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Gary Belkin, M.D., Ph.D.

Climate Change: What Does it Mean for the Mental Health System?

August 31, 2020 | Population Health | Comments
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We are pleased that Gary S. Belkin, M.D., Ph.D., MPH, is joining us as a guest blogger, bringing new ideas and fresh concepts to the table for discussion. Dr. Belkin is the founder of the Billion Minds Institute, which aims to bring policy and practical attention to taking on the social climate crisis that is intertwined with the global climate crisis. He was recently named the 2020-2021 McSilver Institute fellow-in residence and as a visiting scientist at the Harvard TH Chan School of Public Health, and serves as an adjunct professor of psychiatry at New York University School of Medicine.

We increasingly see the impact of climate change up close – in accelerating and record-breaking coastal flooding, heat waves, wildfires, droughts and widespread species loss.

These changes result from the rapid warming of the atmosphere and what happens when oceans, icecaps and land all absorb this heat. The warming itself is a result of unprecedented increases in “greenhouse gases” in the atmosphere, especially those released in the use of fossil fuels that act as a kind of blanket that holds onto heat that would otherwise radiate out into space.

Increases of just 1.5oC or 2.0oC average temperature globally from pre-industrial levels are projected to markedly escalate these changes, such as expected flooding of major portions of coastal cities, displacing tens of millions of people in the U.S. alone. The World Meteorological Association has projected that the 1.5oC mark is likely to be reached at least for some portion of the year by 2024.

Such far-reaching and mind-boggling threats are getting increasing attention for their social and emotional ramifications. Reports like the comprehensive Mental Health and Our Changing Climate: Impacts, Implications and Guidance call on us to consider what this means for the mental health community.

It definitely means more demands. We know a lot about the extensive impact of acute extreme weather events alone on elevating intergenerational trauma and population levels of PTSD, substance use, depression and suicide. But add similar burdens from the chronic effects of environmental change such as already growing displacement and migration, disrupted food and economic security. The consequences of these effects on health, well-being and overall community efficacy and social cohesion will only become more destructive and widespread. Finally, on top of all that are the increasingly studied impairment from anxiety, fear and existential loss in anticipation of these changes.

Unfortunately, we can expect the effects of climate change to grow in severity, reach, frequency and mental health and social impact. The demands on an already over-burdened mental health system will only intensify in magnitude and breadth. How will we respond?

These challenges present an opportunity to shine a light on what has long been known but is now evident in even starker relief; the crucial role of population social and emotional resilience in the course of mental illness and in the overall life and strength of whole communities.

The “social climate” – emotional resilience, social ties, collective efficacy – is a sorely needed resource in the face of these challenges. It is also a key factor in recovery from illness and promotion of mental health. There is much work to be done to prepare our communities to be that resource in the face of ongoing trauma and distress from this uncertain and difficult future.

COVID-19 has been attributed by some to unsustainable and destructive land and agriculture practices and we can expect more such emerging infections. The pandemic also offers a glimpse into a future of unraveling ecological harm, chronic instability, systems failures, economic fragility and extensive emotional suffering, as well as a premium on bolstering socioemotional strength.

The realities of climate change make it even more critical to create a mental health system that has the resources to contribute to the social climate to respond to the most serious levels of need, illness and impairment, but also to command social, preventive, promotional and early-intervention tools, partners and impact.

Achieving that will challenge the current system not just in capacity and resources, but design. Perhaps there is now an opening to make the case for a “next system” for mental health that is designed to be part of building broad emotional capacity and strength in substantive collaboration with communities and neighborhoods.

Growing evidence supports methods of what the World Health Organization (WHO) describes as “task-sharing,” or imparting a range of mental health skills and ownership in the hands of an array of non-specialists. Teachers, clergy, peers, parents, community mental health workers and other members of the community are able to effectively adopt and use basic counseling skills like problem solving therapy, behavioral activation and motivational interviewing to lead interventions that build resilience and promote mental health, from pro-attachment parent coaching, to mindfulness, centering or socioemotional learning practices.

This kind of role and methods for providers to help build the capacity of communities and extend their own reach and effectiveness, can be building blocks for a needed next system. But it will require resources, training and organizational commitments to flourish.

A drastically changing global environment and our responses to it will sorely test the human future. What we know and do as a mental health community is critical to help grapple with the implications of that for individuals and communities. The importance of the mental health system’s contributions to bolster the social climate we need has brought together the nation’s largest mental health professional and allied organizations, including the National Council, to form the Social Climate Leadership Group. We created and agreed on an initial statement and roadmap of purpose to build upon.

One initial step is to engage people working in community mental health for insights, ideas and direction. We hope this blog can be ongoing and serve as a forum for these issues.  Please share your reactions, suggest topics to explore moving forward and add your ideas and perspectives in the Comments section below or contact me directly at g@abillion.org.

A key question to start with might be: What does a “next system” look like and what do we need to do to get there?