Q&A: Climate psychiatry making strides to tackle psychological fallout of climate change

As climate change continues to alter the physical landscape for populations throughout the world, it is also incurring profound effects on people’s psychological wellbeing and mental health.

The field of climate psychiatry, although relatively new, is beginning to tackle some of the psychological fallout of the growing climate crisis, according to Beth Mark, MD, MES, staff psychiatrist at the University of Pennsylvania’s Counseling & Psychological Services, as well as a member of the Climate Psychiatry Alliance’s Steering Committee.

Healio Psychiatry spoke with Mark about the mental health effects of climate change, areas of unmet research needs in climate psychiatry and how psychiatrists and mental health professionals can help patients navigate climate change and its related effects.

Healio Psychiatry: How can climate change affect the overall mental health of a population?

Mark: It is already having a profound effect and will continue to do so in more and more ways. The specific effects vary and depend on many factors, from geography to an individual’s or a community’s financial, social and/or psychological vulnerability. But climate change is, and will continue to, hit us all. It’s useful to look at how our vulnerabilities vary. The impacts are more significant for children, the elderly, the mentally or physically ill, the marginalized, indigenous populations who live more tied to the environment, people whose jobs are tied to the environment, first responders, climate experts, activists, etc. We can look at it from the cellular level, too. Air pollution is a huge detriment in terms of neuroinflammation and behavioral/cognitive changes in children, and there are documented links to increases in depression, dementia, stroke and other neurodegenerative diseases in adults. It impacts human development since children are not equipped physically and psychologically to navigate environmental insults.

Extreme weather events like hurricanes and floods often create trauma, particularly for children and marginalized people; the evidence shows links to irritability, distractibility, post-traumatic stress, depression and anxiety disorders. Extreme heat episodes increase interpersonal violence, suicide rates and impaired sleep, cognition and concentration. Slow-moving climate related events like droughts are associated with increases in anxiety, depression, hopelessness and suicide in those communities contending with the drought.

We are all facing an existential crisis about the future — what is going to happen to us as the planet continues to warm? This uncertainty is a huge challenge to our psychological health and sense of wellbeing.

With all these different layers, from the cellular to the psychological, to family and community dysfunction, to contemplating our species’ extinction, the effects of climate change are like the tossing of a pebble in the pond — the ripples keep going.

Healio Psychiatry: Can you provide a brief overview of the intersection of climate change and psychiatry?

Mark: Climate psychiatry as a field is very much in its early stages. There is a small but growing pool of experts. There are significant gaps in knowledge, and only recently, some developing educational programs in the health professional schools. It is important to emphasize that all doctors, no matter what specialty, are having to quickly become experts on how climate change is affecting their patients through their specialty’s lens.

I think psychiatry has a unique and important perspective to bring to health care in terms of climate impacts. We not only can understand and highlight the science of climate impacts at the neurological-cellular level (air pollution, etc.), but we're also concerned with the impacts on normal childhood development and adult psychological and cognitive development/functioning, as well as the effects on psychological health, wellbeing and resilience. All stages of human life and development are being challenged — not only by the real and tangible changes occurring due to the warming planet, but by the more existential threats of climate change.

Most importantly, as psychiatrists we are trained to witness and sit with people's fear, anxiety and anger, and we are also trained to sit with our own fear, anxiety and anger (as of course we have to navigate the challenges of climate change like everyone else). We're trained to help people move out of stuck places in their lives, to help them find hope, to help them put feelings to words, to help them move from inaction to action. I think that is necessary for us all in thinking about climate impacts. Psychiatrists are in a position to help people out of their denial, even as we're helping them with their pain and helping them to develop resilience. There is no medicine, and there is no easy treatments. We're moving into this uncertain, hard time. But this is what we do as psychiatrists: we sit with the hard feelings and help patients work through them, so hopefully we can bring our unique perspective to climate change work.

Healio Psychiatry: What are significant unmet research needs in the area of climate psychiatry? How might these be addressed?

Mark: There is an ocean of unmet research needs. We need epidemiologic studies looking at eco-distress and eco-anxiety. These terms have risen out of the ether, capturing the population's experience of unsettled, negative feelings about climate change. This is particularly important to examine in the pediatric population. Children are inheriting this mess, and they're the toughest to access in terms of research, in part because of necessary protections regarding accessing children for research aims. There is a lot more research on adults and how they're feeling about climate. I worry about the kids. This population believes that the climate is changing and that the change will have a negative impact on their life and life span. The limited survey data we do have indicates that most kids, around 80%, report feeling scared and angry about the climate crisis. We have a lot of anecdotal and early informal survey evidence that children are hurting and scared, but we have no research.

