emergency & disaster preparation for people with...

Emergency & Disaster Preparation for People with Psychiatric Disabilities

Beckie Child, MSW Mental Health America of Oregon

Peerlink National Technical Assistance Center 3534 SE Main Street Portland OR 97214

503-922-2377 [email protected]

www.peerlink.us www.mhaoforegon.com

This work is licensed under the Creative Commons Attribution-NonCommercial-

NoDerivs 2.5 License. To view a copy of this license, visit

http://creativecommons.org/licenses/by-nc-nd/2.5/ or send a letter to Creative

Commons, 543 Howard Street, 5th Floor, San Francisco, California, 94105, USA.

National Technical

Assistance Center

mailto:[email protected]

http://www.peerlink.us/

http://www.mhaoforegon.com/

Emergency & Disaster Preparation for People with Psychiatric Disabilities Beckie Child, MSW Mental Health America of Oregon Peerlink National Technical Assistance Center 042811 v6

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Emergency and Disaster Preparation for People with Psychiatric Disabilities

Many government and human service agencies have been discussing disaster preparation since the devastating destruction of Hurricane Katrina in 2005. Most of those discussions do not including people labeled and diagnosed with psychiatric disabilities. While it is not possible to prepare for every possible type of emergency or disaster, there are things that you can do that will make things easier for you and your loved ones.

Given that there are large numbers of people who live in group homes, adult foster care homes, state hospitals, secure residential facilities, board and care homes, independent living with supported housing, and completely independent living, below are some recommendations and resources to help you do your own planning. While not everyone will experience a natural or human-caused disaster in their lifetime, most people will experience some kind of emergency of a much smaller size such as a fire, storm damage, flooding, or medical emergencies.

The Red Cross has a number of recommendations for helping people

with disabilities prepare for emergencies and other disasters. However, while much of the information is helpful in general, people with psychiatric disabilities may have additional needs and considerations that need to be kept in mind when planning and preparing for disasters and emergencies.

It’s very challenging to prepare oneself for disasters and other

emergencies when living on a fixed income. It’s important to start preparing now—to do what you can. Preparing for future emergencies and/or disasters can help you remain in control of the choices you want to make for your life in the midst of disasters and emergencies. If you have the space and/or the money, you might want to consider having extra supplies on hand. Not everyone will have prepared for an emergency, and some people may be unable to get to their emergency kits—so if you have space in the trunk of your car for an extra kit, consider purchasing one to help someone else out.


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Important things to think about and plan ahead

If your home is heated by gas—do you know how to shut the gas main off—you can ask your gas company to show you how to shut the gas main off. Most gas mains require a certain type of wrench to shut the gas main off. You may wish to consider purchasing the wrench.

Do you know how to turn the water off to your house?

Do you and the people you live with have an agreed upon meeting place if something happens to your home or the place where you live? Do you have a backup place in case the first place is inaccessible?

If you work—how about your co-workers? Do you have a list of everyone in your office, or on your floor? Do you know who didn’t come in today? Do you have an agreed upon place that people from your office or floor of your building will go if there is an emergency that requires you to evacuate the building? Who has the home and cell phone numbers of all the people you work with or who work on your floor or your section of the building?

Do you have an emergency water kit or emergency preparedness kit for your office or place of work for yourself? Your co-workers? Your car(s)?

Think about the types of emergencies/disasters that could happen in the area where you live. Some places in the US are more likely to experience earthquakes while others are more likely to experience hurricanes and/or tornadoes. Some people who live in the desert may want to have additional water on hand because of the heat in the summer time. There really is no way to figure out what a terrorist might do—so it is essential that we be prepared as best we can.

Also consider the types of animals that you may encounter if you are forced to be outdoors due to a disaster. Some areas of the US have poisonous snakes—so having a snakebite kit in your first aid kit may be essential. Make sure you know how to use the snakebite kit.


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If you live in a rural or frontier area, you may want to have more than a week’s worth of supplies because it may take first responders a while to get to you.

If you live in an apartment, talk to your neighbors—what are they’re plans for an emergency? Are they interested in working with you to prepare for a disaster or an emergency? Not all of your neighbors will be interested—but your interest may get them to be interested.

