May Is Mental Health Awareness Month

This May, ecoAmerica recognizes Mental Health Awareness Month by bringing awareness to the mental health and well-being impacts of climate change. Each week, we will feature blogs that provide a closer look on topics of mental health and climate change, featured in the report, Mental Health and Our Changing Climate. 

Because solutions are at hand, we are also featuring guidance for building community resilience against the climate change impacts on mental health. Below are ten steps to get you started.

1. Expand disaster response and resiliency plans
2. Increase social cohesion
3. Address disparities
4. Preserve cultural connections
5. Involve the community
6. Strengthen mental health services
7. Update infrastructure
8. Develop a trusted and effective warning and communication system
9. Train the people who will serve the community during a disaster
10. Prepare post-disaster recovery resources

GUIDANCE FOR STRENGTHENING COMMUNITY RESILIENCE

1. Expand disaster response and resiliency plans. Mental health professionals should be invited to add to or strengthen plans for mental health care and support as components of local and regional disaster response and resiliency plans. Ensure that plans include longer-term climate change and mental health considerations — and that impacted community members themselves are involved in the planning (The Praxis Project, 2021). Disaster management in the United States is most often described as a cyclical process with phases including prevention or mitigation, preparedness, response, and recovery. Mental health considerations are essential in all stages. 
2. Increase social cohesion. Resilient communities have strong networks of individuals and local organizations willing and able to work together, and a sense of trust among community members. This social cohesion arises from three types of social capital: bonding social capital is the close relationships among members of the same group, such as neighbors or church members; bridging social capital is the connections that occur among people from different social groups; and linking social capital is the relationships that bring groups into contact with other groups that hold economic, political, or other forms of power and influence (Pfefferbaum et al., 2017). Individual mental health is better in communities with stronger social fabric (Friedli, 2009). In a study of German flood victims, perceptions of collective-level forms of social support, such as a strong sense of community belonging, were more strongly linked to positive mental health outcomes than personal social support (Masson et al., 2019). And, older adults in communities with stronger social cohesion fared better after Hurricane Sandy (Heid et al., 2017). Community-wide social bonds are also more prevalent when social infrastructure exists that supports casual, daily interactions between residents. This includes parks and other green spaces, libraries, schools, recreation centers, public transportation, retail spaces, and cafes — shared spaces that allow community members to come into friendly contact with one another (Klinenberg, 2018). This was borne out during the 1996 Chicago heat wave. People living in Chicago’s Auburn Gresham neighborhood fared much better than those in the adjacent and demographically similar (poor and largely Black) Englewood neighborhood which suffered three times more heat wave-related deaths. Analysis showed that people in Auburn Gresham were more likely to check in on one another. Their high social cohesion was facilitated through an urban landscape of shops, public spaces, and community organizations (Klinenberg, 2013).
3. Address disparities. Unfortunately, the buffering effect of social support and social networks does not provide complete protection from the negative impacts of living in a marginalized and under-resourced community (Wickes et al., 2015). High levels of inequality in society obviously disadvantage those at the lowest levels of social and economic status, and can harm others as well. It is linked to greater population-wide levels of mental illness (Friedli & WHO, 2009; Pickett & Wilkinson, 2010), including depression (Patel et al., 2018). Rising inequality not only leads to larger numbers of disadvantaged people, but also to decreased social trust and cohesion (Friedli & WHO, 2009; Pickett & Wilkinson, 2010). Countries with greater inequality have been shown to be more susceptible to impacts from natural disasters (Cappelli et al., 2021). Within the United States, income disparity at the local level has been linked to higher community-wide vulnerability to climate risks (Lim et al., 2017; Kim et al., 2019). Communities cope better with an acute event when economic disparity is reduced and the needs of the economically vulnerable are attended to (Iacoviello & Charney, 2014; Norris et al., 2008). A first step in addressing disparities at a community level is a vulnerability assessment: an analysis of the community’s physical and social aspects that create higher or lower susceptibility of some groups to the impacts of a disaster. Vulnerability assessments typically include surveys of physical infrastructure like levees, dams, stormwater systems, and common structural characteristics of local homes and other buildings (Highfield et al., 2014). They also examine the social foundations of vulnerability that influence how exposed different groups or individuals are to climate impacts, their sensitivity or susceptibility to those impacts, and their resources and capacity to respond. Indicators and measurements of mental health outcomes have not generally, to date, been included in vulnerability assessments. Scholars point out that, given the growing impacts of climate change on mental well-being, these indicators provide an important knowledge foundation for communities as well as for larger resilience building efforts (Hayes & Poland, 2018). Using the results of the vulnerability assessment, local governments, including public health agencies, can design strategies that address sources of climate change vulnerability (Ebi et al., 2021), reduce the sources of exposure for vulnerable groups, and shore up the resources available for resilience building.
