What is geopsychiatry?

Geopsychiatry is a relatively new and exciting field in psychiatry. The discipline studies the interface between geography and psychiatry. The main focus in the field is on the impact and effects due to various factors such as climate change, disasters, globalisation, population growth and movement, urban conglomerations, agricultural production, industrialisation, geopolitics, socio-economic transformations, and cultural practices in the mental health-mental illness processes. Thus, it is an intersectoral field that involves professionals from varied disciplines such as geographers, physicians, anthropologists, sociologists, health professionals (i.e., nurses, social workers, physicians, psychologists, occupational therapists), architects, urban planners, economists, politicians, agronomists among other interested parties.

Geopsychiatry is in line with the bio-psycho-social model, which aims to explain health, illness, and health care delivery through biological, psychological, and social aspects and the complex relationships between these disciplines. The field of Geopsychiatry has the causal chain involving geographic risk factors and incidental mental and substance use disorders. Furthermore, protective factors and environmental interventions are being increasingly investigated.

Several studies have elucidated the mental health effects of natural disasters (e.g., tornadoes, volcanic eruptions, earthquakes, hurricanes, tsunamis, storms, firestorms, dust storms, floods, among others), for which climate change may play a role. Various psychological symptoms occur after these, including substance abuse, uncontrollable stress, long-term feelings of sadness and grief, and adjustment issues. All these symptoms might interfere with the individual's and community's ability to function properly, resulting in family conflicts and other consequences (Makwana, 2019). Natural disasters can affect the victims' ability to operate normally and cause loss to people, families, and communities (Makwana, 2019). Individuals who had lost their jobs due to natural catastrophes experienced a loss of identity, poor self-esteem and consequent stress and depression which may get them into a vicious cycle of poverty and mental ill-health. Natural disasters can leave victims in a condition of despair and shock. There is also a loss of optimism and a disruption in their communities' duties following the accident (Makwana, 2019).

Climate change can lead to subacute or long-term changes like drought and heat stress, the threat of higher temperatures, rising sea levels, and a permanently altered and potentially uninhabitable physical environment. Despite various studies revealing the mental health effects of global climate change, the extent of such effects is still not very clear. The repercussions of global climate change can be both direct and indirect (i.e., collective violence, damaged environment alienation, involuntary migration, displacement, health and well-being vulnerability, civil strife, and economic loss) (Palinkas & Wong, 2020). Unfortunately, man-made disasters (i.e., terrorism) has also emerged as a serious worldwide fear in today's globe, and it is a tragic but contemporary type of interpersonal violence (Fischer & Ai, 2008). Several large-scale studies have found that international terrorism poses a severe short- and long-term harm to mental health, generating post-traumatic symptoms in those who have been directly or indirectly exposed to terrorist acts (Fischer & Ai, 2008).

As the global number of refugees and asylum seekers has continued to increase, mental health practitioners have become more conscious of the need to recognise and react to the mental health needs of displaced people (Hynie, 2018). Although pre-migration trauma predicts mental disorders, the post-migration setting can significantly predict mental ill-health. The significance of post-migration stresses to refugee mental health emphasises the necessity for psychosocial treatments which address the larger realities that refugee and asylum seekers face (Hynie, 2018). Moreover, migrants tend to move to urban areas. Generally, urbanisation may raise the likelihood of mental illnesses such as psychotic episodes, depression, and stress-related diseases, especially in vulnerable persons (Lecic-Tosevski, 2019). These challenges of urban living are particularly exacerbated in low- and middle-income countries for a number of reasons such as rapid industrialisation and urbanisation, changes in family structures and support. In addition, different brain pathways for an established environmental risk factor, establishing a relationship between the urban environment and social stress processing. Therefore, environmental interventions may be beneficial in both preventing and treating mental problems (Lecic-Tosevski, 2019).

On the other hand, rural areas are often at a disadvantage as these systematically receive less health policy preventive intervention and suffer from the lack of easy access to specialised mental health care even in high-income countries. In the U.S., it is estimated that two in every three nonmetropolitan counties lack psychiatrists and that the majority of people living in rural counties face mental health provider shortages (Morales et al., 2020). Other contextual and cultural factors affect inequities in mental health treatment in rural areas, in addition to a lack of educated and certified clinicians. While there is no universal definition of rurality, several widely accepted variables shape rural culture and its impact on mental health, including farming, stigma, religious beliefs, poverty, social support, low population density, isolation, and remoteness (Morales et al., 2020).

The Compassion, Assertive action, Pragmatism and Evidence (CAPE) Vulnerability Index is an interesting Geopsychiatry attempt to identify countries that require foreign aid and how that aid can and should be prioritised for global foreign mental health policy (Persaud et al., 2021). Countries with lower Index scores are more likely to be failed or fragile nations. Such governments are frequently authoritarian and corrupt, may engage in major human rights violations, and are characterised by various forms of conflict (Persaud et al., 2018). These governments are also likely to face disadvantages as a result of extreme poverty, pockets of insurgency in the form of terrorism, ethnic and social divisions, inequality, inability to deliver essential services, and climate change extremes, which are often violent and merciless (Persaud et al., 2021).

In conclusion, Geopsychiatry is an exciting new developing field that is truly intersectoral looking at and involving health, environmental, human, social, economic, and political sectors. It can help clarify the mental health causal chain and propose therapeutic and preventive macro- and micro-level interventions. It is also potentially useful to help policymakers and international aid agencies correctly allocate funds for mental health purposes.