The German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) has addressed the public with the "Berlin Declaration on Climate Change and Mental Health". Two members of the task force that drew up the paper belong to University Medicine Oldenburg: Prof Dr Dr René Hurlemann, Director of the University Clinic for Psychiatry and Psychotherapy at the Karl Jaspers Clinic (KJK), and Dr Nina Marsh, Head of the "Social Neuroscience" research group at the KJK.
Terms such as "solastalgia" and "eco distress" are now heard more frequently, and they also appear in the Berlin Declaration. What do they mean and how seriously should these phenomena be taken from a therapeutic perspective?
Hurlemann: These are neologisms. Eco distress, often also called eco anxiety, describes the stressful feeling of living in times of climate change and against the backdrop of increasing environmental problems and being powerless in the face of them. I would not say that eco distress is a disorder per se, but rather describes a heightened awareness, which in turn can be a harbinger of a disorder. If I develop strong feelings of fear, anger and helplessness against the background of the changed environmental conditions, I also have a higher risk of stress-induced mental illnesses such as anxiety disorders.
Marsh: The emotional pain that we call "solastalgia" can often not be clearly categorised by those affected. They describe it as a kind of homesickness, even though they may never have left their home country. It affects people who see their own living space destroyed by environmental disasters. If you look at the Ahr valley, for example, where many people have lost their homes due to flooding, events like this can lead to solastalgia.
However, environmental influences can also have a much more direct impact on mental health. What connections are there?
Hurlemann: There are a number of studies that show that the number of people suffering from depression increases with particulate matter pollution. This observation has been particularly well established for air pollution. However, it could be that other environmental toxins also have an influence on mental health.
People living in cities are particularly affected by environmental pollution. It has long been known that urban living spaces harbour greater risks for mental illness. For example, people who grow up in cities have a higher risk of developing schizophrenia. Life there is characterised by less social support, greater economic pressure and greater isolation and loneliness - but also by unfavourable environmental conditions.
Marsh: Environmental influences also have a fundamental effect on cognitive functions such as memory performance. This does not only affect people with mental illnesses, but has a particularly unfavourable effect on them due to their pre-existing conditions.
According to the "Berlin Declaration", heat is particularly dangerous for people with pre-existing mental illnesses and can even lead to death. How is that connected?
Hurlemann: Very different things come together. On the one hand, when temperatures are high, we register an increase in behavioural problems of an aggressive or impulsive nature, for example risky driving, which can lead to a fatal accident. People with addiction problems respond to the stress caused by the heat by increasing their consumption. This harbours the risk of overdoses. In addition, as already mentioned, cognitive abilities decline when it is hot. As a result, older people with classic Alzheimer's dementia, for example, drink even less. The consequences: an electrolyte shift that causes those affected to lose consciousness or, in the worst case, die of thirst.
You also warn of the indirect consequences of climate change. What do you mean by that?
Hurlemann: Above all, this includes the aspects of food and drinking water. If both are no longer sufficiently available in a region, there will be an increase in flight and migration with the corresponding psychological consequences for those affected. Those who are forced to leave their family or home involuntarily have an increased risk of suffering from depression, anxiety and adjustment disorders.
People who have not experienced displacement will also be affected by the indirect consequences of climate change. I'm thinking of agriculture in Lower Saxony, for example. It is facing major transformation processes, such as the switch from conventional to climate-friendly livestock farming. Electromobility is causing changes in the automotive industry, which is strong here. Such processes always harbour the risk of people losing their jobs and experiencing personal economic hardship. And those who are not doing well financially also suffer more from mental illness in global crises, as studies have shown during the Covid-19 pandemic.
The task force recommends focussing on prevention in particular. How can we achieve the "mental fitness" we need to be able to deal with the impending climate changes and their consequences?
Hurlemann: One key aspect is to increase resilience, i.e. the ability to get through difficult life situations well. This includes educating people about the connection between environmental conditions and mental health. This is also one of the reasons why we published the Berlin Declaration.
There are also a number of other prevention strategies that need to be promoted. One of these, for example, is aimed at empowerment and ownership. This means that people should acquire enough health literacy to be able to take care of themselves. This also includes seeking psychological help at an early stage. Low-threshold services must be available for this.
Marsh: However, prevention also means that we as a society must pay particular attention to those people who are at the greatest risk of being affected by the consequences of climate change and who have few options to protect themselves effectively: Homeless people living on the streets, elderly frail people, or people with mental illness who are dependent on support from others.
The Berlin Declaration is also aimed at psychiatric and therapeutic institutions and makes recommendations for climate-conscious behaviour in everyday working life. Why do you combine the two areas?
Marsh: We don't want to give the impression that we are excluding ourselves from this major challenge as a specialised discipline. The implementation of sustainability strategies in hospitals under the heading of "green hospital" also affects psychiatric clinics. It is important to raise the awareness of those involved and to make the topic of climate protection more present in everyday working life.
A sustainability strategy should include ambitious goals, but at the same time be clear about the limits of climate protection for the respective sector. For example, due to hygiene standards, a hospital will always produce a certain amount of packaging waste that cannot be completely avoided. Only if climate targets and measures are clearly defined can all stakeholders focus on those areas where changes are actually possible, so that climate protection and sustainability are more than just PR phrases.