4. Preserve cultural connections. The mental health of new immigrant and refugee communities is strengthened when those groups maintain a connection to their cultures, especially during adversity. Weine et al. (2014) interviewed Burundian and Liberian refugees, many of whom were adolescents who had recently moved to the United States. The authors noted family cohesion, participation in religious traditions, and cultural connectedness as resources that protected individuals’ mental health during difficult times. Indigenous communities in the United States are also likely to benefit from a continued connection to culture and traditions. Studies suggest that people from Inuit communities, who are witnessing extreme loss of sea ice, experience better mental health and are more American Psychological Association | ecoAmerica 57 resilient in the face of environmental impacts when they maintain a strong connection to their culture (Ford et al., 2020). This is particularly true for Inuit youth (Petrasek MacDonald et al., 2013; Petrasek MacDonald et al., 2015). Focus group research with Wabanaki peoples in Maine and the Canadian Maritime provinces suggests that the storytelling traditions of their culture give them a resilience advantage by helping them process and make sense of the many alterations in their environment wrought by climate change (Daigle et al., 2019). In addition, for many tribal communities, traditional culture and knowledge enable practical and emotional resilience by giving tribal communities a source of sustenance through hunting, fishing, and gathering, which can be vital after an extreme storm has cut off electricity supplies or made it difficult to reach a grocery store (STACCWG, 2021).
5. Involve the community. Because every community has unique characteristics and needs, adaptation and resilience efforts are more likely to succeed when community members are involved (Cox, 2012; Norris et al., 2008; Moser & Boykoff, 2013; Moser & Pike, 2015; Gislason et al., 2021). Top-down disaster planning decisions can be effective in providing basic infrastructure such as emergency responder training, shelters, food, water, and energy. However, given the unpredictability and unevenness of climate change impacts, and the many contextual differences between communities, there is no one-size fits-all solution. Not engaging with a broad spectrum of community members risks creating a response with negative unintended consequences (Hayes et al., 2020). Involvement can help combat the denial and passivity that undermine effective responses (Ojala, 2012; van Zomeren et al., 2010) and decrease the skepticism that some communities feel toward help from outsiders, especially government or local agency officials (Phadke et al., 2015). Community members are also more likely to participate if someone from their social network is already involved in efforts and reaches out to them personally (Phadke et al., 2015). Ensure participation of people who have experienced inequality to assure that safety and resilience for all will be the outcome of planning and governance processes (Adger et al., 2019). Those who navigate the world of inequality and discrimination, such as people of color, indigenous communities and people with disabilities, know what will materially improve their own and others’ quality of life. As researcher Lichtveld (2018, pp. 28) points out, “Protecting the most vulnerable is the proven strategy to protect all.” For example, a gender non-binary youth participant in a community-engaged research project pointed out that public cooling centers, storm shelters, and other community resources may not feel safe for other nonbinary or transgender community members without some form of anti-bias training for those working in the facilities (Phadke et al., 2015). It is particularly important for young people to be involved in planning as it provides a greater sense of ownership, which likely increases their sense of efficacy (Gislason et al., 2021). Create opportunities for community-oriented action. It is a well-known finding in psychology that one’s own well-being increases through helping others (Hui et al., 2020). For example, individuals impacted by Hurricane Harvey who communicated with others about how to assist with disaster recovery experienced more posttraumatic growth, without symptoms of post-traumatic stress, compared to those who did not (Spialek et al., 2019). When people see first-hand that many others are participating in resilience-building efforts, they become more confident not only in the collective efficacy of the community, but also that help will be available when they themselves need it (Kaniasty & Norris, 2009; Kaniasty, 2012). Coping communally also appears to build a stronger bond among community members as well as to their place (Richardson & Maninger, 2016; Woodhall-Melnik & Grogan, 2019).
6. Strengthen mental health services. To protect community well-being, mental health services should be assessed and strengthened, with particular attention to the needs of populations who have been systematically disadvantaged by power and wealth 58 Mental Health and Our Changing Climate: Impacts, Inequities, Responses disparities. As part of addressing this, public health agencies and other organizations can engage in education and outreach to reduce stigma associated with seeking treatment while also reducing cost and increasing access for treatment (e.g., through Federally Qualified Health Centers and mobile and virtual healthcare). Increased insurance and Medicare and Medicaid reimbursement for mental health care treatment will also increase access to care. When assessing community mental health services, here are some specific questions to consider: 1) Does the community have a plan to serve people in need after a shock/disaster? 2) Does the community have the capacity to serve the potential increased needs of people as climate impacts grow? 3) Currently, can all community members access the mental health care they need? 4) What are the gaps, and what areas of service may need to be augmented? Dominelli (2013) suggests that part of the assessment of mental health infrastructure should include questions about who may be available on an informal basis to provide help, care, medicine, and comfort when formal services break down. For example, neighbors and community members are often the most available and quickest to help people in their proximity (Dominelli, 2013). Public health agencies are one channel through which adaptation and preparation expansion of infrastructure can be encouraged and guided.

