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Draft Chapter on the  Impact of Climate Change on  Mental Health and Psychosocial Well-Being: Guidelines for Action

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Chapter Working Paper Draft , May 10^th 2008 Version

TITLE: NGO Working Group on the Impact of Climate Change on Mental Health and Psychosocial Well-Being: Guidelines for Action

Description of the Issue

Purpose. The purpose of this working group is to review current scientific and empirical evidence on the psychosocial and mental health impact of climate change, and to recommend specific actions that can be implemented by UN agencies, governments, and civil society at large.

Background. The prevalence of disasters and adverse weather conditions is increasing worldwide due to climate change, with particularly devastating effects on developing countries. Growing scientific evidence shows that such changes and events can have severe and long-lasting effects on mental health and psychosocial well-being, which can impact quality of life, economic recovery, and social development of families and communities for years to come. Mental health and psychosocial problems often result in chronic impairment and can increase the risk for substance abuse, interpersonal problems, suicide, vocational difficulties, long-term physiological changes, crises of faith and subsequent physical health problems. Children are especially vulnerable, since disaster can disrupt critical stages of their psychosocial and physical development. They are at risk for serious problems ranging from school maladjustment and drug abuse to exploitation and human trafficking. In addition, individuals with pre-existing psychological problems, prior trauma or poor resources are more likely to show severe and persistent stress reactions after adverse events and are less likely to recover socioeconomically. On the other hand, individuals and communities can often show resilience in the face of crises. It is crucial to build on such existing strengths in order to improve psychosocial well-being and to empower communities. There has been an increasing awareness that mental health and psychosocial factors should be included when addressing the adverse effects of climate change, and that special attention should be paid to developing countries and to vulnerable individuals. By fostering dialogue among UN agencies, NGOs, governments, universities and civil society at large, which addresses psychosocial and mental heath issues, and by implementing concrete action priorities, we can reduce suffering and protect the well-being of communities worldwide.

Draft Chapter Text

1) Introduction

There is scientific consensus that climate change will lead to wide ranging changes in weather patterns, causing increased temperatures, rising ocean levels, changes in climatic zones and ecosystems, air pollution and more weather fluctuations (1). It is also projected that the incidence of climate-related events such as storms, droughts, floods and wild fires will continue to increase globally, with particularly devastating effects on developing countries (1).

 Growing evidence suggests that environmental changes and natural disasters can have severe and long-lasting effects on mental health and psychosocial well-being. The World Health Organization (WHO) defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”, asserting that mental health is the “foundation for well-being and effective functioning” (2). However, the prevalence of mental health problems is already a global concern. Depression for example, was the 4th leading contributor to the global burden of disease (DALYs) in 2000 and is projected to reach 2nd place in 2020 (2). Climate change is likely to impact mental health and psychosocial well-being via multiple pathways (see Figure 1), thereby increasing the global burden of mental illness and psychosocial problems.

2) Effects of Climate Change on Mental Health and Psychosocial Well-Being

Climate scientists project that the impact of climate change on human health will be mostly negative (3). So far, research and projections of the impact of climate change have focused on physical health conditions such as infectious diseases (3). However, environmental changes and disasters can impact mental health and psychosocial well-being both directly and indirectly.

2.1.) Direct Effects of Weather and Climate Change

 Although most changes related to climate change on mental health may be indirect, weather and climate may also exert direct effects. It has been recently pointed out that interactions between ozone depletion and global warming may not only be related to an increase of various diseases such as skin cancer, and suppressed immunity but that such changes may also lead to altered general well-being, disrupted sleep wake cycles, mood problems and seasonal affective disorder (4). Furthermore, both laboratory and field research has found associations between higher temperatures and increased violence and aggression (5).

2.2.) Social and Economic Stressors

While we can continue to measure the direct consequences of climate change such as rising sea levels and changing temperatures, the indirect social and economic impact may be far reaching but more difficult to foresee or quantify (3). Effects of climate change including weather-related events are likely to set into motion a cascading sequence of inter-related social and economic stressors (see Figure 1). Such stressors in turn, may have a profound and lasting impact on mental health and psychosocial well-being.

