Mental health impacts of climate change

There have been rising concerns over the impact of climate change on mental health worldwide. It is argued that psychological impacts of any form of disaster exceed physical injuries by 40 to 1.^{Reference Hayes, Blashki, Wiseman, Burke and Reifels7} Globally, climate change has had effects of varying duration on mental health, both directly and indirectly.

Some direct impacts of climate change on mental health include trauma suffered due to climate events such as wildfires, hurricanes, earthquakes and droughts. Many perceived environmental stressors resulting from changes in climate directly affect brain function and mental well-being, as seen in studies showing that people living in flooded areas reported poor mental health as well as the more commonly reported physical ailments.^{Reference Borg, Greibe Andersen, Karekezi, Yonga, Furu and Kallestrup8}

Common outcomes of intense or persistent stressors include anxiety disorders, post-traumatic stress disorder, suicidal ideation and depression.^{Reference Charlson, Ali, Benmarhnia, Pearl, Massazza and Augustinavicius9} There is evidence supporting the correlation of extreme heat with violent behaviour towards themselves and others, increased rates of suicide and hospital admissions for self-harm, and tripled risk of mortality for those with pre-existing mental health conditions.^{Reference Charlson, Ali, Benmarhnia, Pearl, Massazza and Augustinavicius9} For example, in India, global warming was associated with suicides of up to 60 000 farmers in three decades.^{Reference Carleton10} Floods and droughts have also been associated with heightened levels of anxiety and depression as well as post-traumatic stress disorder from loss of land, work and disruption of community connections.^{Reference Dodgen, Donato, Kelly, La Greca, Morganstein, Reser, Crimmins, Balbus, Gamble, Beard, Bell and Dodgen11}

The different impacts of climate change that impair mental health are summarised in Fig. 1.

Fig. 1 Impacts of climate change on mental health.^{Reference Clayton12}

The dread of environmental disaster has also resulted in eco-anxiety, and the anguish from or in anticipation of ecological losses has been shown to lead to ecological grief.^{Reference Cunsolo and Ellis13} Related to this dread, there is emergence of new terminology such as ‘solastalgia’, coined by Glenn Albrecht to describe the feeling of homesickness when one is still at home but, because of environmental change, that home no longer looks familiar, leading to disintegration of cultural ties between the people and their land.^{Reference Albrecht, Sartore, Connor, Higginbotham, Freeman and Kelly14} This change may be caused naturally by droughts, floods and fires, or artificially through war, terrorism and economic activities such as mining.

Vulnerability to climate change-related mental health problems is higher among certain marginalised groups, including children, women, the elderly, the economically disadvantaged, emergency workers, first responders, the homeless and persons with pre-existing mental conditions.^{Reference Dodgen, Donato, Kelly, La Greca, Morganstein, Reser, Crimmins, Balbus, Gamble, Beard, Bell and Dodgen11} Additionally, refugees, indigenous communities, members of the armed services, farmers and persons with disabilities have an increased risk of adverse mental health outcomes in these settings.^{Reference Dodgen, Donato, Kelly, La Greca, Morganstein, Reser, Crimmins, Balbus, Gamble, Beard, Bell and Dodgen11} The impact of climate change is often compounded by other factors, such as poverty and lack of access to social services, further exacerbating negative outcomes.

Evidence from Africa on the impact of climate change on mental health

Mental health perceptions in many African countries are often coloured by stigma, myths and superstition, lack of adequate human resource, and unavailable or inaccessible mental health facilities.^{Reference Monteiro15} Nonetheless, as demonstrated in Kenya, there is a growing positive response to mental health, with increased awareness and recognition by governments and calls for investment in mental health.

There is less systematic work on climate change and mental health in Africa, although recent funding initiatives may increase research output in the near future. Although the concepts of climate change and global warming may be unfamiliar to many in the general population, a cross-sectional study on mental health in six African countries representing different regions revealed that more than half of the population acknowledged the occurrence of climate change and reported experiencing some form of impact.^{Reference Opoku, Filho, Hubert and Adejumo4}

Climate change has had impacts on African cultural heritage markers such as historic buildings, archaeological sites and museum collections, seasonal festivals, sacred sites, traditional fishing practices, traditional crops and foodways. For example, in East Africa, extreme heat and rainfall lead to vulnerability of low-lying coastal heritage sites built on coral, and low rainfall has an impact on traditional fishing practices relying on freshwater fish. In Benin, coastal inundation affects boatbuilding and fishing practices and rise in sea level forces relocation of people.^{Reference Markham16}

As a result of changing climate patterns, pastoralists in Kenya, Somalia and Tanzania have been forced to leave their land and livelihoods and to move from rural to urban areas or end up as internally displaced persons or immigrants.^{Reference Heaney and Winter17} In the process, they often lose their flock, property and their community. This evokes feelings of hopelessness, helplessness and homesickness, often correlated with mental ill health. Many of those affected turn to consumption of alcohol or other substances as a coping mechanism to deal with the stressors. Higher rates of substance misuse have been reported among people displaced and exposed to extreme climate stressors in South Africa.^{Reference Myers, Young, Galloway, Manyike and Tucker18} In addition, the stigma of substance use and mental illness often hinders populations affected by climate change from accessing mental health services.^{Reference Heaney and Winter17}

In many instances, such climate-driven displacements affect children physically, mentally and emotionally. Forced migration due to adverse climatic conditions has been seen for instance from Somalia into Kenyan refugee camps, where many experience water and food shortages as well as disruption of schooling.^{Reference McMichael19} These children are reported to have been placed at high risk of developing trauma-related disorders, malnutrition, disease and premature death. Many displaced children are often left unsupervised, negatively affecting their emotional development and potentially contributing to school absenteeism.^{Reference Godsmark, Irlam, van der Merwe, New and Rother20} Unfortunately for many of those adversely affected on the continent, mental health services are still largely unavailable.^{Reference Heaney and Winter17}

Coping and adaptation

Many African communities have derived coping mechanisms from indigenous and local knowledge to withstand negative impacts of climate change and adapt to the effects of environmental stresses.^{Reference Leal Filho, Matandirotya, Lütz, Alemu, Brearley and Baidoo21} These include weather-forecasting systems based on changes in animal behaviour, livestock and crop diversification, cattle stress-management techniques and division of labour, thus allowing acclimatisation to drought challenges.

Additionally, climate-smart agroecological production systems such as the cultivation of drought-tolerant cereals, tubers and vegetables have led to enhanced food security, sustainable land management and minimised water use. However, the development of most of these coping and adaptive mechanisms has been small-scale and largely unsupported by sustained research. It is therefore imperative that research institutions and governments incorporate and acknowledge indigenous and local knowledge in climate action to complement scientific research, as indigenous knowledge is under threat of being sidelined, marginalised or lost.^{Reference Leal Filho, Matandirotya, Lütz, Alemu, Brearley and Baidoo21}

There is a dire need for more research and surveillance data on mental health effects of climate change in Africa. In view of its urgent nature and the global estimated effect, there needs to be a call for action to increase the resources to deal with climate change on the continent as well as in other low- and middle-income regions. Healthcare professionals in Africa have expressed concern for the lack of preparedness to deal with the health (including mental health) impacts of climate change, with little or no funding allocation and an inadequate human resource mix for research and interventions to mitigate the impact of climate change on health.^{Reference Opoku, Filho, Hubert and Adejumo4}