EDITORIAL Year : 2022  |  Volume : 20  |  Issue : 1  |  Page : 1-4

Exploring current responses to the climate crisis in MHPSS interventions in humanitarian settings

Wendy Ager1, Lennart Reifels2, Jura Augustinavicius3, Lena Pschiuk4
1 MSc, Editor in Chief, Intervention, Amsterdam, The Netherlands
2 PhD, Senior Research Fellow, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
3 PhD, Assistant Professor, School of Population and Global Health, McGill University, Canada
4 BA Social Work – Migration and Globalisation, MSc Student Global Health, Queen Margaret University Edinburgh, UK

Date of Submission24-Mar-2022Date of Decision19-Apr-2022Date of Acceptance19-Apr-2022Date of Web Publication31-May-2022

Correspondence Address:
Wendy Ager
Editor in Chief, Intervention, Nienoord 5-13, 1112XE Diemen
The Netherlands

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/intv.intv_3_22

How to cite this article:
Ager W, Reifels L, Augustinavicius J, Pschiuk L. Exploring current responses to the climate crisis in MHPSS interventions in humanitarian settings. Intervention 2022;20:1-4
  Introduction 

Welcome to the first issue of Intervention for 2022. We are opening the year by focussing a special section on the climate crisis and mental health and psychosocial support. We hope that the articles included demonstrate useful approaches and lessons learned in terms of practical MHPSS (mental health and psychosocial support) actions for the field.

We are also featuring a range of other articles that have been submitted alongside the ones received in response to the call for papers about the climate crisis. The paper by Oriya and Alekozai (pp. 28-35) concerns family caregivers of relatives with mental health difficulties in Afghanistan. Findings indicate the distress caused to caregivers in terms of their own wellbeing as well as to their immediate family through being stigmatised and outline the positive and negative coping strategies caregivers use in these very difficult circumstances. Two papers focus on children – the one by Ajwang' Warria (see pp. 5-11) being a review of the connections between trafficking and exploitation of children in fragile settings and the other by Nemiro et al. (pp. 36-45) concerned with integrating mental health and psychosocial wellbeing in education. The paper by Tankink et al. (pp. 46-57) moves into different territory, reporting on the intersection between post-conflict trauma, peacebuilding and economic development in northern Uganda. The remaining article by Sateemae et al. (see pp. 14-27) describes the experiences of high school students living in Southern Thailand in relation to a subnational conflict there. We also have an interesting field report on drama interventions in Lebanon written by Sakhi et al. (pp. 58-64). Finally, we are publishing a personal reflection from Sabah Abdulrahman (pp. 65-67) who established a non-governmental organisation called Azhee because of their experience of a family member taking their own life. The author reflects on the development of a suicide prevention national strategy in Iraq and the part played by Azhee in this initiative. We would welcome responses to all the issues raised in these articles.

  The Special Section on the Climate Crisis and MHPSS 

The Lancet Countdown (2022) on climate change and health states that “climate change is the greatest global health threat facing the world in the 21st century, but it is also the greatest opportunity to redefine the social and environmental determinants of health”. Climate change is rooted in human activities, including burning fossil fuels for energy, transport, and manufacturing, and changing natural landscapes for agricultural crops and farming animals. Overall, these activities contribute to an increase in greenhouse gases and a rise in global temperature, leading to an increase in the frequency and intensity of extreme weather events (e.g., heavy rainfalls, high winds, storms), extreme climate events (e.g., droughts) and effects linked to these such as flooding and wildfires (IPCC, 2021). A comprehensive body of research describes the detrimental impact of climate change on physical health, including a rise in vector-borne, water and food-borne diseases, an increase in acute and chronic respiratory conditions, and heat-related and extreme weather-related morbidity and mortality (Romanello et al., 2021).

