Dr Rosen is an officer of the Order of Australia, a Fellow of the Royal Australian and New Zealand College of Psychiatrists, is affiliated with the Brain & Mind Centre at University of Sydney and the Institute of Mental Health at the University of Wollongong (Australia), and is Chair of Transforming Australia’s Mental Health Service System (TAMHSS).He has been a psychiatrist serving Aboriginal communities in a remote region of New South Wales for 35+ years.
Australia’s cascading environmental crises are all likely effects of climate change. How can psychiatrists and other mental health stakeholders respond?
EARTH & PSYCHIATRY
If you have read Thornbirds, Colleen McCullough’s 1977 blockbuster novel, you will know that Australia is not all panoramic vistas and rural dynasties, but also a nation that contends with, absorbs, and bounces back from occasional disasters: bushfires, floods, and droughts. But our recent experiences have been very different.
Over the last few years, Australia has been afflicted by an overlapping sequence of unusually prolonged droughts,1 extreme bushfires that cast persistent heavy and potentially deadly smoke over urban as well as rural populations,2 pandemic-induced lockdowns, with its isolation and uncertainties, and most recently, devastating storms and widespread flooding. All of these caused deaths, grieving, and trauma, to say nothing of the vast loss of wildlife and habitat.3 They also have been punctuated by additional plagues of dust storms, locusts, and mice.
Studies suggest that it may be more difficult to recover resilience from recurrent knocks than from a single event. Taken together, adverse events are sometimes called “domino crises.” The more dominos over a shorter period, the more difficult it is to recover.
In the Australian countryside, more than 60% of communities that bore the brunt of the floods were also still recovering from the extreme fires a year earlier, followed by the pandemic. Climate change-related disasters increasingly overlap both temporally and geographically, and occur with greater frequency, intensity, and duration. Such a staccato volley of climate crises may be “threat multipliers, compounding harms” from vector-borne diseases, stressful secondary life events, and compromised mental health.3-5 Historically, societies that fail to develop buffers and strategic resilience against the domino effects of climate change and other disasters may be more vulnerable to instability and collapse.6
With the recent flooding, many rural landscapes became temporary inland seas. To provide some idea of comparative scale, the affected areas are reported to have been about the area of Alaska. On a brighter note, floods have likely broken the years of drought in some rural regions, but not all of the worst affected. The intensity of these extreme droughts, fires, storms, and floods indicates that they are likely to cause a cascading sequence of severe climate change related events.
As well as stress, anxiety, depression, and trauma responses, distinct mental health conditions relating to climate change are now increasingly recognized internationally (eg, eco-anxiety: the chronic fear of ecological doom7; and solastalgia: the existential distress and grief due to the loss of familiar habitat8). The latter condition may have been familiar to indigenous peoples, who lost familiar environments, custodial roles, and sovereignty over their lands and waters due to colonization. Perhaps our wider societies may now be catching up and beginning to understand indigenous concerns better, especially in Australia. Indigenous quests to have their expertise in communal, land, fire, and water management more widely valued and re-established are crucial not only for the continued existence of indigenous societies, but also arguably for the survival of our species and our planet.
It is important to acknowledge the well-documented risks and existential threats of the pandemic and other climate change-related events to all vulnerable individuals, especially those in indigenous communities. Indigenous communities are particularly concerned about the effects of climate change on their elders, who have a life expectancy more than a decade lower than wider populations.9
At the same time, there is also a glimmer of hope. Australasian indigenous communities effectively prepared their communities to for COVID-19, demonstrating their ability to act with self-determination and full community consultation. National and regional Aboriginal organizations rapidly mobilized local networks to take preventative action, invoking prompt government support for community-controlled strategies. These included: Aboriginal health and community workers proactively assisting with contact tracing and deterring overcrowding; ensuring food and medicine supplies; and immediate lockdowns with exclusion of visiting strangers.10-12
Nationally, over the first year of the pandemic, the per capita rate of COVID-19 cases among the indigenous population was only one-sixth of the per capita rate among the general population, with 22 hospital admissions, 1 intensive care unit admission, and 0 deaths.12 Maori individuals in New Zealand have a similar story to tell. Despite constructive attempts by Aboriginal groups to bring these encouraging outcomes to national and international attention, it has been difficult to do so. Is this due perhaps to our media attention being attuned mostly to bad news? Or have the pervasive expectations and dire warnings poor outcomes for indigenous peoples (due to the pandemic and other climate change related events) led too many governments to accept the inevitability of a dismal fate?
There have been lessons for and from Aboriginal and Torres Strait Islander communities and other indigenous communities on ameliorating the impacts of climate change. How can the wider medical community learn and benefit from this traditional knowledge and wisdom, so both practical application and modern technology can be integrated?
There is a strong parallel here with working “2 ways” or in “2 worlds” in mental health, as advocated by indigenous leadership.13-15 Working in 2 worlds means using traditional cultural “healing in combination with (evidence based) clinical approaches when working to restore the wellbeing and mental health of Aboriginal and Torres Strait Islander peoples,” and training an Aboriginal mental health workforce in both traditional and modern methods.14 It is crucial to build synergies between traditional cultural healing practices and evidence-based clinical interventions. They can both optimize transgenerational resilience and outcomes for mental health sequelae of complex psychiatric disorders caused by climate-related and other severe trauma. Similar synergies could be applied fruitfully to land, water, fire, and pandemic management.
