More focus needed on mental health triage in disaster preparedness, bioethicists urge
May 23, 2011 in Psychology & Psychiatry
Johns Hopkins University bioethicists say disaster-response planning has generally overlooked the special needs of people who suffer from pre-existing and serious mental conditions. Survivors already diagnosed with schizophrenia, dementia, addictions and bipolar disorder are vulnerable long before a disaster strikes, they point out.
In a commentary appearing in the June issue of the journal Biosecurity and Bioterrorism, faculty from the Johns Hopkins Berman Institute of Bioethics say that more attention should be devoted to triaging and managing those already identified as having mental disorders. This group must be given just as much consideration during the planning stage as is given those who will have physical injuries and more obvious anxiety-related reactions, such as post-traumatic stress disorder (PTSD).
"Disasters limit the availability of resources, and these groups are especially vulnerable because they cannot advocate for themselves," says Peter Rabins, M.D., M.P.H., a core faculty member at the Berman Institute. "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."
In the article, Rabins and Nancy Kass, Sc.D., the Berman Institute's deputy director for public health, say that many of the mentally ill are dependent on caretakers and aren't fully capable of making sound decisions on their own. Emergency planners are ethically obligated to ensure that immediate and adequate mental health services are provided alongside more traditional triage, the bioethicists state.
"Disaster-response managers and those on the front line are well aware that survivors may succumb to PTSD and other mental disorders," says Rabins, the Richman Family Professor for Alzheimer's and Related Diseases at the Johns Hopkins University School of Medicine. "But sudden devastation also puts people with both lifelong and acquired intellectual disabilities in grave danger as well."
Whether a disaster is natural, as in an earthquake, or is caused by man, as in war, the ethical obligation to treat those with mental disabilities in the aftermath is just as important as aiding those with flesh wounds, Rabins says.
One study the authors cite found that 22 percent of Hurricane Katrina survivors who had pre-existing mental disorders faced limited or terminated treatment after the disaster.
Beyond patients with dementia and others who are mentally impaired, the authors say that this vulnerable group includes those who suffer from chronic pain and may be dependent on opiates, as well as substance abusers who receive treatment in the form of powerful sedatives classified as benzodiazepines. Withdrawal can be life threatening, the authors note.
The authors acknowledge that drug and alcohol addicts are often seen as unworthy of focused attention during a state of emergencyand scarce resourcesbecause their condition is widely perceived as "self-inflicted." But distinguishing between conditions that individuals have or don't have control over "is neither practical nor ethically justifiable, and in emergencies becomes wholly impractical," the authors assert.
Recommendations
As a first step, the authors recommend that disaster-response planners proactively identify and anticipate what needs might arise by meeting with clinicians and public health officials. Those discussions would then guide comprehensive advance planning.
Because licensed practitioners will likely be scarce immediately after a disaster, planners should consider training emergency medical technicians (EMTs) and other first-responders to identify those with pre-existing mental conditions and recognize those in need of prompt attention.
Acknowledging that first-responders may also be spread thinly post-disaster, the authors also suggest that planners consider turning to volunteers from the community, such as religious leaders and trained civilians, to distribute basic materials and temporary services to at-risk individuals.
To further make the best use of limited resources, the authors say that broad-based primary interventions, such as psychological debriefings, might be a lower priority than implementing potentially more effective "secondary prevention" measures, which seek to reduce long-term ill outcomes.
In particular, EMTs could be asked to responsibly distribute sedatives to manage short-term anxiety-related symptoms. But the authors say that policies would need to be developed to expand the list of those authorized to prescribe such drugs, as they are at present strictly regulated by federal law.
The authors note that sedatives were distributed in New York City immediately after the Sept. 11, 2001, terrorist attacks.
Ethical challenges
The authors also recommend that planners focus on ethical challenges likely to arise when assisting the mentally disabled during and after a disaster. These challenges may be partially addressed by adopting a "crisis standard of care" consistent with guidelines from the Institute of Medicine, they say.
