Why heatwaves are a mental health emergency we must address

Larry Freeman, MD, McKenna Parnes PhD, and Robert Berley, PhD,  are mental health professionals who have been concerned about the emotional and psychological toll of climate change, and members of the Climate and Health Task Force at Washington Physicians for Social Responsibility.

With summer upon us, heat and smoke are once again looming threats. Among these threats is a quieter, equally as serious crisis: the mental and emotional impacts of our changing climate.

Climate change is driving a wave of emotional distress, especially among young people. A 2023 global survey found that over 85% of people around the world report some form of anxiety about climate change and their futures. The severity of distress increases as respondents indicate that they do not feel governments have addressed this problem effectively. Roughly two thirds of young adults report climate distress, but less than half of that group believes others share their fears - worsening feelings of helpless concern and isolation. A majority of adults over 30 worry about the emotional effects the younger generations will face. Chronic worry and feelings of isolation and powerlessness have not only psychological harms: physical health and interpersonal relationships suffer as well.

Even here in the Pacific Northwest where many don’t consider it to be “too hot”, excessive heat has specific mental health effects: irritability, anger and conflict; domestic violence and resultant PTSD incidents; apprehension and feeling trapped; sleep loss which undermines physical and psychological well-being. The groups most at risk, i.e., young people, outdoor workers, the elderly, and people without air conditioning deserve particular concern.

We see elderly patients who become housebound during heatwaves, developing depression from isolation. We hear stories of workers, of whom mom or dad is one, at risk in the hot weather. Children share their concerns about the future, seeing an orange sky and worrying that the apocalypse is happening. Outdoor workers wrestle with the decisions between safety and a paycheck.

A 2022 study in Environment International shows for every 1 degree celsius increase in temperature, emergency psychiatric visits increase and heat-related mental health deaths increase by 2.2%. Domestic violence incidents spike during these times.

For those already struggling with climate anxiety, extreme heat becomes confirmation that their fears are materializing. The combination creates a dangerous spiral: heat worsens mental health, while climate anxiety makes each heat event more traumatic. People taking psychiatric medicines frequently have even greater susceptibility to heat related physical health complications.

The “heat dome” we experienced in 2021 will happen again. How will we react? Or most importantly, how will we prepare? We cannot let another summer pass without acknowledging this emergency. The mental health impacts of climate emergencies need more attention.

We must treat this like the public health crisis it is. Mental health considerations must be built into every layer of our emergency response.

Ensuring mental health considerations in emergency preparedness is no longer a “nice to have”,  but a necessity. We call upon physicians, hospitals, counselors, schools, governments, religious leaders, and businesses to accept their responsibility and lead us through this crisis. When communities prepare for heat emergencies together, they build physical safety and psychological resilience.

We’re obliged to consider things we might not have considered. For example, cooling schools isn’t just about keeping a school cool, but reducing the emotional burden on children, teachers, and caregivers. Employers must adjust the expectations of workers during heatwaves. 

Governments have a significant role to play. Expanding urban tree canopy keeps those in public spaces cool, and increasing access to greenspace has significant benefits for children’s mental health. Developing heat mitigations plans will equip hospitals and emergency department with the funding and processes they need to save lives during heat crises. Buildings - both new and old - must equip the cooling infrastructure they need to protect those most vulnerable.

Being upset about the climate means one has the courage to pay attention and care appropriately. Having these concerns isn’t so-called “climate hypochondriasis”. We are facing a real crisis that needs action. The good news is that action itself heals. Community efforts to address climate change provide us the sense of agency and connection that counters climate anxiety.