Reflections of mental health professionals on working with and in the climate crisis

Abstract

The aim of this paper is to share our experiences of engaging with the climate crisis as citizens and mental health professionals (MHPs). We hope the outputs will usefully validate the experiences of fellow MHPs and support them to reflect on their role in this crisis. We came together as eight MHPs, participating in group discussions and one-one interviews with the first author to reflect on our experiences. The collaboratively generated themes reflect how engagement with the crisis has: (i) disrupted our personal and professional experiences; (ii) helped us adapt and grow; and (iii) enabled us to live, work and act in more accordance with our values. A key reflection was that these experiences are not linear and we continue to wrestle with our responses to the climate crisis. Discussions also elicited visions of how mental health paradigms could be better adapted to meeting the escalating public health need that this crisis is generating. We conclude by advocating for MHPs to process and respond to the climate crisis and recognize that their skills can make a vital contribution to this global challenge.

Keywords:

• Climate change
• mental health
• adaptation
• trauma
• eco-anxiety
• resilience
• mental health professionals

Introduction

As part of contributing to this special edition, we, a team of eight mental health professionals (MHPs) from varied professional, geographical and sociocultural backgrounds, came together to share what it means to do our work in these times of climate crisis. This paper is intended as a case study of both diverse and shared experiences of engaging with the climate crisis in our personal and professional lives. We hope that by sharing our voices we will animate the curiosity of other MHPs, validate their related experiences, and perhaps even catalyse them to join us in processing and responding to the climate crisis.

The team came together initially to discuss the need to better engage MHPs with issues of planetary health. It became evident that we were all struggling with how to live and work in this time of climate crisis. We concluded that sharing these experiences from across the globe may support other MHPs who were wrestling with similar issues, both personal and professional. We are drawn from a cross-section of disciplines within the mental health care space, including adult psychiatry, child and adolescent psychiatry, general practice (with a special interest in palliative care and public health), clinical psychology and psychotherapy. In this work, we speak from diverse global experiences, from island nations with developing economies in Southeast Asia (Philippines) and the Caribbean (Barbados), and nations with developed economies (Ireland; United Kingdom; and the United States of America).

The intention of this paper was to describe the wide range of experiences of MHPs engaging with the climate crisis. To draw out the key themes, we participated in a collaborative process of one-to-one interviews and group discussions with the first author over a two-month period. In conversation, we explored our motivations, emotional experiences and our vision for the future of MHPs in the context of the climate crisis. This paper is a distillation of our dialogues where we intend to take you inside what it has been like for us to engage with the climate crisis.

The paper is structured to illustrate our ongoing journey from our status quo being disrupted by growing awareness of the climate crisis, to a growing process of learning and adapting, through to the ways in which our engagement with the crisis has enabled us to live and work more congruently with renewed values. We chose verbs for theme titles to emphasize that these are ongoing non-linear processes, and we do not wish to communicate the idea of distinct phases we have moved through and beyond. A key aim in writing this paper was to emphasize that MHPs experience distress when contemplating the climate crisis; to normalize such reactions and their impact on our professional perspectives. We also wished to highlight how our skills and knowledge as MHPs equip us in particular ways to attend to both the emotional and practical challenges of the climate crisis in ourselves, our clients and wider society.

Although we have all found numerous texts important in making sense of our own reactions to climate breakdown, we have avoided using many references in this article. This is because we each have found different theoretical frameworks useful, and because theory can detract from personal narrative. Verbatim quotes are offered in the hope that these support connections to our personal experiences.

Disrupting

This theme is concerned with our reflections on becoming aware of the urgency of the climate and ecological crises and the disruption this awareness caused us personally (Section ‘Personal’) and professionally (Section ‘Professional’).

Personal

We identified becoming aware of the urgency of the climate crisis through different channels. For some of us, it was related to supporting those acutely distressed by the impacts of increasingly disturbed weather patterns. For those of us living in countries currently less exposed to climate breakdown, we have woken up to the extent of the threats through hearing or reading about the urgency of the situation. We tried to stay connected with the feelings of all that is at stake: ‘I wasn’t deeply in the evidence until recently and then I was reading these IPPC reports and I was like…wait a minute, wow! Why isn’t anyone in authority saying this every day outloud?’ (GB).

