Good for the planet, good for our patients

It may seem counterintuitive, but the pandemic has reinforced that we in the medical profession are in a position of privilege; we are trusted, and our voices carry weight. As the pages of this edition show, the climate and ecological emergency, and the disruption to life that it poses, presents an unprecedented threat to our health. However, I’m hopeful that this is an opportunity to use our voices and work towards collective goals to make a real difference.

My work as a psychiatrist has demonstrated that we cannot afford to ignore the increasing evidence of both direct and indirect impacts of climate change on mental health any longer. I’m so pleased that the issues discussed in this edition are as wide-ranging as they are persuasive. It is clear that our health is intertwined with that of all life on earth. This is without doubt a core mental health issue.

We know that the increase in climate-related hazards is exacerbating existing mental health problems and leading to psychological distress and the onset of new episodes of mental illness (Beaglehole et al., 2018). Extreme weather events and ecological degradation can have a direct psychological impact on those who experience them firsthand. The changing climate is causing instability to land use and access to resources which in turn leads to forced migration and armed conflict, which can have profound impacts on people’s health. Simultaneously, witnessing these disasters from afar and the growing awareness of the need to act can provoke a deeply psychological response. Furthermore, climate change only exacerbates existing social, economic and demographic inequalities, which is magnified in the Global South (Watts et al., 2018).

I’m proud that the Royal College of Psychiatrists published our position statement a year ago, which described some of the far-reaching effects of the climate and ecological emergency on mental health and looked at how we, as psychiatrists, can help prevent disaster. New evidence on this topic has been published over this past year and this edition synthesises much of this to offer a state-of-the art overview.

I’m certain that the solutions are not just ones that will be good for our planet—they have the potential to fundamentally transform patient care in the process.

As individual mental health professionals we have a real opportunity to play our part. This could be through having conversations with our patients that help them to make better decisions about their care. At RCPsych we are calling for health organisations to incorporate the goals of Choosing Wisely (2022) into daily practice, empowering patients to ask questions to avoid unnecessary tests and treatments where these are unlikely to be of benefit.

However, keeping patients well is one of the most sustainable things we can do as psychiatrists. With the right resources, we have the power to detect and treat illness early, or even halt or slow their progress, which in turn can prevent deterioration to the point of needing hospitalisation. Prevention efforts come in many different forms, and there are growing opportunities to explore this including via digital interventions, which can contribute to promoting mental wellbeing and resilience. Through making use of treatments such as social prescribing, we can help prevent mental illness, and aid in recovery and maintenance of remission. It can play a substantial part in reframing psychiatric treatment to make it more preventative, holistic and sustainable (Royal College of Psychiatrists, 2021).

However, we must acknowledge that individual action will only get us so far. Organisations and governments have the biggest load to carry. The College is calling on the UK government to prioritise a unified approach with sufficient resources to tackle the climate and ecological crisis across all areas of policy. Governments can do more to lead on public mental health and preventative healthcare, tackling the social determinants of health early. And of course, there are significant actions needed outside of healthcare to mitigate climate change and biodiversity loss. The voices of experts in this area must be heeded.

Since COP26, health systems in 18 countries have committed to NetZero emissions (https://www.who.int/initiatives/cop26-health-programme/country-commitments). For example, in England, individual NHS organisations are setting a path by which they can improve the health of their local community in a way which respects their dependence on the planet—a Green Plan (https://www.england.nhs.uk/greenernhs/). These are actionable plans that allow NHS trusts to work towards meeting their carbon reduction targets. Clinicians are crucial to the delivery of these through utilising sustainable care models, green space and biodiversity and sustainable use of resources. Wherever you work in the world, you can advocate for and input into your employer’s response to the climate emergency.

The climate crisis demonstrates how interconnected we all are and how this is fundamentally a global issue. Colleagues in the Global South are already facing more extreme weather events, working with populations who are often much more vulnerable to their catastrophic consequences. As this edition shows, those in the Global South have first-hand expertise and have an especially important place in helping us to understand the impacts of the climate emergency on a deeper level. It is vital that we work hand in hand to protect the mental and physical health of our patients, wherever they are.

I have no doubt that this edition is an invitation—a demand—for us to grow the evidence in this area and show that we can build sustainable models of healthcare that has benefits for our patients and the planet alike.

Disclosure statement

No potential conflict of interest was reported by the author(s).