SPEAKER_03 0:00

We acknowledge Aboriginal and Torres Strait Islander peoples as the First Nations and the traditional owners and custodians of the lands and waters known as Australia and Maori as Tangata Fenua in Aotearoa. We honour and respect the elders past and present who weave their wisdom into all realms of life.

SPEAKER_01 0:23

Welcome to another Psych Matters podcast from the Royal Australian and New Zealand College of Psychiatrists. Psych Matters is a series of discussions on training and practice issues facing trainees and fellows of the college and other important topics in mental health.

SPEAKER_06 0:39

Hello everyone and welcome to the latest Psych Matters podcast. My name is Dr. Anna Illiston, and I'm an advanced trainee in child and adolescent psychiatry in Nippaluna, Hobart, on the lands of the Muanina people. We're meeting today at the RANZCP Congress in 2026 in Nam, Melbourne, on the lands of the Wurundjeri, Wurarong, and Bunarong, Wulwarong people of the Eastern Kula Nation. And I'd like to acknowledge the traditional owners of the land and pay respects to elders past, present, and emerging. I'm here today as a member of the Planetary Health and Mental Health Advisory Group. This advisory group was established in 2025 with the aim to offer guidance to the College on Policy, sustainability, and climate-related mental health issues. And I'm joined here by three other members of the group, Dr. Sabel Day, Professor Carlo Longetano, and Professor David Menkis. I'd also like to extend our gratitude and a warm welcome to our medical student Elizabeth Golding from Bodden University who has joined us today. So thank you very much. And welcome everyone. Firstly, I'd like to start by asking everyone to introduce themselves and where they're from and a bit about their everyday work and also how they came to be interested in the or passionate about the area of planetary health and mental health. So we can go around if you like.

SPEAKER_08 1:54

Right. Yes. Hello, everyone. Yeah, my name is David Menkus. I'm an academic psychiatrist working for the University of Auckland. I'm based in the Waikato region of New Zealand, North Island. As my accent suggests, I'm originally from North America, but I've been in New Zealand most of my life and working in academic psychiatry. This my environmental awareness uh dates way back to when I was growing up and just realized the impact of rampant development on the environment around me. And even as a school kid, you know, just looking at you know the consequences of rapid growth and particularly uh car dependence made me realize that you know the way we manage economic growth is really important, not just for our physical well-being, but also our mental well-being. And so that awareness, I suppose, has continued and evolved since that time. But I'm very pleased to be part of this group and to offer a few thoughts about what we as uh psychiatrists might be thinking and doing about the issue.

SPEAKER_05 3:00

Thanks, David.

SPEAKER_06 3:01

That's wonderful.

SPEAKER_05 3:01

Sabelle? Um, thank you. Yeah, my name's Sibelle Day. I'm a child and adolescent psychiatrist working in the public sector in New South Wales on Gadigal and Darrick lands, which is in the Sydney area of Australia. And in my public work, I'm doing rural and regional telehealth as well as consulting to an adolescent medicine clinic. I'm also involved in uh research on climate and mental health, uh, and I have a few other hats in other organisations related to this area because it's something I've become incredibly passionate about. And really, for me, I had a long-standing awareness in my personal life that having a healthy environment was important. But I really didn't get that there was a connection between my personal view and understanding that climate change mattered and that we needed a healthy environment and what was going on at work until the 2019-2020 black summer in Australia when we had so many things happen in sequence. And for me, it was the heat that really made me understand that something had changed. We had had more and more young people presenting to emergency departments with distress, including suicidal thoughts and behaviour, that had been going on for eight or nine years by that stage before COVID, and it was a global phenomenon. And what I came to realise was that the heat had gone up at the same time, and then when looking at the research, that actually there was a connection, and I'll probably speak a little bit more about that later, but that really just actually graphing it at home using an Excel spreadsheet and realizing that the two things were happening at once, and then looking at a few articles made me really the the penny dropped that I could no longer see this as separate from what I was doing at work, and I really needed to do something about it.

