Climate change disproportionately affects young people’s mental health

Climate change is a public health emergency with now well-recognised physical health sequelae.5 Increasingly, it has been further acknowledged that the climate crisis impacts population mental health in profound ways.6 The complexity of emotional responses—beyond sadness, anger, grief, fear and helplessness—have necessitated an entirely new vocabulary. Ecoanxiety or climate anxiety refers to the feelings associated with the awareness of looming environmental threats, while solastalgia describes the psychological pain from not being able to derive solace from one’s home environment in the face of mounting crisis.7 8

At the core of the climate justice movement is the idea that some populations are more likely to bear the burden of climate-related effects than others. Children and youth have been identified as one of the most vulnerable population groups amidst the climate crisis, and are being disproportionately impacted in regards to their mental health in particular ways.1 6 9

First, childhood and adolescence are critical life stages for brain development and psychological growth that necessitates stability and a sense of predictability regarding the future.1 Young people today, however, are presented with an unprecedented planetary threat. In a 2020 Royal College of Psychiatrists survey of child and adolescent psychiatrists in the UK’s National Health Service (NHS), almost 60% of the respondents had seen a patient who was ‘distressed about environmental and ecological issues’ in the past year.10 This prevailing climate distress likely contributes to and compounds with the prevalence of mental health conditions among young people worldwide. As youth mental health forms the foundation of future overall well-being, young people have been denied the guarantee of a safe environment crucial for a healthy start in life.

Second, it can be argued that those least responsible for the climate crisis are the most severely impacted by it.3 11 The vast majority (approximately 85%) of the world’s young people reside in the Global South.12 These lower-income regions have contributed the least to greenhouse gas emissions, yet have been the most affected by climate change-related displacement and food and water insecurity. Further, they are home to the very same populations that have the least access to mental health and healthcare services as a result of systemic social disenfranchisement. The current climate crisis exacerbates existing global inequalities, and marginalised youth arguably bear one of the greatest burdens.

Finally, young people have little influence over a warming planet, depending instead on adults in positions of authority to take corrective measures. As such, youth are faced with a clear existential threat while being denied the agency to manage it. ‘Not voiceless, but unheard’ is a frequent reprise among the over one million youth activists who have rallied in support of Greta Thunberg’s ‘Fridays for Future’ movement (also as known as the school climate strike movement), revealing a sentiment of dismissal and inability to participate in making decisions that affect their lives.13 The largest and most international survey of climate anxiety in young people to date shows a majority feels betrayed and abandoned by governments, which are perceived as failing to respond to the climate crisis adequately.14 In the words of clinical psychologist Thomas Doherty, many young people feel they are being kept ‘climate hostage’.15

What does this mean for health professionals? A call for action

While we wait for our political leaders to take necessary action, how should doctors and other health professionals respond to the climate crisis and the growing impact it is having on the mental health of children and young people?

Numerous recent articles have proposed therapeutic approaches to support patients presenting with climate anxiety.16–18 However, in addition to approaching our patients’ distress from a clinically individual perspective, we argue that the medical community has a responsibility to do more. Specifically, from our respective positions of medical student, resident and consultant—and drawing from our interdisciplinary experience in paediatrics and psychiatry—we call for our profession to take the ‘leap’ beyond the walls of our clinics and laboratories, and take a courageous stance on the topic of climate change.

Medicine as a discipline traditionally prides itself in scientific objectivity, which carries with it implications of being ideology-free. However, the science of medicine cannot be separated from the sociocultural contexts within which it is researched and practised. Ignoring this social dimension has resulted in medicine historically overlooking the connection between illness and broader economic and political systems.

Given the scale of climate injustice exemplified by young people’s experiences, such a neutral position is no longer tenable; the stakes are simply too high. In this sense, the climate crisis could be a turning point for our profession in truly acknowledging some of the macro-level ‘causes of the causes’ of ill health.

The ‘social lens

Such a turn would compel us to adopt a wider ‘social lens’—a perspective which recognises that individual patients are social beings engaged with and affected by complex systems. These wider social, economic and political systems exist above the traditionally defined ‘social determinants of health’ (eg, inequity, poverty), which we are taught to consider during our professional training. However, these macroscale systems are often so immersive that they appear normalised and are therefore difficult to reflect on. A social lens helps to reframe our roles and responsibilities as individual clinicians, and opens avenues for socially conscious professionalism and collective action.

In an exciting first step, organisations such as the British Medical Association, American Psychiatric Association have now recognised the important role doctors have in tackling climate change and promoting the public health benefits of lowered carbon emissions.19 20 But while there is general agreement about the need for high-level policy change to prevent unmanageable climate change, it is much less clear what individual clinicians can do to contribute to this process. Adapting the author’s work in the area of poverty and deprivation,21 we propose a framework to fill this vacuum and to promote climate activism within the medical community (see table 1).

By no means intended to be exhaustive or prescriptive, table 1 is very much seen as a starting point; a place from which others are encouraged to develop tools that will allow clinicians around the world to respond tangibly and meaningfully to the climate emergency.

A moral community for the 21st century

The UK General Medical Council publishes a guiding document called the Duties of a Doctor, widely taken as the gold standard on good clinical care.22 It states that ‘patients must be able to trust doctors with their lives and health’ and that we must ‘take prompt action if you think that patient safety, dignity or comfort is being compromised’. How do we reconcile these duties with the scientific consensus that our climate is rapidly approaching a threshold beyond which there will be major and irreversible changes, some of which are already playing out as catastrophic health outcomes globally?

What emerges from applying a social lens to the climate crisis is the understanding that this is a question of medical justice. Much as climate justice aims to reveal the unequal spread of the climate crisis across populations, medical justice acknowledges the complicated world beyond the walls of our clinics. A social lens teaches us that health cannot be separated from wider social, economic and political factors. If our social and economic system is harming our patients, we have a responsibility to diagnose and treat that problem too.

Imbalances in power, rapacious resource extraction, and a global economy that privileges commodity production and consumption have led to a system that is making our planet and our patients sick—and climate anxiety is an understandable response. Failing to take the courageous social stance would be a failure to take action in the interest of patient health and well-being.

Action on climate change is a prescription for improved health and equity. But this is not a job to leave to politicians and leaders. Health professionals have a role too. The history of social change and activism tells us just this: it is the cumulative power of the often small but brave acts of a large number of ordinary people that has made all the difference. But as our patients’ illnesses only too well remind us, we have no time to lose. The time to act is now.