A recent Washington Post got the story right, but the headline a bit wrong. It trumpeted: “Australia made a plan to protect Indigenous elders from covid. It worked.”16 Australia did not make a plan. The headline should have read: “Australian Aboriginal national networks and local communities collectively prepared with a community-controlled plan for COVID-19, and for once, persuaded government to back them promptly. It worked.” Hopefully we are all learning the value of this for managing the climate change phenomena that we have yet to face.
All future mental health and wellbeing strategies should include participatory, collaborative, hyperlocal work that permeates, mobilizes, and engages all communities and societies as whole ecosystems.17,18
Learnings from Professors Alexander MacFarlane, Pat Dudgeon and Fiona Stanley, Mr Tom Brideson and Ms Vivienne Miller.
Dr Rosen is an officer of the Order of Australia, a Fellow of the Royal Australian and New Zealand College of Psychiatrists, is affiliated with the Brain & Mind Centre at University of Sydney and the Institute of Mental Health at the University of Wollongong (Australia), and is Chair of Transforming Australia’s Mental Health Service System (TAMHSS).He has been a psychiatrist serving Aboriginal communities in a remote region of New South Wales for 35+ years. Dr Rosen has no conflicts of interest.
To see more on Earth & Psychiatry, please see The Power and Potential of Earth Week and Psychiatry.
1. Rigby CW, Rosen A, Berry HL, Hart CR. If the land’s sick, we’re sick:* the impact of prolonged drought on the social and emotional well-being of Aboriginal communities in rural New South Wales. Aust J Rural Health. 2011;19(5):249-54.
2. Rosen A. Climate changes are leading to ‘eco-anxiety,’ trauma. Clinical Psychiatric News. April 22, 2020. https://www.mdedge.com/psychiatry/article/221163/anxiety-disorders/climate-changes-are-leading-eco-anxiety-trauma
3. McInerney M, MacKee N. Another catastrophe: back-to-back climate emergencies are taking their toll on our health. Croakey. March 24, 2021. https://www.croakey.org/another-catastrophe-back-to-back-climate-emergencies-are-taking-their-toll-on-our-health/
4. Salas RN. The climate crisis and clinical practice. N Engl J Med. 2020;382:589-591.
5. Kessler RC, McLaughlin KA, Koenen KC, et al; WHO World Mental Health Survey Consortium. The importance of secondary trauma exposure for post-disaster mental disorder. Epidemiol Psychiatr Sci. 2012;21(1):35-45.
6. Feng Q, Yang L, Deo RC, et al. Domino effect of climate change over two millennia in ancient China’s Hexi Corridor. Nature Sustainability. 2019;2:957-961. https://www.nature.com/articles/s41893-019-0397-9/
7. Usher K, Durkin J, Bhullar N. Eco‐anxiety: How thinking about climate change‐related environmental decline is affecting our mental health. Int J Ment Health Nurs. 2019;28(6):1233-4.
8. Albrecht G, Sartore G-M, Connor L, et al. Solastalgia: The distress caused by environmental change. Australas Psychiatry. 2007;15 Supp1:S95-8.
9. Rosen A. For Indigenous communities, climate crisis could prove calamitous. Clinical Psychiatric News. May 13, 2020. https://www.mdedge.com/psychiatry/article/222198/anxiety-disorders/indigenous-communities-climate-crisis-could-prove
10. Dudgeon P, Wright M, Derry K. 2020, A national COVID-19 pandemic issues paper on mental health and wellbeing for Aboriginal and Torres Strait Islander Peoples. The University of Western Australia Poche Centre for Indigenous Health. 2020. https://apo.org.au/node/306661
11. Eades S, Eades F, McCaullay D, et al. Australia’s First Nations response to the COVID-19 pandemic. Lancet. 2020;396(10246):237-238.
12. Talley NJ, Stanley FJ, Lucas T, Horton RC. Health and climate change MJA-Lancet Countdown report: Australia gets another failing grade in 2020 but shows signs of progress. Med J Aust. 2021;214(2):75-76.
13. Durie M. Providing health services to indigenous peoples. BMJ. 2003;327(7412):408-409.
14. NATSIMHL. National Aboriginal and Torres Strait Islander Leadership Mental Health. Gayaa Dhuwi-Proud Spirit Declaration. 2019. https://natsilmh.org.au
15. Coopes A. Relationships, stories and healing: Indigenous knowledges for mental health and wellbeing. Croakey.August 31, 2017. https://www.croakey.org/relationships-stories-and-healing-indigenous-knowledges-for-mental-health-and-wellbeing/
16. Pannett R. Australia made a plan to protect Indigenous elders from covid-19. It worked. The Washington Post. April 9, 2021. https://www.washingtonpost.com/world/asia_pacific/australia-coronavirus-aboriginal-indigenous/2021/04/09/7acd4d56-96a4-11eb-8f0a-3384cf4fb399_story.html
17. Belkin G, Appleton S, Langlois K. Reimagining mental health systems post COVID-19. Lancet Planet Health. 2021;5(4):e181-e182.
18. Rosen A, Gill NS, Salvador-Carulla L. The future of community psychiatry and community mental health services. Current Opinion in Psychiatry. 2020;33(4):375-390.