Natalie attended the 71st World Health Assembly in Geneva in 2018. She is currently completing a Graduate Certificate in Clinical Ultrasound at Central Queensland University, alongside a Bachelor of Medicine/Bachelor of Surgery degree and a Masters degree in Public Health.
Climate change has been described as the greatest global threat of the 21st century. The risk it poses to human health is multifaceted and complicated. Already, the health effects of climate change are being experienced, with the impact on health projected to increase with forecasted population growth. Only now is the threat to mental health posed by climate change being raised by governments around the world.
This paper will review the direct and indirect impacts of climate change on mental health. It will also explore the international actions dedicated to addressing the mental health impacts on climate change, focussing on investigating applicability to the Australian population. Finally, it will outline two key strategies to mitigate the potentially-dangerous effect of climate change on mental health, with a focus on psychological preparedness training and integrating mental health information into existing community programs.
Context and Background
Changing regional and global climate patterns resulting from climate change are creating numerous consequences for the environment and human health. Climate change can directly impact health through extreme weather events, including cyclones and flooding, as well as chronic climate-related events, like drought and heatwaves (Change, Intergovernmental Panel on Climate, 2007). Through its impact on ecosystems, such as changing disease patterns, and social structure, such as increasing conflict or migration due to limited resources like water, climate change also impacts health (Watts et al., 2015).
The 2015 Lancet Commission Report on Health and Climate Change further recognised the complex impact of climate change on mental health (Watts et al., 2015). The report highlighted numerous effects, including mental health effects of natural disasters and forced environmental migration (anxiety- and stress-related responses and resulting chronic mental health conditions) as well as the potential impact on mental health service provision, and influence on social determinants of health such as employment (Watts et al., 2015). Considering the intricate ways in which climate change can impact mental health, and the myriad of acute and chronic outcomes, it is important for policy to address this issue with the aim to mitigate some of these outcomes. This paper aims to strengthen the Government’s understanding of the relationship between climate change events and mental health and contribute to the creation of better policy outcomes regarding this connection. Through further exploring the complex relationship between climate change and mental health, this paper will propose two strategies that can be implemented to promote and protect mental health during acute climate-related disasters and chronic climate events.
The Complex Issue of Climate Change and Mental Health
In communities that have experienced climate-related disasters, the prevalence of PTSD, depression and anxiety has been shown to increase immediately following the event, and to remain greater than pre-event levels for years after the event (Albrecht et al., 2008; Berry, Bowen & Kjellstrom, 2010; Watts et al., 2015). Furthermore, some studies have reported an association between suicide and drought and heatwave over an extended period (Basangana et al., 2011; Kloves, Kloves & De Leo, 2013; Nicholl, Butler, Hanigan, 2006; Page, Hajat & Kovats, 2007).
Research into Australian populations has reported higher rates of psychological distress and probable post-traumatic stress disorder (PSTD) in individuals who were directly impacted by the 2011 Brisbane floods (Alderman, Turner & Tong, 2013). Longitudinal research into flood-affected communities in Victoria and NSW has complemented these findings, with greater anxiety and PTSD symptoms reported by post-flood (Bei et al., 2013). Similar longitudinal research into the impact of the Ash Wednesday bushfires in South Australia in 1983 has demonstrated the longevity of the psychiatric morbidity following the event, with almost 50% of participants experiencing significant psychiatric morbidity 12-months after the disaster, and approximately 25% of participants still experiencing this a further eight-months on. Despite little quantitative epidemiological research into the impact of chronic weather events, like drought, research into Australian farmer suicide has indicated that drought, as well as specific financial difficulties resulting from drought, are common factors contributing to death from suicide (Kunde, Kolves, Kelly, Reddy & Se Leo, 2017).
With the creation of the 2030 Sustainable Development Goals (SDGs), the World Health Organisation (WHO) recognised the promotion of mental health as an important health goal and it is, therefore, a vital area of consideration when addressing the public health impact of climate change. This paper will focus on providing recommendations that focus on strengthening resilience and promoting positive coping strategies prior to climate-disasters, with the intention of improving both individuals and the communities’ ability to cope with climate-related events and to recover post-event.
