Table 1

Physician action on mental health impacts of climate change on young people at different levels

Level of intervention	Examples of intervention
In the clinic	Take sensitive histories Obtain a more comprehensive social history and be attuned to a young person’s immediate environment and larger social forces that shape it. Find time to read trusted sources of information on climate change and its wide-ranging impacts. Provide opportunities to discuss these issues that may be worrying young people. Be prepared to ask hard questions and hear hard answers. Invite young people to share their narratives—rather than solely focusing on symptom checklists—and allow them to feel heard, validated and understood. Reconsider the diagnosis Formulate the young person’s presenting difficulties in their situated social context. Reflect critically on what defines a ‘disorder’, and what are the implications of providing a psychiatric diagnosis. Question whether an unexamined practice would reinforce the medicalisation of a justifiable response, or risk turning societal issues into personal ones. Keep count of the ecoanxiety-related clinical encounters to help make change at the next level (see local services). Referrals and social prescribing Adopt the practice of social prescription, or facilitation of non-clinical activities that improve individuals’ holistic well-being. For example, spending time in nature as a family is one of the actions suggested by the RCPsych to manage ecoanxiety for young people. Explore your local resources and develop social prescribing packages that consciously encourage nature-oriented activities. Consider the cobenefit of climate action for both mental health and the environment. Given that much of the climate distress is rooted in helplessness, consider referrals to both activist groups and mental health supports.
In the clinic		Local services	Refocus local service provision Health services are constantly undergoing transformation, and opportunities exist to help mitigate the effects of climate change through this evolving process. Work with others—including stakeholders outside of the health sector—to think about solutions at a community level. Examples include: Share social prescribing pathways mentioned above. There also needs to be agreement and collaboration among organisations Collect on-the-ground data and put a ‘price tag’ on how climate change consequences cost the local health system. Discuss the impacts of climate change on young people’s mental health and psychosocial well-being with local commissioners and authorities. ‘Green’ your local health service. Advocate for the reprioritisation of the local health system’s budget to divest from fossil fuels, change to renewable energy sources, recycle medical waste, etc. Research activities At your local educational and granting institutions, advocate for research priorities that focus on the needs of young people and the wider determinants of health. Consider conducting a research project to strengthen the evidence base on the impact of climate change on youth mental health, and to address the many outstanding questions in this area, such as scalable mitigation strategies. Collaborate with colleagues in the Global South and individuals with lived experiences to ensure the voices of the most vulnerable are included. Support school action A large part of the problem of ecoanxiety is feeling helpless at a time of global calamity. This helplessness can be ameliorated by taking action, but this can be difficult if others, especially those in governing or authority positions, are not similarly motivated. For young people, it would be critical for their schools to recognise and support climate action. Connect with your local school or school boards and work together on ecosolutions (eg, establishing climate action groups, promoting active travel to school, supporting climate strikes, involving young people in nature-related community projects)
Larger community and social milieu	Leverage your social capital as a doctor Exert pressure within the medical profession: Urge medical organisations to take a stance on the climate crisis and lead by example (see position statements by Royal College of Paediatrics and Child Health, RCPsych and American Psychiatric Association) Talk to your medical peers about climate change, find your support networks and take collective action. Write articles, opinion pieces and letters to mainstream print media and the editors of journals urging immediate climate action and protect young people of today and tomorrow. Exert pressure on systemic agents: Vote in your elections and support climate action platforms. ‘Vote with your wallet’ to withdraw support from organisations whose pursuits directly or indirectly hasten climate breakdown. Write or call your representatives, or run for office to initiate the change. Publicly stand shoulder to shoulder with young people in protests and school strikes against injustice. Join organisations such as MedAct (https://www.medact.org), XR Doctors (https://www.doctorsforxr.com/), Climate Psychiatry Alliance (https://www.climatepsychiatry.org).

RCPsych, Royal College of Psychiatrists.