SPEAKER_06 4:48

Thanks, Sibelle.

SPEAKER_05 4:49

Carlo?

SPEAKER_07 4:50

Thank you. And um, I'm Carlo Lungitano, I'm also a psychiatrist. In my clinical role, I'm a forensic psychiatrist by training, and um, I also hold a position as an academic psychiatrist, being the mental health coordinator for the medical students at James Cook University in uh Townsville, Queensland. So I work for Townsville Hospital and for James Cook University, and I'm passionate about teaching and about improving kind of mental health outcomes for people in remote areas as well as worldwide. And I suppose my interest for planetary health comes from uh the say day that comes to my mind when I think about physical health. And there is no mental health without physical health, but there can't be any physical health without planetary health at the same time. And that really is striking for me because of course I'm my accent, uh, just to paraphrase David's stance there, probably reveals I'm not from around North Queensland originally. I've been there for eight years and I'm very proud to be in North Queenslander now. But I hail from Europe and uh grew up in uh in Italy and then trained in the UK. And you're sort of passion when you are uh over there, uh in green Europe. Uh then moving to Queensland in the tropical part of this beautiful country. I absolutely felt the brutality of kind of North Queensland summers and the tropical summer there. And then I moved just before the floods uh that occurred in 2019. So I had only been there for a year. So I experienced firsthand what it means to have been involved in a one in 1,000 years kind of climate change events that was not meant to happen, and it did, and then it happened again two years later. So I'm beginning to wonder whether these are no longer events that happen so rarely. And uh and as I said, as a psychiatrist, we have to be mindful of what we do with our patients' population who do suffer firsthand from the consequences of a very changing landscape when it comes to climate. And that we as psychiatrists really have to take the leadership and help people understand what to do and how to look forward and how to soothe themselves as well, and you know, deal with that really massive burden of mental and physical uh health that comes with climate change.

SPEAKER_02 7:05

Thanks, Carlo. And last but certainly not least, Elizabeth. Hi, yeah, um Elizabeth Golding. I'm a fourth year medical student at the moment up on the Gold Coast, originally from Newcastle, which is Awabikol and Waramai Land. I'm like a member of the Australian New Zealand Society of the History of Medicine, um, as well as the Psychiatric Interest Forum, which brings me to the conference today. Yeah, I've always kind of as a young person, I think interest in the environment and environmental justice is very important for most kind of youth people today. And I grew up kind of attending school that strikes the climate, and particularly in Newcastle, it can be a very controversial area when it comes to coal mining and a lot of waste disposal. So I've always kind of been around people who talk about environmental justice a lot and kind of quite passionate about that, and as well seeing the passion as well in like a lot of young people growing up in high school. This was what we would discuss at recess. It's like, what is the government doing? What can we do? Where do we go from here? Is enough happening? But also I think growing up in that environment, I also noticed a lot of I I don't know if necessarily the right word was burnout, but generally some really strong feelings from people my age that didn't really know where to go or how to deal with them, which was yeah, quite frustrating. So I think it's really important the psychiatric part of climate justice and trying to, yeah, cope with all the big things that are happening in the world right now and what we can do to help. Thanks, Elizabeth.

SPEAKER_06 8:40

So I guess to kind of start off the questions, I just wanted to start by asking, what do we mean when we say planetary health? And how is the issue of planetary health relevant to psychiatry?

SPEAKER_05 8:50

So planetary health is really a relatively new term in English language and Western scientific context over the last couple of decades. And really what it refers to is that the activities of humans, and in this case we're talking about climate change, biodiversity loss, and pollution, have an impact on the health of the planet, which in turn impacts human health. The concepts that are underlying that planetary health idea, though, are much, much older than the last couple of decades. And if you get the opportunity to learn from and with First Nations knowledge bearers, including in some of the country that I'm fortunate to live on, in Bidigal and Gadigal country, and across other parts of the world, there's been knowledge about that inherent interconnection between human health and the health of the natural world of which we're a part. So the planetary health, in a sense, is the newer Western scientific term for something that's been understood in many cultures for thousands of years.

