Oliver Freudenreich, MD, FACLP Co-Director, Massachusetts General Hospital Psychosis Clinical and Research Program Director, Massachusetts General Hospital Fellowship in Public and Community Psychiatry Associate Professor of Psychiatry Harvard Medical School Boston, Massachusetts
Katherine A. Koh, MD, MSc Co-Chair, Disaster Readiness Committee, Massachusetts Psychiatry Society Assistant Professor of Psychiatry Harvard Medical School Boston, Massachusetts
Elizabeth K. Haase, MD Chair, Climate Committee, Group for the Advancement of Psychiatry Physician Chief, Carson Tahoe Regional Medical Center Behavioral Health Clinical Professor of Psychiatry University of Nevada School of Medicine at Reno Reno, Nevada
Disclosures Dr. Freudenreich has served as a consultant for Alkermes, the American Psychiatric Association, Janssen, Karuna, Neurocrine, and Vida, received research grants from Alkermes, Janssen, Karuna, and Otsuka, received medical education honoraria from Elsevier and Medscape, and received royalties from Springer Publishing, UpToDate, and Wolters Kluwer. The other authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
Clinics must prepare for disasters in their communities to prevent disruption of psychiatric care by having an action plan, including the provision of medications. Such action plans should be prioritized for the most likely scenarios in an individual’s setting (eg, heat waves, wildfires, hurricanes, or flooding).
It is important to educate clinic staff and include them in planning for emergencies, because an all-hands approach and buy-in from all team members is critical. Clinicians should review how patients would continue to receive services, particularly medications, in the event of a disaster. In some cases, providing a 90-day medication supply will suffice, while in others (eg, patients receiving long-acting antipsychotics or clozapine) more preparation is necessary. Some events are predictable and can be organized annually, such as clinicians becoming vaccine ambassadors and organizing vaccine campaigns every fall50; winter-related disaster preparation every fall; and heat wave education every spring (leaflets for patients, staff, and family members; review of safety of medications during heat waves). Plan for, monitor, and coordinate medical care and services for climate refugees and other populations that may otherwise delay medical care and impede illness prevention. Finally, support climate refugees, including connecting them to services or providing trauma-informed care.
Political
Some clinicians may feel compelled to become politically active to advocate for changes within the health care system. Two initiatives related to decarbonizing the health care sector are My Green Doctor51 and Health Care Without Harm,52 which offer help in shifting your office, clinic, or hospital towards carbon neutrality.
Climate change unevenly affects people and will continue to exacerbate inequalities in society, including individuals with mental illness.53 To work toward climate justice on behalf of their patients, clinicians could join (or form) climate committees of special interest groups in their professional organizations or setting. Joining like-minded groups working on climate change at the local or national level prevents an omission of a psychiatric voice and counteracts burnout. It is important to stay focused on the root causes of the problem during activism: doing something to reduce fossil fuel use is ultimately most important.54 The concrete goal of reaching the Paris 1.5-degree Celsius climate goal is a critical benchmark against which any other action can be measured.54
Planning for the future
Over the course of history, societies have always faced difficult periods in which they needed to rebuild after natural disasters or self-inflicted catastrophes such as terrorist attacks or wars. Since the advent of the nuclear age, people have lived under the existential threat of nuclear war. The Anthropocene is a proposed geological term that reflects the enormous and possibly disastrous impact human activity has had on our planet.55 While not yet formally adopted, this term has heuristic value, directing attention and reflection to our role and its now undisputed consequences. In the future, historians will debate if the scale of our current climate crisis has been different. It is, however, not controversial that humanity will be faced with the effects of climate change for the foreseeable future.10 Already, even “normal” weather events are fueled by energy in overcharged and altered weather systems due to global warming, leading to weather events ranging from droughts to floods and storms that are more severe, more frequent, and have longer-lasting effects on communities.56
