Signs of climate breakdown are evident across the globe. From wildfires in the US and Europe to heatwaves in India and Pakistan and heavy rainfall in the UK, record-breaking extreme weather events are occurring in every continent and increasing in frequency and intensity. What is unexpected, however, is the speed with which global warming even at the current level of 1 C is resulting in climate chaos. Contrary to earlier scientific forecasts that temperatures would rise to over 40 C by 2050 in the UK, this record has already been reached by the summer of 2022, prompting leading climate scientists to warn that the future is already here. We are informed that climate breakdown is inevitable and global leaders acknowledge that they are scared, as avoiding the most catastrophic outcomes is the best we can now do.
That climate change is the biggest threat to global public health was recognised more than a decade ago but carbon emissions have simply continued to increase. Estimations of the direct health effects of aspects of climate change such as heat stress, floods, air pollution, food insecurity and the spread of vector-borne disease demonstrate that the global burden of morbidity and mortality is also increasing steeply on every continent. But, despite the recognition that the mental health toll is likely to be as severe, few efforts have been made to quantify this burden, study its extended impact on society, forecast its effects on socio-economic trends of the future or to explore ways by which the negative impacts could be addressed and hope could be harnessed to ensure the best societal outcomes for the future. This collection of research studies, commentaries and analyses aims to help remedy this gap, as it shines a light on this relatively neglected area of the health impacts of climate change. It brings together authors drawn from a uniquely broad range of backgrounds including mental and public health, climate and social sciences, the arts and young people’s networks, united in their ambition to emphasise the mental health impacts of climate change and encourage everyone to contribute to action.
A growing body of evidence is demonstrating that the direct impacts of the climate chaos on mental health range from an increase in suicides and worsened outcomes for those with diagnosable mental health disorders to declining population mental health and wellbeing. Authors commenting from geographies as diverse as Bangladesh, South Africa, the Philippines and the Caribbean confirm that acute extreme weather events as well as chronic extreme climate events such as prolonged drought are associated with an increasing burden of post-traumatic stress disorder (PTSD), depression, anxiety, extreme psychological stress and distress, substance use and suicidality in people of all ages groups. Healthcare professionals working in disaster relief are not invulnerable to these risks. Longer term, climate impacts such as rising sea levels, forced migration and conflict are resulting in the loss of community identity and disruptions to emotional bonds to place and ancestral heritage, with profound effects on the wellbeing of the affected communities. However, these impacts are not confined to those countries hardest hit by the climate crisis, as being aware of current and future climate-related risks is adversely affecting the psychological and emotional wellbeing of all populations.
What of young people around the world, on the frontline and the worst off, in terms of facing the consequences of inaction in previous generations? A study of the climate-related feelings, experiences and hopes of 23 young people aged 16-29 from 15 countries around the world reported on the following pages makes for uncomfortable reading. Authored by the young people themselves, this unique study highlights the intensity of their emotional stresses, as they find themselves often coping alone with feelings of unimportance, and anger and distress at the indifference and lack of urgency with which adults and organisations treat climate change. Their feelings of powerlessness, hopelessness and uncertainty, especially among those living in the most climate-vulnerable communities deserve attention as the consequences of their neglect may be a fatalism and inability to engage with positive action or imagine a hopeful future.
Despite this bleak background, solutions are emerging, offering a glimmer of hope for the future. There is growing awareness that it is a false dichotomy to separate human health and ecosystem health and that access to and the nurture of the natural environment have the dual benefit of delivering mental health improvement and restoring nature. A study of nature based activities offered as a therapeutic intervention in a child and adolescent mental health service has demonstrated this, as outcomes included wide-ranging health benefits as well as an enhanced appreciation of the environment. The authors recommend that nature restoration activities should become an essential component of the mental health armamentarium of interventions.
