The COVID-19 pandemic has taken a toll on everyone. No one is immune to it, and although some good news is on the horizon, we are still considered at war with this virus.

The weapons at our disposal vary, from various mitigation measures to the vaccine which brings hope for a better future. The vaccination process does not come without its challenges, and although some individuals might have their reservations about the vaccine, it has been reported that the Maltese are mostly eager to receive it. This brings us to the endless debate regarding who should be given priority to get vaccinated.

Malta has a detailed staged plan for the vaccination rollout, prioritising frontliners, the most vulnerable and at risk, educators and other population constituencies in a staggered manner, according to perceived risk and complications related to contagion. So far so good.

So what is the point of this article?

It is the issue of vulnerability or rather, its definition. We define vulnerability from a medical perspective, that is, if someone is considered vulnerable, they are more likely to get infected or else may have a worse prognosis if they catch the illness. This may be due to chronic illness, pregnancy, age, respiratory problems and other specific conditions listed in the ‘Guidance for the protection of vulnerable persons during the transition phase of the COVID-19 pandemic’ issued by the Ministry of Health (2020).

Severe mental health conditions can be severely debilitating, thus affecting the individual’s ability to function in a ‘normal’ reality, let alone during a crisis situation

Such guidance and the inoculation schedule fails to include those individuals with severe mental health conditions − conditions that have been exacerbated due to the coronavirus situation. Are those individuals who suffer from obsessive compulsive disorders, social anxiety disorders, phobias and irrational fears, to name just a few, not vulnerable?

Of course they are. Primarily mental health conditions, such as the ones mentioned, that are based on anxiety of such a debilitating nature that it is considered as pathological, have been fuelled by the ongoing threat of the virus as well as by the mitigation factors that have been in place.

Just imagine, for instance, that you have obsessive compulsive symptoms related to hand washing or a phobia of germs, as a pre-COVID default condition. Finding yourself in a new reality in which your ‘nemesis’ is the main topic of discussion and certainly runs the agenda, can be horrific. 

As presented in the narratives that have been shared by a few individuals with these conditions, such as that by Dione Pizzuto (2020), it is quite clear that the pandemic has placed this group of people in a precarious and vulnerable niche.

Moreover, there is the pre-pandemic morbidity related to the mental illness itself, keeping in mind that severe mental health conditions can be severely debilitating, thus affecting the individual’s ability to function in a ‘normal’ reality, let alone during a crisis situation.

An ongoing pandemic is certainly the metaphorical last straw that an individual who is already struggling with mental health issues may need to collapse. In this view, are these individuals not vulnerable, considering that due to their mental health condition, their life quality and even life itself may be at risk?  A lot has been published about the need to take care of our mental well-being during the pandemic and the increased risk factors of such a pandemic on our mental health. So what about those who already endured the challenges of living with a mental health condition during these unprecedented times?

We sincerely hope that individuals with a severe mental health condition, whose life is being greatly impacted by COVID-19, are not forgotten. The nature of mental illness can be stigmatising and impacts the ability to speak out and be heard. Let us not leave out these individuals and realise that we need to start looking at mental illness as any other condition which each and every person may encounter during their lifetime.

Mental health has been previously termed as the ‘Cinderella of health’, referring to the low priority that is often designated to this sector. If this same attitude is exhibited during such a critical moment, the consequences can be devastating. There is no question really – this group is indeed vulnerable. This said, measures should be in place so that no abuse of the system occurs as in any other priority group.

Alexei Sammut is a lecturer and Paulann Grech is a senior lecturer, both within the Department of Mental Health, Faculty of Health Sciences, University of Malta.