Whatever route we have taken to this point, for all of us our increasing engagement was intertwined with waves of fear, grief, rage and despair that at times have been overwhelming. It has caused considerable disruption to our personal lives, such as causing sleep deprivation, irritability, less functional coping strategies, avoidance and a hypervigilance to warning signs that things were not as they should be with our planet. Many of us mentioned our children as a key motivator in taking action: ‘The sick feeling I get when they speak of their hopes for their futures in ways that don’t connect with the likely reality of social collapse’ (GM).

We have found it an existential challenge and a source of cultural trauma (Woodbury, 2019). Our beliefs in the myth of progress and that humans and the more-than-human world will continue to thrive for many generations has been stripped away by our evolving awareness. We are experiencing a complete threat to our way of life where we are ‘having to mourn that kind of childhood notion of stability and see the world in the way that it really is' (CL). For those of us who are already experiencing the acute impacts of the climate crisis ‘the unfortunate reality is that we know and are experiencing on a daily basis the world changing around us’ (NG).

These insights are at times a real burden to carry as they have alienated us from friends, colleagues and loved ones who do not seem to grasp the severity of the threats. For example, in the Philippines, ‘there is this extreme weather condition in the country but no one talks about it because it seems it's just normal’ (SS). We can struggle to break this taboo of raising our concerns and the necessity for urgent radical action that hangs over us: ‘I find it quite hard to talk to other people about climate change outside of this group of people working in it because you don’t quite know how it is going to come across and whether you share a common language’ (CL). Our difficulties speaking about our fears have been in tension with the enormous, sometimes paralysing sense of responsibility we experienced to take action: ‘The question is, what do you do, and how do you do it, and who do you do it with, especially when you and everyone else feels stretched?’ (NG).

Professional

The feelings of isolation and frustration are also experienced within our workplaces, where other professionals and institutions seem oblivious or unwilling to make the links between high carbon lifestyles and climate change, and the fact that those least responsible for emissions will suffer the most. There is a tendency for leaders in the Global North to underplay the trauma of how much our world is changing since our baseline weather patterns are often milder: ‘people talk in therapy about things like the local impact of flooding, but we are not, at a governmental level, making the same connection' (MH). For some of us, being surrounded by this dissonance and our growing involvement with the climate crisis has impacted our ability to engage in aspects of employment we had previously valued because ‘on an emotional level, what I’m doing feels a bit meaningless in the bigger context of the urgent crises that we have' (CL).

For those of us living in nations with relative material deprivation and which have already been harder hit by climate change, the work is growing exponentially and is taking a significant personal toll: ‘At some point it does become tiring just being in the aftermath all the time. And knowing it’s going to happen year after year after year' (AS).

We have found the volume of work for MHPs is not only driven by an increase in natural disasters but also by the compounding stressors of the longer term effects of climate change. Barbados' increased water shortages have meant the closure of schools and the huge increase in Sargassum seaweed on beaches create a ‘distortion of safe zones’ (NG) where people could previously unwind and reconnect. In the UK increased erosion, flooding and storms also have longer term mental health effects such as the loss of beloved landscapes and break up of communities. These effects and fears are beginning to enter our clinical spaces and the need will only grow as the climate crisis continues.

Given this interconnectedness of our wellbeing and planetary wellbeing, we have all questioned the individualistic orientation of mental health provision and the pathologizing of distress, which serves to obscure our mutual interdependence with communities, ecosystems and planet. Current mental health paradigms can perpetuate individualistic values, for example by focussing on treating climate anxiety individually rather than attending to the primary systemic drivers of such legitimate fears: ‘we need to be shifting to non-pathologising understandings of…all forms of distress. A lot of people are aware [of the crisis] and find it so anxiety provoking they shut off and deny. We need spaces where we can recognise that shared trauma’ (GM).