Strategies to address the mental health impacts of the climate crisis are also beginning to be developed at scale. Bangladesh has been notable in utilising its presidency of the global Climate Vulnerable Forum to prioritise mental health and to develop an ambitious plan to build resilience in the population. Its Crisis Preparedness and Management for Mental Health programme is an exemplar, with its formally evaluated framework of capacity building for post-trauma psychological support to communities offering a model which may be replicable in other countries.
There is growing recognition among mental health professionals that they have a crucial role in supporting people through the uncertainties, anxiety and instability associated with the climate crisis, whilst ensuring that their own mental health and wellbeing is protected. Their emotional struggles resulting from the incongruity and tensions of living and working alongside climate deniers and sceptics is no different to that faced by everyone who cares about the climate crisis, and needs to be considered in the context and against the scale of the eco-distress they are diagnosing among children and young people. The traditional models of therapeutic care which focus on the needs of individuals remain important but are no longer adequate. Their professional knowledge and expertise puts them in a uniquely advantaged position not only to empower themselves and treat individual patients but also to make a difference at a societal level as the climate crisis unfolds. This realisation is adding a new layer of responsibility but also fresh opportunities for innovation. The model of training in the Philippines which is democratising access to appropriately contextualised mental health knowledge and care in communities devastated by climate disasters and their socioeconomic impacts is an example. At an institutional level, the Royal College of Psychiatrists is among the first health organisations in the UK as well as globally, to use its authority to highlight the seriousness of the erosion of public mental health and its likely societal consequences as the climate crisis deepens and to challenge governments to lead the journey to a better future. But given the sheer scale of the problem, do mental health professionals have a role in climate activism? A reflection of the benefits and opportunities of and barriers to medical activism included in this edition concludes that they do. Building on the history of medical activism and its impacts on several transformative societal changes, it presents a compelling argument for mental health professionals to recognise the emotional benefits which collective action and advocacy can bring, through social connectedness, agency, empowerment and knowledge sharing. Such activism is not without its challenges, ranging from the need for activists to protect their own wellbeing to potential discordance with the demands of professional regulation, but the authors argue that the overall benefits outweigh these risks, and urge the medical institutions to support such activities given the exceptionality of the circumstances.
The climate crisis is an existential threat and while fearfulness about the future can be managed, balancing it with hope and optimism will require commitment and action at the levels of global and national decision-making as well as at the individual and everything in between. This issue is a call to action not just for mental health professionals, but people concerned about the climate everywhere to utilise their knowledge, skills, influence, and public trust to advance societal understanding of health implications of the climate crisis, highlight the health co-benefits of climate mitigation and adaptation, support individuals and communities to cope with the psychological impacts, and advocate for greater urgency, ambition and action at systemic level. John Kenneth Galbraith, the distinguished American economist, said, ‘All of the great leaders have had one characteristic in common: it was the willingness to confront unequivocally the major anxiety of their people in their time. This, and not much else, is the essence of leadership.’ Mental health professionals and all who share their concern for the climate are urged to be leaders in shaping the radically more compassionate future which young people deserve and are asking for.
Acknowledgements
This special issue is testimony to the commitment and efforts of a wide range of people united in their belief that the mental health impacts of the climate crisis need to be recognised and addressed as a global priority. I am grateful to them for their support to me in guest editing this issue. In particular, I would like to thank the editorial team, Richard Powell, Neil Jennings and Emma Lawrance for their help with planning the content, assistance to other authors, reviews and contribution of papers to this collection. I am also very grateful to Adrian James not only for contributing an editorial and reviewing manuscripts, but also for facilitating the wider involvement of the Royal College of Psychiatrists and its members in this undertaking. Special thanks go not only to the authors but also to the many reviewers – Natalie Greaves, Guy Harvey, Philip Campbell, Ans Vercammen, Juliette Brown, Kirsten Shukla, Jacob Krzanowski, Ryan Essex, Shivali Fulchand, Dasal Abayaratne, Patricia Simon, Adam Monsell, Panu Pihkala, John Jamir Benzon Aruta, Phil Davison, Saverio Krätli, Salome Divya Joseph and Helen Berry – whose inputs have been critically important in shaping the content of the edition.