Economic Losses. Rising temperatures, coastal flooding, and variable precipitation patterns are projected to significantly reduce agricultural land and water resources, resulting in significant economic losses, especially in developing countries (1). One alarming example of how rising agricultural losses can impact mental health has been the high rate of farmer suicides in some Indian states (6). Repeated crop failures, rising costs of cultivation, lower profits, increasing debt, and the absence of social support infrastructure are thought to have contributed to the suicide of close to 150,000 Indian farmers from 1997 to 2005 (ZNET India, 2005).

Food and Nutrition. Reduced agricultural production is projected to have the highest impact in many developing regions, where food security is already a problem (4). More variable rainfall patterns leading to both flooding and droughts are also likely to compromise the supply of drinking water (3). Globally, water scarcity already affects four out of every 10 people. Food insecurity and water scarcity are likely to increase the risk of malnutrition, diarrhea, and various other illnesses as well as of violence and conflict, resulting in suffering and distress in the affected population.

Displacement. Rising sea levels and coastal flooding as well as other adverse environmental conditions such as droughts or disasters may cause further large scale population displacement. More than half of the world's population now lives within 60 kilometers of shorelines. As of 1995, at least 25 million had already fled their homes for environmental and climate reasons and this number is projected to double by 2010 (7). The Red Cross estimates that more people are now displaced by environmental disasters than by war. Internally and externally displaced individuals often loose ties with their extended families, their social networks, and their community and culture (5). Furthermore, population displacement can increase tensions and the risks of conflict in host communities (4, 7). Psychological distress, social isolation, and depression are likely to result. Indeed, various studies have reported an increased prevalence of domestic violence, suicide, substance abuse and depression among people in refugee camps (5) (8).

Violence and Conflict. An increase in violence and conflict has now been recognized as another potential adverse outcome of climate change, caused by scarcity of resources, crop failures, economic losses and population displacement. Conflict may especially manifest in regions that are already struggling with pre-existing unrest, poverty, unequal access to resources, weak institutions, food insecurity and poor health (9). Indeed, recent research suggests that a drought one year increases the risk that an African country will slip into civil war the next year by 50 percent (9). Violence and conflict are known to have devastating and profound mental health consequences that can impact communities for generations (5).

Infrastructure and Institutions. Infrastructure and institutions are often damaged or non-functional for extended periods of time after extreme weather events such as storms. Two years after hurricane Katrina for example, only a third of child care centers and public schools were open in some New Orleans parishes and a major mental health hospital had not been replaced (10). Access to healthcare, including mental health is often compromised. Major shortages of psychiatrists, psychiatric nurses, psychologists and social workers already exist in many communities. Low-income countries have 0.05 psychiatrists and 0.16 psychiatric nurses per 100,000 people, compared to 200 times more in high-income countries (2). With damaged infrastructure and insufficient access to education, healthcare, and other institutions, individuals may be reluctant to return to their homes, prolonging problems of displacement, community fragmentation, and uncertainty.

The multiple social and economic stressors discussed above, are likely to cause and reinforce one another, possibly leading to cumulative effects on mental health and well-being. Extreme weather events for example, result in multiple and enduring stressors. Disasters involve trauma from the initial event, subsequent uncertainty and anxiety, separation from loved ones, loss of income and property, disruption of routines, displacement, relocation, and rebuilding (11, 12). Such acute and chronic stressors can continue to affect the mental health and well being of communities for years to come.

3) Effects on Human Health

Physical Health. Based on assessments by the Intergovernmental Panel on Climate Change (IPCC), “rapid climate change poses substantial risks to human health, particularly among the poorest populations” (4). Indeed, a WHO quantitative assessment, taking into account only a subset of the possible health impacts, concluded that the effects of the climate change that have occurred since the mid-1970s may have caused over 150,000 deaths by the year 2000. These impacts are likely to increase in the future (4). Climate extremes such as heat waves and cold spells have been linked to excess mortality and morbidity, especially affecting those with pre-existing cardiovascular and respiratory conditions, and the very young and the elderly (4). During the heat wave of 2003 in Europe for example, 70,000 excess deaths were recorded (3). With climate change, transmission seasons of vector borne diseases are projected to increase, along with expanding geographic ranges (3). Both floods and droughts can lead to contaminated water supplies, which in turn increases the prevalence of diarrhea and other illnesses (4). Changes in seasonal patterns of air-borne particles, such as plant pollen, can trigger asthma, which is projected to increase by 20% in the next 10 years (4).