Building Your Emergency Kit Building your emergency kit can be quite expensive, especially for people who are dependent upon SSI or SSDI for their monthly income. However, if you begin to make preparations now, and do what you can to prepare for emergencies and/or disasters, you will be more prepared than if you did nothing. Below are some ideas as to how you can start to build your emergency kit and supplies.

Ask friends and family members to help you build your emergency supply. Ask them to purchase a 3-day emergency kit from the American Red Cross or other organization in lieu of a birthday gift or other gift.

Purchase one item per month and slowly build your emergency and disaster kits.

Sometimes you can purchase multiple quantities of certain types of supplies and split them amongst 2-3 people reducing your overall costs.

Updating Your Kit

Get in the habit of updating your kit at least once per year. One way to make this fun is to have an emergency preparedness party every year—where you serve the food and water you’ve had in your kit (provided you haven’t had to use it)—and you replace it with new and fresher food and water supplies. You can also check your kit for completeness—if your needs change you can add additional


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information—update your medication logs and the meds you take, etc.

Medical Emergencies

Write down the type of medications you take, the reason you take them/or the condition that you use them for, and the dosages that you take. Print legibly or ask for a copy of the meds you take from your pharmacist. Write a note to put on the inside that states ―For Medical Emergencies‖ in red ink; place the zip lock bag on the fridge either with a magnet or tape. If you aren’t able to communicate in a medical emergency, the firefighters and paramedics will be able to find this information easily.

Have medical and psychiatric advance directives. Give copies to a family member, a close friend, your doctors and the hospital that you are most likely to go to if you are in need of care. You can ask that your advance directives be added to your medical record. You may also want to place a copy in the bag that contains your medication list. If you have a car, place a copy in your glove box.

Many people haven’t taken time to write out their wishes for physical health care if they are unable to communicate their wishes. Most people have preferences about whether or not they want to be kept on a ventilator, be tube fed, or other treatments if they are unable to communicate their wishes. No one wants to have their loved ones fighting in the courts and the media about whether or not their life should be prolonged as what happened with Terry Shiavo. Take time to put your wishes in an advance care directive.

Place phone numbers of people whom you want notified in case of emergencies near your phone and in your wallet and advanced directives. If you have a service animal or pets, you may want to leave instructions of people to call to care for the animals if you’re unable to care for them.


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Many service animals have vests that have pouches on them. Keep a copy of your list of medications, identification cards, and people to contact in the pouch of the vest of the service animal.

The Red Cross sells 3-day emergency kits for about $80 in 2011. There are other companies and organizations that sell 3-day emergency kits as well. Many people who receive SSI and SSDI cannot afford these kits—but if you begin now there are ways to build your own emergency preparedness kits. If you can set $10 dollars aside each month, then within 10 months you would have enough money set aside to purchase the kit.

If you have a money manager, explain to them that you want to be prepared for an emergency and want to purchase a 3-day emergency kit.

Store your emergency kit in a place that is easy to access. If you own a car or a truck, you may want to purchase a 3-day kit to keep in your car in case you either need to live in your car in an emergency and/or you ever develop car problems and need to wait for help to arrive.

Disaster Preparation The Red Cross recommends having a minimum of a 3-day supply for disasters. But if you have the space, I would recommend a minimum of a 7-day supply. As we saw with Hurricane Katrina, some disasters can overwhelm emergency services and government systems, and you may exhaust your three day supply and still be waiting for assistance. You may want to purchase a big container to store your emergency supplies in. Some people may wish to use a suitcase with wheels in or a storage container that has wheels in case you need to evacuate your home. If you have a car, you may want to keep a 3-day supply of water and food and a blanket in your car.


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Water

The Red Cross recommends one gallon of water per person per day. One of the effects of many medications especially those used to treat psychiatric conditions is dry mouth. You may want to increase the amount of water per person that you keep for emergency supplies.

Sucking on hard candy or chewing gum may help decrease dry mouth. You may want to add some hard candy or chewing gum to your emergency disaster supplies.

Some people who have psychiatric disabilities also have other health conditions such as diabetes. Many drug stores in the US sell sugar-free hard candies that you may wish to purchase. If you use these sugar-free candies, be careful not too eat too many at once. The sweetener that is used in the sugar-free candies can be really hard on your digestive system and can cause you to have bowel and stomach problems such as gas and diarrhea.

