Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-20T17:22:34.077Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethical Issues Raised in Addressing the Needs of People With Serious Mental Disorders in Complex Emergencies

Published online by Cambridge University Press:  08 April 2013

Lawrence S. Wissow ,
Lainie Rutkow ,
Nancy E. Kass ,
Peter V. Rabins ,
Jon S. Vernick  and
James G. Hodge Jr
Get access Rights & Permissions [Opens in a new window]

Abstract

Recent manmade and natural disasters highlight weaknesses in the public health systems designed to protect populations from harm and minimize disruption of the social and built environments. Emergency planning and response efforts have, as a result, focused largely on ensuring populations' physical well-being during and after a disaster. Many public health authorities, including the World Health Organization, have recognized the importance of addressing both mental and physical health concerns in emergency plans. Individuals with mental disorders represent a notable proportion of the overall population, and anticipating their needs is critical to comprehensive emergency planning and response efforts. Because people with serious mental disorders historically have been stigmatized, and many individuals with mental disorders may be unable to care for themselves, ethical guidance may be of assistance to those engaged in emergency planning and response. This article considers several broad categories of ethical issues that arise during emergencies for people with serious mental disorders and offers recommendations for ways in which emergency planners and other stakeholders can begin to address these ethical challenges.

(Disaster Med Public Health Preparedness. 2012;6:72–78)

