SPEAKER_01 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_00 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. Before we begin, a quick note that this is part two of our conversation. If you haven't already listened to part one, we strongly recommend starting there first, as this episode builds directly on topics and discussions from the earlier conversation. Once you've caught up, come back and join us for part two.

SPEAKER_04 0:56

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, 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 Carlos 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 a 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. 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 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 Taroa, New Zealand have as well, how is it that we seem to be so paralyzed in responding more effectively?

SPEAKER_03 3:07

Absolutely. Thanks everyone. I just wanted to turn now to Elizabeth. So Elizabeth is a fourth, fourth year medical student at Bond University, and she's kindly joined us. And we'd love it if you could perhaps talk a little bit about your kind of perspective on the issue of planetary health and its relationship with mental health from your, you know, your experience as a student and a young person. Yeah, absolutely.

SPEAKER_02 3:31

So I guess like I mentioned earlier, I kind of grew up in the period after, you know, climate change is now an accepted thing. We know that it happens, there's no myth of global warming, it is real. Where do we go from here? And I think what I saw, particularly amongst, you know, my friends and the high schools that I was seeing, I don't know, with regards to the rest of the country, but particularly in New South Wales, there was a lot of passion. There was so much passion from all the students. We had so many feelings about, you know, this is the world we're going to inherit. We want to take care of it, we want to do something, we want to go somewhere with it. But at the same time, there was all of this really intense fear growing up. Um, like I can remember, you know, being at lunch and people just having really normal natural conversations. You know, I remember a friend being like, Yeah, I probably won't have kids because, you know, the world's doomed. So what's the point of, you know, bringing anyone and we were probably about 13 or 14 at the time, and this was just a very, very normal thing to talk about. So yeah, it's sort of been weird growing up in a time where it feels like yes, people are doing amazing things to help the world and to really stop the environmental destruction that's been going on for a while. But yeah, at the same time, you still have all of these feelings of like, is it enough? What can we do? And the frustrating thing about being a young person is you're not at the point where you have any serious power to change policy or change things from um upwards coming down. So you're left with a lot of confusion and a lot of fear. Like, we don't we don't know where to go with this. And particularly at like the school climate strikes, I was thinking previously I've spent a little bit of time studying like history and different maybe past examples of where other youth have felt similar similar problems and similar fears. And it kind of reminds me a lot of like the 1960s and people growing up in the shadow of the cold war and nuclear annihilation. And I couldn't find any articles or papers online, but I imagine that there were a lot of really, really similar feelings of hey, the world is ending, we can't do anything. Where do we go? Back then it was maybe, well, we just have to make sure the bombs go don't go off. Whereas now it's kind of like a marathon, not a sprint. We've got to keep pushing gradually and gradually and gradually and making sure changes are enacted rather than any kind of quick fix, which you know can sometimes yeah, weigh on you a little bit heavier.

SPEAKER_03 5:59

Thanks, Elizabeth. It was just so nice to hear you speak about those experiences that you've had. And I absolutely love that really fascinating kind of insight that we've actually seen periods of time before in history where we've felt these kind of same feelings of existential kind of threat. And maybe there are lessons to be learned from previous times where we've we've felt collectively quite worried about the future and what that will look like. So thank you so much. I just wanted to briefly touch on the concept of eco-distress because this is a phenomenon that has had kind of a lot of publicity and research on it in the last few years, and also something that I have a lived experience of as well as the person in the world kind of coming to terms with how best to live well with this backdrop. So the just a brief definition of eco-distress, it is worried, anxious, or fearful responses to the awareness of climate change in broad terms. And I'd like to ask what guidance does everybody have for psychiatrists who might come across this clinically? Thanks very much.

