Ethical Questions Are Raised Regarding Mental Health Care Availability After Disasters

Faculty members from the Johns Hopkins Berman Institute of Bioethics stress the need for more targeted care management after a disaster for those with pre-existing mental health challenges. In a recent article, they emphasize that this segment of the population should receive as much consideration for disaster preparedness as those with physical limitations, and even more regard should be taken for people with anxiety issues or post-traumatic stress. The authors state that people with conditions such as dementia, bipolar, schizophrenia, and addictions are far more vulnerable to declined health and impairment, long before a disaster occurs.

“Disasters limit the availability of resources, and these groups are especially vulnerable because they cannot advocate for themselves,” says faculty member Peter Rabins, M.D., M.P.H. “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.” Rabins and others insist that many people with mental issues rely on others for their care, and are not able to make their own decisions in emergency situations. They urge emergency response plan administrators to be ethically responsible and plan for the necessary mental health care needed by these people.

“Disaster-response managers and those on the front line are well aware that survivors may succumb to PTSD and other mental disorders,” says Rabins. “But sudden devastation also puts people with both lifelong and acquired intellectual disabilities in grave danger as well.” Although many people with addictions are seen as less than deserving of immediate treatment, these people are at risk also, many of whom are on strong sedatives and cessation of treatment could cause serious physical and psychological impairment. Additionally, the authors remind planners that determining if a person’s condition is worthy of care or under one’s own control, “is neither practical nor ethically justifiable, and in emergencies becomes wholly impractical.”

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Leona J. Collins

    Leona J. Collins

    May 28th, 2011 at 8:24 PM

    That is a very valid point the gentleman brings up. I fully support that idea. The mentally vulnerable absolutely deserve the same considerations as the physically impaired in disaster situations.

    Imagine how some Iraq vet with PTSD would react to the devastation. These disaster sites look like war zones and that potentially could bring it all back to him/her.

  • Bethany


    May 29th, 2011 at 5:20 AM

    yes this is so on target because it makes me think of all of the elderly who lost their lives during the Hurricane katrina storm. I know that chances are this is a little bit of a different situation because those were people who in all likelihood could nt have much helped themselves. But it is sad to think that there are people who could do something to help themselves and their situation if a disaster were to strike but no one thought it necessary to tell them the things that they could do to save their lives. I am sorry people but this is a segment of the population that we need to stop overlooking and give them the same respcet that we and our own family and loved ones deserve.

  • qualir


    May 29th, 2011 at 10:59 PM

    I agree with what you said!

  • louis


    May 29th, 2011 at 11:58 PM

    you may have seen on television or seen something like this in real-whenever there is a disaster we see ambulances,paramedical staff and various other people trying to offer help to those injured.all this is good.but how often are there mental health professionals to help those affected by a disaster?not too often if you ask me.this is something that definitely needs attention.

  • Sally


    May 30th, 2011 at 6:05 AM

    I can’t believe that anyone would think that this is not a good idea. Or that there would not be enough staff members to supervise and get them through it.

  • MB


    May 31st, 2011 at 4:58 AM

    The main problem after a disaster, suppose we consider a flood, is that people are rushing to secure themselves,their family and their belongings…in such a situation,it is not often that one would think of looking after his mental health…if one gets injured, he will get the medication and continue his life struggle post-disaster…but that’s not the case with a mental ‘injury’…

  • Sherry Whitney

    Sherry Whitney

    June 5th, 2011 at 2:05 PM

    I’m sorry but when you’re on a disaster zone, you don’t look for schizophrenics and bipolar citizens first. Everyone is freaking out, some are badly injured.

    Who do you go to first? The one losing a pint of blood every minute.

    Medics are not trained to spot those who are mentally unstable on the spot. There is no chance that preparing for the mentally unstable can even work.

  • V.B. Ingram

    V.B. Ingram

    June 5th, 2011 at 2:34 PM

    @Sherry, I think a simpler way to put it would be “There is absolutely no feasible way to spot mentally-challenged individuals during a crisis.” Any method of quick identification such as an armband would cause an uproar among the community as profiling.

    There is no way I can see to prioritize mental health like this on a local scale. Talk to any psychologist and they will tell you no two people are alike in their mental disorders. You might end up doing much more damage than good if it goes wrong.

    In fact, wouldn’t the human instinct of running like heck mean that the able-bodied, whether mentally ill or not, are already at less of a risk in a crisis than physically disabled ones?

  • Murray Redfern

    Murray Redfern

    June 9th, 2011 at 1:14 AM

    @V.B. Ingram: You hit the nail on the head. They don’t have time to deal with those who have mental problems on top of those physically injured. Their job is to keep folks alive and get you to a hospital if you need it.

    If they could arrange to go check on them after the physically injured were dealt with, that would be a good thing.

    Think about it. Disasters are like war zones and in a war zone a soldier traumatized by seeing his buddy’s leg get blown off isn’t going to take priority over the injured soldier himself.

  • Yvonne Sawyer

    Yvonne Sawyer

    June 11th, 2011 at 9:07 PM

    Well let’s all come up with a way to quickly diagnose a mental illness sufferer when a disaster suddenly strikes. The conditions are:

    – You have five seconds to diagnose the person.
    – You have to do it while someone is dying.
    – You have to do it in the middle of a natural disaster.
    – You have to do it while surrounded by frantic screaming people.

    Yeah, not that easy after all.

  • Scott Lazio

    Scott Lazio

    June 11th, 2011 at 9:19 PM

    Whoa!! I think many of you are jumping the gun here and assuming the emergency staff need to make an immediate diagnosis there and then.

    What’s being talked about are not just those whose mental state is affected by the immediate disaster, but those the community is already aware of, say outpatients of addiction treatment centers or in halfway houses.

    What’s wrong with keeping a register of such vulnerable people and having specially trained staff go check on their wellbeing the same as they would if they knew of a man in a wheelchair?

    That’s what they mean by preparedness: they want to plan ahead to help those with mental frailties just as much as those with physical one. Personally I feel it’s a very sensible idea.

  • Danielle Newman

    Danielle Newman

    June 13th, 2011 at 12:05 AM

    @V.B. Ingram-I think the armband idea would be a good idea, actually. Maybe something smaller like a lapel pin that only the medical staff would recognize the significance of, or a bracelet like diabetics often wear to alert others of their condition.

    Nobody’s going to complain about their privacy being violated if it gets them help. And anyway, ultimately it’s down to them if they put it on or not.

  • Dave G. Fleming

    Dave G. Fleming

    June 15th, 2011 at 1:05 AM

    @ V.B. Ingram : “You might end up doing much more damage than good if it goes wrong.” Not necessarily. As part of the plan they could put together a group of local emergency volunteers on standby that are psychologists, therapists, counselors etc who would know how to deal with them properly.

    I can think of nothing much worse than a person suffering from a severe mental disorder having to go through a disaster alone and forgotten.

    I agree those dying need care first, of course they do. But there’s nothing to stop this other team of psych professionals doing their thing in tandem with the medics and seeking out the mentally challenged to help and comfort them.

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