It Takes a Village to Take Care of a Planet

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By Elizabeth Haase, MD, for the Climate Psychiatry Alliance

All together, right now, no matter what it takes-only this attitude can unite our response to the climate catastrophe that is the imminent consequence of our many small everyday actions. And the APA Assembly seems to know it, rising in near unison to support all action papers addressing climate change at the May 2019 meeting in San Francisco. The action papers ask the APA to review the literature demonstrating climate-specific psychiatric impacts and to perform a study on how climate disruption will change psychiatric service needs in different regions of the United States. They provide for a climate mental health curriculum for residents and medical students, and will provide APA members and leaders with evidence-based conclusions and recommendations for best practices to help patients with climate distress and impacts of heat and fossil fuel pollution on the brain. A final action paper recommends a tool to assist psychiatric practices in creating sustainable policies and procedures.

The Assembly’s bold actions place the APA squarely on the right path to educate a new generation of psychiatrists for sustainable psychiatry and prepare them for coming climate mental health challenges. As recent studies demonstrate, their action comes just in time to respond to increases in suicide that will counterbalance the positive influence of “all existing suicide prevention programs” (Burke, 2018) and double rates of dementia (Cacciottolo, 2017), among other critical impacts.

Joint Reference Committee 2 moved the papers, under Chair Dr Mary Ann Schaepper, who voiced her excitement to “lead forward on climate change and mental health,” noting, “My sister, an environmental activist, is proud of me!” Younger members of JRC2 helped articulate the urgent need for action. Dr Jorien Breur made it clear that “the mental health consequences of climate change are occurring here and now.” Dr Hector Colon-Rivera, APA Hispanic Caucus President, spoke to the importance of “a well-structured public health system to address these effects” in supporting an action paper asking for climate service-need research. He continued, “Our field of psychiatry should move forward with strategies that could bring resilience as well as reduce inequities for our patients. There is a need to mainstream research efforts on climate change in order to systematically collect data on adverse effects of climate change on mental health.”

Members of the Climate Psychiatry Alliance, a group that has been working for several years on how psychiatry can respond to climate disruption, collaborated with members of the Assembly in the writing of these action papers. The CPA group also led 13 presentations at the meeting, addressing everything from the latest translational psychiatry research on how air pollution damages neuronal function to the uses of nature in psychiatric treatment.

CPA members kicked off the APA meeting with an 8 AM presentation Saturday morning, “Climate 101,” led by Chair Dr Anne Richardson. In other presentations, Dr J. C. Chen of USC reviewed the epidemiological evidence connecting greenhouse gases and dementia. Dr Pamela Lein from UC Davis showed preliminary results on microglial activation with exposure to traffic-based pollution. Dr Lise Van Susteren played the sounds of birds and rain to relax an overflow crowd in a panel on incorporating nature into psychiatric practice. Small groups then engaged in enthusiastic brainstorming and shared the ways they might incorporate nature-based practices into their work. Drs Janet Lewis and Elizabeth Haase explored theoretical and technical approaches to working psychotherapeutically with the extreme emotions generated by the existential threats of climate. Dr Cabán-Alemán gave a lecture showing how climate change interacts with social determinants of mental health such as poverty, systemic oppression, and structural racism, particularly as manifest in Puerto Rico after Hurricane Maria. Along the way, Drs Alex Trope, David Pollack, and Robin Cooper and many international experts from outside psychiatry led panels on ways the APA can innovate and advocate for a more sustainable path, including panels on Refugees, Sustainable Psychiatry and a healing path for “Good Enough Mother Earth.”

Building on the meeting theme “Revitalizing Psychiatry: Disrupt, Include, Engage and Innovate,” the meetings gave opportunities for groups and caucuses with shared concern for the environment, climate change, equity, and justice to build alliances and begin longer conversations. As the United States stalls on climate action despite the hundreds of billions of dollars already lost to climate disruptions in weather and food supplies for our great nation, these actions are a much needed part of a program forward, one based on science and sane concern for the welfare of our children.