SPEAKER_06 9:54

So it sounds like it kind of broadly summarizes our relationship with the world and the sense that we're actually kind of we are connected to to the world and to the earth, and that that that relationship is actually, it can be health-giving. And that has a relevant, that's really relevant to our to our practice in psychiatry.

SPEAKER_05 10:15

Absolutely, and in a sense, the the key, I guess, thing that you you're highlighting there, Anna, is that it is our relationship with the rest of the natural world and our understanding that we're part of it, that is the opportunity to thrive and to to you know to improve human health, and conversely, when we're disconnected from it, when we are uh approaching the rest of nature as a thing from which we take rather than something of which we're a part, then we end up with things like climate change, loss of nature and biodiversity and pollution, which in turn harm our human health. Absolutely.

SPEAKER_08 10:53

Perhaps I could just add that the concept of ecosystem health is perhaps more familiar to some people. And that is something that most of us will have a more direct experience of in the areas in which we live and work. And I guess planetary health is more of an overarching concept where we see the same threats often are played out in different regions of the world. So we're really talking about the earth as a big ecosystem, but our own personal experience is generally rather more limited. But when we communicate with our friends and colleagues and sources of information from around the world, we realize that these challenges are hardly unique to us and they may manifest in different ways, but we are, in a sense, very much in the same woka as we would say in New Zealand, that the challenges are very similar and need to be understood as a global challenge.

SPEAKER_06 11:49

Absolutely. And thinking about how those challenges might manifest, um, Sibelle actually has a really interesting case that she's able to briefly share with us, given the generous permission of the young person and their family. And I think this case is really helpful because it highlights how the issue of planetary health and particularly climate change and the increasing likelihood of severe weather events can impact mental health and which these things are things that we might potentially see clinically. So thanks, Sabel.

SPEAKER_04 12:19

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SPEAKER_05 12:38

Very, very happy to describe this a young person and their family that I was fortunate to meet back in 2020. And for me, this was really one of the times when it became so clear that the impacts that I understood were coming were already here. So this is a little boy who I saw in my regional rural telehealth clinic with his parents, who was coming to see me as a child and adolescent psychiatrist in a tertiary referral context because he'd become so unwell, not after just one extreme weather event, but after two. And to go back to the beginning of that story, he'd been a little boy who was a little bit quirky, had some particular sensory sensitivities, but was functionally doing really well. Was at school, had friends, got on well with his family, loved animals, and was living in this regional town. Then the bushfires came. And his dad, who was a you know, member of the community, volunteer bushfirefighter, went out and was fighting the bushfires. And so every day his dad would leave to go and fight the fires with the community team. And his mum was also someone who was active in the community and helping to look after people who were having to shelter from bushfires and organising all of the things that go along with the community, having to deal with an extreme weather event that went on. And so this little boy did understandably get significant anxiety, and that got to the point where he really couldn't separate from his mum, and even when things were physically safe and dad was back and he was uninjured and mum was okay, this little boy was left with being unable to go away from his mum and go away from home and really struggling to get back to school. That did all get better with local supports, the local psychologist working with the family and his school, and he got back to school, was doing well again. Then came the floods. And with these severe floods that came through the same region, it wasn't actually this little boy's personal environment that was most profoundly impacted, but one of his friends, who lived also in a rural setting, where a number of animals died in the floods. And it was that for him that was really the tipping point where he became overwhelmed and he became so distressed that he wasn't even able to manage eating and drinking normally or interacting at all. And he did get better, but if we think about the severity of that, what became essentially a total refusal situation from very severe anxiety from these two compounding extreme weather events, despite having the best efforts of his local community and his family. So this was not in any way something that I guess could be understood as somehow a question of needing to be more resilient. In fact, this was for me a real demonstration that even for people who are doing everything they can and have lots of strengths, this amount of compounded events can get so strong that it overwhelms all of our resources. So this little boy got better, but had they not been so many events, he would have not needed the specialist health care.

