Recommendations

Climate change is likely to impact mental health and psychosocial well-being via multiple pathways, leading to new challenges and greater mental illness burden and suffering among affected communities. UN agencies, NGOs, governments, donors, academic institutions and civil society at large need to work together to reduce this increasing threat to global health. The projected impact on mental health and psychosocial well-being underlines the urgency of addressing climate change at all levels. Several implications for prevention, preparedness, mitigation, adaptation, response, and recovery related to climate change and adverse weather events are outlined as follows:

1)        Mitigating Climate Change. Individuals and communities, especially those in countries with the highest carbon emissions, must have access to ways in which they can actively contribute to reducing climate change. Viable options for protecting biodiversity and ecosystems, access to public transportation or safe ways to bike or walk, can entail buying 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 from the individual to global level.

2)        Promoting and Protecting the Right to Mental Health. The “International Covenant on   Economic, Social, and Cultural Rights” (ICESCR), ratified by over 150 UN member states, contains the “right of everyone to the enjoyment of the highest attainable standard of physical and mental health” (OHCHR, 2008). General Comment 14 specifies the provision of “appropriate mental health treatment and care” and outlines that “health facilities, goods and services” should be available, accessible, acceptable and of good quality (Committee on Economic Social and Cultural Rights, 2000). UN member states are obligated to respect, promote, and fulfill the right to mental health, which includes the implementation of domestic mental health law and policy as well as the provision of technical, administrative, and budgetary resources (Committee on Economic Social and Cultural Rights, 2000). Multi-lateral agencies and donors should provide technical and financial support to aid governments in fulfilling this right.

3)        Empirical Research and Projections. Current projections have mostly focused on direct weather-related effects on physical disease such as malaria. Research must now examine more complex relationships that include social, economic and gender-sensitive variables (Aguilar & Aguilar & Quesada-Aguilar, 2008; McMichael, Woodruff, & Hales, 2006) and that estimate effects on mental health and psychosocial well-being. (World Health Organization, 2003). Such research should drive pre-emptive policies aimed at protecting the well-being of communities.

4)        Coordinating Efforts and Partnership Building. Coordinated efforts must take place among NGOs, UN agencies, governments, civil society, health care workers, and academia to address psychosocial and mental health factors in the context of climate change.

5)        Building Capacity for Addressing Mental Health Issues. Both specialized and non-specialized staff must receive training in mental health and psychosocial care (Lancet Global Mental Health Group, 2007). Local paraprofessionals (e.g. school teachers, nurses, first responders) must be trained in the basic principles of psychological first aid and in providing referrals to specialized staff if necessary. Staff that may be deployed during environmental events and is not familiar with local customs, must also be trained in evidence-based interventions and best practices that are culturally informed and gender-sensitive. Intervention packages consisting of management and prevention of mental disorders (World Health Organization, 2008c) should be prepared for countries who do not currently provide mental health services. Vicarious traumatization in humanitarian staff and other volunteers and health workers should be addressed via appropriate confidential referral mechanisms and by promoting self-care.  

6)        Attending to Populations at Risk. Special attention must be paid to populations at risk for the psychological effects of climate change. These include children, women, the elderly, the disabled, those with less access to resources, and those with pre-existing mental health or substance use problems (Lancet Global Mental Health Group, 2007). Providing aid to at-risk populations through parent and teacher training, advocacy, and community mobilization is essential (Brown, Cohen, Goodman, & Mannarino, 2004; World Health Organization, 2008c). In particular, it is necessary to strengthen women’s participation in decision making at all levels of climate and disaster mitigation and response (Aguilar, 2004; Aguilar & Quesada-Aguilar, 2008).

7)        Increasing Resilience. Building resilient communities must involve capacity-building, strengthening existing structures, creating new or reinforcing social networks and recognizing the value of local and indigenous community knowledge and perspectives, as well as increasing the availability of psychosocial resources and services (World Health Organization, 2008c). Strengths of specific social groups as well as talents and skills within the community must be identified and utilized. Individuals who are able to function, contribute to community recovery, and maintain their role during stress often cope better and experience less disability following a stressful event (Caplan, 1975).

8)        Continued Monitoring and Evaluation. Mental health and psychosocial indicators and resources must be monitored and evaluated on a continuous basis. 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 must include mental health issues. In addition, follow-up assessments and evaluations which incorporate mental health indicators and treatment outcomes must be conducted not only during the acute phase of environmental events but also in the following years (Inter-Agency Standing Committee, 2007).

9)        Disseminating Public Information. Information on mental health and psychosocial issues, which is aimed at improving coping strategies and reducing the stigma associated with psychological problems or stress reactions must be disseminated to the general public. NGOs and others must actively challenge and educate community members regarding false beliefs or harmful practices. Media guidelines, advocating against the use of harmful images and for the broadcasting of accurate information, must be implemented. Stories of resilience must be included when reporting on disasters and/or events related to climate change.

10)     Providing Access to Mental Health Interventions. Access to quality psychosocial and mental health services must be scaled up, especially to underserved and vulnerable populations (World Health Organization, 2008c). Mental health services must be integrated with primary care and other community health services (Prince et al., 2007). Since most groups suffering from distress respond better to people from within their own community, community support services should be given particular attention (Freedman, 2004; Hoffman, 2005). Interventions must be empirically based and culturally sensitive (e.g. Bolton et al., 2007) and follow recently developed IASC guidelines (Inter-Agency Standing Committee, 2007)..

11)     Creating Community-based response training. Where possible, community-based training in the form of disaster response, first aid, urban search and rescue, and disaster mental health should be implemented in the community, using existing community training models used successfully in Japan, the United States, and elsewhere (Simpson, 2000; Simpson & Strang, 2004, World Cares Center, 2008).

12)     Community Building and Rebuilding. NGOs and governmental organizations must 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 (Inter-Agency Standing Committee, 2007). Special attention must be paid to rebuilding key community institutions and structures such as schools, places of worship and community centers. This may help individuals to function in their roles and re-establish routines, which can reduce distress, especially in children. Furthermore, community interventions that may involve art, crafts, or performance and take local history, traditions, and customs into account may aid recovery in the affected population.

13)     Considering Different Cultural Perspectives. All action priorities must be implemented from a multi-cultural and multi-ethnic perspective that is sensitive to specific developmental ages, cultures, and contexts and make the best use of local and traditional knowledge.