The impact of hurricanes on established mental health diagnoses and psychiatric care: a case report

Over the years, numerous high-intensity hurricanes have struck Florida, United States of America, resulting in catastrophic damage. This is expected to surge, as climate change causes storms of greater intensity. Damage associated with hurricanes is typically based on destruction of property and loss of life; however, the impact on the mental health of those affected is more challenging to assess. The following case demonstrates a patient who survived a hurricane but emerged from the storm with an exacerbation of previously diagnosed mental health conditions. In the days following a major hurricane strike, a young male in his 20s required inpatient psychiatric hospitalization after reporting a suicide attempt by consuming large amounts of alcohol and cocaine. The patient, who lived on a boat, experienced total loss of housing and personal belongings following the hurricane, a stressor that contributed to significant psychosocial distress and a subsequent suicide attempt. The patient reported previous diagnoses of bipolar disorder and anxiety, for which he was currently being treated with psychotropic medications. At the initial presentation, his affect was flat, and he appeared guarded towards the staff. Adjustments to his psychotropic medication regimen were made throughout his admission. After the third day of admission, he was deemed stable for discharge. This case demonstrates the fragility of mental health in the setting of natural disasters and the complexity of maintaining mental health care in the aftermath. Most studies have focused on the incidence of mental health conditions after storms have caused areas of devastation, rather than on how storms precipitate decompensation in patients with pre-existing mental health illnesses, including substance use. This report explores management options and highlights the need for new policies and resources.