Knowing Neurons
Science PolicyMental HealthNeuropolicy Paper Competition 2023

Mental Health: The Forgotten Casualty of Climate Change Policy

Op-Ed by Elissavet Chartampila

Climate change presents a formidable and urgent threat to human health. From the loss of life and illness caused by more frequent and severe extreme weather events, to the increase in vector- and animal-borne diseases, the climate crisis has significantly escalated pressures on our healthcare systems (World Health Organization, n.d.). This crisis coincides with the potential closure of 30% of rural hospitals in the US, threatening the availability of access to healthcare and exacerbating existing disparities (CHQPR, 2023). These closures are also likely to disproportionately burden underserved and vulnerable populations, compounding the adverse health effects of climate change (CHQPR, 2023; US EPA, 2021).

Further complicating the issue, the US healthcare sector contributes significantly to greenhouse gas emissions, accounting for 8.5% of the country’s total output. Notably, this constitutes 25% of global healthcare emissions – the largest contribution by a single nation. These emissions arise primarily from day-to-day operations within healthcare facilities and the supply chain involved in delivering healthcare goods and services (Dzau et al., 2021). Emissions from the US healthcare sector have been steadily rising. The growth rate from 2010 to 2018 was at 6% – the highest among industrialized nations (Dzau et al., 2021; Eckelman et al., 2020).

In the face of the escalating climate crisis, the Green New Deal for Health emerges as a powerful piece of legislation aiming to protect our workers, communities, and planet (Green New Deal for Health, 2023). This comprehensive proposal demonstrates a commitment to mitigating the physical health risks associated with climate change, along with promoting equitable access to healthcare and the environmental sustainability of our health systems. However, it overlooks a critical piece of the puzzle – the impact of climate change on mental health.

Here, I will delve into the intricate relationship between climate change and mental health, highlight the shortcomings of this legislation and propose recommendations for a more inclusive and effective approach to mitigating the health risks posed by climate change.

The Green New Deal for Health

The Green New Deal for Health, an extension of The Green New Deal, was introduced in April 2023 by Senator Ed Markey of Massachusetts and Representative Ro Khanna of California. The bill was referred to the Committee on Energy and Commerce, and the Committee on Ways and Means, and Science, Space, and Technology (US Congress, 2023). These committees now hold the responsibility of reviewing and editing the bill. The following policy recommendations are directed to Congress members in those committees, since they have the power to amend the bill before it proceeds through Congress. They are also intended for all members of Congress who will be called to vote on the bill.

If passed, the bill would:

  • Allocate $100 billion in federal grants to public and nonprofit medical facilities seeking to reduce their emissions and enhance their climate resilience.
  • Establish a task force to design policies and guidelines for the mandatory public disclosure of emissions and the overall climate impact of FDA-approved drugs and devices.
  • Allocate $9 billion in federal grants to healthcare providers to safeguard essential healthcare workers during public health emergencies and to train and educate them on how to manage the health risks associated with climate change.
  • Allocate $500 million to empowering resilient community mental health and preventing heat risk.
  • Allocate $50 billion over ten years for research and innovation at the intersection of climate change and health.

Policy Recommendations 

The consequences of climate change extend far beyond physical health and ecological disruption. By impeding access to healthcare resources, destabilizing social and economic structures, and jeopardizing the natural environments people rely on, climate change and natural disasters can dramatically impact our mental health and well-being (Liu et al., 2020). Further research is undoubtedly required to elucidate this complex relationship. Nevertheless, it is clear that mental health – and not only physical health – should be a priority in climate policy.

“…mental health – and not only physical health – should be a priority in climate policy.”

In the US, the Green New Deal and associated bills represent the most comprehensive legislation on climate change proposed to date. Our policy recommendations build on this promising proposal by providing strategies to better integrate mental health into climate resilience efforts.

  1. Uninterrupted Access to Mental Health Services
    Under Title II, legislators proposed necessary actions for the protection of continued access to healthcare services in the face of climate-related challenges. This includes funding for community health centers and stringent measures for maintaining healthcare access in the event of hospital closure or discontinuation of services. However, Title II includes no measures that ensure access to mental health services remains uninterrupted.On the other hand, Title VI allocates $500 million to grant programs for building community wellness and resilience programs. Eligible programs must take a public health approach to mental health, aiming to strengthen the community’s psychological and emotional wellness and resilience by assessing and addressing community risk, strengthening protective factors, and/or building awareness. While this is a valuable contribution to preserving mental health services, it is not sufficient.These grant programs are likely to benefit privileged communities that have the means to learn about and apply for them. As a result, rural, immigrant, tribal, and low-income communities may be overlooked without the enforcement of systemic changes. These communities are already disproportionately affected by both the impacts of climate change and mental health disparities (US EPA, 2021). Thus, neglecting to account for the barriers in their access to mental health services would exacerbate existing inequities.

