New Psychiatric Times Climate Change Section Editor

CLINICAL CONVERSATIONS

More than two-thirds of US adults (68%) have reported some anxiety about climate change.¹ As part of our 40th anniversary celebration, Psychiatric Times welcomed Badr Ratnakaran, MBBS, to join the board as a dedicated climate change section editor to best cover important updates related to climate and psychiatry.

Ratnakaran is a geriatric psychiatrist at the Carilion Clinic Center for Healthy Aging in Roanoke, Virginia. He earned his medical degree from Government TD Medical College Alappuzha in India and completed residency training in psychiatry at Government Medical College, Thiruvananthapuram. He completed his second residency training in psychiatry and fellowship training in geriatric psychiatry at Carilion Clinic-Virginia Tech Carilion School of Medicine.

Psychiatric Times: When did you realize you had an interest in climate psychiatry?

Badr Ratnakaran, MBBS: I am an immigrant physician from India. I was born and had my initial childhood in the United Arab Emirates. In middle school, I moved to my hometown of Kochi, Kerala, in southern India. Growing up in both countries, I lived in 2 different geographical regions, having very contrasting primary conditions: the Middle East's dry, hot, and arid summers and the tropical and humid conditions with monsoon rains in South Asia. The climate patterns were stable then. I moved to the US in 2017 to pursue residency and fellowship training. I have been staying and working in Roanoke, Virginia, for the last 8 years. When I first moved to Roanoke, I could not afford a car in my first year of residency training. I would use public transportation or walk to work in the small town of Roanoke. The summer, fall, and spring walks were pleasant and joyful.

Multiple climate-related events started happening in my life from 2018 onwards. In August 2018, the State of Kerala witnessed a devastating flood due to heavy rainfall during the monsoon season.² The floods were devastating to many of my family and friends, who lost much of their homes and property. Around the same time, Hurricane Florence came close to Roanoke and caused much damage to North Carolina.³ With these climate change-related disasters, I became more vigilant about climate change worldwide and noticed patterns. The summers back home in India and in Roanoke began to get hotter. We are experiencing more heat waves in the country and more destruction caused by tornadoes, hurricanes, and snowstorms. I have learned to become more vigilant about the weather in Roanoke and my hometown in India to prepare myself and my family for weather-related events which has started to become more frequent. Because of the time zone differences between the US and India, this meant sometimes losing sleep, keeping track of the weather, and ensuring my family is safe. I still have family and friends in the United Arab Emirates and surrounding Middle Eastern countries, and in the last few years, the region has also started witnessing climate-related changes and disasters, with its historic record-breaking range and flood affecting the United Arab Emirates in April 2024.⁴ I also started coming across more news about the rise of zoonoses-related infections and threats to coastal towns,⁵ including my hometown, from rising sea levels due to climate change.⁶

My interactions with patients, friends, and colleagues made me realize I was not the only person worried about climate change. They all have their grief, anxiety, and worries related to it. My appreciation for the impact of climate change on mental health began from these interactions. I started to learn more about how climate change can impact mental health, primarily through organizations like the Climate Psychiatry Alliance and the American Psychiatric Association.

PT: In your view, what are the most pressing challenges in climate psychiatry? How does the environment impact clinical care?

Ratnakaran: The most important thing now is to raise awareness of current and future mental health clinicians on the implications of climate on mental health care beyond climate change-related disasters. Ongoing changes in climate, including changes in ambient temperature, worsening pollution, displacement due to changes in geography from climate change like rising sea levels and droughts, rise in zoonotic and water borne-diseases, etc, have implications on both physical and mental health.⁷ Vulnerable populations, including children, older adults, individuals who have medical and mental illnesses, individuals who have substance use disorders, those who are homeless, anyone belonging to lower socio-economic status, and racial and ethnic minorities, are the most likely to be impacted by climate change and health. Increase in ambient temperature can increases the risk of adverse effects of psychotropic medications like lithium, stimulants, anticholinergics and antipsychotics.⁸ An increase in ambient temperature is associated with poor mental health outcomes,⁹ including an increase in attempted and completed suicides and psychiatric hospitalizations. Air pollution has been associated with depression and cognitive dysfunction.¹⁰ Climate change-related events can also disrupt the medical supply chain and affect the quality of medications that need to be maintained at a constant temperature, such as long-acting injectable antipsychotics.¹¹

PT: What should every clinician know about disaster psychiatry, especially in the wake of the recent wildfires?

Ratnakaran: With climate-related disasters like wildfires or hurricanes, we often think of the immediate consequences like displacement, physical injuries, psychological trauma, and grief from loss of property and family members. Clinicians should be ready to these immediate consequences, including addressing immediate needs, mass trauma response, and providing psychological first aid.¹² Clinicians can also prepare their patients for climate-change related disasters, especially during months where it can occur more often, like fire or hurricane season,^13,14 by stocking up medications, preparing an emergency kit, having emergency contact numbers, and identifying shelters. But the work does not end there. Climate change-related disasters have also been found to have long-term effects including depression, anxiety, posttraumatic stress disorder, and substance use disorders.

PT: Patients with psychiatric disorders are at increased risk during times of high heat.As the summer approaches, what recommendation can you offer patients?

Ratnakaran: As mentioned earlier, increased ambient temperature, especially heat waves, can worsen psychiatric symptoms and physical health conditions, and impact the effectiveness of psychiatric medications. Patients should talk to their psychiatrist about mitigating adverse effects from psychotropic medications, especially if they are taking medications like antipsychotics, anticholinergics, lithium, and stimulants. It is essential for patients to inform doctors or visit nearby hospitals if they feel their mental health symptoms getting worse, have thoughts of suicide or hurting themselves or others, or are experiencing intolerable adverse effects from medications. Patients need to adequately hydrate themselves and have proper air conditioning at home. If they struggle with air conditioning, they should identify cooling centers in their neighborhood, like libraries.¹⁵ Local government offices and organizations like Climate Psychiatry Alliance also have resources for coping with heat waves.¹⁶

PT: Do you have any recommendations for patients on how they can improve their resilience in the face of climate distress? What conversations should clinicians be having with their patients who have climate anxiety?