7. Update infrastructure. Physical infrastructure. Physical infrastructure, such as roads, bridges, sidewalks, parks, housing, water and sewer systems, energy, telecommunications, and public transportation plays an enormous role in shaping the vulnerability of communities to the effects of climate change, including psychological impacts. A community with older or poorly maintained infrastructure is more susceptible to the impacts of disasters and heat, which in turn create trauma and negative psychological outcomes. Updating infrastructure can have both positive health and environmental benefits. For example, permeable paving on roads or sidewalks helps control flood water while allowing the restoration of the natural water cycle. Community solar gardens increase urban residents’ energy resilience while also lowering carbon emissions and the many health impacts associated with pollution. Healthy access to nature and protection of natural assets. Increasingly, urban planners are focused on buffering the effects of climate change, which may include increased tree planting and greater access to green space, especially for disadvantaged communities (Hayes et al., 2019; Liu et al., 2020). Expanding greenspace and tree cover in cities lowers the urban heat island effect and offers residents the mental health and restorative benefits of natural spaces while also creating habitat for other species and sequestering carbon. Green space has also been shown to reduce crime rates (Shepley et al., 2019). 
8. Develop a trusted and effective warning and communication system. An effective, reliable, and accessible warning and communication system for severe weather events can save lives, reduce property damage, and potentially reduce trauma. In several studies of severe flooding events in Europe, those who had received a warning before evacuating were less susceptible to later PTSD and other mental health issues (Munro et al., 2017; Foudi et al., 2017; Cruz et al., 2020). Many of those impacted by a flood in Canada noted the absence of an effective early warning (Hayes et al., 2020). Unfortunately, warning systems do not always function as effectively as they could. This is due in part to limitations and uncertainties inherent in forecasting technologies, or due to language barriers or other accessibility issues. Additionally, some individuals ignore or downplay warnings. Research suggests a number of factors that influence the likelihood people will take warnings seriously and take protective action. People with little personal prior experience with a disaster or who don’t understand the severity of possible impacts appear to be less motivated to take the warning seriously or to seek further information (Knocke & Kolivras, 2007; Lee et al., 2009). Or when warning systems are perceived as unreliable, they are less likely to evoke a response (for a discussion, see Barnes et al., 2007). Communities should deepen relationships with the breadth of community constituencies and consider testing their warning and communication systems regularly. This effort should include ensuring that warnings are translated into community spoken languages and are accessible to the Deaf community and to those with vision loss. 
9. Train the people who will serve the community during a disaster. When people are in the throes of extreme distress and high emotion typical in the immediate aftermath of a disaster (e.g., fear, anger, terror, helplessness, shock, grief), it is crucial that the services available to them be sensitive and interactive (Raphael, 2007). Hobfoll (2007) offers five evidence-based principles to guide intervention in the aftermath of a disaster or acute event. Communities that institute these principles, through training of first responders and rescue workers, can limit the long-term negative psychological consequences of acute events (Morgan et al., 2018). Hobfoll’s principles include promoting: 1) A sense of safety; 2) Calmness; 3) A positive sense of self and a sense of collective efficacy; 4) Connectedness; 