SPEAKER_06 15:46

Thanks, Sabelle. And I guess listeners might sort of think, well, this is one case, and perhaps, you know, maybe it's not representative of broader trends, but actually there's plenty of established literature to suggest that people, and particularly young people, are really feeling the impact of environmental changes on their mental health. And I wanted to reference one article regarding this, which is by Hickman and colleagues, which was published in the Lancet Planetary Health in 2021, which was a survey of 10,000 young people aged 16 to 25 across 10 countries, including a thousand people from Australia. And the findings were quite concerning, actually, and quite quite shocking. So that there was a large amount of concern, really. So 59% of people were very or extremely worried about the climate, and 84% were moderately worried. And 45% said that their feelings about climate change actually affected their their daily life and their functioning. So it is significant, and there's some concerning global trends. And the college has acknowledged this in its position statement on mental health and and the impacts of climate change as well. So we've talked a little bit about the relevance of the environment and planetary health on mental health, and that the issue is very much within our remit as psychiatrists, given it's a clear determinant of health and therefore mental health. And I wanted to ask what might be the role of psychiatrists in addressing the issue more broadly? Carlo?

SPEAKER_07 17:09

I think psychiatrists have a really, really uh great role here. Because I think if you think about psychiatry as a discipline, in a way we are kind of the old-fashioned doctor, uh, still that discipline that looks at patients who suffer with a range of mental health issues very holistically. So a good psychiatrist doesn't just look at what is the medication regime in front of you, but you you actually see the patient as a person, as a whole. And that that includes uh that includes the social circumstances, their family, their ideas and dreams and what they have achieved so far. But it also should involve looking at the environment and looking at whether or not they are on a trajectory to be impacted by planetary health issues as well. And because there are, there's no ways around that. There are effects that are tangible already. There was a review, I mean, just looking, there's so many reviews out there, of course, that are really, really interesting to read. But uh, of course, I'm familiar with um the work done in uh the Australian Institute for Tropical Health Medicine in James Cook and um and by my colleague Zalton Sharon with Tina Mengesha, and they reviewed the literature for the effects of sea level rise and extreme better remains in the Pacific Islands uh as well as in Australia. And they they found quite a number of uh studies that have been looking at population level, uh, the effect uh just the anxiety and the uncertainty that comes with uh not knowing whether your country will still exist in a generation time, which is the case in Pacific Islands. And they found that there was a significant effect on a measure of mental health, including anxiety, depression, and psychosis as well. And so they found that that effect was not insignificant and it was tangible, and it's already here. It's not in the future, it's actually already affecting populations in our Pacific Island neighbors. And a similar study has shown that a similar effect is also happening in the north of Australia, very, very, very much so. Uh so we think about the Torres Strait Islander population from Cape York and the Solomon Islands, um, just over across the across the sea and Papua New Guinea. I mean, it's just there's so much impact. We had six cyclone crossings this year already. One went from the the Coral Sea all the way to Western Australia, and it took two weeks for that to happen. And the amount of distraction and how many, and it's of course when if you're sitting on a on a city on the south coast, maybe it's difficult to imagine it, but for in Townsville, we you could feel the effects, even if it's just because you have families who people are traveling. Um, we had a clinic, I do cover Mount Isa as well with my clinical hat. And the clinic had to be canceled because of the amount of rain and floods. Once again, Mount Isa doesn't normally flood, and it's flooded again this year. So these are tangible effects that are already here. So as a psychiatrist, you know, you you're caring for uh for families who are affected by these changes, and uh, so of course supporting them, but also providing solutions and providing an understanding. But also I think, and I would like to hook somebody else into this conversation who is probably more of an expert than I am, but thinking about what is the level of resistance at population level that makes so that no, we just get on with our lives without actually doing much about it. When the planetary health is a very pressing need. I mean, yes, we can talk about everything else, but without the planet, there's nothing else that we can think about or do, or there's just not going to be us anymore. So, what as psychiatrists shouldn't we help humans understand why we are in continuous denial about what's happening? And should we uh actually just sit down and stop doing anything else we're doing here, never mind wars, but anything else we're doing, and start uh looking about healing our planet, and and through healing our planet, healing us as well and our future.

