Climate Change and Mental Health: Implications for the Psychiatric Workforce

Climate change is considered the leading existential and global public health crisis of this generation and is associated with a seemingly endless list of physical, emotional, social, financial, and ecological consequences (1). Included among these threats are climate change–associated mental health needs and resulting psychiatric service gaps. When climate change is acknowledged as a social determinant of mental health, a risk factor for mental illness associated with social inequities, providers can start to incorporate ways to address climate events into their scope of mental health care. As with other social determinants of health, climate change is a societal problem, perpetuated by both public policies and social norms, that will disproportionately affect vulnerable and marginalized communities (2). Moreover, climate change affects other social determinants of health, from economic conditions to the physical environment in which people live, contributing to unjust and avoidable differences in health status.

An emerging body of literature underscores the dire nature of the relationship between climate change and mental health (3, 4). Studies have found associations between extreme weather events and increased general distress, psychiatric symptoms, risk of suicide, and despair related to the loss of a habitable planet. Other work has described indirect links between climate change and mental health due to loss of housing, forced migration, food shortages, disruptions in daily living and community infrastructure, and threats to general medical health (3–5).

A considerably smaller sector of research has focused on the implications of climate change for the psychiatric workforce in terms of labor and resource needs, education gaps, potential training opportunities, and ways in which psychiatrists can directly be involved in helping mitigate climate change (and thus reduce associated mental health effects). This information could be vital for the development and implementation of prevention measures, interventions, adaptation efforts, and future research. On the basis of the limited existing research, this column suggests five areas, summarized in Box 1, that should concern the psychiatric workforce.

Labor and Resource Shortages

Projections of workforce labor and resource needs to help prevent and respond to mental health needs associated with climate change are invaluable for the purposes of resource planning, occupational recruitment, and educational planning. However, to our knowledge, no published research has yet specifically quantified mental health workforce labor needs (e.g., number of psychiatrists) due to climate change. On the basis of empirical evidence of worsening mental health symptoms associated with increased environmental temperature and a projected rise in average temperature, an increase in the workforce will likely be needed as climate change persists. For instance, on the basis of studies that have found increases in suicide rates and mental health–related emergency room visits associated with rising mean temperatures (6, 7), the field could expect more volatile and frequent climate events to lead to increased demand for mental health services. In addition, antipsychotics may interfere with thermoregulation, placing individuals taking these medications at higher risk of harmful health effects due to heat waves and increasing ambient temperatures (7). These projections reflect a need for the development and growth of psychiatry residencies to train clinicians in medication management and therapy for emerging climate change–associated mental health needs, both to provide anticipatory guidance to individuals and families and to address new mental health concerns.

Training and Education Gaps

Additional education and training are needed to make psychiatrists more aware of the relationship between climate change and mental health and of their potential role in mitigating poor outcomes (8, 9). Examples of specific training and education needs include curricula within residency programs to address climate change–associated mental health needs broadly; curricula to address climate change–related disasters and resulting trauma (e.g., identifying at-risk populations, helping individuals and families prepare for disasters, learning about evidence-based treatments); integration of climate change–related topics in organized educational activities within departments (e.g., grand rounds) and across the field as a whole (e.g., regional, national, and international meetings); continuing medical education programs focused on climate change–associated mental health needs; and workforce preparation, such as first-responder mental health first aid, to ensure that clinicians understand how to intervene before and during climate–related disasters and emergencies.

In addition, psychiatrists will play a key role in leading health care professionals in allied specialties, such as those in psychology, social work, and primary care, to treat individuals affected by climate change. Through team-based care and consultation services, psychiatrists will be called on to address mental health conditions related to natural disasters and other climate events and will need frameworks and formulation models for approaching treatment (10).