Water can be stored in clean plastic pop bottles. You may want to store a few in the freezer—in case you need ice—be careful to leave 1-2 inches of space in the bottle to allow for the water to expand as it freezes.

Check your bottled water every year to make sure that the containers aren’t leaking.

Some people don’t like the taste of water. There are some ways to deal with this challenge. Crystal Lite On-The Go® now has mini-paks that will fit very nicely in an emergency kit that will allow you to add flavoring to your water to make it easier to drink. Another idea is buy unsweetened packages of Kool-Aid® and have sugar or Splenda® (sugar substitute). Using Kool-Aid® and sugar or sugar substitute will require more space in your emergency kit. I’ve noticed in my local grocery store that Crystal


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Lite On-The-Go® and Kool-Aid® are generally less expensive to purchase in the summertime as compared to the wintertime.

Have water purification tablets on hand in case your water source is contaminated—the water may look clean, but it may not be safe to drink without purifying the water. Water purification tablets work well in emergency kits—because you don’t have to boil the water.

Food There are a lot of companies that sell MRE’s (Meals Ready to Eat), and other foods that can be stored and used easily when in the midst of an emergency or disaster. However, before you rush out to spend your money on these types of meals—consider the following information.

Disasters and emergencies are times of high stress. One way to ease the stress or at least not create more stress is to have foods that you like to eat and are familiar with. While you may get nutrition from MRE’s and other survivalist foods, if you aren’t familiar with their tastes and textures, it will be hard to eat enough to sustain your nutritional needs—and more than likely you may need additional nutrition in order to deal with the high stress, grief, and loss that comes with surviving a disaster or emergency.

You can purchase food bars that have the equivalent nutrition of an entire meal. However, some of the bars may contain a lot of salt that will cause you to dehydrate and become thirstier for water. The Red Cross sells food bars that do not promote thirst.

You will want to have foods that don’t require refrigeration, lots of storage room, cooking or a lot of preparation.

Some people will stock up on crackers for their emergency supplies. Many crackers contain a lot of salt that will increase your thirst and increase your need for water, and crackers don’t have a long shelf life. So be cautious about including crackers in your emergency food supply.


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Some people have restricted diets—it will be a challenge to have foods that you can eat if you don’t prepare for the emergency or disaster ahead of time.

Some people think that tuna is a good food to have for emergency supplies, you will need to eat it almost immediately after opening it. Don’t mix it with mayonnaise—because more than likely you won’t have the refrigeration to keep it stored safely.

Storing Your Emergency Supplies

You may want to keep your emergency supplies in a suitcase with wheels (easier to carry than a box or something without wheels). If you don’t have a suitcase with wheels, you might look for a picnic cooler that has wheels on it to put your emergency supplies in or many department stores have storage containers on wheels—Make sure that they are food safe if you plan on storing food in them.

Another option for storing your emergency/disaster kits is a backpack. Many backpacks also have wheels. If you can’t afford the price of a backpack from a department store, you might find a container or backpack at a thrift store.

Supplies What kinds of things do you think you’ll need in an emergency?

Flashlights and batteries—they are now making some flashlights that don’t require batteries—but require you to shake them vigorously to keep the light going—the light may only last 5 minutes—but that may be an alternative to having flashlights with batteries.

Can Opener and Bottle Opener—having canned food as part of your food storage supplies without having a can opener is like


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having no food at all. Some can openers have bottle openers on them. Others do not, so you may need both.

Scissors or pocket knife

Duct tape

Flares (also important if you have a car)

Thermo reflective blanket (costs approximately $15 in 2006)

Whistle

Compass

Crossword puzzles, pen, pencils and paper—you may spend a lot of time waiting to be rescued or waiting in line for services—having something to do, or read can help ease the anxiety and frustration of waiting for services. If you have hobbies that you engage in (e.g., such as knitting or crocheting, playing a harmonica, etc. may also help pass the time and give your hands something to do.

Sewing kit

Matches (in water proof container)

Radio—if you use one that requires batteries, make sure you purchase batteries for the radio. You can also purchase solar-powered radios.

