Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Addressing the Needs of the Seriously
Mentally Ill in Disasters■ Social services. Those withIn the acute stages of a naturalAssisting
personswithseverementalchronic mental illness generally
disaster, those with serious mental
need enhanced social services
illness may function relatively well.
illness can mitigate or prevent
during the post-disaster
Like the rest of the population, they
adverseoutcomes.
recovery stages, including
often rise to the occasion to assist
assistance with housing,themselves and others in a time ofgreat need. However, persons with
employment, and re-establishment of psychiatric care.
severe and often chronic mental illness are a vulnerable
group whose well-being is especially threatened by thePersons with serious mental illness are vulnerable tosocial disruption of the post-disaster setting. In addition,disasters.
the existing resources and damage to infrastructure may■ Less prepared. Persons with serious mental illness
significantly impact treatment care options. Assisting
are less likely to be prepared for a disaster. Evidence
persons with severe mental illness can mitigate or prevent
suggests that those with serious mental illness are lessadverse outcomes.
likely to have supplies on hand or an emergency plan
■ Special care and services. Disaster mental healthin place in the event of a disaster. They may be more
services designed for the general population, such as
dependent on others to assist them to evacuate or takethose based on concepts of psychological first aid, areother necessary precautions prior to a disaster.
equally beneficial for survivors with mental illness.
■ Onset of new and recurrent symptoms. Persons withProcedures addressing safety, connecting, calming,a history of mental illness are more likely to develop
learning disaster behaviors, and facilitating a sense ofstress-related symptoms or a relapse of prior symptoms
hope and optimism are helpful during or immediately
following a disaster. Those with a chronic mental illness
after a disaster. Care should be particularly sensitive
may have difficulty tolerating psychological distress or
to not isolate or stigmatize those with chronic mental
a disruption in their social situation. Those with priorillness. Pharmacologic formularies in the disasterthe diagnosis of posttraumatic stress disorder may beregion should include a broad range of psychiatricparticularly vulnerable to an exacerbation of symptoms
medications in order to allow those with chronic mental
due to an association of the current disaster andillness to stay on their prior regimens. The stress of theresponse (sirens, for example) to their prior trauma.
disaster and disruption in prior treatment may resultin the deterioration of mental health status for some.
Disasters disrupt mental health care and services.
Psychiatric hospitalization may be necessary in these■ Loss of caretakers. Persons with chronic and severecases to help the persons re-stabilize.
mental health problems are often cared for by family■ Responders trained to help. Disaster responders
members. In the wake of a disaster, caretakers may haveshould be trained to identify and assist persons with
been killed or injured. Family members may divert
signs of active mental illness. They need training totheir time and energy to basic tasks of recovery suchfeel comfortable in assisting with appropriate resources
as securing food, water, and safe housing, leaving lessincluding medical and psychiatric referral, whentime and resources to care for their mentally ill family
possible. Symptoms of particular concern include:
member.
psychosis (hallucinations, delusions, and disorganized■ Mental health services are disrupted. Persons withthought processes), severe depression, suicidal orserious mental illness are often in the care of thehomicidal ideation or behavior, and substance abuse.
mental healthcare system. During a disaster, mental
Asking if someone has their usual medications and what
health services are often disrupted. This can include thethey are for can begin a helping relationship.

Continued

shutting of inpatient psychiatric units and hospitals
and outpatient clinics. Pharmacies may be closed or
their supply chains interrupted, resulting in patientsnot receiving their medications. Problems withtransportation infrastructure may make it difficult to
get to appointments.
■ Loss of hospitals and care facilities. Many chronicallymentally ill live in supported environments, including
psychiatric hospitals or other skilled facilities, grouphomes, or shelters. In the aftermath of a disaster, thesefacilities may close or be understaffed; residents may beforced to either relocate and/or be underserved.
■ Increased demand for mental health services.
Demand for mental health services often increases in

the wake of a disaster due to the mass trauma that hasoccurred. This greater need for services for many new
people may result in a diversion of resources away fromcare for the chronically mentally ill.
Disaster preparedness and planning.
■ Assist those with chronic mental illness and theirfamilies to develop a disaster plan including emergency
contact information and a supply of medications.
■ Identify group residences and shelters that house
serious and chronically mentally ill persons in order tofacilitate evacuation, rescue, or safety check at the timeof a disaster.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org