental illness, including an upcoming qualitative research project on the unique experiences of women living with severe mental illness. – NR 

Wishing you and your loved ones a safe, happy and healthy new year!  
Elizabeth Sinclair Hancq is the director of research, Kelli South is the research associate, Sophie Ali and Nina Robertson are the research interns at the Treatment Advocacy Center. 

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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.  

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