Climate change and psychiatry

Introduction

No longer vague, remote or credibly deniable, anthropogenic climate change is now viewed as ‘the defining issue’ for 21st century health systems by the World Health Organization (WHO). The Intergovernmental Panel on Climate Change (IPCC), an authoritative panel of 1250 experts approved by 194 governments, is emphatic: ‘warming of the climate system is unequivocal’. Australia may face disproportionate temperature increases, outpacing global warming worldwide (IPCC, 2014). Heat waves are becoming more frequent, intense and longer with increasing risks of drought and desertification. Meanwhile, many of our Pacific Island neighbours face the prospect of disappearing, Atlantis-like, under rising seas.

Australia has a poor track record in addressing climate change

Despite its particular vulnerabilities, Australia has woeful climate change credentials. The coalition government, which up until recently was headed by a self-proclaimed sceptic renowned for his 2009 declaration that climate change science was ‘crap’ (www.theguardian.com/environment/planet-oz/2014/jun/16/what-does-australian-prime-minister-tony-abbott-really-think-about-climate-change), recently abolished the independent Climate Commission and jettisoned a carbon tax. Australia performs ignominiously on the Climate Change Performance Index 2015, a league table of 58 nations responsible for 90% of global emissions. Here, Australia languishes, in second-to-last place between Kazakhstan and Saudi Arabia, at the bottom of the ‘very poor’ group; New Zealand does marginally better in 43rd position.

The predicted mental health effects are significant

It behoves mental health professionals to be informed on climate change; current models anticipate both direct and indirect impacts on mental health (Berry et al., 2010). Extreme weather events (floods, droughts, heat waves, wildfires and storms) increase the prevalence of acute traumatic stress, post-traumatic stress disorder (PTSD), depression, anxiety, substance use disorders and stress-related relationship difficulties. Indirect effects will arise primarily from damage to land, infrastructure and community functioning, leading to climate-related migration, armed conflict and other violence.

While the full extent of indirect effects is speculative, growing evidence supports the direct impact of extreme weather events, temperature rises and drought on mental health (Berry et al., 2010). The relationship between severe anxiety disorders (such as PTSD) and weather-related disasters, including floods, forest fires, heat waves and cyclones, is clearly established, while high temperatures have been linked to suicide, psychiatric and other hospital admissions. For example, in a large Australian epidemiological study, average monthly temperature increases were associated with a significant (p = 0.001) rise in suicide rate (Qi et al., 2015).

By increasing the incidence of mental disorders, climate change will amplify demands on already stretched services (Berry et al., 2010). The risks of climate change are also anticipated to be ‘unevenly distributed and are generally greater for disadvantaged peoples and communities in countries at all levels of development’ (IPCC, 2014), putting those with mental illness at greater risk and disproportionately affecting indigenous populations.

The role of medicine and psychiatry

The medical profession has an inconsistent but often proud history of advocacy against threats to humanity. In the 1980s, the International Physicians for the Prevention of Nuclear War (IPPNW) attracted 250,000 members from 80 countries, made medical and scientific facts about nuclear war widely accessible and advocated effectively for an end to the Cold War. In the words of former New Zealand Prime Minister David Lange, ‘IPPNW made medical reality a part of political reality’; for this the organisation received the Nobel Peace Prize in 1985.

Psychiatrist Eric Chivian, a co-founder of IPPNW, advocates for similar action on climate change, arguing that medical professionals have the responsibility to provide clear and compelling examples of the health consequences of climate disruption. The WHO and prominent medical journals, including Lancet, BMJ and PLoS Medicine, have reiterated this message.

In 2014, the WHO held its first dedicated conference on climate change and health, concluding ‘climate change will be the defining issue for health systems in the 21st century. Health professionals have the knowledge, cultural authority and responsibility to protect health from climate change’.

While several medical disciplines have been active in this regard, psychiatry is poorly represented. Locally, the silence is striking. Despite Australia’s particular climate susceptibility and leadership role in the vulnerable Pacific region, the profession as a collective, including the Royal Australian and New Zealand College of Psychiatrists (RANZCP), has been largely silent on the issue.

We have repeatedly encountered the view from psychiatrists that climate change is important, but ‘not really our business’. We do not accept this. While it is true that psychiatrists are more accustomed to dealing with individuals than the bigger picture (Maughan and Davison, 2015), it is also our professional (and ethical) responsibility to address the environmental, social and economic determinants of mental illness. Acknowledging the widely recognised CanMEDS physician competency framework, we propose four ways in which Australasian psychiatry can join the growing number of medical entities identifying climate change as a mainstream health priority. The ‘CARM’ approach is useful: collaborate, advocate, research and mitigate.

Collaborate

Psychiatrists, like other doctors, have an important role to play in raising awareness of health risks from climate change and the plural health benefits of climate action. We must work with policymakers, community organisations and other stakeholders to drive change, collaboratively formulating and disseminating appropriate messages. We recommend joining a multidisciplinary health organisation established to achieve these objectives such as Doctors for the Environment Australia (http://dea.org.au/) and OraTaiao: New Zealand Climate & Health Council (www.orataiao.org.nz/).

Advocate

In addition to informing governments, policymakers, industry, the public and our colleagues about climate change–related mental health risks, we must advocate for the most vulnerable, particularly those with serious mental illness: climate change will exacerbate existing health inequalities making life even harsher for those already marginalised (IPCC, 2014; McMichael et al., 2008). A position statement from the RANZCP in this regard would be appropriate and useful.

Research (and educate)

Better evidence from further research into mental health and climate change is needed to develop effective health promotion, define appropriate remediation strategies for climate change–associated psychiatric morbidity and inform both undergraduate and post-graduate medical education. As a profession, we must promote both research and education in this area.

Mitigate

While the negative effects of climate change are inevitably emphasised, addressing climate change also offers significant opportunities. The likelihood of increased extreme weather events requires communities to develop resilience; building such social capital can benefit mental health. Services can adapt to a low-carbon economy by emphasising green prescriptions, psychological therapies, waste reduction and low-carbon technologies.

A recent Lancet paper on sustainable psychiatry (Maughan and Davison, 2015) argues that mental health clinicians need to be mindful of reducing the carbon footprints of our institutions, practices and other activities. The UK Academy of Medical Colleges has published a useful online resource (see www.aomrc.org.uk/dmdocuments/Promoting%20value%20FINAL.pdf) which outlines strategies for reducing waste in clinical care: avoiding unnecessary tests, minimising non-attendance, promoting early intervention and integrating models of care. In the same vein, the British Royal College of Psychiatrists has appointed a sustainability fellow and committed to reducing carbon consumption, a precedent worthy of emulation in Australasia.

Conclusion

Climate change will harm mental health, most significantly among disadvantaged individuals (including those with pre-existing mental illness) and communities. Psychiatrists, both individually and collectively, have important roles to play in addressing climate change. As a major threat to population mental health, climate change most certainly is our business.