In Conversation with Dr. Jura Augustinavicius

Dr. Jura Augustinavicius, Assistant Professor at the McGill School of Population and Global Health, explains how climate change impacts mental health.

By Anna Palmer

Dr. Jura Augustinavicius is an Assistant Professor at the School of Population and Global Health at McGill University and an Adjunct Professor in the Department of Mental Health at the Johns Hopkins School of Public Health. Her research focuses on mental health assessment and intervention among populations in low-resource humanitarian settings and in the context of climate change.

Climate change and mental health are not often thought of as being linked. Can you talk about some of the ways climate change influences mental health?

There are a number of pathways through which climate change affects mental health. One group of pathways involves acute climate change exposures – like extreme heat, hurricanes, floods, and wildfires. The associations between acute exposures and mental health outcomes have been documented in part by the disaster mental health literature. For example, this literature includes post-disaster mental health surveys and a few comparisons of pre-disaster to post-disaster symptom levels in different populations. 

Another group of pathways relates to chronic climate change related exposures – such as long-term changes in temperature, sea-level rise and loss/change of landscapes and environments. In addition to potential impacts on mental health symptoms and mental disorders, the literature has also highlighted effects on cultural and social outcomes. Work in this area has resulted in the emergence of concepts such as “ecological grief”, which was initially used to describe experiences among specific Indigenous and rural populations who have experienced tremendous changes to their landscapes due to climate change. 

The third group of pathways relates to the existential threat of climate change and what we anticipate the impacts will be based on what we know to be going on around us. There’s a lot written in the media about anticipatory anxiety. You’ve probably heard about things like “eco-anxiety” or “climate change anxiety”. These would fall into this bucket.

It’s also important to mention that many mental health and well-being responses to climate change represent normative reactions to a very serious threat affecting the world and its inhabitants. We must be careful not to pathologize normative reactions. In parallel to understanding population needs in the context of climate change and mental health, our ultimate goal with mental health assessment is to ensure that people are provided with the rights kinds of services to meet their needs.  

Many people experience negative mental health impacts from climate change. Can you talk about who is most vulnerable to mental health impacts from climate change?

There are vulnerabilities across the life course. For instance, there is broad recognition that children, adolescents, and young people are disproportionately affected, because of developmental vulnerabilities and life stages. At the other end of the life course, older adults are also at increased risk, for example, due to possible physical health challenges and risks associated with social isolation.

Living with fewer resources, or an existing physical/mental health condition, is also something that will put people at enhanced risk. These factors can interact. For instance, people with very limited resources who may not have access to air conditioning and who also have severe mental illness can experience worse outcomes during periods of extreme heat due to exacerbation of symptoms and the impacts of heat on how medications work. 

We also know about a lot of environmental health inequalities that are also relevant to climate change and mental health. For example, particular racialized populations may be disproportionately affected based on where they live and resources that may not be available in those areas, such as clean air, water, air conditioning, or green space. Migrants and people experiencing conflict are also at very high risk of adverse mental health outcomes in the context of climate change. These dynamics are very complex because climate change can serve as a factor that forces people to move, or that exacerbates conflict. Climate change may also impact the conditions in places that people move to. 

Many of the groups that I mentioned are at risk of other adverse health impacts of climate change, not just mental health. The overarching idea is that climate change is a risk amplifier. If there is an existing risk, then climate change will make that worse.

Can you talk about the extent of research that has been done on climate change and mental health?

Climate change and mental health is not an entirely new area. There have been some great thinkers and people writing on this topic for a long time. But unfortunately it’s really only gained traction within recent years. You’ve probably noticed a growing number of media reports and reviews and commentaries in the academic literature on this topic. 

One area in which there is a noticeable gap is on intervention research related to climate change and mental health. There also isn’t a lot of research at the policy level and there are no attribution studies that explicitly link climate change to mental health outcomes. 

What can governments and communities do to support people who are at risk of mental health impacts in relation to climate change?

A lot of work has been done among people living in low resource contexts or in humanitarian contexts. There are many interventions already being delivered by international NGOs and UN agencies. All of that is applicable to climate change and mental health work.

I think when it gets more challenging is with chronic climate exposures and anticipatory anxiety because the impacts of those things are not as well understood. It’s hard to develop interventions when we are still trying to understand the problem.

There are also interventions that we may or may not classify as mental health interventions but that are relevant to climate change and mental health. For instance, the way that humanitarian aid is delivered, or the availability of livelihood opportunities that both contribute to mental health and well-being and support climate change adaptation, or gender-based violence reduction are all relevant to mental health and climate change.  

From my perspective, an area where further work is needed on the intervention side is integration with non-mental health services. In many contexts we tend to deliver services in a very siloed way. For example, people get their mental health services, then their livelihoods, and violence prevention supports separately. They are independently delivered, which is not only inefficient but also fails to realise the holistic impacts of climate change on people, families, and their communities. Climate change isn’t just something that impacts mental health and we need to treat people in a way that holistically addresses their needs.

Understandings of mental health can vary substantially around the world. What are some of the challenges of studying mental health within a global context?

This comes back to a lot of the discourse on and critiques of global mental health. A lot of the way that we look at mental health has a Global North perspective based on psychiatric diagnoses stemming from the DSM or ICD. There is utility to that, particularly in contexts where these systems were developed and where they are deemed relevant. However, these classifications may not be the most relevant or most appropriate in all contexts. People experience all kinds of mental health problems and dimensions to mental wellbeing. These can vary substantially across cultures and contexts. 

We often talk about “etic” and “emic” approaches. “Etic” approaches take an outsider’s perspective. This can be useful for comparing mental health concepts across countries and populations. But we know that this approach is deeply imperfect because it is generally based on tools and classification systems developed in the Global North according to Western conceptualisations of mental health. These tools are not necessarily well-adapted for every population. “Emic” approaches take an insider’s perspective, allowing us to conceptualise and measure concepts as they emerge from within a population. These conceptualizations can give us a more specific and potentially accurate picture of what is going on in a particular locality or community. The challenge is that we can’t compare these measures across settings. My opinion is that we need both of these perspectives to understand how climate change is affecting mental health.

It is also important to remember that when we’re thinking about climate change, the people and communities who are most impacted by the problem should be at the centre of the work being done. They should be participating equally and leading or co-leading the work to understand what is going on. Interventions should also directly respond to the most important needs in communities. These are just basic good practice principles in global health work, but they are also critical to work on climate change and mental health.

Thank you Dr. Augustinavicius for speaking to me and for sharing your insights on this important topic.