Natural disasters have both acute and chronic effects on health, leading to excess deaths, injuries, and infectious diseases (3). Disasters have also been associated with higher incidences of various medical conditions (13, 14), increased somatic complaints (15)# and high medical service utilization during the years after the event (16). Mental health problems and psychological distress may play a role in such chronic health effects. Studies suggest for example, that PTSD and psychological problems are risk factors for medical illness (17) and related to higher medical services utilization (18, 19). Health problems associated with PTSD include reproductive, metabolical and immunological problems such as type II diabetes, delayed wound-healing, increased disease susceptibility (20).

Mental Health. There currently is little research investigating the effects of gradual environmental changes on mental health. However, it is likely that such changes will pose new challenges. Recently, the term “solastalgia” was coined to describe the psychological distress caused by environmental change and degradation (21). This type of distress is characterized by negative feelings, powerlessness and lack of control, and has been studied among people affected by persistent drought and coal mining in rural Australia (21). With the advent of climate change, we may be confronted with an increased prevalence of such ‘psyco-terratic illnesses’ which result from compromising the healthy link between people and their home territory (21) (5).

Research has documented pervasive mental health and psychosocial problems following disaster, including increased risk for substance abuse, interpersonal problems, suicide, vocational difficulties, long-term physiological changes, and subsequent physical health problems. Research suggests that more than one third of adult (22, 23) and child (24, 25) disaster victims suffer from post-traumatic stress disorder (PTSD). Individuals can also experience from chronic anxiety and depression, while children often display long-term behavioral problems (26)#.

4.) Populations at the Highest Risk

Developing and Low-Resource Countries. It has been noted that developing countries, which contribute relatively little to greenhouse gases and global warming, are likely to bear the greatest burden of climate change (1). Environmental events in developing countries result in higher death rates and destruction than similar disasters in developed nations (27). Of about 600,000 deaths that occurred worldwide as a result of weather-related natural disasters in the 1990s, about 95% occurred in developing countries (4). The lack of adequate resources, increased structural vulnerability (e.g., less stable building structures and poor infrastructure), socio-economic and political conditions, differences in risk perception, inadequate disaster preparedness and response, agrarian practices (e.g. deforestation) as well as population density in areas at risk, likely contribute to this inequality (28, 29). The adverse effects of climate change may limit or even reverse improvements that have been made in developing countries (4). Not surprisingly, the prevalence of acute and chronic psychological impairment following disaster may be higher in developing countries (30). However, adequate mechanisms for assessment, culturally informed treatment and follow-up regarding mental health problems in such countries is often lacking (29).

Women. Women may be especially affected by climate change including environmental events (31). Indeed, natural disasters for example, have been shown to result in increased domestic violence against, and post-traumatic stress disorders in women (32). Furthermore, culturally demanded dress codes can increase their risk of being unable to flee from a disaster area or being caught by debris, such as with women wearing sari’s in the South East Asian tsunami (33).

Children. Children may be uniquely vulnerable to the impact of climate change since environmental stressors and disaster can disrupt critical stages of their mental, social and physical development (34, 35). Orphaned or separated children can be at increased risk for living on the streets, human trafficking, being exploited, or joining armed groups (29)#. Children as young as five years old are cognitively capable of understanding the effects of disaster (36). Research suggests that children are more severely impacted by adverse environmental events than adults (30) and may suffer mental health problems (25), impaired functioning in family, school, and social environments, stress-related illness as well as developmental problems (34, 37, 38). It is noteworthy that chronic PTSD in children has been associated with increased risk for suicide, substance abuse, aggressive and violent behaviors, interpersonal problems, vocational difficulties, long-term changes in brain structure and function, and health problems later in life (39)#. About 90% of the disease burden of malaria, diarrhea and undernutrition are borne by children under 5, mostly in developing countries (8). About 20% of the world's children and adolescents are estimated to have mental disorders or problems (2) and effects of climate change are likely to increase those numbers.