How does climate change impact mental health?
There are multiple ways that climate change impacts mental health:
·Extreme weather events indicative of climate change can impact on the experience of mental health conditions, including acute traumatic stress immediately post-disaster, which can persist into chronic stress disorder, depression or anxiety even once stability has been restored.
·Climate change events (drought, flooding, etc) can impact on the social, emotional and environmental determinants of mental health. For instance, through loss of income for farmers or loss of home through flooding. Furthermore, the impact of climate change on infrastructure can impede an individual’s ability to receive treatment following an extreme weather event.
·The presence of climate change as a global threat can result in distress and anxiety. This can also be true of communities in event-prone areas, particularly in the disaster season (eg. communities in bushfire-prone areas in summer) (Fritze et al., 2008).
The recommendations outlined in this report follow a prevention-focused approach. This approach advocates for the prevention of climate-related mental health concerns by fostering individuals’ and communities’ resilience. This allows for recovery and positive adaption to climate change-related events. Prevention-focused approaches can be conducted in the lead-up to a climate-related disaster, or in communities particularly prone to experiencing a climate-related event.
Recommendation 1: Integration of mental health information within community gatherings.
As part of the 2003 Centre for Rural and Remote Mental Health conference on drought and mental health, the positive impact of farm family gatherings was highlighted (Sartone et al., 2005). In such gatherings, organised by the Department of Agriculture, families and mental health- and support-service providers had the chance to meet and socialise. These discussions allowed for unfamiliar information about mental health to be disseminated to the whole community, fostering community support and knowledge of service providers. This also allowed for mental health information to be linked to issues that community members were familiar with, like farm management issues, encouraging a deeper understanding of this complex issue.
Previous research into preparedness and coping during climate-related disasters has advocated for community involvement, and the use of community events for information dissemination (Clayton, Manning & Hodge, 2014). A similar approach to the farm family gatherings could be implemented in communities experiencing chronic climate-related events, like drought, along with those preparing for a climate-disaster like a flood, bushfire or cyclone. In communities that regularly experience climate-related events, community-based gatherings often already occur (eg. bushfire preparedness meetings), and the Department of Agriculture has previously led gatherings of farm families in drought-prone communities in New South Wales. This department could be consulted to assist with organising similar gatherings in different regions that do not currently have such events.
This proposed recommendation would involve the recruitment of general practitioners, mental health workers and mental health service providers within communities who are willing to attend community gatherings. During these meetings, these individuals can present information about how climate-related events can impact mental health, engage the community in a discussion about what individuals and groups can do to maintain good mental health, and discuss the support options available within that local community. In communities that already host similar gatherings, for example, communities in Upper Hunter NSW as part of the Department of Primary Industries’ Rural Resilience Program, discussions with event organisers could determine the best way to involve mental health workers (NSW Government).
The initial organisation of a community gathering in an area without an existing event would involve the coordination of various stakeholders, in addition to mental health-focussed professionals. These stakeholders include local government, disaster-specific service providers including the CFA and SES and representatives from charities or organisations that provide assistance during climate events (eg. Rural Aid for drought-prone farming communities, or the Red Cross in bushfire-prone areas). Engaging a range of different stakeholders at a community gathering is necessary for promoting co-operation and communication between different staff and agencies operating in that community. Furthermore, it enables mental health information to be integrated into a community’s broader response to a climate-related event and allows individuals who may otherwise not have attended a mental health-specific event the opportunity to receive useful information and resources. Costs associated with conducting a community gathering may include venue hire, catering and advertising, but could be lessened by using a venue without a hire fee, utilising free advertising methods including social media and community events sections of newspapers and local newsletters, and encouraging attendees to bring a plate of food to share. Individuals and agencies presenting at community events may also charge a fee, but this would need to be discussed on a case-by-case basis.
The overall goals of integrating mental health information into community gatherings are as follows:
1) To increase community members’ understanding of how their mental health may be impacted by their climate and strategies that they can adapt to protect their mental health. This will be discussed below as part of Recommendation 2.
