A Missed Psychiatric Medication Should Not Become Another Disaster
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When people talk about emergency preparation, we hear the same list again and again: water, canned food, flashlight, batteries, and important documents.
Those things matter. But for many people living with mental illness, one often forgotten item may be just as life-saving: psychiatric medication.
A flood, wildfire, tornado, heatwave, or power outage can close a pharmacy in one day. It can cut phone service. It can cancel clinic appointments. It can force someone to leave home without enough medication. For a person with bipolar disorder, schizophrenia, severe depression, post-traumatic stress disorder, or anxiety, this is not just a small inconvenience. It can become a medical crisis.
As a resident physician in psychiatry, I have seen how much stability depends on daily routine. A patient may be doing well, not because life is perfect, but because treatment is steady. They take their medication. They sleep. They see their therapist or prescriber. They know where to go when symptoms get worse.
Then a disaster comes and breaks that routine.
I recently cared for a patient who lost almost everything after a storm. That experience stayed with me. It made me ask a simple question: when we make disaster plans, are we really thinking about people with mental illness?
Many times, I don’t think we are.
A prescription is not helpful if the pharmacy is closed. A follow-up visit is not useful if the patient has no phone, no transportation, and no safe place to sleep. A safety plan is weaker if nobody knows how the patient will keep getting medication when the system around them stops working.
Climate change is making this problem harder to ignore. We are seeing more heat emergencies, stronger storms, poor air quality days, and more sudden disruptions. These events do not affect everyone the same way.
A person with money may be able to evacuate early before an extreme weather event, stay in a hotel, pay for an early refill, or call another pharmacy. A person living paycheck to paycheck may not have that option. An unhoused person may lose the only bottle of medication they own. A person with limited English proficiency may miss emergency instructions. A patient without stable transportation may be cut off from care very quickly.
This is why psychiatric medication continuity should be part of every emergency plan.
To be sure, I am not saying everyone should stockpile pills or that clinicians should ignore medication safety. Some psychiatric medications need close monitoring. Some can be dangerous if taken incorrectly. But that is exactly why we need a plan before the emergency happens, not after.
Clinics should identify patients who may be at higher risk if treatment is interrupted. This may include people with severe mental illness, people taking medications that cannot be stopped suddenly, people with limited support, people without housing, and people who already struggle to get to appointments.
Clinicians should talk with patients about what to do if a pharmacy closes or if they must evacuate. Patients should know how to request an emergency refill. They should have a written list of medications, doses, allergies, prescriber contact details, and pharmacy information. This should not only live inside an online portal because the internet may not work during a disaster.
Hospitals, clinics, pharmacies, and public health departments should also work together. During emergencies, there should be clear refill rules, backup pharmacy options, emergency telehealth lines, and outreach for patients who suddenly disappear from care.
We already plan this way for people who need oxygen, dialysis, insulin, or other life-sustaining treatment. Mental health treatment deserves the same attention.
This is also a health equity issue. The people most likely to lose access during a disaster are often the same people already carrying the heaviest burdens: poverty, unstable housing, language barriers, disability, and limited family support.
We should not wait for the next storm to learn this lesson again.
Every clinic can start with one simple question: if this patient is cut off from us for 1 week, what happens?
Answering that question now may prevent the next disaster from becoming a psychiatric crisis too.
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