    “…neglecting to account for the barriers in their access to mental health services would exacerbate existing inequities.”

    To ensure uninterrupted access to mental health services in the face of climate-related disruptions, climate policy should prioritize improvements in mental health care capacity and the removal of barriers to access and cost. This could include expanding mental health infrastructure, increasing the availability of mental health professionals, and integrating mental health services into primary care settings. Additionally, efforts should be made to destigmatize mental health, raise awareness about available resources, and provide culturally sensitive and linguistically appropriate care for marginalized communities.Furthermore, it is essential to address the unique challenges faced by individuals with mental illnesses during climate-related events. This may involve developing emergency response plans that consider their specific needs, establishing support networks, and ensuring the availability of crisis helplines or telemedicine services.
  2. Mental Health of Healthcare Workers
    Title V establishes grant programs for safeguarding healthcare workers during public health emergencies. While provisions are made for monetary compensation and protection from hazards that threaten physical health (e.g., by providing alternative transit options, personal protective equipment, or other safety measures), little is explicitly mentioned about addressing mental health concerns. However, it is crucial to recognize that during public health emergencies, such as pandemics and natural disasters, healthcare workers are exposed to stressful conditions, putting them at an increased risk of experiencing mental health problems (Palmer et al., 2022).The profound psychological burden of such events is exemplified by the COVID-19 pandemic, during which healthcare workers experienced increased rates of burnout, anxiety, depression, and PTSD (Azoulay et al., 2020; Greenberg, 2020; Johnson et al., 2020; Spoorthy et al., 2020). They were required to work unbearably long hours in high-stress environments. They may have also been exposed to trauma or faced ethical dilemmas and challenges during the delivery of care. These challenges were often the result of staffing shortages and the lack of training or equipment. According to estimates, 23%-46% of healthcare workers experienced symptoms of anxiety (World Health Organization, 2022).With changing temperatures and precipitation patterns, we will experience more frequent and intense natural disasters (IPCC et al., 2021). The resulting shifts in habitats and migration patterns will also lead to the rise of vector- and animal-borne diseases (Rocklöv & Dubrow, 2020). Collectively, these changes will increase pressures on our healthcare system. Thus, it is imperative that we take the necessary measures to promptly identify and appropriately support those within the healthcare system who experience psychological injuries (Tracy et al., 2020).Two key risk factors that strongly predict long-term mental health outcomes for healthcare workers exposed to trauma are: the absence of post-trauma social support and the experience of stressors during the recovery phase (Greenberg, 2020). Thus, to support the mental health of healthcare workers, it is crucial to provide comprehensive support systems that address both immediate and long-term needs. This can include implementing comprehensive mental health support programs, ensuring access to mental health services, providing resources for post-trauma social support, and establishing mechanisms for debriefing and counseling. By addressing the mental health needs of healthcare workers, we can help maintain a resilient healthcare workforce that can sustainably and effectively respond to climate-related emergencies
  3. Classification of Disproportionate Vulnerability
    The Green New Deal for Health refers to “disproportionately vulnerable populations” in several sections. For example, under Title V, funds for the education and training of healthcare professionals must be used to identify health risks and mitigation strategies specifically as they relate to “individuals disproportionately affected by climate change.” This is one of many examples where this classification of vulnerability would determine the strategy for identifying and mitigating climate-related risks and the allocation of funds for research, training, and education. Disproportionately vulnerable populations, as defined in the bill, do not include individuals with mental illnesses, despite growing evidence demonstrating their unique vulnerability to the impacts of climate change.For example, individuals with mental illnesses often struggle with building coping mechanisms and developing resilience in the face of challenges. Thus, climate change-induced events, such as extreme weather events, natural disasters, and the resulting disruptions to their routines and support systems can have a significant impact on their mental well-being. The increased stress, anxiety, and trauma resulting from these events can worsen symptoms and increase the risk of relapse. Barriers to adaptation also include the limited or disrupted access to mental health services during and after climate-related emergencies, which can further exacerbate their distress.

