Lockdown measures in response to the coronavirus disease 2019 (COVID-19) pandemic can have serious mental health effects on the population, especially in vulnerable groups, such as those living in poor socio-economic conditions, those who are homeless, migrant workers and asylum seekers/refugees. In addition, these vulnerable groups frequently have greater difficulty accessing health services and in treatment adherence. The aim of this study is to estimate the impact of the COVID-19–related lockdown on service utilization and follow-up adherence in an Italian mental health outpatient service for migrants and individuals in socio-economic difficulties.

There is evidence that the COVID-19 crisis has had a negative impact on the mental health of vulnerable populations through different mechanisms.22,23 Unfortunately, no data are currently available in specific populations, such as those investigated in this study; however, the authors recently performed a phone-based data collection survey (personal data, article in preparation) showing that there are several pathways leading to mental distress. For example, participants reported intrinsic effects related to anxieties of being infected; consequences of the quarantine, both on living experience (e.g. sense of imprisonment reminding traumatic experiences, intolerance to inactivity, boredom, depression) and interpersonal relationships (e.g. forced and conflictual cohabitation in reception centres); fears for the health of relatives living in their home countries; increased social marginalisation (e.g. homeless remained without food, clothing, furniture, laundry and washing facilities or without acceptance in public dormitories); job loss and additional economic difficulties; reduction of the activities in the mental health outpatient services, with increased difficulty in accessing them; increased fears of being taken by the police in the cases of undocumented migrants (the reduction of people around the city made them more visible in the streets) and inability to obtain necessary medications.

Evaluate the impact of the COVID-19–related lockdown on two specific problems possibly faced by mental health patients with a history of immigration and/or socio-economic difficulties: that is, difficulties in mental health service utilisation and follow-up adherence. In particular, the study was conducted in an Italian public health outpatient service that was specifically dedicated to migrants and individuals with socio-economic difficulties. The authors believe that this study is necessary because problems at this level have been predicted on the basis of theoretical considerations but, to the authors’ knowledge, no evidence measuring this effect is currently available. Moreover, centres dedicated to migrants are frequently based on volunteers, and their reports often remain in the grey literature, thus remain difficult to access by the scientific community.

The lockdown-related reduction in number of patients accessing the mental health service makes it difficult to help vulnerable populations during a period of time in which their mental health needs are expected to increase. Moreover, the reduction seen in follow-up compliance increases the risk of treatment discontinuation and possible relapse. Proactive alternative strategies need to be developed to reach these vulnerable populations.