Climate impact: Providers should prepare for uptick in acute anxiety and chronic PTSD

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In the U.S., more than 40 million adults suffer from a mental illness. But that number could jump drastically as a result of the impacts of climate change, experts warn.

"Climate-related changes to weather, resulting in flooding and hurricanes, storms, wildfires, rising sea levels, droughts, are the perfect setup to cause individuals already with mental illness to have a flare and create new symptoms for those that didn’t have mental illness before," said Caroline Carney, M.D., chief medical officer for Magellan Rx Management, the pharmacy benefit management division of Magellan Health.

For example, following Hurricane Katrina—the devastating Category 5 hurricane that hit the U.S. Gulf Coast in 2005—studies showed that 49% of adults developed an anxiety or mood disorder and one in six developed PTSD, Carney said.

Most people are familiar with the initial shock and grief following an incident like a hurricane or a fire. But many more possible chronic psychological consequences can occur after a natural disaster such as anxiety, PTSD, compounded stress, strains on social relationships, depression, anxiety, suicide, substance abuse, aggression and violence, loss of control, loss of identity, and feelings of helplessness.  

Among the concerns is the impact of displacement as a result of sea level rise or other environmental changes. Similar to being forced to migrate from a home environment, a phenomenon known as solastalgia—a feeling that the person is losing a place important to them—can occur. In fact, a common prediction is that 200 million people will be displaced due to climate change by 2050.

Yavar Moghimi, M.D.,, medical director of behavioral health for AmeriHealth Caritas District of Columbia, has been working with the Medicaid population and marginalized communities in Washington, DC, for some time, and some of his patients happen to be displaced from Hurricane Katrina. “One patient pretty much relocated up to the DC-area and never went back to his home town or New Orleans. Just imagine leaving New Orleans, with its unique culture,” Moghimi said.

And Moghimi says that while PTSD, anxiety and depression can develop, other behavioral disorders can be hard to define, such as dealing with the loss of family or culture.

“My fear is that the marginalized are most impacted by these types of events,” he said. “We have to be much more mindful of who will be impacted, in a proactive way.”

Children and young adults are especially vulnerable and are on the minds of many behavioral health specialists. Jim Laughman, executive director of PerformCare, the behavioral health and managed care arm of AmeriHealth Caritas, believes that while mental health has come a long way in the past 10 years, there are still challenges to overcome surrounding children and trauma.

According to a study from Kaiser Permanente and the CDC, people who had four or more adverse childhood experiences were 12 times more likely to commit suicide. And physically, the propensity for lung and heart disease is higher among people who are traumatized.

“The healthcare industry does not understand the complete impact of childhood trauma on physiology and health outcomes,” he said.

What can be done

As with other healthcare issues in the U.S., it's important for providers to recognize that certain communities are at greater risk of mental health issues due to climate change. For instance, individuals who live in communities where agriculture is a staple profession, or where the geography is more vulnerable to storms and rising seas, are more likely to experience negative mental health impacts. 

More impoverished communities, too, tend to suffer the most during natural disasters. For example, following Hurricane Sandy, lower-income residents reported weak or absent social support networks and reported the greatest percentages of severe depression following the storm.

One of the challenges seen with these at-risk communities is getting them comfortable enough to open up to a mental health worker. When someone is not willing to come and say they have had trauma, it’s the healthcare worker’s job to spot this trauma and help them through work with community partners.

Moghimi says there are psychological first-aid and crisis intervention programs that have proven to help people bounce back from a trauma more quickly. However, mental health workers need to get to these populations where and when they are needed.

This is a space where Carney believes peer interventions could work really well. Peers could go into the communities hit by a disaster and talk about the mental health resources available. It’s also a place for telehealth and digital technology to continue ongoing care.

Magellan, for instance, has apps for substance abuse, anxiety, depression, and identifying symptoms and guided therapy. “At Magellan, we open up our call center lines so that our mental health clinicians can talk to individuals and get them triaged to other services,” Carney said.

But she notes an increased need for hospital emergency departments to recognize when mental illness may be present, as PTSD may not present itself for weeks or months after a trauma or disaster ends. Prolonged help is often important since a person having a hard time finding shelter and food is not likely to prioritize mental health resources. “Basic hospitals can and should focus as a public health interventions center and a pillar for the disadvantaged,” Carney added.

Carney sees a need for developing more mental health content specific to climate change and natural disasters for educating providers. “There is a tremendous need for many people to use the public mental health system, and so we need to train primary care providers in mental health,” Carney said.

Climate impact: Providers should prepare for uptick in acute anxiety and chronic PTSD
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