    “…climate change-induced events…and the resulting disruptions to [individuals with mental illnesses] routines and support systems can have a significant impact on their mental well-being.”

    At the same time, individuals with mental illnesses are at greater physical risk during climate-related disasters. A study published earlier this year revealed that individuals with schizophrenia were more likely to die during extreme heat events compared to individuals with other chronic conditions traditionally associated with heat susceptibility (e.g. heart disease and kidney disease; Lee et al., 2023). The exact mechanism underlying this effect is unknown. However, mental illness is associated with many risk factors for heat-related mortality, such as social isolation, economic marginalization, and substance use (Alegria et al., 2018; Henderson et al., 2022; Lõhmus et al., 2018; Liu et al., 2021). Cognitive impairments, difficulties processing information, or anosognosia may also interfere with proper understanding of and response to evacuation orders or other emergency measures (Liu et al., 2021).Given the broad influence of climate change on physical, social, and economic systems, which are key determinants of psychological well-being, it is essential to include individuals with mental illnesses in the definition of disproportionately vulnerable populations. This recognition can help shape policies and interventions that address their specific needs, ensuring that mental health support and resources are readily available and accessible during and after climate-related events.

Conclusion

The convergence of the climate and mental health crises poses a significant challenge that cannot be ignored. While the Green New Deal for Health is a promising step toward addressing the physical health risks associated with climate change, it falls short of adequately considering mental health. The policy recommendations outlined above aim to better integrate mental health into climate policy.

One may argue that with limited resources come competing priorities. In other words, implementation of these recommendations might divert resources away from more pressing challenges and slow down progress. However, it is important to recognize that mental health and climate change are interconnected challenges that require a unified solution. It is also crucial to acknowledge that these issues are not isolated in their complexity. Income inequality, racism, and other societal challenges play significant roles in exacerbating both the mental health and climate crises. Neglecting mental health (and other interconnected challenges) in climate policy would perpetuate existing disparities and hinder the resilience of communities and healthcare services in the face of climate-related disruptions. In the long term, recognizing mental health as a casualty of climate change and prioritizing its inclusion in climate policy discussions, legislation, and resource allocation will foster our adaptive capacity and facilitate other response and recovery efforts. Ultimately, it will allow us to develop more effective and equitable solutions to the climate crisis.

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Written by Elissavet Chartampila
Edited by Honoreé Brewton and Lauren Wagner

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References

Alegría, M., NeMoyer, A., Falgàs Bagué, I., Wang, Y., & Alvarez, K. (2018). Social Determinants of Mental Health: Where We Are and Where We Need to Go. Current Psychiatry Reports, 20(11), 95. https://doi.org/10.1007/s11920-018-0969-9

Azoulay, E., De Waele, J., Ferrer, R., Staudinger, T., Borkowska, M., Povoa, P., Iliopoulou, K., Artigas, A., Schaller, S. J., Hari, M. S., Pellegrini, M., Darmon, M., Kesecioglu, J., Cecconi, M., & ESICM. (2020). Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak. Annals of Intensive Care, 10(1), 110. https://doi.org/10.1186/s13613-020-00722-3

Center for Healthcare Quality & Payment Reform. (2023). Rural Hospitals at Risk of Closing. https://chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf

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Author

  • Elissavet Chartampila

    Liza Chartampila is a second-year PhD student in the Neuroscience program at the University of North Carolina at Chapel Hill. Her current research focuses on understanding the role of sleep in development and neurodevelopmental disorders like autism and schizophrenia. Before beginning her doctoral studies at UNC, Liza completed her B.S. in neuroscience at Washington and Lee University and worked as a research assistant at New York University. Outside of research, she enjoys painting, hiking, reading, listening to podcasts, and playing sports (especially volleyball).

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Elissavet Chartampila

Liza Chartampila is a second-year PhD student in the Neuroscience program at the University of North Carolina at Chapel Hill. Her current research focuses on understanding the role of sleep in development and neurodevelopmental disorders like autism and schizophrenia. Before beginning her doctoral studies at UNC, Liza completed her B.S. in neuroscience at Washington and Lee University and worked as a research assistant at New York University. Outside of research, she enjoys painting, hiking, reading, listening to podcasts, and playing sports (especially volleyball).