Is "eco-psychiatry" a field for the future?

Two psychiatrists who spoke to Psychiatric News say dramatic environmental and climatic events— draughts, cyclones, storms, heat waves— have profound effects on mental health and should be the concern of the psychiatric profession and APA.

"Climate change is a unique challenge in the history of humanity, given our ability to computer-model future climate change and its risks," psychiatrist H. Steven Moffic, M.D., a professor of psychiatry at the Medical College of Wisconsin, told Psychiatric News. "Never before have we had such an opportunity to slowly, but surely improve the well-being of our entire planet. Psychiatry has a role to play, if only we become more involved.

"For psychiatrists, being concerned has important ethical and preventive aspects and really doesn't take much time," he said. "They can make changes in their personal life and in that way be a model and produce some social contagion. They can support anything that will move us toward clean energy, help us to realistically tell the youth about the risks to their future, and join with other concerned mental health and health professionals."

Moffic is joined in this passion by Washington, D.C., psychiatrist Lise Van Susteren, M.D., an environmental activist who ran for the U.S. Senate from Maryland in 2006. In July 2009 she helped to organize a forum in Washington, D.C., on "The Psychological Effects of Global Warming" sponsored by the National Wildlife Federation's Climate Education Program with support from the Robert Wood Johnson Foundation.

Participants in the forum included Moffic; Eric Chivian, M.D., who is a professor of psychiatry at Harvard and founder and director of the Center for Health and the Global Environment; and Spencer Eth, M.D., who at the time was chair and medical director of psychiatry and behavioral health services at St. Vincent's Medical Center in New York City.

In columns in the Huffington Post, Van Susteren has sounded a strident alarm about climate change and the need for mental health professionals to take up the cause as a "moral obligation."

In a column of the same title, Van Susteren said psychiatrists and other mental health professionals have a duty to warn patients, co-workers, families, neighbors, and friends.

"We have a duty to act—within our professional organizations, in our communities, offices, and homes," she wrote. "Climate scientists are desperately trying to tell us to reduce our carbon emissions— to stop building new coal plants, to switch to clean renewable energy, to embrace energy efficiency.... Mental health professionals vigorously endorse requirements to report cases of child abuse. It is a legal obligation, but it is also a moral one.

"Is it any less compelling a moral obligation, in the name of all children now and in the future, to report that we are on track to hand over a planet that may be destroyed for generations to come?"

In interviews with Psychiatric News, Moffic and Van Susteren noted that the American Psychological Association has addressed the issue with a task force on the interface between global climate change and psychology. In August 2009 the task force released the report "Psychology and Global Climate Change: Addressing a Multifaceted Phenomenon and Set of Challenges."

The report stated that while most Americans view climate change as an important issue, they don't see it as an immediate threat, so getting people to "go green" will require policymakers, scientists, and social marketers to address psychological barriers and incentives.

Moffic and Van Susteren say they would like to see APA address the scientific issue of global warming in a similar way. Doing so would enhance the credibility of psychiatry in the eyes of the public, they believe, and they added that psychiatry has the expertise to help overcome what they say is widespread denial about global warming.

"Our psychological defense mechanisms and need for security are contributions to ignoring global warming," Moffic told Psychiatric News. "The consequences include the PTSD in refugees of climate disasters, escalating temperatures in warm climates leading to more violence, unusual grief related to environmental change as is being seen in the Australian draught, and anxiety about the future."

In fact, APA has a long history of responding to natural and man-made environmental disasters with an emphasis on addressing the mental health needs— current and future—of the populations impacted by them. Recent examples include Hurricane Katrina, the earthquake in Haiti, and the Gulf oil spill. APA has also been involved in efforts to plan postdisaster responses; directing the bulk of this work is the Committee on Psychiatric Dimensions of Disaster.

Additionally, the Office of Minority and National Affairs (OMNA) has formed the All Healers Mental Health Alliance in response to Katrina, an effort whose scope has been expanded beyond Katrina.

The alliance's mission is "to organize a long-term, culturally competent response to the mental health needs of people of the United States, particularly people of color and people living in poverty affected by all hazards and disasters."

OMNA Director Annelle Primm, M.D., noted that OMNA's efforts to promote healthy lifestyles among racially diverse communities that experience health disparities include addressing social determinants of health—racism and poverty—but also disproportionate exposure to environmental hazards.

Many of these communities have very little green space, may be located in "food deserts" where grocery stores with healthy foods are not available in close proximity, and may be more likely to be located in proximity to toxic waste dumps and other toxic exposures, she said.

Many of APA's own efforts at efficiency also have a "green" effect—much of the information used by the Association's governance structure is now online, replacing the volumes of paper that used to be sent out to Board and Assembly members. And the consolidation of components and increased use of conference calling to replace meetings has cut down on travel and airline usage.

In 2008, the AMA's House of Delegates approved, with support of the Section Council on Psychiatry, a report by the AMA's Council on Science and Public Health on global climate change and human health (see AMA Report on Global Climate Change).

Robert Cabaj, M.D., chair of APA's Council on Advocacy and Government Relations, said Moffic and Van Susteren are to be commended for their passion and for their dedication to educating APA members about these concerns. He hailed the work of APA's Committee on Psychiatric Dimensions of Disaster as well as Physicians for Social Responsibility, whose domain of activities encompasses the issues raised by Moffic and Van Susteren.

"I would encourage local efforts such as workshops or symposia at the district branch level, as well as seeking educational avenues at the APA annual meeting or Institute on Psychiatric Services," Cabaj told Psychiatric News. "Given the very limited resources of APA and the focus of APA on patient care and advocacy, such educational efforts would be a practical approach.

"APA advocacy needs to focus on health care reform, parity, access to needed psychiatric care, and other topics that immediately impact patient care," he said.

The American Psychological Association's Task Force Report on Psychology and Global Climate Change is posted at <www.apa.org/science/about/publications/climate-change.aspx>. Resources related to APA's Committee on Psychiatric Dimensions of Disaster and responses to environmental disasters can be accessed at <www.psych.org/Resources/DisasterPsychiatry/Current-Disasters.aspx>. Information about the APA Office of Minority and National Affairs All Healers Mental Health Alliance is posted at <www.ahmha.net>.