A recent population study from New South Wales examined hospitalisations for 19 vaccine-preventable conditions among more than 400,000 mental health service users. The findings tell a concerning story. People receiving mental health services were more than three times as likely as other NSW residents to be hospitalised for vaccine-preventable illnesses. The disparity was evident across influenza, hepatitis B, pneumonia, shingles and COVID-19. Perhaps most strikingly, they were admitted almost a decade younger than the broader population.

These findings build on earlier work showing that vaccine-preventable conditions are among the largest contributors to potentially preventable hospitalisations for people receiving mental health services. Vaccine-related admissions occur earlier, are more frequent, and account for a substantial proportion of excess hospital bed days. In one study, people receiving community mental health services experienced almost five times the rate of vaccine-preventable hospitalisations compared with other residents, with vaccine-preventable conditions accounting for nearly one-quarter of excess preventable hospital bed days.

At first glance, this seems paradoxical – Vaccines are not an experimental or difficult-to-scale intervention. Australia already has the infrastructure, such as general practices, pharmacies, community health services, immunisation registries, public funding mechanisms and trained workforces. The technical challenge has largely been solved.

Yet the implementation gap remains. The answer may lie in something health systems rarely fund or measure adequately: connection.

This idea aligns with a broader challenge that people with lived experience have been highlighting for decades: that health systems focus on biomedical interventions while overlooking the contextual and relational factors that determine whether people can actually access and benefit from care. Relationships, trust, and inclusion are fundamental influences on health and wellbeing rather than optional extras.

Many preventive health programmes are designed around an implicit assumption that people are connected to the system. They assume people receive information, trust the source, attend appointments, navigate services and respond to reminders.

For many people this works reasonably well. For others, it does not.

People living with mental illness are disproportionately affected by fragmented care, social isolation, unstable housing, poverty, and discrimination. The challenge is not simply making vaccines accessible, the challenge is maintaining connection between the people and services that make preventive healthcare possible.

A vaccine sitting in a refrigerator cannot improve health outcomes on its own. A reminder letter cannot build trust. A clinical guideline cannot overcome disengagement from a service.

Prevention requires a pathway. And pathways are built through relationships. Connection should be considered a health system capability in its own right.

When a mental health clinician provides a warm referral to a GP, when a peer worker re-engages someone with care, when a service coordinates physical health appointments, when a trusted relationship encourages attendance at a pharmacy or a vaccination clinic, these activities are often treated as supplementary supports. They are not. They are implementation strategies founded in the understanding that people need people.

Equally Well’s Call to Action described the need for health and social care systems to become more relational, recognising that social environments, community participation, relationships and interactions with services are fundamental determinants of health. Vaccination provides one of the clearest examples of why this matters. We possess an intervention that is highly effective, relatively inexpensive and readily scalable. Yet outcomes remain inequitable because the final implementation challenge is relational, not technological, clinical or logistical.

If we are serious about improving health equity for people living with mental illness, we need to think beyond screening and treatment itself. We need to strengthen the networks of connection that enable prevention to reach people in the first place. This includes more integrated physical and mental healthcare, greater care coordination, stronger lived experience workforces, physical healthcare navigation, community partnerships and service models that prioritise relationship-building rather than assuming people can navigate complex systems alone.

Key Sources:

Sara, G., Gould, P., Curtis, J., et al. (2023). Vaccine-preventable hospitalisations in adult mental health service users: a population study. Psychological Medicine.

Chapman, J., Erskine, V., Allan, J., Peters, D., & Roberts, R. (2025). Enhancing physical healthcare in the mental health system: Perspective from the 2024 Equally Well Forum Embedding Lived Experience. Australian & New Zealand Journal of Psychiatry.

Sara, G., Chen, W., Large, M., et al. (2021). Potentially preventable hospitalisations for physical health conditions in community mental health service users: a population-wide linkage study. Epidemiology and Psychiatric Sciences.