Ethnic Minority and Indigenous Groups. Evidence also suggests that both adults and children from ethnic minority groups are more likely to experience increased stress due to relocation, slower recovery and more severe PTSD symptoms following disasters (34, 40-42). Hurricane Katrina, for example, especially affected people with lower SES and African Americans. Such disparities may be exacerbated by pre-existing inequities, cultural insensitivities of relief workers and organizations and by inadequate provision of aid or other resources (42)#. Indigenous people who often depend on their physical environment for their livelihoods may loose their traditional ways of life (8). Forced displacement and urbanization may result in loss of community cohesion and culture as well as in increased mental health problems (8).

5) Vulnerability and Adaptation

There are several factors that increase vulnerability to mental health problems related to environmental changes and events, as well as factors that are related to resilience and adaptation.

Pre-Existing Factors. Individuals with pre-existing mental health or substance abuse problems, prior trauma or poor social resources are more likely to show severe and persistent stress reactions after an environmental event and are less likely to recover socioeconomically (30). Children with prior psychological problems such as anxiety (34, 41), or academic difficulties (43)# for example, are at greater risk for mental health problems after disaster (44).

            Exposure. Exposure to an adverse environmental event including the proximity, presence and perception of life threat, and the experience of personal loss or disruption of everyday events are considered to be the primary and most critical factors predicting the severity and persistence of mental health problems (30). Exposure can also occur if individuals view negative media images surrounding an event, and research has shown that children exposed to such images suffer more severe psychological stress reactions (45).

Concurrent Stressors. In many countries, environmental changes and disaster are accompanied by concurrent or pre-existing conditions resulting from poverty, civil unrest or conflict, for example (29). Individuals who encounter major stressful life events following a disaster are at higher risk for severe and persistent posttraumatic reactions and poor adjustment (30, 46).

Characteristics of the Social Environment. Various studies suggest that social support can buffer the effects of stress (47)#. The family environment is one of the most important factors in predicting recovery from disaster among children and youth (30). Social support from family, friends, classmates, and teachers can mitigate the impact of disasters on the mental health of children and adolescents (46). Indeed, strong social support networks in general have also been linked with effective coping skills during a life stressor (48, 49). In turn, high levels of negative behaviors towards children and parental distress can exacerbate their stress reactions after disaster (44, 50).

Resilience and Coping Efforts. Most recently, the emphasis has shifted from identifying vulnerabilities and what is missing in crisis, to also considering people’s own strategies to cope and adapt (51), including concepts such as resilience, post-traumatic growth and spirituality (52, 53). Resilience describes the capacity to survive and adapt within the context of significant adversity or crisis and research shows that resilience is common among both adults and children (52, 54). It has also recently been suggested that community resilience can play a key role in disaster readiness (55). Community resilience has been conceptualized as including economic development, social capital, information and communication, and community competence adaptive capacities (55). Furthermore, spirituality well-being (56) and the idea of both suffering and growth (PTG) through traumatic experience has been increasingly recognized as a key part of recovery (53, 57, 58). Those experiences contribute to individual growth, consequently affecting others within the community. Post traumatic growth involves the repair, restructuring and the ‘reauthoring’ of oneself (59)#, which can involve spirituality and readdressing fundamental existential questions after a traumatic event. While this process does not necessarily require a counselor or other professional, it calls for a sensitivity and awareness by responders, communities or governments, to incorporate and support such aspects during the recovery from environmental events.