Adapting and growing

The disruption brought into our lives by our growing engagement in the climate crisis drew us all into a process of adaptation and growth. We have shared how this has manifested for us within the personal (Section ‘Personal’) and professional (Section ‘Professional’) spheres of our lives.

Personal

We reported using a wide range of strategies including ‘the usual functional and dysfunctional ways of dealing with stress' (MH). In line with the literature (e.g. Randall & Hoggett, 2019), everyone spoke of finding connection with like-minded others, partners and friends as helpful: ‘Someone I can talk to, share with. Just sit with you, even in silence. People don’t need to understand that weight for them to support you' (AS). Many of us have found rewarding new communities and colleagues as a result of engaging more with the climate crisis (the team on this paper is such an example). We spoke of seeking connection beyond our fellow humans through meditation, spirituality, religious texts and connecting with the other-than-human:

My day starts very early in the morning around 3:30 or so – I don’t see how I can do it all without connecting to a source of power bigger than myself – so for me that looks like: praying; reading; and listening for a response. (NG)

We have found connection to others or to contemplative practices to be not only an antidote to isolation, but also supportive of self-compassion and reparative for the anthropocentric and individualistic lenses that are so implicit in this crisis. Connections support us to face into and bear witness to our lived reality.

Many of us have found that engaging emotionally with the climate crisis and taking action within our professional domains has been hugely beneficial in reducing feelings of anxiety and powerlessness. Engagement has supported a sense of agency, while ‘within that being humble, knowing that is not something that you can fix on your own' (CL). However, due to the gravity of the crisis, many of us have found ourselves over-committing, in spite of placing importance on boundaries between work and personal life. Remaining connected to our values has supported us in pushing on with this work:

It is difficult, yes, but at the end of the day it is worth it, we can see some progress. I am not doing this just for me, I am doing this for my kids, for them to be able to experience, say, how to be outdoors as I used to. Currently they can’t because of sunburn and the heat. (SS)

Overall, there was a collective appreciation that our skills as MHPs have played a role in supporting us to remain engaged with the threats posed by the climate crisis without always being overwhelmed. This insight has been a key driver in wanting to share our experiences with fellow MHPs; to indicate how they are uniquely positioned to play a vital role in the unfolding global crisis.

Professional

One of the striking and perhaps less predictable features of both the interviews and group discussions was that, in spite of the differences in our professions, geography and culture, there was a remarkable level of overlap in our vision of how MHPs need to adapt and change to develop ‘a far richer lens of mental health and wellbeing' (CL). Everyone spoke of the need for new models of mental health that attend more to the societal and structural causes of poor mental health over individualization or compartmentalization of distress: ‘Therapy doesn’t take place in a bubble…just as there is always a race element, a gender element, there is always a climate catastrophe element to how things present. Sometimes explicitly but always at least implicitly' (MH).

GB put this in the context of the ripple effects that global instability can cause to our wider well-being and survival: ‘[climate change] really accelerates social disorder and capacity to problem solve. Covid in this country [USA] being “exhibit A” – Covid just nudged on the social fault lines, the inequities, the prejudices, the disparities, the power differentials – therefore the social glue. Cutting across those fault-lines and many ways incapacitating us and polarising us. That dynamic is a minor walk in the park compared to the pressure of climate change and so …the resilience of the social climate is as important as the resilience of the natural climate.’

As MHPs, our pre-existing knowledge and expertise in processes such as change, power dynamics and relationships can be applied to make sense of and support the ‘social climate’ that is under threat from intersecting pressures of climate change. Without this work, social cohesion may breakdown: ‘We have to be ready to love each other when it is really hard to do so' (GB).

With the growing distress, anxiety and instability that is evoked by the climate crisis, we as MHPs have a role in supporting people through these uncertainties. However, with the sheer scale of the need many of us have described how we need to redefine and broaden the role of MHPs to include being advocates and coaches. We can train and support members and groups within communities to attend to their own wellbeing rather than depend upon a limited number of trained ‘experts’. In the Philippines for example, there are 100,000 Phillipinos and less than 2000 therapists. This coaching approach to mental health has already been extensively used after natural disasters such as after the earthquake in Haiti. It can also have the added benefit of democratizing access to mental health knowledge and so empower communities whose mental health are being eroded by structural impacts of the climate crisis, such as loss of livelihoods from desertification or fractured communities from flooding.

