Page - 437 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

437Weighing Public Health and Mental Health Responses to Non-Compliance… • A person is showing unusual behaviour suggestive of psy- chosis, and is refusing to leave a public park, which has been closed pursuant to a public health directive. • A person is approaching strangers in the community and spitting or coughing on them without apparent reason or provocation. Could such situations lead to serious bodily harm to the person or others or to serious physical impairment of the person? We explore this possibility below. Vulnerability of Persons Who Have a Mental Illness in the Context of COVID-19 As a group, people with mental illnesses are vulnerable in the face of COVID-19 and the associated public health precautions because of risk factors that are correlated with mental illness. They may be at greater risk of infection and severe course of disease, their underlying psychiatric condition can be exacerbated by the public health precau- tions, and they may face greater barriers to accessing care for their psychiatric condition or for COVID-19 or both. The risk of contracting or transmitting COVID-19 may be increased for multiple reasons when a person has mental illness, trauma, or substance use disorders. Some people with mental illnesses may have trouble understanding and responding to public health directives.6 Homelessness and mental illness are both associated with worse baseline health and medical comorbidities compared to the general population, which increase the risk of developing a compli- cated course of illness if a person becomes infected.7 Furthermore, some homeless shelters and community resources are refusing access to people who do not abide by precautions in order to protect other clients and staff, leaving them with reduced access to vital commu- nity-based resources. Since self-isolation can exacerbate some mental 6. J Clapton et al, “Precarious social inclusion: chronic homelessness and impaired decision-making capacity” (2014) 23:1 J of Social Distress and Homelessness 32. 7. A Chevance et al, “Assurer les soins aux patients souffrant de troubles psy- chiques en France pendant l’épidémie à SARS-CoV 2  ; Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review” (2020), online: L’Encephale <doi.org/10.1016/j.encep.2020.03.001>; SW Hwang et al, “Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study” (2009) 339 BMJ b4036.