Ethical issues raised in addressing the needs of people with serious mental disorders in complex emergencies

Recentmanmadeand 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 proportionoftheoverallpopulation, andanticipatingtheirneedsiscriticaltocomprehensiveemergencyplanningandresponse efforts. Because people with serious mental disorders historically have been stigmatized, and many individuals with mental disordersmaybe unable to care for themselves, ethical guidancemaybe 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.