Special attention should be given to assisted-living and long-term care facilities that house many residents with significant cognitive impairment, such as dementia. If these people are forced to evacuate, they may not fully comprehend the crisis and may be at risk for extreme emotional distress.
Hence, disaster-preparedness training for first-responders should also include information about how to interact with such individuals in a way that respects their dignity, the authors say.
More broadly, criteria for priority setting and the allocation of scarce resources can be based on objective factors, such as the likelihood of response to intervention, the prevention of chronic health problems, and the impact on public safety, the authors explain.
More information: The commentary, "Challenges for Mental Health Services Raised by Disaster Preparedness: Mapping the Ethical and Therapeutic Terrain," was published online ahead of print: www.liebertonline.… sp.2010.0068
Provided by Johns Hopkins Medical Institutions
-
Rethinking who should be considered 'essential' during a pandemic flu outbreak
Oct 02, 2008 |
not rated yet |
0
-
Emergency mental health lessons learned from Continental Flight 3407 disaster
Mar 01, 2011 |
not rated yet |
0
-
Disasters especially tough on people with disabilities, mental disorders
Aug 23, 2010 |
not rated yet |
0
-
Victimized children involved with disasters more likely to have mental health issues
Aug 26, 2010 |
not rated yet |
0
-
Psychological first aid for survivors of disaster
Oct 14, 2010 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Why is zone 1 in liver more prone to ischemic injury?
May 23, 2013
-
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013
-
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013
-
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013
-
If you became brain-dead, would you want them to pull the plug?
May 17, 2013
-
MRI bill question
May 15, 2013
- More from Physics Forums - Medical Sciences
More news stories
Storm chasers: born to be wild?
(HealthDay)—We've all seen them: the surfers who race to the beach when a hurricane hits, the guy who decides to ride out the storm in his overmatched boat, the tornado chasers who fearlessly steer their ...
Psychology & Psychiatry
4 hours ago |
not rated yet |
0
Hormone levels may provide key to understanding psychological disorders in women
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
Psychology & Psychiatry
5 hours ago |
5 / 5 (1) |
0
|
Are there atheists in foxholes? Study says they're the minority
Ernie Pyle – an iconic war correspondent in World War II – reportedly said "There are no atheists in foxholes." A new joint study between two brothers at Cornell and Virginia Wesleyan found that only ...
Psychology & Psychiatry
7 hours ago |
2.5 / 5 (4) |
1
Breathing exercises help veterans find peace after war, scholar says
(Medical Xpress)—Research by Stanford scholar Emma Seppala at the Center for Compassion and Altruism Research and Education found that post-traumatic stress disorder decreased in veterans who participated ...
Psychology & Psychiatry
8 hours ago |
5 / 5 (1) |
0
Depression raises diabetics' risk of severe low blood sugar episodes
(Medical Xpress)—Patients with diabetes who are depressed are much more likely to develop episodes of dangerously low blood sugars, or hypoglycemia, than are those who are not depressed, a new study has ...
Psychology & Psychiatry
9 hours ago |
not rated yet |
0
|
Engineered cytomegalovirus protects monkeys from HIV equivalent
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
Researchers identify first drug targets in childhood genetic tumor disorder
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
Going live: Immune cell activation in multiple sclerosis
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
Driving and hands-free talking lead to spike in errors, study shows
Talking on a hands-free device while behind the wheel can lead to a sharp increase in errors that could imperil other drivers on the road, according to new research from the University of Alberta.
Controlling mood through the motions of mitochondria
(Medical Xpress)—Regulating the distribution of power in neurons is done by a system that makes the national electric grid look simple by comparison. Each neuron has several thousand mitochondria confined ...
Audiologists recommend smart phone apps to monitor noise levels
After studying noise in one French Quarter neighborhood of New Orleans to determine whether or not noise levels exceeded municipal ordinances, Annette Hurley, PhD, Assistant Professor of Audiology at LSU Health Sciences Center ...