In recent years, the stark reality of climate change has come to the fore. Record-setting heat waves and devastating wildfires have resulted in lost lives, ill health, and the destruction of property. But the climate crisis has also had another, more insidious, but equally devastating, impact on mental health and well-being.
Recent data from a 2022 nationally representative survey showed that a little over two thirds of Americans surveyed in 2022 (64%) report being at least "somewhat worried" about global warming, and 27% reported being "very worried."
Furthermore, about 1 in 10 Americans reported experiencing symptoms of anxiety and/or depression related to climate change, prompting many to seek emotional and social support.
In response, one unofficial subspecialty of psychiatry is acting to address not only the emotional response to climate change but also the psychiatric fallout from extreme weather.
Pulmonologists and cardiologists once dominated the talking points on the negative impact of climate change on health, Robin Cooper, MD, an associate clinical professor of psychiatry and behavioral sciences at the University of California San Francisco, told Medscape Medical News.
"At the end of their presentations, almost as an afterthought, they would say, 'There are also mental health repercussions [of climate change]', and I asked myself, 'Why aren't we as psychiatrists lecturing on this, since we are the experts?'" she said.
Information Is Power
Cooper organized 10 other like-minded psychiatrists, and together, they began combing the literature for evidence of how climate change affects mental health.
The research describing the harms of climate change on mental health has "exploded," said Cooper, and "is truly related to the sphere of what we now conceptualize as climate distress — the wide array of feelings about the impact of climate change and ecological destruction," she said.
It also covers the impact of climate disasters on mental health and how extreme heat can negatively affect those with serious mental illnesses.
For instance, a study of 280 deaths in British Columbia from a 2021 heat wave showed more than 13% of those who died had schizophrenia. It is well-known that people with schizophrenia have an impaired ability to thermoregulate and respond to heat stress. In addition, certain antipsychotic medications can raise the body temperature.
Though the factors contributing to suicide and violence are complex, Cooper noted that the rates of both have been known to increase during heat waves.
Out of the group's efforts emerged the Climate Psychiatry Alliance (CPA), an organization dedicated to educating the mental health community and the public about the psychiatric risks posed by the climate crisis. The CPA's mission extends to advocating for better environmental policy and recognizing the critical intersection between environmental well-being and mental health.
Getting Involved
The site also provides tips about how psychiatrists and other mental health professionals can "go green" to reduce their carbon footprint. The medical field contributes to about 10% of greenhouse gas emissions, Cooper noted.
While psychiatry ranks among the medical specialties with the lowest carbon footprint, the lessons learned from the COVID-19 pandemic underscore the possibility of maintaining professional activities that reduce the impact on the environment. For instance, said Cooper, the pandemic showed that physicians could conduct office work, meet with patients, participate in conferences, and teach, all contributing to a significant reduction in carbon emissions.
Cooper also hopes that psychiatrists will become involved in environmental advocacy and suggests that they join CPA's outreach and advocacy committee to get involved.
"I speak about the mental health impact of climate change at the local, state, and national levels — policy-driven solutions are important," said Cooper.
In March 2023, the American Psychiatric Association (APA) issued a position statement on mental health and climate change, stating that "efforts should be aimed at reducing the progression of climate change, enhancing infrastructure, and developing a response plan to address the mental health effects of climate-related weather events."
Joshua Wortzel, MD, chair of APA's committee on climate change and mental health, told Medscape Medical News that the committee has been drafting action papers with the aim of persuading the organization to divest itself of fossil fuels and significantly reduce the carbon footprint of its annual meeting by 2030. They have also produced a video on the effects of climate change on mental health.
As committee chair, Wortzel briefed Congress on the Community Mental Wellness and Resilience Act, a bipartisan bill that would establish community-based programs to promote mental wellness and resilience and heal mental health problems spawned by disasters.
Preparing Psychiatrists to Treat Patients
Wortzel said that his committee is working with the CPA to develop courses for medical students, residents, and practicing psychiatrists. These courses will explore the mental health implications of climate change and help students and physicians understand the mental health implications of climate change and equip them with effective strategies to support distressed patients.
"Ideally, we aim to balance the fear of what nature can do with the beauty that is our world," said Wortzel. He added that psychiatrists won't necessarily need to learn new skills. Instead, he said, their therapeutic skills can be "repackaged and applied in a way that is relevant to climate change."
Cooper and Wortzel both noted that psychiatrists and other clinicians need to ensure patients know that they are receptive to discussing emotions around climate change.
Wortzel added that it is incumbent upon psychiatrists to help patients with existential distress related to future national disasters to cope and build resilience.
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