Change of clothes—especially clean underclothes

Hand sanitizer

Soap (liquid and/or bar soap)


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Moist towelettes (think baby wipes)

Light sticks

Matches (kept in water-proof container or zipped baggie)

Face mask—in case the air is unhealthy to breathe

Rain gear—umbrella, raincoat, etc.

Change of clothes—Having a clean pair of underwear and socks tucked away in your emergency kit may offer you a small bit of comfort since it may be difficult to get access to clothes during an emergency.

Paper Records

Make copies of important records—Photo ID, Passport, Driver’s License, Social Security Card, Medicare Card, Medicaid (Oregon Health Plan) Card, Medical and/or Psychiatric Advance Directives, copy of birth certificate, insurance cards, etc.

List of Medications that includes why you take them, and how much you take—ask your doctor, nurse practitioner or physician’s assistant for a copy of your med sheet. If your primary care doctor prescribes meds, get a copy of that med sheet—and if you see a psychiatrist or nurse practitioner ask for a copy of your med sheet from her/him as well.

Copy of phone numbers of friends and relatives that you wish to have contacted in case of an emergency

Copy of veterinarian records that document that your service animal/pets have had rabies shots and other immunizations.

Communication Challenges


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Sometimes when people experience extreme distress and trauma from disasters or medical emergencies, it becomes very difficult for them to communicate what is happening. Some people can experience this as psychosis or extreme withdrawal. While it would be nice to think that people who are responding would be helpful and respectful of a person’s inability to communicate, they may also be experiencing extreme stress and duress. That is why it’s important for you to think about how you communicate when you are experiencing extreme duress and write out or have someone else write out what would be most helpful to you through advance directives, instructions on how to help you when you have difficulty communicating, etc. You will want to store this both with your information on the fridge that contains the list of medicines that you take and also with your disaster preparation survival kit.

Medications Arrange to have one week's worth of all medications on hand in your emergency supplies. If you have Medicaid (Oregon Health Plan in Oregon) or Medicare Part D, acquiring extra medications for an emergency may be difficult. Oregon Health Plan and some Medicare Part D plans allow you to mail order 90 days worth of medicines at a time. That may also be one way to have some medications on hand for an emergency. But if you collaborate with your prescriber, you may be able to gradually build a week’s worth of medicines. Susan Godschalx, PMHNP, a psychiatric nurse practitioner, suggests the following to help you build a week’s worth emergency supply.

Talk to your doctor, nurse practitioner, or physician’s assistant about your intentions and ask for their help in building an emergency supply.

Providers can order an "early" refill, or simply refill your prescription a few days early each month for several months and put the extra few


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days' worth in your supply. Make sure your provider knows this is what you are doing.

Keep medicines in their labeled bottles. Do not put all together in a pillbox or bag. Although you know today what each medicine is by its shape and color, you may not remember it in a year or two or longer or in the middle of an emergency.

Keep your supply updated. When your provider changes your medication eliminate discontinued medicines from your emergency supply and add in any new ones.

Keep a written medication log, including what they are for and how you take them. Oftentimes directions may change without the pills changing. Keep this written sheet current as possible. If an emergency happens, review your sheet and update it, if needed, so old bottle directions don't confuse you.

If you have only a few pills of a needed psychotropic medication, try to estimate how long it will be before you will have access to a pharmacy. Is this an emergency that is likely to last longer than your supply? If so, then decrease your dosage slightly to spread your medication out longer. Do NOT decrease it so much that you put yourself at risk of symptoms. Ask your provider how much you can safely temporarily decrease your dosage - and write it on your medication log.

Do not throw medications away that have "expired" unless you are no longer using them. Studies have shown that most medications generally continue to be effective for a few years after they have "expired".

Relax and celebrate. You have done a better job of preparing for a disaster or emergency than many people.


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Financial Records Many people carry the name of their bank, and the banks with their credit cards in their heads. But if you’re unable to recall that information due to being injured or stress reaction in an emergency, you will want to have a one-piece of paper crib sheet. Things that you should list on your crib sheet:

Contact information of your closest friends and family members, your doctor(s), veterinarian, any professional advisors (money managers, lawyers, insurance agent(s), etc.)

