In August 2021, the United Nations Intergovernmental Panel on Climate Change (IPCC) released a report which UN Secretary General Antonio Guterres declared was a “code red for humanity.” The report shows that the world will probably reach or exceed 1.5 degrees C (2.7 degrees F) of warming within just the next two decades. Whether we limit warming to this level and prevent the most severe climate impacts depends on actions taken this decade.
The day that report was released I was overwhelmed with feelings of hopelessness, and existential dread. I could barely get out of bed. I feared there is not the political will to take the necessary actions. I worried about the resulting human suffering in the form of famines, fires, melting ice caps, and rising ocean levels. I know I was not alone.
Shortly after the IPCC’s report, the American Psychological Association (APA), in collaboration with ecoAmerica, released a report examining the mental health implications of climate change. According to the report, climate change can affect individuals and communities in their everyday life, perceptions, and experiences, as they struggle, like me, to cope, understand, and respond appropriately to climate change and its myriad of implications. This can lead fear, anger, anxiety, sadness, and even unhealthy coping behaviors such as increased alcohol or other substance use, or even suicide “Like climate change itself, these mental health implications and the related inequities cannot be ignored,” said Meighen Speiser, executive director of ecoAmerica.
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It is widely known that the need for mental health services increases in the aftermath of a climate-related disaster. Persons immediately impacted by severe weather such as fire, floods, or hurricanes are at high risk to experience post-traumatic stress disorder and other mental health conditions. For example, one study found that survivors of Hurricane Katrina experienced increased depressive and PTSD symptoms in addition to demonstrating poorer performance on mental flexibility, cognitive processing, and sustained attention tasks. The researchers suggest that even individuals who did not exhibit major post-traumatic symptoms were still affected by cognitive changes that challenged their ability to recover from the disaster.
More recently, fires and floods in the western United States, such as my home state of Colorado, have forced evacuations, and led many to experience fear and uncertainty. According to Deb Sprague, Director of Special Projects with Mental Health Partners in Boulder, Colorado, climate change in its most extreme has meant for some losing their homes, but for many more community members it has led to “losing our sense of safety in the world.”
Sprague is also a volunteer fire fighter. She points out that fire fighters, along with other first responders, are the primary connection to services for people in crisis after a natural disaster. Yet most fire fighters are not trained in mental health and may not know how to intervene appropriately. Further, these individuals may be both a responder and victim, required to provide care for the public while managing the adverse impacts of a disaster individually.
Climate change has had similar dramatic impacts in Oregon, where fires and prolonged smoke exposure devastated the Portland area last year. I interviewed Barbara Segal, a Licensed Professional Counselor (LPC), in Portland who has worked with clients experiencing eco-anxiety. She described that while there has been a notable absence of relevant training for clinicians in the area, she has cultivated a four-step approach to supporting clients with eco-anxiety:
- affirming the role structural issues play in mental health
- holding space to allow the client to speak openly while demonstrating compassion
- addressing their values and why climate change matters to them
- empowering the client to take actions whether they be at the micro or macro level
A couple of years ago Oxford Dictionary added the term “eco-anxiety”: a feeling of worry about threats to the environment, such as pollution and climate change. Yet, this is not a diagnostic category in the ICD-10 that payers would reimburse for care, and behavioral health professionals are largely not screening or assessing for the condition. Many private practitioners, such as Segal, accept private pay rather than contract with third party payers and are therefore not held to covered diagnoses requirements. But for the most vulnerable community members, such as those with Medicaid or the indigent, this could be a real barrier to care. It speaks to one of the systemic challenges in behavioral health today, which is an outdated fee-for-service payment structure that is all too often tied to medical diagnoses.
So, what should be done?
- Enhance behavioral health providers clinical practice to address eco-anxiety. The APA offers tips to support individuals in this guidebook updated in 2021
- The 2021 APA report recommends steps that individuals and whole communities can take to mitigate the mental health impacts of climate change. For example, “Communities should also involve mental health professionals in expanding or strengthening plans for mental health care and support in response to local and regional disasters, according to the report. Mental health professionals can help with plans to increase social cohesion in the community, such as social programs and infrastructure planning to increase communal parks and other green spaces.”
- Expand training programs such as Mental Health First Aid for first responders, firefighters, and the community at large to help prepare folks to mitigate the mental health impacts of disasters
- Increase funding and flexibility for the Crisis Counseling Program (CCP) under the Federal Emergency Management Agency (FEMA), which funds mental health assistance and training activities in areas that the President of the United States has declared as a major disaster area. The CCP offers valuable assistance but is all too often short-lived. Regular, rather than intermittent, funding would help sustain an ongoing public health approach.
- Expand flexible, value-based payment models that make behavioral health services more accessible regardless of diagnostic criteria, and help ensure a viable behavioral health workforce
Simultaneously, I believe we also must deal with the root causes of eco-anxiety. Last month, at the United Nations COP26 climate conference in Glasgow, Scotland, nearly 200 countries reached a deal to set more ambitious targets for cutting greenhouse emissions in effort to halt climate change. I personally find hope in these agreements, and in knowing that my own actions can make a small difference. We can and must all do our part, such as driving less, switching to hybrid if not electric vehicles, reducing meat consumption, expanding sustainable energy technologies, and advocating for more decisive and aggressive political action. In the meantime, we must also take care of ourselves and mitigate the impact of climate change on mental health.