Several key changes to policies may allow for vulnerable populations to have improved access to mental health care. These recommendations were published in Psychiatric Services in Advance.

The COVID-19 pandemic has been associated with increased depression, suicide, anxiety, and substance use. In addition, vulnerable populations have a greater risk for contracting SARS-CoV-2. The authors of this special article used a syndemic theory approach to recommend steps which could ameliorate disparities in mental health care among vulnerable populations and ethnic minorities.

The first target should be to protect essential workers who are responsible for maintaining the infrastructure and functioning of the economy. These individuals tend to have lower educational attainment, to be immigrants or ethnic minorities, and socioeconomically disadvantaged. These workers should be prioritized to have more protections under the law, be provided with adequate personal protective equipment, given generous leave for COVID-19 illness, prioritized in vaccination campaigns, and provided with adequate mental health support.

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There should also be a focus on engagement and empowerment on the community level. Political power is often associated with community wealth. Disinvestment in minority communities has removed safety nets which could assist individuals who have lost their job or have been negatively affected by the COVID-19 pandemic in some way. Empowering community members to assess which government assistance is needed in their area and restructuring political composition of local boards may allow for more marginalized communities to impart effective change.

A simple means of expanding mental health services would be to expand financial support. For instance, Medicaid could reduce payment rates for mental health and substance use treatments or Medicaid access could be expanded to cover more families who are in the coverage gap. The expansion of telepsychiatry as a consequence of the global pandemic has increased access of care to many. These remote services should continue, such that service disparities may be improved.

The global pandemic due to SARS-CoV-2 has increased awareness of deep-rooted social and ethnic inequalities in the United States. These disparities are largely responsible for the differences in infection and mortality rates of COVID-19 and unemployment rates due to the associated economic downturn. With a syndemic theory approach to addressing these disparities through policy changes, racial injustices, and increased access to mental health care may be improved for millions of underserved individuals in the US.


Shim RS, Starks SM. COVID-19, structural racism, and mental health inequities: Policy implications for an emerging syndemic. Psychiatr Serv. 2021;appips202000725. doi:10.1176/

This article originally appeared on Psychiatry Advisor