Name of Bank, Name on account (if different than the name you go by), and address of the bank or financial institution

Other financial accounts with name on the account(s) and address of the financial institution

Social Security Number (You may want to want to keep your Social Security Number in a specific place in order to protect yourself from identity theft. So you could say: Social security number is written on piece of paper underneath the cupboard with the plates, or is in sock drawer, etc.)

Employee benefit information and employer Human Resources contact information (if applicable)

Name, phone number and address of Social Security Payee (if you have one)

Where to find the following important documents:

o Mutual funds and brokerage accounts

o Life insurance policies

o Marriage license


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o Divorce decree(s)

o Prenuptial agreement(s)

o Children’s social security numbers, passports if you have them

o Birth certificates and adoption papers for everyone in your

family

o The original copy of your will the only copy that’s signed and witnessed. A photocopy won’t do. If your original will can’t be found, the law assumes that you destroyed it because you had changed your mind about what is said. Your heirs must convince a court that that didn’t happen. If they aren’t successful, the court will distribute your assets based on the State law as if you had no will.)

o The forms naming your retirement account beneficiaries. (It’s

these forms that determine who gets the proceeds from your retirement account(s)—not your will.

o Copies of veterinarian records for service animals and pets

o Physical health care and psychiatric advance directives

Make copies of your crib sheet. Keep one for yourself. Placing it on the fridge with the list of medications, copies of your advance directives, etc. will make it easy to find in case of emergency, (make sure you tell your spouse, significant other, etc where it is!) Put a copy in a sealed envelope and give to a trusted friend, sibling, or adult child, or lawyer. Helping children in times of emergency or disaster

Remember that children and adolescents are emotionally intuitive and will pick up on the fact that you are stressed. If they are asking questions, it’s important to answer their questions in a way that


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acknowledges what they’re experiencing and also doesn’t overwhelm them. Don’t be afraid to tell them that you don’t know—but that you will figure out how to get through this together.

Give the children responsibilities/chores that are appropriate for their age.

Have them help you create their emergency kit with a favorite stuffed animal or a game. Make sure they know where the emergency kit(s) will be stored in case of emergency. Talk to them about what is an ―emergency.‖

Place a list of emergency contact names and phone numbers (grandparents, aunts and uncles, etc.) in their emergency kits in case something happens to you or that you become separated).

Make sure you have some crayons, coloring books or paper, and/or other activities that will entertain the children/adolescents that will help them occupy their time.

Remember that most children appreciate structure so if possible keeping them on a schedule (even if it needs to be modified due to a disaster or emergency will be helpful even though they may protest against it).

Children have growth spurts at different times—you may need to update their change of clothes and emergency food to reflect their growth, likes, and dislikes more frequently than once a year.

Discuss alternate two or three alternate meeting places where the family will gather together in case of an emergency. Make sure that the children know how to get there—perhaps it’s a church, or a school, or a park, or a neighbor’s house.

Limit children’s exposure to media coverage of events. Engage them in other activities.


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Do your best to keep the family and children together when evacuating or going to shelters.

Helpful information Some web sites that have useful information that addresses the needs of individuals with disabilities are listed below.

http://www.fas.org/reallyready/index.html

http://www.nod.org/index.cfm?fuseaction=Page.ViewPage&PageID=11&

http://www.redcross.org/portal/site/en/menuitem.d8aaecf214c576bf971e4cfe43181aa0/?vgnextoid=72c51a53f1c37110VgnVCM1000003481a10aRCRD&vgnextfmt=default

http://prepare.org/

http://www.jik.com/disaster.html

http://www.witnessjustice.org/health/war.cfm Dealing with stress and anxiety due to threats of terrorism Unfortunately, in the world today, the threat of large scale disaster due to terrorism is a real possibility. Part of what helps us deal with stress is the idea that we can control our world. When that sense of control is threatened, it creates stress. Listening to the news about the wars, the atrocities of war, and other frustrating situations in the world about which there is little we can do adds to that stress load. The Witness Justice web site (http://www.witnessjustice.org/health/war.cfm) lists the following ways in which you can deal with stress from events that are beyond your ability to control

http://www.fas.org/reallyready/index.html






http://prepare.org/

http://www.jik.com/disaster.html

http://www.witnessjustice.org/health/war.cfm

http://www.witnessjustice.org/health/war.cfm


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Manage Exposure to News – If watching more gives you a feeling of control by being informed, watch it - if it stresses you, consider opting for other activities to occupy that time.