Despite the growing public awareness about the health implications of climate change as well as the existing literature highlighting the detrimental impact on health outcomes, the effects of climate change on mental health and wellbeing have received comparatively less research attention (Charlson et al., 2022; Charlson et al., 2021; Hayes et al., 2018). Globally, mental disorders are among the leading causes of burden of disease, contributing to increased rates of premature mortality (WHO, 2022). Around 20% of the world's children and adolescents have a mental health condition, with suicide being the fourth leading cause of death among 15-29-year-olds (WHO, 2021). In conflict settings, 1 in 5 people experience a mental health condition (Charlson et al., 2019). The lack of attention to the mental health and climate change nexus is of particular concern as psychological impacts from any form of disaster exceed physical injury by 40-1 (Lawrance et al., 2021). Considering the notable increase of frequency of climate change-related weather disasters, young people are among the most vulnerable to the effects of climate change, carrying the largest burden to adapt and respond to its effects and impacts throughout their lives (Lawrance et al., 2021).

The available evidence suggests that exposure to more frequent and intense extreme weather events and the chronic or slower onset impacts of climate change have detrimental impacts on individuals' and communities' mental health and psychosocial wellbeing (Augustinavicius et al., 2021; Hayes et al., 2018; Lawrance et al., 2021; Leppold et al., 2022). Sudden-onset disasters such as flash floods, bushfires, or tropical storms can raise the risk of experiencing a range of mental health and psychosocial problems, including posttraumatic stress disorder (PTSD), depression, anxiety, grief, survivor guilt, recovery fatigue, substance abuse, and suicidal ideation (Augustinavicius et al., 2021; Charlson et al., 2021; Hayes et al., 2018; Lawrance et al., 2021). Individuals living with pre-existing mental illness are even more vulnerable in disaster contexts (Jones et al., 2009). Chronic or slower onset impacts of the climate crisis, such as rising temperatures, rising sea levels, drought, and desertification, and associated losses of places, landscapes, cultures, and social connections have also been associated with a myriad of adverse impacts to mental health and wellbeing (Augustinavicius et al., 2021; Charlson et al., 2021; Hayes et al., 2018; Lawrance et al., 2021). The climate crisis is causing food and water scarcity, exacerbating the conditions for violent conflict, increasing migration and forced displacement, and damaging infrastructure and supply chains (IPCC, 2018; OCHA, 2021). These effects can further erode health and result in the loss of livelihoods, increase in social and economic instability, loss of community and sense of belonging, and increase the risk of interpersonal violence (Hayes et al., 2018; Hayward & Ayeb-Karlsson, 2021; Romanello et al., 2021). These factors increase risks for poor mental health and wellbeing, exacerbate conditions for those living with mental disorders, and disrupt mental healthcare provision with disproportionate impacts in low resource and humanitarian settings (Augustinavicius et al., 2021; Charlson et al., 2021; Hayes et al., 2018; Lawrance et al., 2021). The large treatment gap for mental health conditions in low- and middle-income country (LMIC) settings leads to a double burden of worsening climate change-related events and a lack of resources to cope with the likely mental health consequences. The threats of climate change are also driving feelings of despair and hopelessness, as political efforts to address the magnitude of problems caused by climate change seem insufficient (Hickman et al., 2021). At the same time, psychological and social responses to the climate crisis may also inspire empathy, compassion, altruism, emotional resilience, and engagement with climate mitigation and adaptation (Augustinavicius et al., 2021; Hayes et al., 2018; Palinkas et al,. 2020, White, 2020).

Climate change exposure and effects are not distributed equally, with LMIC settings being most vulnerable towards health hazards, despite having contributed least to the global climate crisis through their CO2 emissions per capita (Charlson et al., 2021; Hayes et al., 2018; Hayward & Ayeb-Karlsson, 2021). This double inequality of climate change is reflected in the concept of climate justice, highlighting the “inverse distribution between risk and responsibility” (Charlson et al., 2021, p. 13). Many of those already facing adverse social and economic conditions that increase risk of poor mental health are also most affected by the climate crisis, including indigenous peoples, children and youth, seniors, women, people with low-socioeconomic status, outdoor labourers, racialised people, migrants and refugees, and people with pre-existing health conditions (Lund et al., 2018; Patel et al., 2018). Hence, climate change is understood to act as a health threat amplifier, exacerbating already existing health and social inequalities (Watts et al., 2018). The concurrent and interconnected risks posed by a changing climate are understood to overturn extensive efforts in tackling food and water insecurity that still affect the most underserved populations globally, compromising essential aspects of good health (Romanello et al., 2021).

