Oliver Freudenreich, MD, FACLP Co-Director, Massachusetts General Hospital Psychosis Clinical and Research Program Director, Massachusetts General Hospital Fellowship in Public and Community Psychiatry Associate Professor of Psychiatry Harvard Medical School Boston, Massachusetts
Katherine A. Koh, MD, MSc Co-Chair, Disaster Readiness Committee, Massachusetts Psychiatry Society Assistant Professor of Psychiatry Harvard Medical School Boston, Massachusetts
Elizabeth K. Haase, MD Chair, Climate Committee, Group for the Advancement of Psychiatry Physician Chief, Carson Tahoe Regional Medical Center Behavioral Health Clinical Professor of Psychiatry University of Nevada School of Medicine at Reno Reno, Nevada
Disclosures Dr. Freudenreich has served as a consultant for Alkermes, the American Psychiatric Association, Janssen, Karuna, Neurocrine, and Vida, received research grants from Alkermes, Janssen, Karuna, and Otsuka, received medical education honoraria from Elsevier and Medscape, and received royalties from Springer Publishing, UpToDate, and Wolters Kluwer. The other authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
As the inevitability of climate change sinks in, its long-term ramifications have introduced a new lexicon of psychological suffering related to the crisis.27 Common terms for such distress include ecoanxiety (fear of what is happening and will happen with climate change), ecogrief (sadness about the destruction of species and natural habitats), solastalgia28 (the nostalgia an individual feels for emotionally treasured landscapes that have changed), and terrafuria or ecorage (the reaction to betrayal and inaction by governments and leaders).29 Climate-related emotions can lead to pessimism about the future and a nihilistic outlook on an individual’s ability to effect change and have agency over their life’s outcomes.
The categories of direct and indirect impacts are not mutually exclusive. A child may be starving due to weather-related crop failure as the family is forced to move to another country, then have to contend with prejudice and bullying as an immigrant, and later become anxiously preoccupied with climate change and its ability to cause further distress.
Effect on individuals with serious mental illness
Patients with SMI are particularly vulnerable to the impact of climate change. They are less resilient to climate change–related events, such as heat waves or temporary displacement from flooding, both at the personal level due to illness factors (eg, negative symptoms or cognitive impairment) and at the community level due to social factors (eg, weaker social support or poverty).
Recognizing the increased vulnerability to heat waves and preparing for them is particularly important for patients with SMI because they are at an increased risk for heat-related illnesses.30 For example, patients may not appreciate the danger from heat and live in conditions that put them at risk (ie, not having air conditioning in their home or living alone). Their illness alone impairs heat regulation31; patients with depression and anxiety also dissipate heat less effectively.32,33 Additionally, many psychiatric medications, particularly antipsychotics, impair key mechanisms of heat dissipation.34,35 Antipsychotics render organisms more poikilothermic (susceptible to environmental temperature, like cold-blooded animals) and can be anticholinergic, which impedes sweating. A recent analysis of heat-related deaths during a period of extreme and prolonged heat in British Columbia in 2021 affirmed these concerns, reporting that patients with schizophrenia had the highest odds of death during this heat-related event.36
COVID-19 has shown that flexible models of care are needed to prevent disengagement from medical and psychiatric care37 and assure continued treatment with essential medications such as clozapine38 and long-acting injectable antipsychotics39 during periods of social change, as with climate change. While telehealth was critical during the COVID-19 pandemic40 and is here to stay, it alone may be insufficient given the digital divide (patients with SMI may be less likely to have access to or be proficient in the use of digital technologies). The pandemic has shown the importance of public health efforts, including benefits from targeted outreach, with regards to vaccinations for this patient group.41,42Table 2 summarizes things clinicians should consider when preparing patients with SMI for the effects of climate change.
