A Mental Health Emergency Plan for When Disaster Strikes

Two weeks after Hurricane Harvey made landfall on the Texas coast, many highways and homes in my hometown of Houston remain underwater. Things have begun to shift toward rebuilding in most of the city, but the lack of preparation remains disturbing, especially for those with mental health needs. As another disaster already unfolds in Florida and the Caribbean, how can we advocate for ourselves?

In any disaster, basic services are affected. In Houston, 911 call centers prepared for increased calls, but by the first full day of rain, officials were regularly urging people not to call 911 if their house was flooding unless they were truly in imminent life-threatening danger. I’m sure I don’t need to explain that a mental health emergency probably wasn’t an emergency for the week of rain and rooftop rescues.

Emergency rooms were equally overwhelmed, with medical professionals who worked shift after shift, sometimes pulling in interns who’d never worked a day in an ER, and even medical students, to meet the demand. Some mental health treatment centers in the Houston metro, such as our partial hospitalization programs for eating disorders had to be closed for days, and patients in outpatient treatment had no access to their therapist, psychiatrist and other professionals because travel was impossible throughout the city and many homes and offices were flooded. Medications were not readily available. Volunteers at shelters tried to help evacuees who, for the first time, couldn’t get essential medications for mental health conditions like bipolar disorder and schizophrenia, worsening an already vulnerable time for these individuals.

Added to this, the overall need for mental health services skyrockets after a large-scale natural disaster. Several organizations provide different lists to get you started on a disaster or emergency kit depending on your circumstances. Ready.gov has customized lists for seniors, pets and those with disabilities. Unfortunately, since Hurricane Harvey hit, I’ve not seen a list that includes meeting mental health needs.

A disaster or emergency kit is designed to provide the minimum items an individual or family would need to stay safe during and after an emergency. It’s usually pretty customized to meet each person’s unique needs. We know the basics: be prepared for basic services — water, gas, electricity and internet/telephones — to be off for several days. Have plenty of food and water. Review your emergency plan once a year.

But, in addition to planning for the typical outages and reduced ability to travel, it may be essential for someone with mental health needs to prepare for the possibility of cancelled treatment appointments, decreased access to 911, hospitals and emergency rooms for non-life-threatening emergencies, and to plan what to do in unfamiliar and particularly hectic or tumultuous environments.

Before an emergency:

1. Create a support system of people you trust 

This can be family, friends, roommates, co-workers or neighbors. Be sure to include some people in your city, and some people who are out of town in case of a city-wide emergency. Do not depend on only one person — they may be affected, too!

2. Prepare your support network to assist you with your emotional reactions to an emergency or disaster.

It may be especially hard to think clearly and process information, and emotions like fear, agitation, anxiety and depression may increase. Ever see a “What to Say to Someone With [insert condition here]” blog post that really resonated with you? Add it to your plan. Send it to your support network, and ask them to save it in case of an emergency. I love these about what to say to someone with anxiety and depression, PTSD and eating disorders.

3. Think about your personal needs.

What do you most struggle with when things get chaotic? What is most helpful? Share these answers with your support network. Be specific — even for people who “should know already.”

4. Be prepared to communicate your immediate needs to emergency personnel.

Consider situations like calling 911, being at a busy shelter or being at a hospital. It can be much harder to disclose mental health needs in an emergency.

5. Keep an updated list of your treatment providers’ contact information, your diagnoses and medication dosages.

Pharmacies can work with you to get emergency supplies of most medications, but contact information for your professionals will greatly speed up this process. Remember to include a few people from your support system you would want notified (and who could advocate for you) if you were hurt. This is also a good place for a copy of medical and prescription insurance cards. Keep these phone numbers with you in case 911 becomes overloaded. This template from FEMA might help get you started.

6. Build an emergency kit.

Call it a “recovery box,” a “bug-out bag” or a “survival pack,” but think about what you most need to stay stable in a crisis. This isn’t the same as an emergency room or hospital bag — many of the things you might consider there won’t make sense in this kind of emergency. Here’s a great example to get you started. Remember to add a small “comfort item” (a stuffed animal, a meaningful picture) and a small amount of medications, including those that are as-needed.

7. Prepare for pets.

If you are like me and you have a pet that can comfort you when almost no one else can, be sure to think about them, too! In addition to food and water, at a minimum, bring current vaccine records and your veterinarian’s contact information so your pet could be boarded or stay in a “pet-friendly” hotel.

During an emergency:

1. Speak up for your needs.

Don’t be afraid to explain to first responders, humanitarian volunteers, family or friends what you need given your individual circumstances. Do you urgently need medication to prevent symptoms of bipolar disorder or schizophrenia? Do you require a quiet environment to keep panic attacks at bay? Make those needs known.

2. Find something, somewhere to be grateful for. 

When the world is falling down around you, figuratively or literally, it’s surprising how much it can help to push yourself to finding something good in the situation—somehow, somewhere.

3. Consider turning off the news.

Watching the news or reading Facebook stories all day can make the best of us anxious during and after a disaster. Plan ahead for someone to send you essential information. Plan for how you will decrease distractions in a chaotic environment. For example, if you are used to listening to music, what will you do if electricity isn’t available?

4. Be flexible.

Emergencies are always unplanned, and are often unpredictable as they develop. Plan for your plan to change, and be ready to adapt to quickly changing circumstances. Have back-up plans arranged with your support network. What if you couldn’t escape with needed prescriptions? What if cell service were interrupted?

After an emergency:

1. Look for what you can control. 

In the midst of many things that are far beyond your control, what can you control? Check out this great list of 75 things you can control now. What would be on your personal list?

2. Reestablish consistency.

I don’t know anyone who operates at their best when there isn’t some level of consistency and stability. This is often especially true for those with mental illness. Can you eat or sleep at the same time you usually do? Talk to someone you always talk to? Listen to a song, meditate or say a prayer? Look for something, no matter how small.

3. Continue self-care.

I’ve heard this so many times it makes me cringe a little to say it again myself, but if there’s ever been a time to prioritize self-care, this would be it. Eating and sleeping are a must, but check out this fabulous list of 101 self-care ideas — I bet you’ll see some you haven’t thought of in awhile!

4. Find support.

Your normal treatment schedule could be interrupted, and parts of your treatment team or support system may be unreachable. You may need to reach out to friends, family, uplifting social media groups or a phone or text hotline. You can call a 24-hour helpline, or contact the Crisis Text Line by texting “START” to 741-741. Remember that some people you normally rely on may be dealing with their own needs, and you may have to be more creative than usual about how you reach out.

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Photo via CNN Facebook page.