In view of the unfolding and anticipated future impacts of climate change on mental health globally, several key questions are facing the MHPSS field today. These concern a better understanding of the complex spectrum of climate change related mental health impacts, the adequacy and merit of the existing arsenal of MHPSS interventions, and the future role and capacity of MHPSS actors and wider stakeholders to effectively prevent and address these. To this end, researchers and practitioners are increasingly seeking to understand what can be learned from existing MHPSS approaches for future responses in the context of the climate crisis, probing the merit of existing and promising new interventions, whilst striving to establish consensus on key research priorities to drive this field forward.

  Introducing the Articles in the Special Section 

We received a strong response to the call for papers for this special section and after reviewing all the submissions, we selected the eight articles that are featured here: three research papers, two field reports, two personal reflections and one commentary. In the first category, Augustinavicius et al. (pp. 69-80) report on a modified Delphi process used to identify research priorities for MHPSS and climate crisis research. This is a crucial contribution, given the urgency of prioritising MHPSS response to the climate crisis. Devonald et al. (pp. 81-97) then address the extent to which interventions in adolescent mental health in humanitarian settings consider climate change. It is of concern that their review finds no reference to climate change in the literature they identify. They also highlight that studies rarely disaggregate data by sex or disability, making it hard to fully appreciate intersectional impacts of MHPSS on adolescents. Marzouk et al. (pp. 98-106) survey the perceptions of climate change of internally displaced persons in Iraq. This is a particularly useful contribution in presenting the perspectives of those directly experiencing the impacts of the climate crisis in very challenging circumstances.

In the first of the two field reports, Eaton et al. (pp. 107-113) present a series of case studies of MHPSS activities linked to climate change-related emergencies in Bangladesh, Burkna Faso, Madagascar, Nigeria, Sierra Leone and Zimbabwe. Documenting means of effectively engaging marginalised communites across a diverse range of settings, the paper makes a strong case for MHPSS being considered a core component of any coordinated response to climate change. Elshazly et al. (pp. 114-118) relate the work of the MHPSS working group in Cox's Bazar, Bangladesh in developing and implementing an emergency preparedness and response plan in relation to the risks associated with the monsoon season. The authors particularly reflect on lessons learned from this task in relation to other climate change-related emergencies.

The personal reflection by Ziveri (pp. 119-122) is a call to an inclusive debate on global mental health strategies and practices, drawing on the concept of planetary health in light of the climate crisis. Jones (pp. 123-127) then presents a personal account of a children's nature-based, photography project. The author recommends this activity for other children as a means of enhancing nature connectedness, increasing children's wellbeing and encouraging their wish to protect the environment. Finally, Massazza et al. (pp. 128-135) present a welcome commentary on the opportunities for using brief, scalable interventions to support mental health and wellbeing in the context of the climate crisis.

  Future Prospects for MHPSS in Relation to the Climate Crisis 

Despite a clear need for MHPSS in the context of the climate crisis, very little intervention research has been conducted within the broader climate change and mental health literature (Charlson et al., 2022; Charlson et al., 2021). The existing MHPSS literature, developed in the contexts of conflict, migration, and disasters caused by natural hazards, will undoubtedly serve as a useful starting point and guide for work on MHPSS and the climate crisis (Palinkas et al., 2020). Our hope is that this special section will build on this foundation and spark further inquiry and evidence generation in this area. For those designing and implementing MHPSS, there is a movement to integrate mental health and wellbeing in disaster risk reduction efforts (Gray et al., 2020; Gray et al., 2021) and there are calls to integrate MHPSS with work in a variety of other humanitarian sectors as part of climate crisis and MHPSS response as a growing number of NGOs, UN agencies, inter-agency networks, and academic institutions have taken up the issue of climate change and mental health. Inter-agency efforts are also underway to identify, map, and describe climate change and MHPSS activities globally.

