WHAT TO DO?

WHAT COMES AFTER ANXIETY?  WHAT PSYCHIATRISTS CAN DO About CLIMATE CHANGE                                                                            — Robin Cooper, MD

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THIS SHOULD NOT BE OUR RESPONSE. To choose to do nothing is a still a decision.

Despite the enormity and complexity of climate change impacts on mental health, there are things psychiatrists and mental health professionals can do.  The public views physicians and health providers as trusted and credible leaders and can therefore be influential.

We cannot allow ourselves to be pulled into a state of passivity and defeatism. Nor can we afford to wall ourselves off in the comfort of our offices.  There are things that we all can do to maximize good health outcomes for our patients, families and communities.  There is some role that each of us can play.

Health care providers including psychiatrists can have an impact at multiple different levels; the individual patient management, systems of care, and public policy advocacy. Each of these is driven by different skills, perspectives and has different goals and outcomes.

LEVELS OF INTERVENTION

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INDIVIDUAL PATIENT MANAGEMENT       

This is a focus on direct clinical careand derives from the doctor/caregiver-patientrelationship model and principles of clinical practice.  As physicians and providers, we are the first line in keeping our patients safe and healthy during the inevitable extreme weather events and the impacts of climate change.

Some strategies include but are not limited to:

INDIVIDUAL PATIENT

  • Psycho-education: teaching patients and families about health risks and protective behaviors especially regarding heat exposure and flood and storm protection in vulnerable areas  
  • Effective management of psychiatric medications to reduce risk
  • Treatment of specific psychiatric syndromes associated with climate related traumas
  • Psycho-education of individual resiliency behaviors (see article on Transformational Resilience in our Major Topics section under the Learn button in the menu above)
  • Consider psychotherapeutic techniques for patients who present with eco-anxiety; utilize colleagues and peer consultation groups especially to reflect on secondary trauma that therapists experience and counter transference

AGENCY AND PRACTICE PREPAREDNESS

  • Plan for closer monitoring of vulnerable populations; Engage caregivers, case managers, visiting nurses, family members, etc
  • Help patient, families, staff at residential institutes and day centers develop emergency plans including plans for respite shelters during extreme weather events
  • Identifying what your agency/practice needs regarding health record systems and information retrieval, and operating during emergency periods
  • Agency and practice leaders and administrators create a culture of attention to climate related health interventions, providing regular staff training prior to periods of greatest vulnerability and identifying roles of staff members for safety plans.

SYSTEMS OF CARE

This focus derives from a community mental health/public health model with attention to community and population health, safety and resiliency.  Components include prevention and community preparedness as well as community disaster response and recovery.  These focus on improving the readiness of community and mental health systems to respond effectively and quickly to emergencies requiring prior planning, coordination and capacity building.  

Some strategies include:

  • Collaborative relationships between mental health and health agencies and community groups, including public health departments, schools, churches and synagogues, recreational centers, libraries, homeless services etc.;
  • Development of system of responsiveness:  Who alerts vulnerable people/patients?  What plans are in place to direct vulnerable people/patients to areas of safety? 
  • Specific planning for homeless population.
  • Utilize public health educators in developing and implementing community education strategies
  • Educate and coordinate with first responders (police, fire department and local emergency departments)
  • Mental Health Disaster response plans and training: SAMHSA Behavioral Health Disaster Response training modules available:
    https://www.samhsa.gov/disaster-preparedness
    http://store.samhsa.gov/apps/disaster
  • Training in Psychological First Aid; core principles of normalizing stress reactions to abnormal events, identifying and educating public to expected reactions, assisting community leaders in creating sense of safety, calmness, self and community effectiveness, supporting social connections and cohesiveness and sense of hopefulness
    http://www.nctsn.org/content/psychological-first-aid
    https://www.ptsd.va.gov/professional/materials/apps/pfa_mobile_app.asp
  • Develop consultation with community leaders for effective communication during acute disasters with emphasis on Psychological First Aid principles.
  • Media training as effective community communication

The scope of disaster preparedness and response may be beyond the skills of many practicing psychiatrists.   All communities have Disaster Preparedness Plans usually within the Department of Public Health where useful sources of information and guidance may be found.

PUBLIC HEALTH ADVOCACY

This level of engagement derives from a public health prevention model with a focus on influencing pro-health policies thru engagement with social and political institutions.  

Since the impacts of climate change on mental health are substantially influenced by social factors, influencing outcomes requires engagement in public policies.  Physicians and psychiatrists have the expertise and credibility to inform the public and policy makers about the root causes of climate change, the impacts on health and mental health, and the pro-health and mental health benefits of policies that promote community resilience and public mental health. The public health model inherently recognizes that root causes are imbedded in broad socio-political and economic forces and that solutions are beyond the capacity of individuals requiring institutional and governmental programs. Influencing policy touches on creating and changing laws, establishing regulations and rules, and funding governmental and institutional activities.  None of this is done by individuals but requires collective engagement in advocacy organizations. The American Psychiatric Association represents these interests, as do many other effective groups.  

Some additional actions that individuals can do to influence public awareness: 

  • Join with colleagues: Climate Psychiatry Alliance and Climate and Mental Health Caucus of APA to influence professional organizations’ position and action
  • Write Op-Ed letters and Letters to Editor in local newspapers that respond to newsworthy articles
  • Write Blogs for papers, professional newsletters, etc.
  • Testify at public hearings on health and mental health impacts
  • Participate in lobbying activities of legislators, etc that professional organizations organize

Resources

Excellent document covering extreme heat, causes, prevention and management produced by Center for Disease Control:

CDC Infographic for Public Education on Extreme Heat:
http://ephtracking.cdc.gov/images/extremeheat.jpg

Guides for Pre-disaster preparedness, on-the-ground assistance, post-disaster resources and responses:
https://www.samhsa.gov/disaster-preparedness

Excellent document from public health perspective:
http://climatehealthconnect.org/wp-content/uploads/2017/03/Climate-Change-Health-and-Equity-Opportunities-for-Action.pdf

Strategies for interventions with mental health and substance abuse patients with focus on extreme heat: https://www.oasas.ny.gov/admed/recommend/HeatPol.cfm

Extensive document with contribution from more than a hundred public health professionals and community health, equity, and environmental justice advocates outlining opportunities and recommendations for action.
http://climatehealthconnect.org/wp-content/uploads/2017/03/Climate-Change-Health-and-Equity-Opportunities-for-Action.pdf