Climate-vulnerable populations are suffering a mental health crisis

Last year saw one of the worst pandemics in modern times, it was also the warmest year on record with horrifying wildfires in the US and Australia. Now in 2021, we are battling with even more resistant and contagious variants of the COVID-19, worsening monsoon floods in Southeast Asia, and earthquakes in Central Africa. The threats of climate change cannot be denied, including the impact on mental health outcomes.

Mental illnesses, such as depressive and anxiety disorders, are among the 25 leading drivers of global burden of diseases. More broadly, mental health includes mental wellness, emotional resilience and psychosocial wellbeing – all of which are impacted by climate change, particularly among vulnerable communities in natural-disaster prone environments, and in low- and middle-income countries (LMICs).

Extreme weather occurrences such as natural disasters have long-lasting effects on mental health outcomes through exposure to trauma, leading to post-traumatic stress disorders, major depressive disorders, anxiety, depression and self-harm. For instance, an estimated 31.2% of survivors of the 2005 Hurricane Katrina experienced anxiety-mood disorders following the disaster. Meanwhile, in natural disaster-prone Bangladesh, among the 2019 monsoon flood survivors, a staggering 57.5% had suicidal ideation, and 2% had attempted suicide.

Incremental changes in climate, such as rising temperatures and pollution rates, also contribute to poorer mental health outcomes. An increased exposure to 10 micrograms per m³ of air pollution particles for one year or more will likely increase the risk of depression by 10%. It does not come as a shock that with all 15 of the world’s most polluted cities located in LMICs, the negative effects on mental health are gravely exacerbated amongst LMIC populations.

Recognizing the urgency of these issues, the World Health Organization (WHO) made great strides in its Comprehensive Mental Health Action Plan 2013-2020, signalling the first formal recognition of mental health issues globally. Mental health, previously at the periphery of broader health initiatives, is becoming a central element in the global health discourse with greater availability of effective, multi-sectoral, and research-informed identification of the challenges, and the corresponding responses.

Similarly, the 2016 Paris Agreement was seminal in its global commitment to address climate change issues. These led to greater resources and innovation in the lead up to the most ambitious global action plan, i.e., the UN Sustainable Development Goals (SDGs) which drew a stronger relationship between mental health and climate change strategies for countries to adapt and implement.

Nonetheless, the relatively slow progress on mental health and climate change emergency response mechanisms research remains concerning. Between 2007 and 2016, only 208 English language peer reviewed publications focused on climate change and mental health. Most research stops short of connecting extreme weather occurrences to climate change, but instead, treats them as isolated cases. This underplays the micro-level impact of anthropogenic climate change leading to evidence of aggregated multisectoral global risks.

Since acting on climate change requires a trade-off between short-term and long-term benefits, authorities face difficult policy trade-offs given the non-linear correlation between climate change and its observed risks. The lack of resources for better informed decision-making, and the slow push for more research on a clearer connection between mental health and climate change delays the shift from reactive emergency responses to proactive mitigation planning for climate emergencies. Beyond the impact of limited climate strategy on infrastructure and disaster recovery, this prevents the effective management of long-term mental health effects of climate change, particularly in LMICs.

Given the complexity of the climate change and mental health intersectionality, it is necessary to integrate mental health outcomes in national climate change agendas. This requires a systems-thinking approach, which incorporates insights from multiple disciplines, and includes the big picture interaction with micro-factors to identify far-reaching local policy solutions. Understanding the system decodes the complexity of the relationship between climate change and mental health, and allows for learning from existing policies.

High-income countries, such as the US and Japan, have incorporated mental health elements in their emergency responses. These include short-term psychiatric team deployment to disaster sites, nutrition advisories, and tech-accessible help centres during the aftermath of Hurricane Katrina in 2005, and the Great East Japan Earthquake in 2011. These countries can leverage their experiences in emergency responses and crisis preparedness to lead efforts towards an integrated global public system which includes universal opt-in disaster insurance, and peace-time resource and infrastructure preparation for risk mitigation.

Higher commitment by such countries extending beyond regional settings would provide better support for LMICs. While there is increasing spotlight on the climate change mental health correlation, most LMICs are still nascent in developing sustainable climate peace-time plans. Deeper climate change and mental health research intersectionality will better equip policymakers with a systems understanding to implement effective adaptive pathways in local, national, and global communities.

Guided by the WHO’s framework for climate resilient health systems, it is an opportune time for LMICs to overcome the societal stigma by attributing mental health outcomes as part of larger national health and climate policies. Adaptive capacity can be enhanced for stronger monitoring of disease burdens related to climate change and mental health, and for need-specific capacity building – including training community workers and self-help groups (which have been crucial in health intervention deliveries in South Asia and Sub-Saharan Africa) in psychological first-aid skills to reach the most inaccessible and vulnerable communities.

The effect of climate change on mental health will be protracted for years to come. To overcome these challenges, it is crucial that we improve the integration of mental health outcomes in LMICs’ national climate agendas, act as global stewards for equitable allocation of resources, and be drivers of climate change mental health research. Every stakeholder must have a skin in the game to ensure equitable and sustainable outcomes.