We have limited scales and measurement tools, both for children and adults. That is another important part of doing epidemiologic studies. We need to have good tools in order to measure things. We have no research to identify best practices to help people with eco-distress, either to extreme weather events/acute trauma events, or the slower rollout, psychological effects of droughts, wildfires, sea level change or eco-anxiety. We have no data that show us how to treat these issues, so climate-aware mental health professionals are left to consult at grass roots levels to figure out best practices. We need to look more to community approaches as well for several reasons. One is that there aren’t enough mental health providers to provide individual treatment. Even more importantly, larger groups and communities are going to be key components in climate change work. To solve immediate climate impact problems, we need a community-based approach to prepare and implement infrastructure changes that will help us manage extreme weather events and the slow rollout problems. And we need a community, multiple communities, to support our psychological resilience and wellbeing.

Healio Psychiatry: What advice would you give to psychiatrists and mental health professionals regarding treatment of patients experiencing mental health effects linked to climate change until more data start coming in?

Mark: It is important to emphasize that climate concern is a normal stress response to a real threat and is not a pathology. Eco-distress, in and of itself, is not a sickness, and it is not a disorder. Psychoeducation about this to patients is often helpful because they feel like there is something wrong with them, or that they are the only one that is feeling distress. Psychoeducation about the human stress response can help. We can walk patients through what happens when we start worrying about the uncertain future. How might that affect our heart rate? How does that create neuroinflammation, affect our appetite, sleep or sense of being able to concentrate?

Dovetailing with that is a cultivation of coping skills and resilience, such as learning about the relaxation response, breathing, mindfulness meditation, movement and proper eating and sleeping and getting out in nature to enjoy what wonders still remain.

Another important component of building resilience is helping the patient find what matters to them and in their life. This fits in well with Acceptance and Commitment Therapy. Further, meaningful social connections are critical.

When treating these mental health effects, many different types of approaches are useful, from psychoanalysis to cognitive behavioral therapy.

Approaches that help us learn how to live with the fact that the climate is changing, and our life is changing and will continue to change, are key.

Healio Psychiatry: You were recently a co-author of a study in JAMA Network Open about the carbon footprint of the annual APA meeting. Can you touch on the responsibility of physicians and their professional associations to reduce their carbon footprint?

Mark: One of the silver linings of the COVID-19 pandemic is it has forced us to realize that reducing our carbon footprint is doable, both as individuals and as members in our professional organizations. In our article, we estimated the considerable carbon emissions associated with the annual in-person APA meetings, and how meeting virtually due to the pandemic essentially wiped that emissions slate clean for 2020. We also estimated the considerable carbon emissions savings that could result from carefully choosing in-person meeting locations that would require less participant air travel. We suggested other carbon savings options for the future, such as a hybrid of in-person and virtual meetings as a template for future meetings.

It is a paradox that our health care system creates such a large carbon footprint that contributes so much to climate change and resulting health impacts, even as we as health care providers are committed and work so hard to protect and improve the health of our patients. Once we fully accept this paradox head on, we can start to think more creatively about how we can address our health care carbon footprint — in our offices and clinics and in our organizations. The Medical Society Consortium on Climate and Health has links and resources from a number of specialties and treatment settings to help shift to “greening” health care delivery. We need to rethink a lot of the old ways because it is no longer business as usual. Reimagining much of life, including things like conferences, is the challenge of the hour. It is better to think about these things in advance rather than have to scramble during the disaster.

Healio Psychiatry: How might psychiatrists provide climate education?

Mark: We touched earlier on the increasing efforts for curriculum development and continuing education that will provide training opportunities for health professionals regarding climate change impacts and potential treatments. So that is important to continue to grow.

Let’s also consider climate education outside of the health professions. There are significant gaps in how climate science is being taught in elementary, secondary and university settings. It came as a shock to me to learn that science teachers in many parts of the country feel inhibited to teach the science of climate change since it has become such a charged and politicized topic.

But here is another challenge. Once a teacher does feel free to teach the science of climate change and its repercussions, both teacher and students have no guiding framework in which to discuss, in the classroom, the negative feelings that will absolutely arise for them all when teaching and learning about climate change. Psychiatrists and other mental health professionals can certainly help with the development of educational approaches that will not only arm children with the facts but also with the resiliency to manage the facts, and train teachers how to both teach the science and teach their students how to manage these hard facts emotionally. There is so much that has to happen in the classroom that is not happening, and I think psychiatry can help with crafting how to support teachers, students and parents as we work to fill these very significant gaps.

Reference:

Wortzel JR, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2020.35641.