Some of us also saw MHPs as being uniquely placed to be advocates for the communities who are often the most exposed to the climate crisis but least politically empowered: ‘We have the privilege of the stories of the people we listen to. We are literally trained on how best to build rapport and safety. That means we are at the forefront of capturing the narrative that isn’t exploitative…We need to be able to decolonise the language of the climate crisis so that we can connect with the “lived experience” of the people that are most exposed' (AS).

We have the communication skills and hold positions of trust that mean we can be translators, and bridge the conversation between political and professional bodies and those most impacted by the climate crisis.

Acting

One of the emergent themes of the interviews and discussions was the experience we all had of shifting from a place of anxiety and stuckness into one of movement, dynamism and change. There is this sense that by turning towards the reality of the climate crisis and entering into this emotional process, we have been freed to feel and act in ways more congruent with our values. By mourning, learning and connecting we have the space and energy to shift into making sense of what we want to do in response to the climate and associated crises. This we believe is essential for wider society to successfully navigate this crisis: ‘We need to not just have to cope through this where we don’t hate each other and don’t hurt each other, but we need to act together’ (GB).

Many of us also felt an emotional paradox, also described in the literature on sustainable activism (Hoggett & Randall, 2016; Macy & Johnstone, 2012), where a particular ‘mindset and heartset' (SS) is required to act. We need to hold hope without it being attached to the outcome or the likelihood of change. Instead the value of activism is in the act itself. There is an absence of ego in this approach, some of us referred to it as ‘a sense of hubris' and 'not being saviours'. It is the collaboration of all our efforts that we felt can make a difference,

As an individual practitioner, I think of myself as a single blade of grass and no more. Inconsequential in myself, but of course a blade of grass is always within an ecosystem and enough blades of grass popping up independently but also connected, then we have a whole field and the energy of a whole field of practitioners popping up independently, but also connected in an ecosystem, is a powerful thing. (MH)

Conclusions

This paper summarizes the lived experiences of a diverse group of MHPs in engaging with the climate crisis, with the aim to both validate the experiences of other MHPs, and encourage them to engage with our most urgent social challenge. Through our conversations, we have come to acknowledge that the emotional work of the climate crisis is messy. We chose verbs as subheadings to highlight that our engagement, as humans and as MHPs, is an ongoing, active process. Our engagement with the climate crisis has affected our functioning and our relationships as well as calling into question the validity of our work. However, through connection with other concerned professionals, we have found ways to live with the difficult feelings and existential threats, and have found our engagement has supported creativity and new collaborations in our professional lives. We have found our training across our various mental health disciplines of enormous value in supporting this process. Our ongoing engagement with the climate crisis facilitates us to move between states of anxiety to ones of greater purpose where we feel in more alignment with our values and more connected to our planet and all its life.

We want to advocate to other MHPs to recognize how they too can apply their abilities to this global challenge, for ‘If we, as mental health professionals, cannot sit and connect and be present with these feelings then how can we expect other people to make the changes' (GM). The climate crisis represents the single biggest threat to human health worldwide (Watts et al., 2018), and we want to push back against the common perception that taking action is not within the remit of MHPs: ‘It isn’t political to call out the biggest threat to sanity. It is a professional duty’ (GB). The current dominant models of mental health that focus on making sense of and responding to distress at individual level are not well suited to supporting societal adaptation to the unprecedented threats we face. We recognize that engagement with the crisis presents a threat to our personal and professional identities and practice, but in our experience change is possible if we enter into and accept the emotional turmoil that in turn can free us to adapt, and foster change in ourselves and others.

Acknowledgements

We are thankful for the guidance and help from all our colleagues at the institutions mentioned in our affiliations.

Disclosure statement

The authors report there are no competing interests to declare.