2) To educate individuals on the signs and symptoms to look out for in themselves and friends and family members that may suggest a mental health concern.
3) To make communities aware of the specific support services that are available to them if they are experiencing symptoms of depression, anxiety or distress.
In addition to allowing for the dissemination of information and resources, creating an occasion that brings together community members also strengthens social networks, which has also been shown to increase coping through natural disasters (Terpstra, 2011).
In order to evaluate the effectiveness of such community gatherings, brief pre- and post-gathering surveys with attendees should be conducted, which would allow for the collection of information on the benefit of the mental health discussions at community gatherings. Contrasting these results with a survey after the climate-related disaster would also provide information about the utility of the information presented in the gathering, during the disaster period.
Recommendation 2: Psychological preparedness program implemented in at-risk communities.
The pre-event period (eg. pre-bushfire or pre-cyclone season) has been recognised as a critically important time for the prevention and mitigation of the impacts of the event. In addition, effective coping and an adaptive response post-event are significantly influenced by the psychological factors and processes that occur during this pre-event period (Morrissey & Reser, 2003). Psychological-preparedness has, therefore, been recognised as an important way to preserve mental health throughout natural disasters. One approach to psychological preparedness that has been trialled in Australian populations is a stress inoculation approach, derived from Stress Inoculation Theory (SIT) (Meichenbaum, 2017). SIT is an emotional-management strategy that has been recognised for enhancing individuals’ ability to anticipate and cope with stressful situations and stress-induced emotional responses, and for the preventative value in reducing PTSD, depression, anxiety and distress (Morrissey et al., 2003).
A study into the use of SIT in cyclone-prone communities in Cairns, Queensland found the intervention effective at improving coping during and after the cyclone. Individuals who completed a modified SIT intervention were better able to anticipate, identify and manage their feelings, and shared coping and safety strategies with their community (Morrissery & Resner, 2003).
SIT is an ideal program to implement within climate-affected communities, as the three phases are tailored to the specific needs of participants. Furthermore, training in the delivery of SIT is quick and simple. Mental health professionals within the affected communities could receive a detailed SIT training manual with instructions for the delivery of the training. A potential schedule for the SIT program is as follows (Meichenbaum, 2017):
o Phase 1: Individuals discuss their concerns about the relevant climate-related event, about how these can impact their mental health. Further education about the sources of stress and anxiety also occurs, as well as a brief introduction into techniques to reduce stress at a physiological and psychological level. For example, issues like potential loss of home or uncertainty around employment during bushfire or drought could be raised, and participants would discuss their feelings about these stressors.
o Phase 2: The stressors raised in Phase 1 are revisited, and coping skills are introduced. A variety of coping skills may be used, including relaxation techniques, cognitive coping skills, coping imagery, and cognitive restructuring. Individuals have the opportunity to acquire and consolidate these coping skills in this session.
o Phase 3: The final application and follow-through phase allows individuals to gradually apply the skills they have acquired, across different levels of stressors. Techniques including imagery, modelling, and/or role play can be used. Importantly, relapse-prevention procedures are also practised in this session, so that individuals are prepared for stressful situations they may experience (ie. bushfire anniversary.)
Delivering this training across a period of months is preferable, so working closely with the Bureau of Meteorology to monitor weather trends is again important. SIT has been conducted in as little as 20 minutes, so is still a viable option if there is little advance knowledge of an impending climate-related event (Meichenbaum, 2017. Utilising community gathering events to deliver SIT would encourage diverse community participation and help integrate mental health preparedness into wider disaster-preparedness activities.
Whilst a prevention-focused approach is advocated in this report, it is important to recognise that this will not prevent all mental health issues from occurring and does not account for individuals with pre-existing mental health concerns. Further policy must ensure that the acute mental health needs of individuals in disaster-affected communities are met and that long-term support is available to affected individuals, including ensuring access to quality mental health services.