  From the Editor in Chief 

Before closing, I wanted to draw your attention to the forthcoming publication by WHO of the World Mental Health Report: Transforming Mental Health for All, which will be launched on 24 June 2022. It will feature examples of good practice in addressing mental health needs – and give voice to people's lived experience - from across the world. This is potentially an important tool to support advocacy and development where responses to mental health and psychosocal support fall short of what is required. I would very much welcome your commentaries or reflections on the report when you have had opportunity to read it.

Finally, I would like to express my great thanks to the team of guest editors – Dr. Lennart Reifels, Dr. Jura Augustinavicius and Lena Pschiuk – for their collective wisdom and wonderful support in reviewing and guiding the publication of the special section.

Financial support and sponsorship

We would like to acknowledge with thanks the generous financial support of WHO, UNICEF and the MHPSS Collaborative for the costs of publishing the special section on the climate crisis and MHPSS.

Conflicts of interest

There are no conflicts of interest reported.

 

  References 
1.Augustinavicius, J., Lowe, S. R., Massazza, A., Hayes, K., Denckla, C. A., White, R. G., . . . Berry, H. (2021). Global climate change and trauma. Chicago, IL, International Society of Traumatic Stress Studies.  
    2.Charlson, F., Ali, S., Augustinavicius, J., Benmarhnia, T., Birch, S., Clayton, S., . . . Massazza, A. (2022). Global priorities for climate change and mental health research. Environment International, 158, 106984. doi:https://doi.org/10.1016/j.envint.2021.106984.  
    3.Charlson, F., Ali, S., Benmarhnia, T., Pearl, M., Massazza, A., Augustinavicius, J., & Scott, J. G. (2021). Climate Cchange and mental health: A scoping review. International Journal of Environmental Research and Public Health, 18(9), 4486. doi: https://doi.org/10.3390/ijerph18094486.  
    4.Gray, B., Eaton, J., Christy, J., Duncan, J., Hanna, F., & Kasi, S. (2021). A proactive approach: Examples for integrating disaster risk reduction and mental health and psychosocial support programming. International Journal of Disaster Risk Reduction, 54, 102051. doi: https//doi.org/10.1016/j.ijdrr.2021.102051.  
    5.Gray, B., Hanna, F., & Reifels, L. (2020). The integration of mental health and psychosocial support and disaster risk reduction: A mapping and review. International Journal of Environmental Research and Public Health, 17(6), 1900. doi:10.3390/ijerph17061900.  
    6.Hayes, K., Blashki, G., Wiseman, J., Burke, S., & Reifels, L. (2018). Climate change and mental health: risks, impacts and priority actions. International Journal of Mental Health Systems, 12, 28. doi: https://doi.org/10.1186/s13033-018-0210-6.  
    7.Hayward, G., & Ayeb-Karlsson, S. (2021). 'Seeing with Empty Eyes': a systems approach to understand climate change and mental health in Bangladesh. Climatic Change, 165(1), 1-30. doi: https://doi.org/10.1007/s10584-021-03053-9.  
    8.Hickman, C., Marks, E., Pihkala, P., Clayton, S., Lewandowski, R. E., Mayall, E. E., . . . van Susteren, L. (2021). Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. The Lancet Planetary Health, 5(12), e863-e873. doi:https://doi.org/10.1016/S2542-5196(21)00278-3.  
