EHN

Hardly a day goes by where we aren’t reminded that the Earth’s climate is changing and that we are responsible for much if not most of that change.

The findings of one study after another are punctuated by breaking news or the direct experience of wildfires, hurricanes and floods that forced thousands of people to evacuate, damage property, and erase tangible reminders of our past.

More ubiquitous, but less publicized, are the millions of people who are exposed to heat waves, long-term droughts, rising sea levels, and eroding coastlines, forcing them to move elsewhere or spend large sums of money building communities that are habitable.

We respond to such news and events in a variety of ways. Some of us sink into deep despair or simply resign ourselves to the inevitability of global climate change. Some of us live with the trauma of having survived life-threatening extreme weather events. Some of us actively avoid the reality of climate change or spend considerable psychic energy denying that it is happening or, at the very least, denying our responsibility for its happening.

Each of these responses represent a challenge to our mental health. For instance, people exposed to life-threatening extreme weather events are more likely to experience post-traumatic stress disorder, depression and anxiety.

People exposed to prolonged heat waves are more likely to make poor decisions that place them at risk for death or severe injury. People exposed to long-term drought are more likely to experience depression, interpersonal violence and thoughts of suicide. People exposed to sea level rise and coastal erosion are more likely to experience anxiety and interpersonal conflict with others in their community.

However, these mental health challenges are perhaps the most overlooked consequences of climate change.

Increasing temperatures and heatwaves, the spread of emerging infectious illnesses, and the widespread concerns about food security in drought-plagued regions of the world all threaten our physical health.

Environmental changes that threaten our livelihoods, access to food, and habitability of our communities lead to widespread unemployment and poverty, civil conflict, and dislocation.

WHO

Overview

This guide (2011) covers psychological first aid which involves humane, supportive and practical help to fellow human beings suffering serious crisis events. It is written for people in a position to help others who have experienced an extremely distressing event. It gives a framework for supporting people in ways that respect their dignity, culture and abilities.

Endorsed by many international agencies, the guide reflects the emerging science and international consensus on how to support people in the immediate aftermath of extremely stressful events.

World Health Organization and United Nations High Commissioner for Refugees. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Geneva: WHO, 2015.

The target group for WHO work on mental health and psychosocial support in emergencies is any population exposed to extreme stressors, such as refugees, internally displaced persons, disaster survivors and terrorism-, war- or genocide-exposed populations.

The WHO Department of Mental Health and Substance Abuse emphasizes that the number of persons exposed to extreme stressors is large and that exposure to extreme stressors is a risk factor for mental health and social problems. The Department’s work on mental health in emergencies focuses mostly on resource-poor countries, where most populations exposed to natural disasters and war live.

Management of physical health conditions in adults with severe mental disorders

Preventable physical health conditions lead to premature mortality in people with severe mental disorders, reducing their life span by 10-20 years. The majority of these premature deaths are due to physical health conditions.

The physical health of people with severe mental disorders is commonly overlooked, not only by themselves and people around them, but also by health systems, resulting in crucial physical health disparities and limited access to health services. Many lives can be saved by ensuring that people with severe mental disorders receive treatment.

WHO’s “Guidelines on management of physical health conditions in adults with severe mental disorders” provide evidence-based, up-to-date recommendations to practitioners on how to recognize and manage comorbid physical and mental health conditions.

WHO

Being a refugee or a migrant does not, in itself, make individuals significantly more vulnerable to mental disorders, but refugees and migrants can be exposed to various stress factors that influence their mental well-being.

Refugees and migrants have often faced war, persecution and hardship in their country of origin. Many will have experienced displacement and difficulties in transit countries and embarked on dangerous travels. Lack of information, uncertainty about immigration status, potential hostility, changing policies, and undignified and protracted detention all contribute to additional stress.

Furthermore, forced migration requires multiple adaptations in short periods of time, making them more vulnerable to abuse and neglect. Pre-existing social and mental health problems can thus be exacerbated.

Clinical Management of Mental, Neurological and Substance Use Conditions in Humanitarian Emergencies

NPR

“……Only one in 27 people with depression in developing countries receives adequate treatment, according to the report. Developed countries do a bit better – one in five people with depression get treatment. But overall, wealthier countries have a poor enough record of providing adequate services…..”

NPR

“…..the World Health Organization estimates more than a million Afghans suffer from depressive disorders and over 1.2 million suffer from anxiety disorders. The WHO says the actual numbers are likely much higher…….”

WHO

“…..According to latest WHO estimates, more than 300 million people are living with depression globally, an increase of more than 18% between 2005 and 2015. …..”

NY Times

“….Drug treatment, mostly for psychosis, blunted day-to-day symptoms of hallucinations and delusional thinking. But it did not reduce the length of time people were held in chains at the camp.…”

British Journal of Psychiatry

“Care of people with serious mental illness in prayer camps in low-income countries generates human rights concerns and ethical challenges for outcome researchers.

To ethically evaluate joining traditional faith healing with psychiatric care including medications (Clinical trials.gov identifier NCT02593734).

Residents of a Ghana prayer camp were randomly assigned to receive either indicated medication for schizophrenia or mood disorders along with usual prayer camp activities (prayers, chain restraints and fasting) (n = 71); or the prayer camp activities alone (n = 68). Masked psychologists assessed Brief Psychiatric Rating Scale (BPRS) outcomes at 2, 4 and 6 weeks. Researchers discouraged use of chaining, but chaining decisions remained under the control of prayer camp staff.

Total BPRS symptoms were significantly lower in the experimental group (P = 0.003, effect size –0.48). There was no significant difference in days in chains…..”

Mental health nurses and disaster response in Sierra Leone

Harris, Dawn et al.
The Lancet Global Health , Volume 6 , Issue 2 , e146 – e147

Politico

“….. As flood waters recede from Hurricanes Harvey, Irma, Maria and Nate, and survivors work to rebuild communities in Texas, Florida and the Caribbean, mental health experts warn that the hidden psychological toll will mount over time, expressed in * *

• heightened rates of depression,
• anxiety,
• post-traumatic stress disorder,
• substance abuse,
• domestic violence,
• divorce,
• murder and
• suicide. …..”

Medscape