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Annual MeetingFull Access

Climate Change Said to Be ‘Ultimate Social Determinant of Health’

Published Online:https://doi.org/10.1176/appi.pn.2018.3b11

Abstract

Activists say psychiatrists will be treating patients for the acute effects of extreme weather events and will also have a role in addressing helplessness and passivity in the face of climate change.

A growing contingent of psychiatrist activists calling themselves the Climate Psychiatry Alliance (CPA) is seeking to draw attention to what they call a slow-motion catastrophe in the making.

“Psychiatrists and other mental health professionals have an ethical obligation to understand and treat the clinical and public health consequences of the slow-moving disaster that is climate change,” said David Pollack, M.D., a professor of public policy at Oregon Health Science University and a founding member of CPA. “Climate is the ultimate social determinant of health, profoundly, and sometimes acutely, affecting all of those variables traditionally thought of as the social and environmental influences on health and illness. We believe that advocating for rational public policies at the local and national levels to address the risks to health and life posed by climate change is going to be a part of our ongoing practice as psychiatrists indefinitely.  

“We must help to create and sustain our ‘good enough’ Mother Earth,” Pollack said.

Two events—a symposium and a workshop—will be presented by the Alliance at the Annual Meeting in New York:

  • “When the Disaster Is Slow Moving: Implications for Psychiatry of Climate Change”: This symposium will explore a tripartite relationship of psychiatry with climate: the clinical challenge of helping patients engage with the reality of climate change, the professional responsibility to transform mental health care systems into environmental sustainability, and the contribution mental health professionals can make to psychosocial adaptation and resilience. Innovative programs aiming to train communities and individuals in “transformational resilience” will be reviewed and discussed. (Sunday, May 6, 8 a.m.-11 a.m.)

  • “Mental Health Professionals in the Era of Deteriorating Climate Conditions: Do We Have an Ethical Duty to Warn and Protect?”: This workshop, divided into three sections, will address the question in the session title as well as other questions: the first section will provide an overview of the accelerating mental health toll from the impacts of climate change. The second section will look at ethical and legal precedents that serve to guide psychiatrists’ actions, assisting them in evaluating the appropriateness and necessity of speaking up on this issue. The third section will review “good news,” a broadening focus on what psychiatrists can do to reduce future harm to our climate and build resilience both in individuals and in communities. Existing successful efforts in these realms such as the “greening” of practices and “transformational resilience” training will be presented as models. This will be followed by a brainstorming breakout session organized by interest to discuss and to propose new “best practices.” (Monday, May 7, 8 a.m.-9:30 a.m.)

Both events will be chaired by Lise Van Susteren, M.D., a forensic psychiatrist in Washington, D.C. Speakers include, in addition to Pollack, Steven Moffic, M.D., retired tenured professor of psychiatry and behavioral health and family and community medicine at the Medical College of Wisconsin; Janet Lewis, M.D., a clinical assistant professor of psychiatry at the University of Rochester; Elizabeth Haase, M.D., an associate professor of psychiatry at the University of Nevada School of Medicine; Carissa Caban-Aleman, M.D., medical director of behavioral health for student health services at the Herbert Wertheim College of Medicine, Florida International University; and Sara Gorman, Ph.D., M.P.H., a mental health and public health consultant and writer in New York City.

Core members of CPA include members of a similar committee of the Group for the Advancement of Psychiatry that is focused on climate change. It also includes a growing number of others who have been concerned about the issue for years or are becoming so now.

Pollack emphasized that psychiatrists can help address the helplessness and passivity that may keep people from acting and help support what he and others call climate-change denial. “We can and should be the professionals who can say to people that we are falling prey to a collective, maladaptive psychological defense mechanism of denial that we use to protect ourselves from anxiety and distress, but which ultimately does not serve our best interests,” he said.

At the March 2017 meeting of the APA Board of Trustees, the Board approved a position statement on mental health and climate change. It reads: APA “recognizes that climate change poses a threat to public health, including mental health. Those with mental health disorders are disproportionately impacted by the consequences of climate change. APA recognizes and commits to support and collaborate with patients, communities, and other health care organizations engaged in efforts to mitigate the adverse health and mental health effects of climate change.”

Prior to that, the American Association of Community Psychiatrists approved a similar statement that says, “Persons with mental illnesses and behavioral health challenges are disproportionately impacted by the consequences of climate change. Psychiatrists are uniquely positioned to help reduce barriers to addressing climate change, such as denial, hopelessness, and behavioral passivity, and to enhance efforts to communicate the public health and mental health risks of climate change through mechanisms that result in sustained behavioral change.”

Also at the Annual Meeting, the APA Committee on Psychiatric Dimensions of Disaster will present the course “Disaster Psychiatry Review and Updates: Terrorist Mass Killing, Climate Change, and Ebola” on Saturday, May 5, from 1 p.m. to 5 p.m. ■

Information and resources about climate change are posted on APA’s website.