The resonances were eerie as Hurricane Ida, a Category 4 storm, broached Louisiana's coast on Aug. 29, 16 years to the day after Hurricane Katrina ravaged the same area.
"It's very painful to think about another powerful storm like Hurricane Ida making landfall on that anniversary," Louisiana Gov. John Bel Edwards said on the eve of Ida's arrival. As residents of the state braced for a battering of wind and water, many were preparing for another assault - the unbearable emotional toll of living through another such storm.
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This kind of re-traumatization may become increasingly common. Experts say that as the planet continues to warm, and climate change's effects become more apparent and severe across the globe, more people than ever could experience serious challenges to their mental health as a result.
New methods for addressing these challenges are emerging in the United States, though some experts believe a surge in mental health issues related to climate change could overwhelm the system - leading them to consider how to radically remake it.
Just the past few months have spelled a handful of devastating weather extremes in the United States. Record-breaking temperatures scorched the country, prompting heat warnings to be issued for 150 million people. The Dixie Fire, which grew to over 868,000 acres last week, has become the largest single fire in California history. And in August, an unprecedented amount of rain battered Tennessee, leading to floods that killed at least 21 people.
Climate change is suddenly feeling a lot more real for many Americans who have not seen it up close until now, clinicians say, leading many to seek one-on-one therapy.
"Mental health professionals help people face reality, because we know living in denial can ruin a person's life. As the climate crisis unfolds, we see people whose anger, anxiety, and depression, caused by the shortcomings of a previous generation, prevent them from leading productive lives themselves," reads a contribution by Lise Van Susteren to a report by the American Psychological Association and ecoAmerica.
Katharine Wilkinson, an author and strategist who co-edited an anthology about climate solutions called "All We Can Save," said that over the past year more than 600 people had signed up to lead book discussion circles she designed as an outlet for climate grief, signaling a growing demand for climate-related support in group formats. And Daniel Masler, a Washington-based therapist, says requests for climate-related care have only grown since he began his work in 2012.
"We've been for so long in social denial. Now, with the smoke drifting all the way back East and the phenomenal fluctuations in temperature, people can't deny it anymore."
Other groups for dealing with climate grief have emerged in recent years, too.
A nonprofit organization called the Good Grief Network, a 10-step program inspired by the structure of Alcoholics Anonymous whose meetings provide "social and emotional support to people who feel overwhelmed about the state of the world," says it has reached over a thousand people in four years. Steps in the program range from accepting "the severity of the predicament" to reinvesting "into meaningful efforts."
Young adults are among the groups most vulnerable to feelings of depression and anxiety related to climate change, said Leslie Davenport, a climate psychology educator and consultant who is a member of a directory of climate-aware therapists. "It is this sense of looking at their personal future in a way that, in much of the U.S., has not had to be viewed this way before. 'Does it make sense for me to think about starting a family? Does it make sense for me to start thinking about college?'"
Therapy sessions can allow people a space to relieve their stresses through disclosure and reflect on what they can do to slow the earth's warming, which can also be alleviating. "A lot of us tend to go into strong feelings of self blame, and (therapy can) help to shift the blame into something that's more activating," said Masler, another member of the directory.
The effects of climate change on mental health can range from the frightening to the acutely dangerous. Some studies have linked extreme temperatures with an increased risk of suicide, as well as increased hospital admissions for mood and behavioral disorders. One study found that nearly half of mostly young, low-income, African American mothers exposed to Hurricane Katrina likely suffered from post traumatic stress disorder, or PTSD, following the storm. According to estimates, millions, or even over a billion people could be displaced by the climate crisis by 2050.
An article in the medical journal The Lancet emphasizes climate change's disproportionate effect on the world's most vulnerable people - who are more likely to live in countries the least responsible for greenhouse gas emissions.
"Populations with pre-existing chronic health conditions, low socioeconomic status, children, older people, and some ethnic minority groups are particularly vulnerable," the article reads. "Similarly, these populations often lack the financial, social, or community resilience needed to cope, manage, and recover from new environmental hazards or climate stress."
In parallel, the people most vulnerable to climate change's effects may also be the least able to access mental health care, especially in a future that exacerbates existing inequalities. In Colorado, Kritee Kanko, a climate scientist and Zen Buddhist teacher, discussed the need to develop more accessible forms of mental health care for that very reason.
"Whenever I speak about climate grief, I always say that one-to-one psychotherapy has helped me personally, and it's great. We need great therapists," she said. But she added that one-on-one therapy can be prohibitively expensive, and that in the future, individual therapists may not be able to keep up with an increase in demand due to climate change.
"It is not going to be enough, at all, for what we are facing. It will never be enough because of the scale of trauma we face," she said. "I'm thinking about marginalized, racialized communities here who don't have the financial privilege."
A reform to the mental health care system to prepare for climate change "has to be community wide," echoed Van Susteren, a psychiatrist and a co-founder of the Climate Psychiatry Alliance, who helped organize the therapist directory. "It has to be culturally based so that it isn't a one size fits all. It has to be geared towards building resilience."
Gary Belkin, a psychiatrist, founder of the Billion Minds Institute and a visiting scientist at the Harvard School of Public Health, has also been vocal on the demand that climate change will place on mental health resources.
"We are all psychologically unprepared to face the accelerating existential crisis of climate and ecological change that will further deepen other destructive fault lines in our society," Belkin wrote in Psychiatric News in February. "The future will extract enormous social and emotional costs and suffering and require enormous social and emotional strengths to combat. We must sound that alarm and put our own house in order."
He too believes ambitious reform to the very way mental health care is administered will be necessary to meet the moment. Belkin described his work with the Social Climate Leadership Group, a coalition of 17 health and climate organizations announced last August that intends to deepen mental health professionals' relationships with the communities they serve, among other goals. Intermittent therapy sessions will not be able to "solve" the negative mental health effects of climate change, Belkin said, so health systems, grass roots organizations and other entities need to mobilize to empower communities to bolster their own emotional resilience and mental health.
"The mental health system works on the idea of discrete illnesses that are treated and have a distinct beginning and end, whereas, mass population effects like climate change ... are relentless," said Belkin, who served as the deputy health commissioner of New York City in 2019.
One innovation Belkin says could be useful for distributing therapeutic knowledge is "task sharing" - an evidence-based process by which peers, teachers, parents, clergy, health workers and other nonspecialists provide mental health support to others under the supervision of trained clinicians.
He suggests this could be one of the pillars of a new model of community-based mental health care that can rise to the challenge of the climate crisis.
"This is no small task, and I know this. But the methods are there. It's not a complex formula. It's really about the will to do it," Belkin added.
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