5) Hope. Training should also cover the ways in which signs of mental health distress may vary across cultural communities and stages of life. Psychological First Aid (PFA) (McCabe et al., 2014) is an intervention strategy based on the five principles listed above. It provides immediate support, sense of safety, and stress relief to those impacted by an acute event, and it can be learned and used by workers without a mental health background. By alleviating acute traumatic stress in the early stages of a disaster, more serious, long-term mental health outcomes may be prevented (Birkhead & Vermeulen, 2018; Madrid & Grant, 2008). Not everyone experiences psychological distress after a disaster, however, and some may be worse off if coerced into participating in an unnecessary intervention (Bonanno, 2008). PFA training can help first responders and others recognize those who need immediate mental health assistance and those who do not.
10. Prepare post-disaster recovery resources. Climate change has advanced to the point where its impacts are now unavoidable. Communities must also be ready to respond to disasters and other climate impacts and engage in long-term recovery. Strategies include: Mobilize support quickly. Communities need support as rapidly as possible. Many psychological stress symptoms stem from the early phases of a disaster (Simpson et al., 2011), and a sense that aid is nonexistent, slow in coming, or distributed unfairly can contribute to people viewing their community or leaders as uncaring and unavailable (Kaniasty, 2012). Those living in the community itself, and organizations located there, can often come to others’ aid most quickly (Baussan, 2015), which underscores the importance of community engagement in climate resilience planning. Help community members locate separated family and friends, and assist them to reunite. Separation, and the uncertainty about the well-being of loved ones, is a source of stress. It is particularly dangerous for children, who are put at higher risk of PTSD and other negative impacts from extended separation from parents and other family members after a disaster (Bryant et al., 2017). Some post-disaster stress and uncertainty can be alleviated with mechanisms for community members to receive updates on family, friends and neighbors and be reunited.

Provide extra resources for the displaced. Displacement from one’s home, particularly if it occurs on short notice with little warning or preparation time, heightens the risk of negative mental health outcomes after a disaster. Displaced people benefit from increased access to mental health support services, especially those displaced to shelters (Taioli et al., 2018). In addition, communities should have plans in place in advance for the return of evacuated residents. 

Extend support and resources beyond the immediate disaster response. In the immediate aftermath of a disaster, affected community members often experience an outpouring of social and material support. As time goes on, however, offers of help subside, though the need for support may continue to be substantial. Many disaster survivors have reported that this time is difficult, often involving feelings of isolation (Kaniasty, 2020). 

Create long-term sources of mental health and other support. Longer term access to support may also be critical. California wildfire survivors, among other disaster survivors, struggle to find permanent housing and steady employment even as much as a year after the event, and they express a need for psychosocial health services (Rosenthal et al., 2021). 

Assist affected communities with insurance processes and other paperwork. A frequent experience of people who have survived a disaster is the frustration of filling out paperwork and dealing with insurance companies once the recovery and rebuilding process has begun. Foudi et al. (2017) call for simpler and faster insurance protocols as key to reducing psychological distress in the aftermath of an extreme event.

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