Introduction

On 17 November 2019, the SARS-CoV-2/COVID-19 epidemic (hereafter: COVID-19) first broke out in Wuhan, a city in the province of Hubei in China (Zhu et al., 2020). The novel virus quickly spread around the world, and on 11 March 2020, the World Health Organization declared that the world was faced with a pandemic (Cucinotta & Vanelli, 2020). The COVID-19 pandemic has caused significant uncertainty as it has negatively impacted almost all aspects of society resulting in near universal hardship and stress.

While COVID-19 has affected the entire population, the focus of this special issue is on persons with serious mental illnesses (SMI) and autism spectrum disorders (ASD). These individuals were found to be at higher risk of becoming infected (Nishimi et al., 2022; Krieger et al., 2023), and because of greater prevalence of co-occurring medical conditions including obesity, cardiac and respiratory conditions (Jones et al., 2016; Kohane et al., 2012), they were at increased risk of morbidity and mortality once infected (Centers for Disease Control and Prevention, 2020).

People with SMI and ASD experienced pre-pandemic health disparities, which were exacerbated during the pandemic (Baweja et al., 2022; Diaz et al., 2021; Jesus et al., 2021). It is also not a surprise that access to health and mental health services has also been greatly impacted during this time. Outpatient and in-home services had either paused or quickly converted to digital health solutions (Baweja et al., 2022; Benjenk et al., 2021). Outpatient psychiatry visits have also widely converted into virtual visits to mitigate the impact of COVID-19 (Eyllon et al., 2022). Finally, many day treatment programs and other community-based programs were either closed or delivering services through digital health platforms, which had limited to no evidence of feasibility or efficacy (Substance Abuse and Mental Health Services Administration; SAMHSA, 2021).

Special Issue on the Life Impacts of the Pandemic

A significant literature has emerged on the impacts of the pandemic on health outcomes, service delivery, and mental health and distress experienced by individuals with SMI and ASD. What has been less discussed is how the pandemic may have impacted the daily lives and activities of these populations, which was already limited pre-pandemic (Song et al., 2022; Nagata et al., 2020). Such participation has been described as a “medical necessity” in the sense that it is related to physical, cognitive, and mental health and wellness outcomes (Salzer, 2021). Countries across the globe launched actions to fight the threat, including various preventive measures and restrictions that disrupted, limited, or completely shut down in-person participation in occupations related to work, education, leisure, faith, and other spaces where social interactions and meaningful participation typically take place (Onyeaka et al., 2021). While restrictions have lessened as vaccines and treatments were developed, residual impacts on community participation plausibly remain. This includes more remote work and education, and even the likelihood of virtual mental health services becoming a long-term option may decrease the likelihood of people getting out of their homes and into the community (Townley et al., 2022).

The World Health Organization defines vulnerability following major events as “the degree to which a population, individual or organization is unable to anticipate, cope with, resist and recover from the impacts of disaster” (World Health Organization, 2002). Individuals with ASD and SMI may be more impacted in terms of their community participation because of differences in communication, cognition, and emotional and behavioral responses, especially to stressors and change, as well as socialization and executive functioning differences (American Psychiatric Association, 2013). Moreover, they may experience difficulties because of different resilience capabilities, such as anticipating consequences and adapting and being flexible to abrupt changes (Wallace, 2016).

There are several reasons that drive the need to explore how the pandemic has impacted the lives and activities of individuals with SMI or ASD. One is that some of these individuals who were able to do reasonably well in terms of their community participation prior to the pandemic might have experienced a setback because of the various pandemic-related restrictions they experienced. They may have trouble regaining the losses they experienced. A second concern is that others with SMI and ASD may have particular challenges adjusting to the “new normal” of post-pandemic life. Understanding how the pandemic may have impacted the lives of these individuals may provide insights into what is needed to help some of these individuals “re-start” their lives post-pandemic and others negotiate the new world we all live in.