SPEAKER_06 21:01

It's such a fascinating question, Carlo, and thank you for posing it. And I think you've really touched on something that we probably all think about really quite a lot, which is that the so planetary health and the climate crisis as it is kind of represents a huge existential threat. And how do we actually manage that? And how do we kind of metabolize that um as humans? And it always seems like we're so kind of preoccupied with other things, and I think psychiatrists can bring a lot actually to this problem. So you know, we can support people in in psychotherapy and in our clinical practice, but we can also understand it from the perspective of psychodynamics and, for example, defense mechanisms such as denial that might be at play. And we also have a lot of roles and a lot of different hats, like you said. So as advocates for you know patients and communities who are affected, and as health experts and scholars as well, David?

SPEAKER_08 22:00

One of the things to um follow that Carlos comments is just to point out that the extreme weather events that we've witnessed in the last decade are almost certainly set to increase in the coming decades. Because we we know this is a progressive thing that is actually related to global warming. And so, particularly as sea temperatures rise, the rate of those extreme weather events is almost certainly going to uh increase and intensify. So I think we need to be prepared for that, both to deal with the psychological and psychiatric sequele, but also to uh build in lobbying efforts to ensure that resilience uh on the part of governments and politicians is emphasized because it's coming to some extent. And we might be well able to mitigate the extremity of this challenge, but the fact that we're going to be facing it is undoubted at this stage. And I think we've got a good deal of science to back up that assertion, and we should be prepared to make that case uh to governments uh as appropriate, since we are indeed medically trained and we know a bit about critical appraisal to have those facts and figures available should that argument need to be taken in the correct opportunities.

SPEAKER_05 23:24

Absolutely. I might jump in here at Sabel. Um so, in terms of the science and the evidence around the impacts on mental health, there have been really measurable, substantial impacts that have been documented in the literature now increasingly. And while back five or six years ago, when uh Fiona Charlson, who's done a lot of research in this area, was looking at it, there was only a handful of studies in the previous couple of decades. From about 2020 onwards, we've had a huge increase in the number of peer-reviewed publications that have actually been examining mental health outcomes in relation to climate change. And these include the direct impact. So we've talked about these extreme weather events, but there's also heat, not awareness of global warming, but actually being too hot and the increase in heat exposure, then those indirect effects, the flow-on effects of the disruptions to school, work, forced migration, the impacts on physical health that Carlo started to talk about as well. That again, you know, we know that when someone has a heart attack, and that happens much more often during heat wave, they've got a 20 to 30% chance of having an episode of major depression. So this is definitely something where we need to be making people aware and working collaboratively with our colleagues in primary health and looking at policy to try and prevent it. And one more way in which it impacts, which we have talked a little bit about, is through awareness that this is happening. Just that to think about the amount of exposure when they've been looking at studies in Australia, which is one of the most climate-impacted high-income countries in the world, it's estimated that around 80% of the Australian population has had some direct experience of an extreme weather event. So this is not a something that might happen later. This is very much something that is already here. And I think the question that Carlo posed about why is it that when we already have this lived experience that in fact, you know, the majority of people living in this country have, and many people in our Tara, New Zealand have as well. How is it that we seem to be so paralysed in responding more effectively?

SPEAKER_00 25:41

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