Authored by Jennifer Honig, MHLAC Senior Attorney
Introduction
According to the World Economic Forum’s 2016 Global Risks Report, the failure to mitigate and adapt to climate change will be “the most impactful risk” facing communities worldwide in the coming decade—ahead even of weapons of mass destruction and water crises. Blame its cascading effects: As climate change transforms global ecosystems, it affects everything from the places we live to the water we drink to the air we breathe. – National Resource Defense Council
As climate change alters the earth, degrades our ecosystems, and propels mass migration from areas that become uninhabitable, people around the world will increasingly face mental health challenges. Likely outcomes include depression, anxiety, and post-traumatic stress disorder.
Our experience during the COVID-19 pandemic should serve as a warning for how extensive the effect of a global crisis potentially could be on mental health. The psychiatry journal, The Lancet, attributed deteriorating mental health to the pandemic, which has affected psychological well-being and compromised the delivery of mental health services. The most vulnerable populations are most severely affected: those communities that endure other hardships such as poverty; racial, ethnic and linguistic discrimination; and institutional barriers to upward mobility. These communities, already at greater risk for mental health problems, experience greater suffering in a crisis.
Treatment for such stresses, in these time and others as well, tends to focus upon the individual outside of a larger social context. This approach has serious limitations. We should pursue methods of treating mental health problems, particularly those generated by world-wide disasters, in a way that integrates people with their communities and uses local resources as a source of support. As climate change triggers pervasive societal decline, social engagement on a wide scale is necessary to preserve mental health and to sustain and repair communities.
In the face of societal crises, mental health providers continue to focus on individual problem and offer individual responses
When individuals seek help for mental health concerns, providers often view the problems as internal and offer treatments focused solely on that person, even when common external forces are clearly at play. We have seen this tendency in the services offered to people suffering from mental health problems during the COVID-19 pandemic: medication and self-help solutions.
Medication
Since the 1990s, there has been a growing tendency for general practitioners and psychiatric clinicians in the U.S. and elsewhere to treat patients’ emotional discontent with medication, notwithstanding the clear bearing of social determinants. Some providers have been even more inclined than usual to rely on prescription drugs during the COVID-19 pandemic, and for all types of disorders, including anxiety, insomnia, and depression. In the case of anti-depressants, the data suggests both that existing customers are filling more prescriptions and that there is a growing number of new users as well. Particularly worrisome is the potential exacerbation of the long-standing problem of psychotropic drug overuse by elders. These medications are fraught with problems. They have side effects, present withdrawal issues, and often don’t work, especially when used over longer periods of time.
In addition, recent guidance directed to psychiatric prescribers potentially expand the use of medication beyond what might be originally intended or even prudent. For example, the Royal College of Psychiatrists warned U.K. prescribers to closely scrutinize plans to withdraw from or switch medication because of monitoring capacity. Similarly, researchers suggested prescribers working with people with schizophrenia write prescriptions with longer durations, when it was considered safe to do so, in order to avoid risk of COVID-19 infections. While one London provider did recognize the need for ongoing oversight during the pandemic and issued a guidance advising close monitoring, longer prescription periods pose the risk that patients will not get adequate oversight, be maintained on medication they no longer need, or both.
Observers of the mental health system have challenged this medicalized response to the pandemic. Psychiatric survivor Karin Jervert describes how medicalizing suffering during the pandemic prevents collective grieving and recovery: “If there was ever a time to shed psychiatry’s influence over oneself, well, now is both a good and a horrible time to do so…. the truth is that life offers such things—pandemics, wars, economic depressions – and medicalizing such pain does nothing more than steel our language around our global grief and make the process of healing so much harder.”
Neuroscientist Peter Sterling makes a similar point, arguing that medication must be replaced with societal restructuring as we address the pandemic’s aftermath. He posits that “chronic stress and despair – caused by societal dysfunction” in the post-COVID world will result in a public health crisis. This crisis, caused by “failures of human interaction,” cannot be treated with medication but requires significant changes to the ways we work, live, and learn so that we promote sociality, equality, and opportunities for individual growth.
In other words, we must share emotional effects of societal crises and derive solace from recognizing and responding to our common experience. As Jerry Useem wrote recently in The Atlantic, lamenting the lost, but empowering concept of the nervous breakdown, “it focused the cause of distress on the outside world and its unmeetable demands. You weren’t crazy; the world was.” By contrast, Useem explains, a medical explanation atomizes one’s situation and fails to see it as part of a collective sociological response to the moment. Rejecting the concept of a society-driven nervous breakdown, we fail to seek remedies that would tackle the common problem and benefit all of us.
Self-help solutions
The recent focus in popular literature on self-help solutions as remedy for emotional distress is another example of the misplaced search within the person for relief from externally caused grief. A New York times series, entitled “How to Be Happy,” proposes these recommendations: conquering negative thinking; controlling one’s breathing; get moving; and practicing optimism. According to the author, in one’s home, one might: find a happy place; spend time in nature; declutter; do one-minute tasks, sleep and have sex. Similarly, the Mayo Clinic advises that appropriate responses to the pandemic include self-care, in the form of exercise, sleep, and relaxation techniques, and the pursuit of professional help.
