When states and nations began to implement forced lockdowns to combat COVID-19, the SARS-CoV-2 coronavirus that has now killed 20,000 more people than the flu did two years ago, there was relatively little mention of mental health. For those who wanted to stay home and learn to bake bread, it was a paid vacation, but for those more susceptible to psychological stress it is a risky time.

A recent review of other studies obviously does not have meaningful data on coronavirus but pandemics like SARS, MERS, H1N1 can inform how people with mental health issues reacted to concerns about biological pathogens. It finds that people with psychosis may present a major challenge and potential infection control risk to clinical teams working with them.

Psychosis, and first episodes of psychosis, are commonly triggered by psychosocial stresses, which could include stress relating to isolation and having to remain within challenging family situations. They also may have different ideas about social distancing and contamination than people without the mental health issue. And this is a concern for families also; what do you do if a loved one hears voices tell them it's safe now.

Mental health disorders such as depression and anxiety are not given much voice during the debate about how to re-open the world; on one side are people, presumably being paid whether they go outside or not, who demand three more months of Zoom meetings while government officials and business owners see a collapse of the economy as a greater problem than the deaths we would've gotten during a bad flu year. If more moderate mental health issues are not being voiced, it is almost certain that the more severe spectrum of mental health conditions is ignored.