Recommendations

Climate change is likely to impact mental health and psychosocial well-being via multiple pathways, leading to new challenges and greater psychological disease burden and suffering in affected communities. UN agencies, NGOs, governments, academic institutions and civil society at large need to work together to reduce this global and continuing threat to global health. Several implications for preparedness, mitigation, response, and policy can be outlined as follows:

1)      Addressing Climate Change. The projected impact on mental health and psychosocial well-being underlines the urgency of addressing climate change at all levels. Individuals and communities, especially those in countries with the highest carbon emissions, should have access to ways in which they can actively contribute to reducing global warming and climate change. This includes viable options for protecting biodiversity and ecosystems, access to public transportation or safe ways to bike or walk, access to local produce, incentives to make use of renewable energy, and various other opportunities that help individuals reduce greenhouse gases. Living healthy and environmentally friendly lifestyles including physical exercise, a diet rich in plant based foods and low in animal products and sustainable living practices can benefit both mental and physical health at the individual and global levels.

2)      Coordinating Efforts. Coordinated efforts should take place among NGOs, UN agencies, governments, civil society, and scientists to address psychosocial and mental health factors in the context of climate change and for NGO’s in particular to collaborate on the basis of their expertise.

3)      Conducting Impact Research. Current projections of climate change effects have mostly focused on physical health such as vector-borne diseases. Research should examine early effects of climate change on mental health and well-being that have already taken place and estimate projected effects on health given current models of climate change scenarios (also see (4)).

4)      Attending to Populations at Risk. Special attention should be paid to populations at risk for the psychological effects of climate change, including children, women, the elderly, those with less access to resources or those with pre-existing mental health or substance use problems.

5)      Increasing Resilience. Building communities that are more resilient to the mental health and psychosocial impact of climate change should involve capacity-building, strengthening of existing structures, reinforcing of social networks, availability of psychosocial resources and services and reinforcing the value of local and indigenous community knowledge and perspectives. Strengths of specific social groups as well as talents and skills within the community should be utilized. Women can make a unique contribution to disaster preparedness and recovery due to their social networks and local community awareness, for example (60). After the 1999 Orissa cyclone, many relief efforts were targeted at women, giving them control over resources as well as house-building grants and loans, resulting in improved self-esteem and social status (4).

6)      Continued Monitoring and Evaluation. Mental health and psychosocial indicators, vulnerabilities and resources should be monitored and evaluated on a continuous basis before as well as after disasters or significant weather-related changes. National governments have a responsibility, under the UN’s Framework Convention on Climate Change (1992), to carry out formal assessments of the risk to their population’s health posed by global climate change. This should include mental health problems. In addition, follow-up assessments and evaluations which include mental health indicators should be conducted not only during the acute phase of environmental events but also during the following years (29).

7)      Disseminating Public Information. Information should be disseminated on mental health, psychosocial and spiritual issues related to climate change and disaster for the general public, aimed at improving coping strategies, and at reducing stigma associated with stress reactions, crises of faith or psychological problems. NGOs and others should play an active role in challenging false beliefs or harmful practices. Guidelines for the media should be provided for reporting on events related to climate change such as disasters, advocating against media use of harmful images and for the broadcasting of accurate information and stories of resilience.

8)      Community Building and Rebuilding. NGOs and governmental organizations should encourage community building and rebuilding involving the preservation of local history and culture. Initiatives that inspire self-reliance and resiliency and promote psychological wellness should be promoted and supported (29).

9)      Training Staff in Mental Health Issues. Local non-specialized staff (e.g. school teachers, first responders) should be trained in basic principles of psychological first aid, spiritual care and in providing referral to specialized staff if necessary. Local specialized staff should be trained in effective and culturally informed practices for stress and trauma interventions.

10)   Providing Access to Mental Health Interventions. Access to quality psychosocial and mental health interventions should be provided, especially to underserved and vulnerable populations. Mental health services should be integrated with primary care and other community general health services. Community support services should be given particular attention as  most groups suffering from distress respond better to people from within their own community (61, 62). Interventions should be empirically based and culturally informed and follow recently developed IASC guidelines (29).

11)   Considering Different Cultural Perspectives. All action priorities should be implemented from a multi-cultural perspective which is sensitive to specific cultures and contexts and makes the best use of local knowledge.

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