SPEAKER_04 6:59

Look, it's such an important topic, and I'm really enjoying being part of this recording with all of you. I think one of the things that is often uh misunderstood about people being distressed around climate change and around the nature crisis is the idea that perhaps this is an unfounded worry. And in fact, that misunderstanding or in fact sometimes deliberate strategy is often a source of distress because, for the most part, being distressed about the current climate and nature crises is a healthy response to an unhealthy situation. And as the group Psychology for a Safe Climate have described in both research and practical elements, we really are looking at a huge range of different emotional responses that can be a normal response to this highly abnormal, unhealthy situation. And that often part of what people need when they are experiencing distress is actually simply to be validated for someone to listen and to be able to sit with them in the distress that they're experiencing. Now, obviously, as a mental health professional, whether it's as a general practitioner or a psychologist or a psychiatrist or another mental health professional, you do want to also be thinking about well, could this sometimes really intense and sustained distress reach a point where it has triggered or worsened a mental illness or a disorder? And that can happen. But we really don't want to confuse that with the idea that there is something uh unhealthy in being worried about a real threat. And we now have quite a bit of evidence about what sorts of worried can be angry, frustrated, hopeless about the state of nature and the climate. That yeah, being listened to and and believed is one part of it. Having opportunities to connect with other people who will support them in their concerns or who share their concerns, opportunities to take action in peaceful ways that fit with their values. And for some people in a school age context, that might be school strikes for climate, a younger child, it might be helping with the recycling, a psychiatrist or psychiatry trainee, it might be joining the Planetary Health and Mental Health Advisory Group, or another group like Doctors of the Environment or Oroteo. There's a group of a number of ways you can get involved. And also spending time connecting with nature. So spending time in nature for many people is beneficial and having breaks. None of us can do this alone. And it's by sharing with other people and also looking after ourselves that we can face the climate crisis in a healthy way.

SPEAKER_05 9:54

Perhaps just to add that those possibilities are not mutually exclusive. I think combining them and something that that we've been doing quite a lot in New Zealand is encouraging people to spend time in nature and while they're in nature to do things like helping to restore the native bush by either eliminating invasive weeds, planting native species, trapping unwelcome predators, including the Australian brush-tailed possum, which does I understand as a protected species in your country, but is a most unwelcome visitor in ours. And doing all those things actually feels very positive. So not only do you get the nature exposure, which is healing and de stressing in its own right, but you actually have demonstrable consequences of doing stuff to enhance the natural environment. And that is enormously gratifying when you might come back a year or two later and see that a stand of native bush has grown up and now has birds in it. You know, that sort of thing is tremendously satisfying to think, well, it's actually catching some carbon and it's providing habitat and it just feels good.

SPEAKER_04 11:09

I just wanted to add, I've been really fortunate to be involved in some research looking at the evidence around programs in school settings. And this is, I think, again, important in thinking about what is the evidence versus what are people guessing might work or not work. And that research, where we looked through all the major health databases from a Western scientific point of view, but also worked alongside three Aboriginal knowledge holders, Auntie Rhonda Dixon-Grosvenor, Uncle Dean Kelly, and Auntie Khalida Murray. And looking at all of the evidence around school programs, what we found was that actually time in nature, whilst learning about it, was one of the predictors of better outcomes in terms of the available evidence across the board, both in indigenous evidence and in Western scientific literature. The other thing that we found, which I think is really important when people are thinking about how to respond to a young person's concerns or distress, is that there were not any harmful effects. So actually having programs in schools that helped young people, children and teenagers learn about what's going on in nature and the climate in psychologically safe ways was not harmful and showed signs of being beneficial. And it's a really important thing for us to be able to kind of lean on that we actually know that it is okay to be talking about these topics and to be inviting peaceful, developmentally appropriate action.

SPEAKER_02 12:40

Absolutely. Yeah, kind of as well, to add on to what's already been said, um particularly by David and Sybil. I think to me, in terms of it sounds like empowerment is really important for people. And I feel like a lot of yeah, the feelings that people have and the problems people are facing, yeah, mentally and psychologically, is from like a loss of control. It feels like there is nothing that can be done that, you know, we're all kind of a little bit helpless sometimes. And that giving people back that power, back that control, saying, you know, yeah, you can like go out in nature and you can grow um this incredible thing and see the fruits of your labour is actually very, very psychologically like helpful and calming to people and empowering.

SPEAKER_06 13:21

So you're telling us we should stop worrying about worrying, or we should rather worry about doing something.

SPEAKER_03 13:28

Well, yes, perhaps for some people some of the time. And I think um probably just in summary about the concept of eco-distress, I would say, and maybe you agree, maybe not, um, is that it is, as people have said before, kind of a healthy and normal reaction to an abnormal situation. We wouldn't want to pathologise it as if we see it clinically. However, that doesn't mean that people who experience this don't need support. So I guess also just on that, in terms of what can be done about it, it sounds like connecting with community, connecting with nature is helpful. And the dialectic, which you know, we all have practice in in DBT and so on, the dialectic being that sometimes we actually also need to slow down, do less, and and take breaks from it as well.