The risks to human health due to climate change are numerous and varied. Mental health represents an important area of health that is significantly impacted by climate-related events and disasters. Higher levels of depression, anxiety and PTSD have been reported in communities that have experienced climate-related events including bushfire, flood and cyclone, and impacts can be debilitating and costly to the individual and community (Albrecht et al., 2008; Berry, Bowen & Kjellstrom, 2010; Watts et al., 2015). It is therefore important that strategies are developed and implemented to improve individuals’ and communities’ ability to cope before, during, and after climate-related disasters. Two strategies to mitigate the negative impact of climate change on mental health have been proposed. Firstly, increasing community exposure to mental health information and resources by integrating it within currently coordinated community gatherings. Secondly, implementing psychological preparedness training to communities at risk of an acute or chronic climate-related event to improve resilience and coping.
Albrecht, G., Sartore, G. M., Connor, L., Higginbotham, N., Freeman, S., Kelly, B., ... & Pollard, G. (2007). Solastalgia: the distress caused by environmental change. Australasian psychiatry, 15(sup1),S95-S98.
Alderman, K., Turner, L. R., & Tong, S. (2013). Assessment of the health impacts of the 2011 summer floods in Brisbane. Disaster medicine and public health preparedness, 7(4), 380-386.
Basagaña, X., Sartini, C., Barrera-Gómez, J., Dadvand, P., Cunillera, J., Ostro, B., ... & Medina-Ramón, M. (2011). Heat waves and cause-specific mortality at all ages. Epidemiology, 22(6),765-772.
Bei, B., Bryant, C., Gilson, K. M., Koh, J., Gibson, P., Komiti, A., ... & Judd, F. (2013). A prospective study of the impact of floods on the mental and physical health of older adults. Aging & mental health, 17(8),992-1002.
Berry, H. L., Bowen, K., & Kjellstrom, T. (2010). Climate change and mental health: a causal pathways framework. International journal of public health, 55(2),123-132.
Clayton, S., Manning C. M., & Hodge, C. (2014). Beyond storms and drought: The psychological impacts of climate change. Washington, DC: America Psychological Association.
Change, I. P. O. C. (2007). Climate change 2007: The physical science basis. Agenda, 6(07), 333.
Kõlves, K., Kõlves, K. E., & De Leo, D. (2013). Natural disasters and suicidal behaviours: a systematic literature review. Journal of affective disorders, 146(1),1-14.
Kunde, L., Kõlves, K., Kelly, B., Reddy, P., & De Leo, D. (2017). Pathways to suicide in Australian farmers: a life chart analysis. International journal of environmental research and public health, 14(4), 352.
Meichenbaum, D. (2017). Stress Inoculation Training: A preventative and treatment approach. In The Evolution of Cognitive Behavior Therapy (pp. 117-140). Routledge.
Morrissey, S., & Reser, J. (2003). Evaluating the effectiveness of psychological preparedness advice in community cyclone preparedness materials. Australian Journal of Emergency Management, 18(2),46-61.
Nicholls, N., Butler, C. D., & Hanigan, I. (2006). Inter-annual rainfall variations and suicide in New South Wales, Australia, 1964–2001. International Journal of Biometeorology, 50(3), 139-143.
NSW Government: Department of Primary Industry. (2018). Upper Hunter Farm Family Gatherings. Retrieved from: https://www.dpi.nsw.gov.au/about-us/rural-support/RRP/upper-hunter-farm-family-gatherings
Page, L. A., Hajat, S., & Kovats, R. S. (2007). Relationship between daily suicide counts and temperature in England and Wales. The British Journal of Psychiatry, 191(2),106-112.
Sartore, G., Hoolahan, B., Tonna, A., Kelly, B., & Stain, H. (2005). Wisdom from the drought: recommendations from a consultative conference. Australian Journal of Rural Health, 13(5),315-320.
Terpstra, T. (2011). Emotions, trust and perceived risk: Affective and cognitive routes to flood preparedness behaviour. Risk Analysis, 31(10),1658-1675.
Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., ... & Cox, P. M. (2015). Health and climate change: policy responses to protect public health. The Lancet, 386(10006),1861-1914.
World Health Organization. (2002). The world health report 2002: reducing risks, promoting healthy life. World Health Organization.