Providers offer similar responses to the mental health harms caused by climate change. For example, one set of researchers writing about how to alleviate such suffering, cling to self-help cures:
Promoting positive mental health is another way to mitigate the psychological distress due to climate change. Human resilience and coping can reduce the effect of mental health stress due to climate change. Utilization of strategies like yoga can be indigenous and acceptable ways to deal with stress.
While perhaps effective, and more benign than offerings of medication, self-help solutions nonetheless reinforce the idea that suffering should be endured (and cured) alone. More importantly, these suggestions obscure the need for wide-ranging public health interventions.
Hopefully, as the necessity for a collective response to climate change becomes more urgent, provider organizations will move in a new direction. Perhaps the American Psychological Association (APA), which issued a 2014 report Beyond Storms & Droughts: The Psychological Impacts of Climate Change, will be a leader. In that report, the APA calls for “actionable ideas about what [individuals] can do to move toward solutions in their everyday lives.” The APA also recommends that people be educated as to the effects of climate change on their own local community, since “locally specific information may be useful in bridging the gap from concern to action on climate preparation and solutions.” Moreover, the APA advises that individuals consider collective action:
Individuals’ perceptions that effective collective action on climate change is possible may be even more important than their beliefs about effective individual action …Providing a forum where people can share what they are doing, and learn about what others are doing can lead to a positive feedback loop in which actions inspire other actions and support the creation of new social norms.
The APA’s proposal that individuals join with others when burdened by climate change, however, is somewhat abstract. It is unclear how the “positive feedback loop” would work and what “new social norms” should be created. Moreover, the overall recommendations are frustratingly modest. Nevertheless, it is encouraging that the APA appears to be moving from a sole focus on the individual to an exploration of the healing impact of collective response to crisis.
It is not entirely unreasonable that clinicians focus on individual responses, particularly during the pandemic. First, social interactions may be discouraged or even unavailable at this time due to fear of contagion. Further, a single clinician is unlikely to change society sufficiently in the short term to meet the needs of a distressed client. And clinicians are traditionally trained to provide certain forms of aid, such as therapy and medication. They are no more able to deliver systemic solutions to massive problems than anyone else. Nonetheless, however, while limited responses to those enduring crises may be explicable, they are not adequate. As we face challenges caused by climate change, provider organizations must lead the way to help their members tread new ground.
Climate change demands dramatic public health interventions
There can be little doubt that climate change, just as the current pandemic, will trigger widespread mental health distress and disproportionately affected the most vulnerable members of our society. And, while the pandemic hopefully will be tamed by vaccines, solutions to climate change, as we near or surpass the so called “tipping point,” may be elusive or even impossible. We face an ever-worsening catastrophe producing ever-more distressing psychological effects and far-reaching disruptions in daily life.
The worst effects of climate change, and consequent impacts on health, are yet to come. Researchers warn of myriad consequences. Rising ambient temperatures increasing rates of aggression and suicide. Mass migration, drought, and corresponding food shortages exacerbating stress disorders and depression. Traumatizing natural disasters causing trauma, as well as physical illnesses (which are secondarily associated with psychological distress). We know that some mental health disorders, such as posttraumatic stress, can even be transmitted to subsequent generations.
People already diagnosed with mental health issues face additional risks. Psychoactive prescription medications impair the body’s ability to regulate temperature, making extreme heat a particular threat. People with mental health problems are also more likely to have co-morbid conditions, including physical ailments and substance use disorders. In addition, times of crisis, the resources to treat such conditions may be scarce, causing further physical and psychological problems.
Treatment for the coming mental health crisis must not be confined to psychiatric medication and self-help efforts. We need to recognize the link between individual mental health problems and the societal inequities that will intensify with climate change. We should demand that our public health system address poverty and structural racism now, in preparation for the task at hand.
Connecting societal conditions and mental health is not a novel notion. Increasingly, policymakers recognize the impact of social determinants of health, including mental health, seeing that social and physical environments profoundly affect health, daily functioning, and quality of life. The higher the level of economic and social inequality, the greater the level of risk. Improving outcomes requires public policy that attends to mutable determinants, such as housing, food security, and transportation.
Additionally, observers have identified one’s physical environment as a social determinate. Researchers recommend transforming the built environment through water and sanitation improvements, energy infrastructure upgrades, transport infrastructure, mitigating environmental hazards, better waste management systems and improved housing. The natural environment can likewise be improved by greater access to nature and the outdoors. With climate change, it is necessary to accelerate our efforts to improve our built environments and protect our natural environments.