Keywords

disaster planningpreparednessethicsmental health servicesmental disordersemergency medical servicesmental health serviceshealth personnelvulnerable population
Type
Special Focus
Information
Disaster Medicine and Public Health Preparedness , Volume 6 , Issue 1 , March 2012 , pp. 72 - 78
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Federal Financial Institutions Examination Council. Lessons Learned from Hurricane Katrina: Preparing Your Institution for a Catastrophic Event. Washington, DC: Federal Deposit Insurance Corporation; 2008.Google Scholar
2.Kirschenbaum, L, Keene, A, O’Neill, P, Westfal, R, Astiz, ME.The experience at St. Vincent's Hospital, Manhattan, on September 11, 2001: preparedness, response, and lessons learned. Crit Care Med. 2005;33 1(suppl)S48–S52.Google Scholar
3.Kost, GJ, Tran, NK, Tuntideelert, M, Kulrattanamaneeporn, S, Peungposop, N.Katrina, the tsunami, and point-of-care testing: optimizing rapid response diagnosis in disasters. Am J Clin Pathol. 2006;126 (4):513–520.Google Scholar
4.World Health Organization. Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors.Geneva: World Health Organization; 2003.Google Scholar
5.National Institute of Mental Health. The numbers count: mental disorders in America. http://www.nimh.nih.gov/statistics/index.shtml. Accessed December 21, 2011.Google Scholar
6.Foa, EB, Stein, DJ, McFarlane, AC.Symptomatology and psychopathology of mental health problems after disaster. J Clin Psychiatry. 2006;67(suppl 2)15–25.Google Scholar
7.Boe, HJ, Holgersen, KH, Holen, A.Mental health outcomes and predictors of chronic disorders after the North Sea oil rig disaster: 27-year longitudinal follow-up study. J Nerv Ment Dis. 2011;199 (1):49–54.Google Scholar
8.US Department of Health and Human Services. Mental Health: A Report of the Surgeon General.Rockville, MD: US Department of Health and Human Services Administration, Center for Mental Health Services; 1999.Google Scholar
9.National Institute of Mental Health. How are medications used to treat mental disorders?. http://www.nimh.nih.gov/health/publications/mental-health-medications/how-are-medications-used-to-treat-mental-disorders.shtml. Published February 26, 2009. Accessed September 5, 2010.Google Scholar
10.Schinnar, AP, Rothbard, AB, Kanter, R, Jung, YS.An empirical literature review of definitions of severe and persistent mental illness. Am J Psychiatry. 1990;147 (12):1602–1608.Google Scholar
11.Wang, PS, Gruber, MJ, Powers, RE.Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. Am J Psychiatry. 2008;165 (1):34–41.Google Scholar
12.Birmingham, L, Mason, D, Grubin, D.Prevalence of mental disorder in remand prisoners: consecutive case study. BMJ. 1996;313 (7071):1521–1524.Google Scholar
13.Kessler, RC, Mickelson, KD, Williams, DR.The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav. 1999;40 (3):208–230.Google Scholar
14.Rabkin, JPublic attitudes toward mental illness: a review of the literature. Schizophr Bull. 1974;Fall(10):9-33.Google Scholar
15.Shorter, EThe birth of psychiatry.In: A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York, NY: John Wiley & Sons; 1998:1-8.Google Scholar
16.Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE.Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62 (6):593–602.Google Scholar
17.Yonkers, KA, Bruce, SE, Dyck, IR, Keller, MB.Chronicity, relapse, and illness—course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Depress Anxiety. 2003;17 (3):173–179.Google Scholar
18.Pesik, N, Keim, ME, Iserson, KV.Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001;37 (6):642–646.Google Scholar
19.Burkle, FM JrAcute-phase mental health consequences of disasters: implications for triage and emergency medical services. Ann Emerg Med. 1996;28 (2):119–128.Google Scholar
20.Achieving the Promise. Transforming Mental Health Care in America. DHHS Pub. No. SMA-03-3832.Rockville, MD: New Freedom Commission on Mental Health; 2003.Google Scholar
21.Patient Protection and Affordable Care Act. PL No. 111-148 (2010) .Google Scholar
22.Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. HR 6983 (2008) .Google Scholar
23.Sundararaman, R, Redhead, CSMental Health Parity: Federal and State Action and Economic Impact, RL31657.Washington, DC: Congressional Research Service; 2003.Google Scholar
24.Payton, AR.Mental health, mental illness, and psychological distress: same continuum or distinct phenomena? J Health Soc Behav. 2009;50 (2):213–227.Google Scholar
25.Gabriel, R, Ferrando, L, Cortón, ES.Psychopathological consequences after a terrorist attack: an epidemiological study among victims, the general population, and police officers. Eur Psychiatry. 2007;22 (6):339–346.Google Scholar
26.Protección de la Salud Mental en Situaciones de Desastres y Emergencias.Washington, DC: Organización Panamericana de la Salud; 2002.Google Scholar
27.Katz, CL, Pellegrino, L, Pandya, A, Ng, A, DeLisi, LE.Research on psychiatric outcomes and interventions subsequent to disasters: a review of the literature. Psychiatry Res. 2002;110 (3):201–217.CrossRefGoogle ScholarPubMed
28.Rutter, M, Moffitt, TE, Caspi, A.Gene-environment interplay and psychopathology: multiple varieties but real effects. J Child Psychol Psychiatry. 2006;47 (3-4):226–261.Google Scholar
29.Kinston, W, Rosser, R.Disaster: effects on mental and physical state. J Psychosom Res. 1974;18 (6):437–456.Google Scholar
30.Monk, M.Epidemiology of suicide. Epidemiol Rev. 1987;9:51–69.Google Scholar
31.Olesen, AV, Mortensen, PB.Readmission risk in schizophrenia: selection explains previous findings of a progressive course of disorder. Psychol Med. 2002;32 (7):1301–1307.Google Scholar
32.Kessing, LV, Olsen, EW, Andersen, PK.Recurrence in affective disorder: analyses with frailty models. Am J Epidemiol. 1999;149 (5):404–411.Google Scholar
33.de la Hoz, RE, Hill, S, Chasan, R.Health care and social issues of immigrant rescue and recovery workers at the World Trade Center site. J Occup Environ Med. 2008;50 (12):1329–1334.Google Scholar
34.Adair, CE, McDougall, GM, Mitton, CR.Continuity of care and health outcomes among persons with severe mental illness. Psychiatr Serv. 2005;56 (9):1061–1069.Google Scholar