SPEAKER_05 14:18

And speaking of doing less, I think it's important to remember that healthcare itself, including psychiatry, is a major contributor to carbon emissions around the world, probably. I think we heard this morning in in one of the plenaries at this Congress that between four and nine percent of global carbon actually comes from healthcare and related industries. An astonishing amount, more than aviation and shipping combined, which really is a bit startling. And it reminds us also that a lot of healthcare is relatively wasteful or low value. And by tidying up our own healthcare house, I think we might be able to have a useful impact there. So this doesn't deal immediately with the way we treat our patients, although it probably has more to do with how we organize services and what treatments are offered, emphasizing high-value health care and often less medicine rather than more.

SPEAKER_04 15:17

Thanks, David. I just I sort of two areas that I particularly wanted to make sure we get to. But one was following on about sustainable health care and sustainable mental health care. As David was saying, it's it's not about withdrawing health care. This is not about limiting access or stopping people from having health care. It's about making sure people are getting health care that is actually helping them at the right time in the right place, and that we are making sure that preventative measures and primary care, which are much less carbon intensive than hospital-based care, and this is coming from someone who works in hospital context, so it's not that I'm against hospital care, but it's just really important that the opportunities for something like short-term cognitive behavioural therapy in a community setting, or changes to lifestyle with exercise that may be able to prevent something getting worse are actually available and being put into action. And that when we're looking at what health care, including mental health care, is delivered, that it that it is actually doing what it needs to do. So preventing people from becoming so unwell that they need to be in hospital, but still making sure that we can provide good mental health care when people do need it. So it's both. And I think the other thing about it is that while we need to focus on making mental health care sustainable, we also need to plan for the projected and observed increases that we're seeing. So we actually need to be doing both. And certainly from the point of view of the impact of increased extreme weather events and heat, it is already happening and it is projected that we will get further increases. So we both need to improve how well we help people protect themselves and make sure that our health system is ready to support the people who still need that more intense health care.

SPEAKER_03 17:09

Absolutely. I just wanted to touch on that one of the issues that we might face as clinicians is kind of coming to terms with our own feelings about the environment, while, of course, also potentially being clinicians that might be supporting patients who are also going through these similar feelings. And perhaps the realization that our identities as climate where individuals are not actually separate from our identities as medical professionals. And I suppose that kind of brings me to the question we've kind of already touched on it a bit, but maybe there are some other comments and suggestions. What can listeners do if they're interested in learning more or becoming engaged in the area?

SPEAKER_04 17:45

So, yes, there are many things people can do to be able to engage, find out more, and learn at how to manage the one's own responses. And some of the organisations that are involved with within the college are the Royal Australia and New Zealand College of Psychiatrists, our Planetary Health and Mental Health Advisory Group, and outside the college, groups like Doctors for the Environment Australia, which is also open to medical students, and psychology for a safe climate, that's a not-for-profit that we mentioned before, that's doing some really good work in this space, as well as in New Zealand or Arotaroa, the Oroteo group, and the overarching group in Australia would be the Climate and Health Alliance. So there's many places where one can be involved as a health professional, as a medical practitioner, or specifically as a psychiatrist, that can really make a difference and that can also offer you resources about how do you actually make sense of it. And certainly Psychology for a Safe Climate has online opportunities to do professional development to make sense of that. The other thing I just wanted to put a little bit of a plug in is that one of the concerns that my colleagues have expressed, and some of this has been in our uh Australasian psychiatry, has been around the need to attend to the impacts on people with serious mental illness. So all of these events are amplifiers of inequity, and people who are living with chronic severe mental illness are some of the most impacted people by these events that are made worse by climate change, by diversity loss. And certainly heat is one of the ones which really does amplify inequity. And as psychiatrists, I think it's really important that we are both advocating for action to reduce the worsening of the heat, but also for our patients to have access to mental health care even during heat waves, good education about continuing mental health care even when it's hot, and prioritizing it in government responses.

SPEAKER_03 19:46

And it's so interconnected as well, because you know, heat stress is also amplified by poor housing and a lack of availability of cooling systems and things like that. And, you know, mental health is a determinant of inequality and an amplifier of inequality as well. So it's it's just such a relevant, complex problem in psychiatry.