Interdisciplinary collaboration with other health care providers and organizations (e.g., physicians’ groups, nurses, psychologists) and other stakeholders in climate change events (e.g., first responders, climate scientists) can enhance outreach and communication efforts and extend the delivery of interventions and prevention programming. Shared dissemination of training and education opportunities across medical and social science disciplines also will help ensure the health care field as a whole is better educated about and prepared to respond to climate change–associated mental health needs.

Prevention and Intervention Needs

Widespread evidence-based intervention, prevention, and resiliency planning and implementation efforts are needed, especially those targeted at vulnerable populations. Studies have identified several at-risk groups disproportionately affected by climate change, including underserved communities, persons with preexisting psychiatric illness, children and adolescents, elderly persons, and people experiencing homelessness (3). Psychiatrists will need to lead the way in protecting these groups through proactive disaster planning, including by identifying high-risk populations, developing a detailed and coordinated plan to deploy mental health services in case of a climate change–related disaster or event, and increasing targeted outreach efforts to the community.

Public Awareness and Mental Health Advocacy

As mental health advocates and representatives, psychiatrists can increase their efforts to help individuals better understand climate change–associated mental health needs, their personal relevance, and how to access treatments and services in response. Public awareness and advocacy efforts could help accomplish multiple goals: destigmatizing the need for mental health services, increasing the odds of engaging in mental health services by making people more aware of climate change as a potential threat to mental health, and informing climate change countermeasures (i.e., community members may be motivated to engage in behaviors to reduce climate change to promote mental health). The psychiatric workforce can play an essential role in education and advocacy efforts by helping individuals and communities build resiliency, learn psychological adaptation, and improve mental health service capacity; engaging in more research on the relationship between climate change and mental health and its implications and in dissemination efforts to make sure the public learns about such research; partnering with community organizations and other health services to stage public awareness campaigns and activities designed to increase outreach and communication; educating policy makers and governments about climate change–associated mental health needs to drive legislation and increase funding to support intervention, prevention, and resiliency strategies; and engaging in media training to improve public messaging about climate change–associated mental health needs (4, 5).

Direct Actions to Reduce Climate Change

Finally, research has noted the importance of psychiatrists engaging in steps to directly curtail climate change by reducing their environmental footprint and energy consumption to help prevent and mitigate climate change–associated mental health needs. Suggestions on an administrative level include changing operational practices to reduce energy use and greenhouse gas emissions (e.g., resetting thermostats, turning off electronics when leaving the office, using LED lightbulbs); using telehealth to reduce the need for travel by air or motor vehicle (e.g., offering telehealth visits for clients; interviewing long-distance candidates for jobs, residencies, and other positions virtually rather than in-person; attending international or long-distance conferences remotely); and considering the environmental cost of interventions, such as making judicious use of office supplies and other materials (e.g., sending clinical e-mail or text reminders rather than paper communications) (8).

With the growing awareness of climate change as a global mental health crisis, the field of research on climate change and mental health is rapidly expanding. Studies to date display wide variability in the quality, scope, methodology, and definitions of climate change. On the basis of this heterogeneity, reading the literature on climate change and mental health requires critical analysis and interpretation. However, the research consistently and overwhelmingly reflects an association between climate change and adverse effects on mental health. With an expected increase in the frequency and severity of climate events, one of the challenges for psychiatry moving forward is determining the next best steps in preventing and mitigating poor mental health outcomes. The five workforce areas briefly summarized here represent starting points for the next phase of research on climate change and mental health as well as targets for addressing climate change–associated mental health needs. Many opportunities exist at the individual, organization, and systems levels for psychiatrists to address climate change–associated mental health needs, but these have not been the primary focus of climate change research as of late. The field would benefit from workforce-related research efforts to quantify psychiatric labor and resource needs to address prevention and intervention efforts; identify whether strategies designed to close gaps in education and training actually improve psychiatrists’ understanding of climate change–associated mental health needs and enhance service provision; and determine whether public health and advocacy efforts improve community understanding of climate change–associated mental health needs as well as mental health access, equity in service delivery, and, ultimately, mental health outcomes.