35.Thomas, KC, Ellis, AR, Konrad, TR, Holzer, CE, Morrissey, JP.County-level estimates of mental health professional shortage in the United States. Psychiatr Serv. 2009;60 (10):1323–1328.CrossRefGoogle ScholarPubMed
36.Shannon, GW, Bashshur, RL, Lovett, JE.Distance and the use of mental health services. Milbank Q. 1986;64 (2):302–330.Google Scholar
37.Ivey, SL, Scheffler, R, Zazzali, JL.Supply dynamics of the mental health workforce: implications for health policy. Milbank Q. 1998;76 (1):25–58.Google Scholar
38.Yellowlees, PM, Odor, A, Parish, MB, Iosif, AM, Haught, K, Hilty, D.A feasibility study of the use of asynchronous telepsychiatry for psychiatric consultations. Psychiatr Serv. 2010;61 (8):838–840.Google Scholar
39.Pyne, JM, Fortney, JC, Tripathi, SP, Maciejewski, ML, Edlund, MJ, Williams, DK.Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression. Arch Gen Psychiatry. 2010;67 (8):812–821.Google Scholar
40.Marcus, EHDisaster mental health services. Internet J Rescue Disaster Med. 2000;1. http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijrdm/vol1n2/dmhs.xml. Accessed August 18, 2010.Google Scholar
41.Substance Abuse and Mental Health Services Administration. Training Manual for Mental Health and Human Service Workers in Major Disasters.Washington, DC: Department of Health and Human Services; 2000.Google Scholar
42.Institute of Medicine. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations—Letter Report.Washington, DC: National Academies Press; 2009.Google Scholar
43.Donohoe, MT.Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med. 1998;158 (15):1596–1608.Google Scholar
44.Hodges, B, Inch, C, Silver, I.Improving the psychiatric knowledge, skills, and attitudes of primary care physicians, 1950-2000: a review. Am J Psychiatry. 2001;158 (10):1579–1586.Google Scholar
45.World Health Organization. mhGAP: Scaling Up Care for Mental, Neurological, and Substance Use Disorders.Geneva: World Health Organization; 2008.Google Scholar
46.Addressing Mental Health Concerns in Primary Care. A Clinician's Toolkit.Elk Grove Village, IL: American Academy of Pediatrics; 2010.Google Scholar
47.Report, IIIContemporary Issues in Medicine: Communication in Medicine.Washington, DC: Association of American Medical Colleges; 1999.Google Scholar
48.National Institute of Mental Health. Mental health medications. http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml#pub3. Published 2008. Accessed August 16, 2010.Google Scholar
49.World Health Organization. WHO Model List of Essential Medicines. http://www.who.int/medicines/publications/essentialmedicines/en/index.html. Published March 2010. Accessed August 18, 2010.Google Scholar
50.Forster, PL, Cavness, C, Phelps, MA.Staff training decreases use of seclusion and restraint in an acute psychiatric hospital. Arch Psychiatr Nurs. 1999;13 (5):269–271.Google Scholar
51.Fenton, WS, Blyler, CR, Heinssen, RK.Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr Bull. 1997;23 (4):637–651.Google Scholar
52.Schneeweiss, S.Reference drug programs: effectiveness and policy implications. Health Policy. 2007;81 (1):17–28.Google Scholar
53.Geddes, J, Freemantle, N, Harrison, P, Bebbington, P.Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ. 2000;321 (7273):1371–1376.Google Scholar
54.Chakos, M, Lieberman, J, Hoffman, E, Bradford, D, Sheitman, B.Effectiveness of second-generation antipsychotics in patients with treatment-resistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry. 2001;158 (4):518–526.Google Scholar
55.U.S. Department of Health and Human Services. Health information privacy. Disclosures for emergency preparedness—a decision tool. http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/decisiontoolintro.html. Accessed August 13, 2010.Google Scholar
56.Moskop, JC, Marco, CA, Larkin, GL, Geiderman, JM, Derse, AR.From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine—Part I: conceptual, moral, and legal foundations. Ann Emerg Med. 2005;45 (1):53–59.Google Scholar
57.Keinan, G.Decision making under stress: scanning of alternatives under controllable and uncontrollable threats. J Pers Soc Psychol. 1987;52 (3):639–644.Google Scholar
58.O’Carroll, R.Cognitive impairment in schizophrenia. Adv Psychiatr Treat. 2000;6:161–168.Google Scholar
59.Martin, JK, Pescosolido, BA, Tuch, SA.Of fear and loathing: the role of “disturbing behavior,” labels, and causal attributions in shaping public attitudes toward people with mental illness. J Health Soc Behav. 2000;41:208–223.Google Scholar
59.Blake, N, Stevenson, K.Reunification: Keeping families together in crisis. J Trauma. 2009;67suppl147–151.Google Scholar
61.Ridgely, MS, Borum, R, Petrila, JThe Effectiveness of Involuntary Outpatient Treatment.Santa Monica, CA: RAND Corporation; 2001.Google Scholar
62.Thienhaus, OJ, Piasecki, M.Assessment of psychiatric patients' risk of violence toward others. Psychiatr Serv. 1998;49 (9):1129–1130, 1147.CrossRefGoogle ScholarPubMed
63.National Center for State Courts. Guidelines for involuntary civil commitment. Ment Phys Disabil Law Rep. 1986;10:410–514.Google Scholar
64.Hall, RC, Ng, AT, Norwood, AEDisaster Psychiatry Handbook.Arlington, VA: American Psychiatric Association; 2004.Google Scholar
65.deSilva, ECSocial workers as responders to disasters. http://www.naswdc.org/practice/intl/Disasters.pdf. Published 2006. Accessed August 15, 2010.Google Scholar
66.American Academy of Child and Adolescent Psychiatry. Disaster resource center. http://www.aacap.org/cs/DisasterTrauma.ResourceCenter#clinicalresources. Accessed August 15, 2010.Google Scholar
67.American Psychological Association. Natural disasters. http://www.apa.org/topics/disasters/index.aspx. Accessed August 15, 2010.Google Scholar
68.Psychological First Aid. Field Operations Guide. Los Angeles, CA: National Child Traumatic Stress Network, National Center for PTSD; 2006.Google Scholar
69.Stephey, MJDe-criminalizing mental illness. Time http://www.time.com/time/health/article/0,8599,1651002,00.html?cnn=yes. Published August 8, 2009. Accessed August 18, 2010.Google Scholar