As the climate crisis gets worse, we know of farmers whose crops are drying up and people who lose their homes due to rampant wildfires.
But there鈥檚 another group for whom the climate crisis is a potentially lethal threat 鈥 people with mental health problems such as schizophrenia, bipolar disorder or anxiety.
And this threat has already become reality for some people. During a record-breaking heat wave in British Columbia in June 2021, 8 per cent of people who died from the extreme heat had been diagnosed with schizophrenia, . That made the disorder a more dangerous risk factor than all other conditions the authors studied, including kidney disease and coronary artery disease.
鈥淯ntil climate change gets under control, things are only going to get worse unfortunately,鈥 said Dr. Robert Feder, a retired New Hampshire-based psychiatrist and the American Psychiatric Association鈥檚 representative to the Medical Society Consortium on Climate and Health. 鈥淎s the temperature keeps increasing, these effects are going to be magnified. There鈥檚 going to be more storms, more fires, and people are going to be more worried about what could happen because a lot more things are happening.鈥
Rising temperatures have also been associated with suicide attempts and increased rates of mental health-related emergency department visits, several studies have found. And long-term exposure to air pollution 鈥 which the climate crisis can worsen by adding more particles from droughts or wildfires 鈥 has been linked with elevated anxiety and an increase in suicides.
What鈥檚 going on in the brains of people with schizophrenia or other conditions is just one factor that makes them more vulnerable to extreme heat, air pollution and stress, experts said 鈥 and in need of support from loved ones, surrounding communities and policymakers.
What makes some psychiatric patients more susceptible to the harms of extreme heat 鈥 such as heatstroke or death 鈥 begins in a part of the brain called the anterior hypothalamus. Think of it as the body鈥檚 thermostat.
鈥淭hat鈥檚 the part of the brain that is working to tell you 鈥 when you鈥檙e too hot or you鈥檙e too cold 鈥 to begin shivering, to begin sweating,鈥 which is the body鈥檚 cooling mechanism, said Dr. Peter Crank, an assistant professor in the department of geography and environmental management at the University of Waterloo in Canada. Crank was the lead author of a March study on associations between temperatures in Phoenix, Arizona, and hospital admissions of people with schizophrenia.
鈥淚t tells the rest of your brain you need to take behavioural action, like drinking water or putting on a coat when it鈥檚 too cold or taking off a coat when it鈥檚 warm,鈥 he added. 鈥淭hese disorders, whether it鈥檚 bipolar, schizophrenia or manic depressive 鈥 all three of them impair the neurotransmission of information to that portion of the brain.鈥
The capacity to regulate body temperature may also have to do with brain chemicals such as serotonin and dopamine, which are generally lower in the brains of people with these disorders, experts said.
鈥淭he hypothalamus is directly dependent upon being stimulated by serotonin,鈥 said Dr. Joshua Wortzel, a psychiatrist at Bradley Hospital at Brown University in Rhode Island and chair of the American Psychiatric Association鈥檚 committee on climate change and mental health. 鈥淪erotonin levels in the brain are affected by temperatures outside, and so you can imagine that when we鈥檙e playing around with serotonin levels in the brain with our medicines, that can change a person鈥檚 ability to sweat.鈥
Some medications used to treat these disorders can add to the risk by affecting the ability to sweat or raising the body鈥檚 core temperature.
Antipsychotic medications 鈥 often used to treat schizophrenia, bipolar disorder, paranoia and delusions 鈥 have the greatest effect, Feder said. Those include aripiprazole, olanzapine, risperidone, quetiapine and lurasidone.
Some stimulant medications for attention deficit hyperactivity disorder, or ADHD, such as lisdexamfetamine and amphetamine/dextroamphetamine salts, and anti-anxiety medications can also cause this problem.
Lithium, a mood-stabilizing medicine, can cause dehydration, Feder added.
Lifestyle habits important for managing mental health symptoms can also take a hit. Warm temperatures can also interfere with sleep, an important factor for managing mental health symptoms, experts said.
Additionally, 鈥渢he nature of most mental health conditions is that once you鈥檙e diagnosed with it, you are at risk for recurrent episodes of that illness,鈥 Feder said. 鈥淎nd these episodes are often brought on by some type of stress. And climate disasters are certainly a stress.鈥
Homelessness is also high among people with mental health conditions, especially in the schizophrenic population.
鈥淎nd if you鈥檙e homeless during a heat wave, that puts you at increased risk for death, because you don鈥檛 have access to air-conditioning,鈥 Feder said.
Behaviours caused by these conditions can also contribute to a higher risk of heat-related illness or death. The psychosis that people with schizophrenia can experience, for example, can mean they鈥檙e not correctly interpreting reality, so 鈥渢hey may not even be aware that they鈥檙e overheated, or they may think that the source of their being overheated is due to some bizarre or irrational reason and not do something appropriate to get out of the heat or to make themselves (safer),鈥 Feder said.
People with mental health issues are also more likely to self-medicate with drugs that interfere with their body鈥檚 ability to sense and respond to heat.
If you鈥檙e on any of these medications and think no longer taking them is the solution, not so fast. 鈥淭hat would be far worse than staying on the medicine,鈥 which plays a crucial role in your treatment, Wortzel said.
Talk with your doctor about whether a medication you鈥檙e on or starting makes you more vulnerable to extreme heat since some informational pamphlets for these drugs may not list that risk as a potential side effect.
鈥淭hese are rather just cautions,鈥 he added, 鈥渢o really just make sure that you鈥檙e staying in cooler environments, making sure you鈥檙e hydrated 鈥 that if climate change continues to get worse, this is going to be really a side effect that we鈥檙e going to have to worry more and more about.鈥
It鈥檚 not a reason to stop taking antipsychotics, Wortzel said, but it鈥檚 good reason to take care of yourself in the heat.
Addressing the climate crisis, the root of the problem, is of course the most important solution, Wortzel said. What鈥檚 also necessary at the policy level, he added, is expanding access to cooling centers and other resources, and providing more funding for research that would help us better understand the impact of heat on mental health.
There are steps individuals and communities can take to protect vulnerable people when hot weather comes.
鈥淧atients need to be aware that they are vulnerable to stress,鈥 Wortzel said. 鈥淵ou need to make sure that you have access to air-conditioning, a cooling center, to stay hydrated and to make sure you鈥檙e monitoring how much you鈥檙e outside, (that) you鈥檙e not out in the hottest times of the day, things like that.鈥
Wear sunscreen, hats and light-coloured, loose-fitting clothing, Crank said. Taking cold showers can also help keep your core temperature down.
鈥淭he other thing that people can do is start getting involved in climate activities,鈥 Feder said. 鈥淔or the anxiety that鈥檚 associated with climate change, the best thing people can do is actually get involved in climate (advocacy) groups and start working for changes to the climate crisis.鈥
Feder also suggested people write or talk to their lawmakers about the issue.
You should also inform your loved ones of your vulnerabilities so they can offer support.
If you鈥檙e not someone at greater risk and are wondering how you can help, practice empathy and awareness by keeping water bottles in your car to hand out to those at higher risk of harm from extreme heat.
鈥淭ake the time to, if seeing someone in distress, call some sort of emergency services so that they can get medical attention,鈥 Crank said. Doing so will likely take only a few minutes out of your day.
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