Proposed remedies must go further in order to promote societal connection and solutions
As individuals experience stress, trauma, and mental health troubles due to the climate crisis, the institutions with which they interact also confront strains and degradation. Our entire social fabric and infrastructure is in jeopardy. As the Co-Director of the Center for m2 Health, Josef I. Ruzek writes, “[o]ver time, global warming is likely to increase social relationship stress, substance abuse, interpersonal aggression, violent crime, and social instability, the combined effects of which are likely to decrease community cohesion and, potentially, divide the global community.”
To combat the threat that climate change poses to our collective mental well-being, one important step we can take is to protect and strengthen community groups. As researchers from Pew who studied community groups found, “The status of Americans’ social ties and the vigor of their communities” may be measured by involvement in the social arena. Their 2010 survey found that 75% of Americans are active in one kind of group or another (e.g., religious or spiritual; sport or recreative; consumer; charitable or volunteer; professional or trade; community; personal support; hobbies; political; and social).
We are healthier as individually when we join such groups. Marta Zaraska writes in her new book, Growing Young: How Friendship, Optimism and Kindness Can Help You Live to 100, that community life is singularly important to mental health and thus physical health. She says that participation in communities and collective good works can lower cortisol levels and improve health. Low cortisol, along with high testosterone, engender feelings of empowerment. (These findings are consistent with other research showing that volunteerism has profound psychological benefits.)
Thus, a healthy social network is a preventative health measure, regardless of whether the purpose is to promote individual mental health or address environmental crisis. All for the better, however, if groups turn their attention to alleviating or even preventing the cause of distress – current and impending climate change.
While social cohesion and social capital are the goals, Ruzek observes that it is not clear how to “rapidly or reliably” create it. Among his suggestions is to bring together various kinds of health, governmental and advocacy organizations to pool their expertise and create resilient communities. He writes:
it seems likely that the expanded threats associated with climate change call for new kinds of interprofessional and interdisciplinary collaboration within the context of new kinds of organizational structures and alliances. Different perspectives on the problems (e.g., climate change versus disaster response, political versus professional, economic versus mental health, social justice versus governmental responsibility) will need to be combined to reach an alignment on common goals and processes. If this can be achieved, it will bring into being many facets of a more robust public health system.
Ruzek proposes that the response must be community driven, public health-oriented and multi-faceted.
We need to think more, however, about the types of community organizations we should foster, how they will evolve and function, and how ordinary individuals will fit in. We want to support places where ordinary people might enjoy the company of others, for its own sake, and also promote social good. And we need to make it easier for people who tend to isolate to join such groups. That is one way to create resilience.
To this end, public health officials seeking to improve mental health in light of climate change should take several tacks. First, they should view existing community groups of various types as a source of mental health support and even treatment. Second, public health officials should think about removing barriers that prevent some people from joining, such as, according to the PEW researchers, time constraints, health issues, and lack of access to the internet.
Social determinants come into play here as well: people who are more highly educated and highly paid tend to be more likely to join groups. Many barriers to community involvement can be surmounted through public health initiatives that target income inequality, health care disparities, and access to education and technology. As recent bloggers in Health Affairs note, there is a growing recognition that “[r]educing health inequities requires moving upstream and address[ing] social drivers of health, such as food insecurity and transportation access.” They say that policy makers can help health care organizations focus on social drivers, such as by giving payers more flexibility in spending and encouraging payers to build capacity for “health and social care integration at the regional or state level” in order to “expand beyond an individual patient.”
Next steps for mental health activists
Will some of these community organizations do the work of social change, the real work that needs to be done on a national and international level? Yes, there are a range of such groups to work with, from social justice to faith-based organizations. There are organizations already talking about how to harness community power to address climate change.
Whether the necessary societal transformations will succeed remains to be seen. Mental health activists should urge public investment so that disenfranchised people have the resources, such as time and technological access, to participate in community organizations. They should examine what might help people feel a sense of connection to existing groups and consider what new community groups might attract engagement. And mental health activists should press community groups to do more outreach to those who have traditionally been outside their realm; the economic and racial justice efforts of environmental organizations are an example of this kind of pursuit. Further, mental health activists can urge private foundations to pledge funding to grassroots organizations.
A glimmer of progress to these ends appeared in January 2021 when the International Transformational Wellness Coalition, an organization of mental health, trauma, resilience and other professionals, released a “Mental Wellness and Resilience Policy.” In conjunction with this release, the coalition called upon the U.S. Congress to enact and fund a “Mental Wellness and Resilience Act.” The Act would prioritize initiatives that prevent mental health and psychosocial problems and, consequently, proactively build psychological, social, and spiritual resilience to climate change.
We can all participate in building community mental health by moving the needle a bit: redirecting our focus from the role of the individual to a belief in community responsibility. In the case of climate change, this is a necessary paradigm shift even apart from the issue of mental health preservation. Climate change activists now strongly propound that the only possibility of stopping global catastrophe rests not with incremental change by individuals but drastic alterations at the national and international level. Suggesting to people that they should feel comforted by their individual steps to combat climate change is deceptive and ultimately fails to help address our advancing environmental crisis.