    9.Intergovernmental Panel on Climate Change. (IPCC). (2018). Summary for Policy Makers. In V. Masson-Delmotte, P. Zhai, H. O. Pörtner, D. Roberts, J. Skea, P. R. Shukla, A. Pirani, W. Moufouma-Okia, C. Péan, R. Pidcock, S. Connors, J. B. R. Matthews, Y. Chen, X. Zhou, M. I. Gomis, E. Lonnoy, T. Maycock, M. Tignor, & T. Waterfield (Eds.), Global warming of 1.5°C. An IPCC Special Report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty (pp. 32). World Meteorological Organization.  
    10.IPCC. (2021). Summary for Policymakers. In V. Masson-Delmotte, P. Zhai, A. Pirani, S. L. Connors, C. Péan, S. Berger, N. Caud, Y. Chen, L. Goldfarb, M. I. Gomis, M. Huang, K. Leitzell, E. Lonnoy, J. B. R. Matthews, T. K. Maycock, T. Waterfield, O. Yelekçi, R. Yu, & B. Zhou (Eds.), Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. IPCC.  
    11.Jones, L., Asare, J. B., El Masri, M., Mohanraj, A., Sherief, H., & van Ommeren, M. (2009). Severe mental disorders in complex emergencies. The Lancet, 374(9690), 654-661. doi:https://doi.org/10.1016/S0140-6736(09)61253-8.  
    12.Lawrance, E., Thompson, R., Fontana, G., & Jennings, D. (2021). The impact of climate change on mental health and emotional wellbeing: Current evidence and implications for policy and practice. Retrieved from: https://doi.org/10.25561/88568.  
    13.Leppold, C., Gibbs, L., Block, K., Reifels, L., & Quinn, P. (2022). Public health implications of multiple disaster exposures. The Lancet Public Health, 7(3), e274-e286.doi: https://doi.org/10.1016/S2468-2667(21)00255-3.   
    14.Lund, C., Brooke-Sumner, C., Baingana, F., Baron, E. C., Breuer, E., Chandra, P., . . . Kieling, C. (2018). Social determinants of mental disorders and the Sustainable Development Goals: A systematic review of reviews. The Lancet Psychiatry, 5(4), 357-369. doi: https://doi.org/10.1016.S2215-0366(18)30060-9.  
    15.OCHA. (2021). Global Humanitarian Overview 2022. Retrieved from https://reliefweb.int/sites/reliefweb.int/files/resources/Global%20Humanitarian%20Overview%202022.pdf.  
    16.Palinkas, L. A., O'Donnell, M. L., Lau, W., & Wong, M. (2020). Strategies for delivering mental health services in response to global climate change: A narrative review. International Journal of Environmental Research and Public Health, 17(22), 8562. doi: https://doi.org/10.3390/ijerph17228562.  
    17.Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., . . . UnÜtzer, J. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553-1598. doi:https://doi.org/10.1016/S0140-6736(18)31612-X.  
    18.Romanello, M., McGushin, A., Di Napoli, C., Drummond, P., Hughes, N., Jamart, L., . . . Hamilton, I. (2021). The 2021 report of the Lancet Countdown on health and climate change: Code red for a healthy future. The Lancet, 398(10311), 1619-1662. doi: https://doi.org/10.1016/S0140-6736(21)01787-6.  
    19.The Lancet (2022) Tracking progress on climate change. Available at: https://www.thelancet.com/countdown-health-climate/about  
    20.Watts, N., Amann, M., Ayeb-Karlsson, S., Belesova, K., Bouley, T., Boykoff, M., . . . Costello, A. (2018). The Lancet Countdown on health and climate change: From 25 years of inaction to a global transformation for public health. The Lancet, 391(10120), 581-630. doi:https://doi.org/10.1016/S0140-6736(17)32464-9.  
    21.White, R. G. (2020). Mental wellbeing in the Anthropocene: Socio-ecological approaches to capability enhancement. Transcultural Psychiatry, 57(1), 44-56. doi: https://doi.org/:10.1177/1363461518786559.  
    22.World Health Organization. (WHO). (2021). Suicide worldwide in 2019. Retrieved from https://www.who.int/publications/i/item/9789240026643.  
    23.World Health Organization. (WHO). (2022). Mental Health. Retrieved from https://www.who.int/health-topics/mental-health#tab=tab_1.