The main goal of this special issue was to highlight research about the impact of the COVID-19 pandemic on the lives of adults with SMI or ASD around the world with particular attention paid to community functioning and participation that might need to be the focus of future services as the restrictions and other impacts associated with the pandemic hopefully lessen over time.

Studies that are included come from research conducted in Italy, Canada, Israel, Nigeria, and the United States. The impacts of the pandemic are also examined in several different service contexts, such as Coordinated Specialty Care programs for those experiencing first-episode psychosis, Clubhouses, peer support, and rehabilitation services focused on educational outcomes.

Tripoli et al. (2023) investigated the impact of COVID-19 on the quality of life and daily lifestyles of 100 service users at the Psychiatry Unit in Palermo University Hospital in Italy. The results showed that most participants reported a significant impact on their quality of life and nearly half reported degraded lifestyles. Diminished lifestyles were linked to poor mental and physical health related quality of life. The findings suggest that people with mental illnesses require interventions for lifestyle changes and that mental health services in Italy should adjust to the pandemic by offering virtual treatments.

Two other studies report some positive impacts of the pandemic. Bella-Awusah et al. (2023) provide further support toward understanding the perceptions and experiences of youth living with psychosis during the COVID-19 pandemic in Nigeria. Twenty participants with a confirmed diagnosis of a psychotic disorder were interviewed. The study found that participants were aware of the nature of the disease and reported worsening mental health and disruptions to daily routines. However, they also described positive experiences such as improved family relationships, skill building, helping others, and extended time for self-development activities. The study utilized a co-production approach with persons with lived experience, which could be valuable for future research on psychosis. Patel et al. (2022) conducted a qualitative study with young adults with psychotic disorders in OnTrackNY and their family members to understand how the pandemic impacted their lives. They found that the pandemic decreased their social contacts and civic engagement and impacted their employment educational pursuits. However, they also found that it was associated with some deeper connections with family and certain friends as well as active efforts to maintain and enhance wellness.

One study led by Davidson and Pfeiffer (2023) investigated the perceived barriers to community participation experienced by individuals with ASD during the COVID-19 pandemic. Seventeen participants used Photovoice methodology to capture their experiences and data analysis showed two major themes as barriers: coping with COVID-19 and transportation barriers. COVID-19 fears and restrictions added to the existing sensory and communication barriers faced by the ASD community and those with co-occurring mental health conditions may experience increased symptoms due to disruption of routines and participation.

Finally, the remaining studies examined the impacts of the pandemic in the context of a new peer support program, an educational initiative, and Clubhouse programs. In their Fresh Focus article, Goldfarb et al. (2022) describe the development of a mental health peer support intervention, UPSIDES, in response to the COVID-19 pandemic in Israel. The researchers focus on the processes and lessons learned during the pandemic and found that a combination of adherence to core principles, use of flexible telecommunication, and a focus on forming reciprocal relationships helped maintain participant engagement and support individuals with mental illness during the pandemic. The study highlights the value of peer support services and the importance of experiential knowledge in addressing mental health needs during challenging times. Hadas Lidor et al. (2022) described the adaption made by National School for Mental Health Rehabilitation in Israel, that includes students with a psychiatric disability, to the challenges of the COVID-19 pandemic by continuing all regular courses remotely and creating new online workshops. The article reviews the school’s transition from being change agents in-person to change agents online through descriptive and qualitative findings. The study found that the large number of participants who had access to distance learning and their positive responses indicated the creation of opportunities alongside challenges faced during the pandemic. This is the first analysis of the challenges, opportunities, and outcomes of a recovery-oriented online academic facility during a pandemic.

Overall, these studies point to a need to focus on how the pandemic impacted the lives of people with SMI, and the one study focused on individuals with ASD also suggests that they also experienced barriers to participation during the pandemic. Services should keep in mind that the pandemic may have long-term impacts on their lives and adjust accordingly.