SPEAKER_04 20:06

Just to sorry, just to add on to that, if people are interested and want to know more about heat and mental health, the college actually has available on its website a webinar about heat and mental ill health, which goes into this in a bit more detail for people who are interested.

SPEAKER_05 20:20

Perhaps I could also just mention the fact that many of us are involved in teaching medical students and training registrars as well. And I think these matters are now seen to be obviously of clinical importance as we've discussed, but making sure that medical students and registrars are well aware of the climate science that that impacts the population health and population mental health, but also ways in which healthcare can be better, more sustainably organized and delivered. So this is uh this is an agenda for all of us in uh academic medicine as well as in clinical practice.

SPEAKER_06 21:00

Well it's said, and I feel that our students probably know more about climate change and they're they're ingrained in it sometimes. They can lead the way and maybe harvesting their passion about the future for climate, uh health. It's probably part of us our role as uh current education leads in this country. So absolutely thank you for saying that, David.

SPEAKER_05 21:20

And perhaps even more than that, to offer them the opportunity to develop and lead the way because this is the next generation, and we have an example with us in the room right now of somebody who will pick up that mantle and run with it.

SPEAKER_04 21:38

I just wanted to, I guess, give a a slightly different angle to that, which is the feedback that I've heard from young people who are very active in this space, is that often what they are missing and looking for is for people in other generations, people in positions of authority, whether it's in medicine or government or business, to be stepping up, standing up. And being accountable for getting action on the fossil fuel-driven climate and nature crises, not just celebrating the fact that young people are awesome. Young people are awesome. They're doing fabulous things. And the rest of us also need to make sure that we're part of the solution too.

SPEAKER_06 22:18

You can also add another angle. When we talk about planetary health, it can feel a bit gloomy, like we are heading towards disaster. That's not inevitable. I think action promptly now can certainly lead to change in the future. The later we start, the worse it's going to be, I guess. So the sooner we start, the better it is, is the other way of looking at that. So let's all do something to improve the future. Final, maybe personal disclosure example could be with my research interest in metabolic health. And of course, I am a big advocate of uh reducing carbohydrate uh consumption as a part as part of a kind of nutrition health in mental health. But part of me also feels there's a cognitive dissonance there, uh, because I'm very much uh aware of environmental issues and and then uh eating a ketogenic diet often is associated with eating a lot more meat. And of course, how do you reconcile that? And that there are ways around that, because of course science in that department is controversial. So meat can be sustainable, and uh uh but it's also you can have a ketogenic diet, it's not necessarily a high carbon footprint diet. And I'm saying that uh because I think it's important. So when when we are developing our understanding of what we as psychiatrists can do, whether that's a pharmacological intervention or a lifestyle intervention, or indeed a nutritional intervention like we are doing in metabolic psychiatry, this needs to be in line with planetary health. So I I really believe that planetary health should be the overarching principle by which we do everything else. And let's try and make sure that whatever is new to start will be in line with the healthy planetary future.

unknown 23:57

Yeah.

SPEAKER_02 23:58

Um yeah, finishing up on my end as well with a bit of a positive note, I think doctors have always been kind of advocates for change in really wonderful ways. Oftentimes governments or um, you know, non-medical people tend to listen in quite distinct ways to doctors. And it's a really powerful position to be in where you can enact a lot of change and it is really wonderful. Like we've seen in the past with things like the civil rights movement, in a lot of ways, was pushed heavily by doctors and all sorts of precedents. So it is exciting for all of the amazing doctors and psychiatrists here today to be in a position where yeah, you can push those things forward and you can enact change and it can be really positive. Thanks everyone.

SPEAKER_03 24:38

Um, I just wanted to say honestly, I just feel so delighted to have had this chat with you all today. And it just brings me so much joy that we're actually sitting here and I'm chatting with a bunch of like-minded people within the college and a wonderful medical student coming through as well. And it's just been such a delight and really filled my cup up in terms of connection, which is really helping my sense of joy and hope for the future. I just wanted to thank you all for coming along today. Thank you for joining us.

SPEAKER_00 25:08

We hope you enjoyed this episode of Psych Matters. Feel free to share it with others and keep an eye out for future episodes. Psych Matters is produced by the Royal Australian and New Zealand College of Psychiatrists.