Persons with psychiatric disabilities must receive the same help as other
people when disasters strike and should be included in every stage of
emergency planning, according to a report from the National Council on
Disability, a federal advisory group.
"We hope that the report will be read by anyone concerned with
disaster relief and prevention," Julie Carroll, J.D., senior attorney
adviser for the council, told Psychiatric News.
That would include psychiatrists interested in disaster issues, said Arshad
Husain, M.D., chair of APA's Committee on Psychiatric Dimensions of Disasters
and director of the University of Missouri International Center for
Psychosocial Trauma, in Columbia, Mo. He plans to send copies of the report to
members of his committee, he said.
The report documented how Katrina and Rita caught so many agencies and
organizations involved with disaster response off guard. It was based largely
on media reports and firsthand accounts of persons with psychiatric
disabilities derived from conference calls organized by the National Council
on Disability, but did not involve any formal survey, said Carroll. The report
said that relief organizations and governments at all levels mismanaged
evacuations, discriminated against persons with psychiatric disabilities, and
terminated recovery services prematurely.
The council used the term "people with psychiatric
disabilities" to describe people who use or have used mental health or
psychiatric services, including those in some phase of recovery prior to the
"People with disabilities were segregated from the general population
in some shelters, while other shelters simply refused to let them
enter," according to the report.
Even before they reached shelters, some persons with psychiatric
disabilities ran into problems. Residents of group homes or other psychiatric
facilities were lost to emergency officials, who were unprepared for the
special requirements needed to transport or relocate them. Some ended up in
state parks or other refuges that were not set up to meet the needs of persons
with psychiatric diagnoses. Still others were inappropriately
institutionalized because they were stereotyped with the stigma of mental
"Shelters were crowded, noisy, chaotic, confusing, and sometimes
violent, all inadequate circumstances for a person with psychosis, anxiety, or
depression," said the report. "Many ended up living right outside
the shelters, and services were not provided to people living outside the
"Sad to say, people with mental illness are far down on the totem
pole in the best of times, but they are even farther down in the worst of
times," said ron Honberg, J.D., legal director of the National Alliance
on Mental Illness (NAMI). "Denying access to shelter to persons with
psychiatric disabilities is almost like sentencing them to death."
These inadequacies were visible right after Katrina, said Honberg. Two
weeks after the storm, NAMI sent a letter to the acting director of the
Federal Eergency Management Agency (FEMA) asking for expansion of the agency's
crisis counseling program to include help for persons with serious mental
illness, both preexisting and triggered by the hurricane.
The lack of preparation affected even the most routine aspects of
evacuation. A police officer's knock on the door could be easily
misinterpreted by a mentally ill person if it raised the image of an earlier
involuntary commitment episode.
Longer-term relief measures raised new problems, said the report. FEMA
forms or applications for housing were often difficult to fill out with
assistance. Untrained FEMA representatives often denied housing to persons
with psychiatric disabilities after incorrectly assessing their disabilities.
FEMA or the Stafford Act may cover short-term mental health services but were
not designed for people who might remain displaced for months or years.
"FEMA mental health resources were designed only for `normal
reactions to abnormal situations,' but not for people with serious mental
illnesses separated from their own services," said Honberg.
In its report, the National Council on Disability urged a range of policy
changes at all levels of government. Relief services like FEMA housing, HUD
housing waivers, and Medicaid coverage should continue for at least two years
after a disaster, argued the report. Medicaid mental health services should
include conditions worsened by the disasters as well as caused by them.
Federal agencies such as the departments of Homeland Security (the parent of
FEMA) and Health and Human Services should adopt policies and regulations that
reflect the requirements of the Americans With Disabilities Act and Section
504 of the Rehabilitation Act to provide relief services that don't
discriminate against those with mental illness. State and local officials
should rethink evacuation procedures, select one person to be responsible for
disaster disability questions, and simplify procedures to allow out-of-state
health professionals to work during an emergency. Trained peer advocates
should be allowed to provide counseling under the Crisis Counseling Assistance
and Training Program. The American Red Cross should train its personnel to
better identify and work with people with psychiatric disabilities. Finally,
the report urged that people with disabilities be included in planning for
disasters and allowed to participate in relief and recovery efforts.
Thus far, many localities have been incorporating similar recommendations
for handling people with disabilities, but not many have yet included people
with psychiatric disabilities, said Carroll.
"All of us should have been better prepared," said NAMI's
Honberg. "Now we are less interested in making accusations and more
interested in learning the lessons, correcting the problems, and making sure
it doesn't happen again."
"The report should be viewed as a beginning of a healthy
dialogue," said David Post, M.D., medical director of the Capital Area
Human Services District in Baton Rouge, La., in an interview. "Certainly
there are many lessons to be learned, especially that we all should be mindful
of the specific needs of those with disability."
"The Needs of People With Psychiatric Disabilities During and
After Hurricanes Katrina and Rita" is posted at<www.ncd.gov/newsroom/publications/2006/peopleneeds.htm>.▪