Focus on mental health triage in disaster preparedness urged

In a commentary appearing in the journal Biosecurity and Bioterrorism, bioethicists at Johns Hopkins University said that disaster response planning must focus on the special needs of people who suffer from pre-existing and serious mental conditions.

In the commentary, faculty from the Johns Hopkins Berman Institute of Bioethics say more attention should be given to managing and triaging those identified as having mental disorders and that the group must be given as much consideration during planning as those with physical injuries and more obvious anxiety-related reactions.

"Disasters limit the availability of resources, and these groups are especially vulnerable because they cannot advocate for themselves," Peter Rabins, a core faculty member at the Berman Institute, said. "But little attention has been given to the ethical challenges that arise when resources are limited, to the importance of identifying these ethical issues ahead of time, and for establishing mechanisms to address these moral dilemmas."

A study cited by the authors found that 22 percent of Hurricane Katrina survivors who had pre-existing mental disorders faced terminated or limited treatment after the disaster. This includes patients with dementia, chronic pain with a dependency on opiates, and substance abusers who are receive benzodiazepines as treatment.

"Disaster-response managers and those on the front line are well aware that survivors may succumb to PTSD and other mental disorders," Rabins said. "but sudden devastation also puts people with both lifelong and acquired intellectual disabilities in grave danger as well."

The authors recommend that disaster-response planners proactively anticipate and identify needs that could arise by meeting with public health officials and conditions. They say that first-responders should be trained to identify those with pre-existing mental conditions and turning to volunteers from the community to distribute basic materials and temporary services.

In addition, they say that planners should focus on ethical challenges that could occur when assisting the mentally disabled during and after a disaster by adopting a “crisis of care” constant with guidelines from the Institute of Medicine.