Some people feel compelled to watch the news—it helps them feel in control of the situation. And at the same time, it causes them extreme stress to watch—so impose limits on how much you watch, or change the medium that you use. Sometimes reading the newspaper accounts puts a little more distance between you and the overwhelming sensations from TV and/or radio. It can also help to put a time limit on how much you watch, listen and/or read about the situations. It may help to limit yourself to 30 minutes a day or some other smaller amount of time that what you typically allow yourself to watch—and preferably not when you first wake up in the morning or right before you go to bed at night.

Keep a Schedule – Routine helps to reinforce feelings of control and responsibility. Sometimes keeping a routine is a struggle. Sometimes we may feel that we don’t want to have a routine—and it can be really hard to force ourselves to do—but it may help. If you have children, helping them keep a routine will also help ease their stress and anxiety levels.

Lessen or eliminate alcohol or drug intake – Using drugs or alcohol can drain your energy and cloud judgment.

Stay connected – Talk with family, friends, colleagues and neighbors about your fears and try to develop a plan in case of an emergency.

Stay focused on the "Big Picture" – Focusing how you are part of something larger (like your family, the community, etc.) can help you feel less isolated during a crisis.

Keep the faith – For those who are spiritual, staying connected to your spirituality and house of worship can be helpful.


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Do What Makes You Feel Safe – Try to focus on healthy activities that make you feel safe and loved.

In addition, you may want to add one or two of the following activities to your routine:

Go for a walk—Notice the beauty in nature. If you live near a waterfall, river, or the beach see if you can spend some time near them. Let the sounds of the ocean and/or the waterfall drown out the worries in your mind. As you walk, think of your body sending all of the anxious energy to be absorbed through the earth.

Spend time with your pets—Pets can provide hours of entertainment. If you don’t have pets—see if you can take a friend’s or a neighbor’s dog for a walk.

Listen to music that you enjoy—Music does wonders to soothe our souls. Take time to listen to your favorite music.

Volunteer—Find some place where you can volunteer. Maybe it’s reading stories to kids at the library. Maybe it’s spending time talking with someone who doesn’t get out of the house much. Maybe it’s volunteering at a shelter.

Spend time gardening—For those of us who don’t have garden spaces, perhaps your community has community gardens, or you might be able to get into container gardening. If it’s not the time of year for planting and sowing, then perhaps you could plan on what you want to put in your garden in the coming spring.

Modest Needs—Help for those who have experienced an emergency or disaster The national non-profit organization called Modest Needs (http://www.modestneeds.org) can and does help individuals with modest needs. Not everyone who applies for help will receive assistance. However, they have guidelines and hints on their web site to help make

http://www.modestneeds.org/


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your request for assistance more likely to receive help. They will also do a due diligence report that will require information from you so that they can assure the IRS that they are providing help to people in need. According to the web site, modest needs are generally less than $350, but occasionally larger requests are granted.

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/2.5/ or send a letter to Creative Commons, 543 Howard Street, 5th Floor, San Francisco, California, 94105, USA.


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ADDITIONAL RESOURCES Crockett, B. How to Assemble a 72-hour Emergency Kit. Second Revised

Edition. 2004. Crockett Publishing Co. Orem, UT. ISBN 0-915131-00-5. Freeman, E. 12 Steps To Build Your Own Personal ARK: A Simple and

Inexpensive Guide to Food Storage and Family Preparedness. 2003. Sound Concepts, Inc. Orem UT. ISBN: 1-887938-66-4.

Salsbury, B. It’s Time to Plan Not Panic: Emergency Evacuation and

Preparedness for Coping Skills. 2006. Horizon Publishers, Springville, UT. www.cedarfort.com. ISBN: 0-88209-810-3.

Salsbury, B. & Simmons, S. Preparedness Principles: The Complete

Personal Preparedness Resource Guide for Any Emergency Situation. Horizon Publishers, Springville, UT. www.cedarfort.com. ISBN: 0-88290-806-5.

http://www.cedarfort.com/

http://www.cedarfort.com/

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