Ratnakaran: Distress due to climate change or eco-anxiety is a real phenomenon.¹⁷ It is becoming more common for individuals to start feeling anxious about ongoing and future changes that can occur due to climate change. Focusing on what we can control and setting boundaries on excessive viewing of climate-related news, like doom scrolling, is important. Engaging in self-care practices like journaling, exercise, and mindfulness is essential. If these measures do not help, it will be important to seek help from a mental health clinician, if possible from a climate-aware therapist, to help address anxiety. Patients can also engage in climate-friendly and sustainable practices, including carpooling, using public transportation, electric vehicles, recycling, reducing food waste, and doing their part in advocating with local government and senators on taking measures to mitigate climate change.

Clinicians should educate themselves about patient’s climate change-related concerns, particularly those pertinent to the geographical region, eco-anxiety, and even solastalgia.¹⁸ They should be able to understand that their patients’ concerns related to climate change are valid and can impact their daily functioning. Educating them about self-care practices and creating a coping plan will be important.

PT: As you take on this role of section editor, what do you want your colleagues to know?

Ratnakaran: As the section editor, I will focus on important topics related to climate change and mental health that are pertinent to clinical practice. I aim to address issues like prescribing psychotropic medications and special populations in the context of climate change. If you want to write on any topics, please get in touch with Psychiatric Times to discuss your ideas further.

PT: Thank you!

Dr Ratnakaran is an assistant professor and geriatric psychiatrist at Carilion Clinic-Virginia Tech Carilion School of Medicine. He also serves as the medical director of CONNECT, 24-hour emergency evaluation and referral service of Carilion Clinic.

References

1. Majority of US adults believe climate change is most important issue today. American Psychological Association. Accessed May 12, 2025. https://www.apa.org/news/press/releases/2020/02/climate-change

2. Floods in Kerala. Reuters. August 24, 2018. Accessed May 12, 2025. https://www.reuters.com/news/picture/floods-in-kerala-idINRTS1XFOF/

3. Held A. Florence blamed for 4 more deaths as 'unheard of amounts of water' keep flowing. NPR. September 20, 2018. Accessed May 12, 2025. https://www.npr.org/2018/09/20/649854188/florence-claims-four-more-lives-as-unheard-of-amounts-of-water-keep-flowing

4. Cornwell A. What caused Dubai floods? Experts cite climate change, not cloud seeding. Reuters. April 18, 2024. Accessed May 12, 2025. https://www.reuters.com/world/middle-east/what-caused-storm-that-brought-dubai-standstill-2024-04-17/

5. Lambert J. What's worse for disease spread: animal loss, climate change or urbanization? NPR May 15, 2024. Accessed May 12, 2025. https://www.npr.org/sections/goatsandsoda/2024/05/15/1251036160/viruses-climate-change-animal-loss-urbanization-infectious-diseases

6. Kellman R, Hersher R. Why Texans need to know how fast Antarctica is melting. NPR. April 19, 2023. Accessed May 12, 2025. https://apps.npr.org/arctic-ice-melting-climate-change/texas-galveston-sea-level-rise.html

7. Climate change. World Health Organization. October 12, 2023. Accessed May 12, 2025. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

8. Hu C. How some common medications can make people more vulnerable to heat. Scientific American. May 1, 2024. Accessed May 12, 2025. https://www.scientificamerican.com/article/how-some-common-medications-can-make-people-more-vulnerable-to-heat/

9. Thompson R, Lawrance EL, Roberts LF, et al. Ambient temperature and mental health: a systematic review and meta-analysis. Lancet Planet Health. 2023;7(7):e580-e589.

10. Bhui K, Newbury JB, Latham RM, et al. Air quality and mental health: evidence, challenges and future directions. BJPsych Open. 2023;9(4):e120.

11. Kaplan WA, Hamer DH, Shioda K. The potential impact of climate change on medication access and quality deserves far more attention. One Health. 2024:20:100957.

12. Filipi L, Pratt N, Khan S. An overview of disaster psychiatry. Psychiatric Times. February 28, 2025. https://www.psychiatrictimes.com/view/an-overview-of-disaster-psychiatry

13. Preparing for fire season. United States Environmental Protection Agency. Accessed May 12, 2025. https://www.epa.gov/wildfire-smoke-course/preparing-fire-season

14. Prepare before hurricane season. National Oceanic and Atmospheric Administration. Updated March 3, 2025. Accessed May 12, 2025. https://www.noaa.gov/prepare-before-hurricane-season

15. Cooling centers by state. National Center for Healthy Housing. Updated July 5, 2024. Accessed May 12, 2025. https://nchh.org/information-and-evidence/learn-about-healthy-housing/emergencies/extreme-heat/cooling-centers-by-state/

16. How to survive extreme heat. Climate Psychiatry Alliance. Accessed May 12, 2025. https://www.climatepsychiatry.org/heat-wave-resources

17. Pearson H. The rise of eco-anxiety: scientists wake up to the mental-health toll of climate change. Nature. 2024;628(8007):256-258.

18. Richardson A. Solastalgia: missing home while being home. Climate Psychiatry Alliance. Accessed May 12, 2025. https://www.climatepsychiatry.org/major-topics-in-climate-psychiatry/solastalgia-missing-home-while-being-home