Climate Emergency Requires Fundamental Expansion of Our Approach to Mental Health

This month’s column frames the mental health impacts of the climate crisis in relation to the need for individuals and communities to be prepared and resilient in the face of such challenges. Bob Doppelt is an international thought leader and coordinator of the International Transformational Resilience Coalition, a network of mental health, social service, climate, and other professionals working to build universal capacity for mental wellness and resilience for the climate emergency. He is leading efforts by numerous mental health and public health organizations, including APA, to incorporate these principles into active federal legislation to support such efforts throughout the United States

—David Pollack, M.D.

It was 80 degrees outside, the record spring drought continued, and a Red Flag Warning was issued to beware of wildfires. No, it was not autumn when wildfire season has historically occurred in Western Oregon, where I live. It was April 16, when it should have still been cool and pouring rain outside. The surprising wildfire warning put everyone on edge, fearful about what would happen to them, their family, and neighbors then and later in the year.

Many local residents developed severe anxiety, depression, and other mental health problems after the wildfires. Thirty-seven percent of first responders fighting wildfires statewide developed posttraumatic stress disorder. The general public was also greatly distressed.

The frightening events occurring in Oregon mirror the disruptions to the global climate system, regional weather patterns, and ecological systems happening across the United States and elsewhere. These impacts will accelerate as the climate emergency worsens.

The COVID-19 pandemic offers a tiny glimpse into some of the mental health and psychosocial consequences of the prolonged climate emergency. Unlike the pandemic, however, the toxic stresses will be mixed with more frequent, extreme, and prolonged storms, wildfires, heatwaves, floods, droughts, and other disasters. More than 47 million Americans are impacted by disasters every year, which can severely traumatize 20% to 50% of those directly impacted. The number of Americans impacted by disasters is expected to double by 2050, affecting a third or more of the population every year.

If we remain unprepared, the vast traumas will threaten everyone's health, safety, and well-being. To avoid these devastating effects, mental health professionals must expand the single-person clinical treatment approach that has dominated the field for years and rapidly build population-level (or universal) capacity for psychological and emotional resilience for climate adversities. This requires a public health and prevention science approach.

A public health approach addresses health and social problems by strengthening and establishing additional protective factors that buffer people from and counter the forces that undermine mental health and resilience. It takes a whole population-level approach, not one that merely focuses on individuals who are deemed to be high risk or show symptoms of psychopathology. It prioritizes preventing problems, not treating people after symptoms appear.

A public health approach also takes a systems perspective that recognizes that most individual, family, and community mental health problems result from numerous interrelated factors that require multisystemic responses, not a few narrowly focused siloed interventions.

The growing field of prevention science expands the public health perspective by showing that mental health and psychosocial problems can be prevented and that it is possible to enhance the capacity for wellness and resilience. Further, there is a growing consensus that the most effective way to prevent and help people heal from widespread traumas is to engage a large and diverse array of trusted local community leaders—with a special emphasis on marginalized groups—in designing and implementing actions that build wellness and resilience among all residents.

Numerous community-based wellness and resilience-building initiatives exist in this country. Mental health professionals typically support the initiatives but do not lead them. They also assist people who, even after engaging in community-based initiatives, are still functionally impaired or are at risk of harming themselves or others.

In their own age and culturally tailored ways, community-based initiatives use evidence-based, promising, historical, and culturally tailored approaches to strengthen individual and collective protective factors. Many, for example, help residents become trauma informed and learn ways to calm their body, mind, and emotions when distressed. Building close connections with family, friends, and neighbors is often an important element. Enhanced capacity for self-regulation, or Presencing, is a central factor of mental wellness and resilience.

Many community-based initiatives also help people enhance their capacity to use hardships as transformational catalysts to find new sources of meaning, purpose, and realistic hope. This is a form of adversity-based growth called Purposing and is another core attribute of mental wellness and resilience because it motivates people to help others or the environment as a way to help themselves.

The combination of heightened capacity for Presencing and Purposing is a powerful form of prevention, resilience, and healing called Transformational Resilience.

Even with aggressive emission reductions, global temperatures are likely to soon reach and exceed levels that generate relentless traumas and toxic stresses for everyone. It is imperative that mental health professionals swiftly grasp what is at stake and expand our approaches to strengthen existing and launch new community-based initiatives nationwide to build population-level capacity for psychological and emotional wellness and resilience in the midst of ongoing adversities. ■