Category: Brain and mental health

Climate change is undermining people’s mental health – it’s time for action

Woman carrying child in flood water due to climate change
Image credit: Banjir Jakarta, World Meteorological Organization

I have spent the last 18 months encouraging effective international responses to COVID-19. I have learned that the coordinated and connected responses needed for responses to global threats are not easily achieved in today’s world. Yet unless nations can find ways to agree on the challenge, combine their responses and work willingly in synergy, success will be elusive.

Building the habit of working together is even more important when tackling climate change and its consequences. This particularly applies when exploring how changing climates affect people’s mental wellbeing.

There is indeed mounting evidence that climate change is affecting people’s minds as well as their bodies. The number who end their lives during extreme weather and climate events is on the increase. Following a climate-driven disaster, cases of psychological trauma can exceed those of physical injury by 40 to 1.

Yet the potent psychological effects of climate change are largely absent from the public and policy discourse. They need to be made tangible and accessible. This is even more important given the expected increase in the extent and severity of extreme weather all over the world.

The issue needs attention now because it has the potential to undermine the lives of millions of people. It needs professional bodies, universities, local authorities, governments and international organisations to act together now. If effective action is delayed, the scale of the challenge will increase sharply, as will the cost of action.

The Climate Cares team from Imperial’s Institute of Global Health Innovation and Grantham Institute has laid bare some of these issues in a major new review, released last week. The review sets out best how to support people whose mental wellbeing is undermined by changing climate. The proposed actions will enable them to live their lives to the full, enjoying good mental health. There is a clear appreciation of who needs to act, and how they should do so. Actions should be implemented with a view to their being adapted to local context and reviewed regularly.

Implementation can be challenging as those most at risk of climate-related mental ill-health often have limited power and agency and are hard to reach. Those who are at risk should be incorporated into any response. As health and social care systems adapt to their specific needs, they will make an even more important contribution to fair, healthy and happier futures for all.

Professor David Nabarro is co-director of the Institute of Global Health Innovation and WHO Special Envoy on COVID-19. 

Download the report, ‘The impact of climate change on mental health and emotional wellbeing: current evidence and implications for policy and practice’, by clicking this link. 

#ForUsByUs – co-designing a mental health solution owned by the Black community 

Image credit: 1388843 from Pixabay

Growing up in a Caribbean family that had experienced various traumas and challenges, I had some awareness of how mental illness impacted myself and my relatives. However, it wasn’t until I attended a masterclass last year on Black mental health hosted by BAME in Psychiatry & Psychology and the Centre of Pan African Thought that I realised the nuanced challenges faced by members of the Black community.  (more…)

Community Makers: Designing for dementia during the COVID-19 pandemic

Woman with dementia reaching out to another woman through a window

People with dementia are some of the most vulnerable, most isolated, and least able to adapt. COVID-19 has therefore made our work with Imperial College’s UK Dementia Research Institute Care Research and Technology Centre all the more urgent.

The Centre develops technologies for a smart ‘Healthy Home environment‘, supported by remote clinical monitoring, to improve the lives of people affected by dementia and further our understanding of this common disease.

The technology aims to make an impact in a number of ways, including early identification of infection, preventing falls, understanding the relationship between sleep and dementia symptoms, and predicting and managing agitation and difficult behaviours. All with the goal of reducing hospitalisation and improving the resilience of at-home care.

Our team at the Helix Centre is using our human-centred design methods to put patient and carer needs at the core of everything the Centre does. This includes designing the monitoring dashboard to optimise the relationship between the monitoring team and the at-home participants, and creating a companion app for people to access their data and assist with the daily tasks of caring for someone with dementia.

We’re also working with science and engineering labs throughout Imperial College London and the University of Surrey to inform the creation of new devices. These range from at-home UTI diagnostics with the synthetic biology team, a smart speaker voice agent to assist in care tasks, and radar sensors and wearables to help monitor behaviour within the house.

Adapting during COVID-19

Our co-design process relies on spending time with people, in their homes, getting to know their lives, aspirations and needs. In response to COVID-19 restrictions, we moved this process online, using video conferencing software to hold regular co-design sessions with a surprising increase in engagement and richness of connection.

Out of this came an idea to help reduce isolation for people with dementia and their family carers during the pandemic. We joined forces with the Alzheimer’s Society Innovation team and the Association of Dementia Studies at the University of Worcester to explore how technology could play a role for this vulnerable and extremely isolated group.

Families living with dementia rely heavily on community support groups, visiting friends, neighbours, carers and community services to help manage the heavy burden of caring for someone with dementia in their own home. All of this support evaporated when lockdown measures were imposed, and the isolation has had a profound impact on the wellbeing and resilience of carers. The alternative of residential care homes has been even less attractive during lockdown for well-documented reasons.

Through this collaboration, we identified a need to help existing groups in the community to go digital and move their support online, so that they could continue to reach their members.

A graphic representing an online dementia community support group
An illustration of Community Makers

Supporting people affected by dementia

We developed Community Makers, a digital resource to help groups set up local online networks to replace the face-to-face meetings that provided key support pre-COVID. This includes a knowledge exchange network that meets online monthly to share experiences and advice, and a library of creative ideas to inspire groups with different approaches to digital involvement.

We also have a Slack workspace, currently consisting of 64 community organisers representing groups from Scotland, Wales and England, rural and urban settings, and including groups focussing on ethnic and minority populations. Groups within the network vary in size from supporting over 150 people with dementia to new groups just setting up. One example is Dementia Matters Here(forshire), established during the pandemic as a digital-first group on the back of our Community Makers collaboration.

If you’re part of a support group that you want to bring online, you can head to our website and use our guide to getting started. We look forward to welcoming you to our growing community.

Community Makers has been led by Matthew Harrison, Senior designer in Helix Centre, supported by Alice Blencowe and Lenny Naar.

Fightin’ Thru: Opening up conversations about mental health for young BME men

Image credit: Jonathan Turton, Instagram @jftfilm

For young men who identify as black and minority ethnic (BME), mental health is not always an easy topic to discuss. Many feel restricted by fear, stigma and barriers inside and outside of the communities they are part of. For some, the available support isn’t appropriate for their needs.

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Being a mental health researcher: ‘Seeing the impact you have makes it all worthwhile’

Mental health researchers on a zoom call
Much research has moved online during COVID-19, but that hasn’t stopped Lindsay and her co-researchers

World Mental Health Day is an opportunity to reflect on what needs to change, but also to celebrate the people who are working to make sure positive change happens. Like Dr Lindsay Dewa, IGHI Research Fellow and mental health expert.

We caught up with Lindsay to find out about her mental health research, her path into academia, and why she’s excited about what the future might hold. (more…)

Tackling our ‘Mental Health Intelligence’ in the workplace

Mental Health Intelligence platform

For the UK workforce, the challenge of mental health at work is significant.

There is an ongoing stigma that prevents an open discussion on the topic. And with more people working longer hours, uncertainty in job security and a lack of understanding about mental health, this a problem which has repercussions for both employers and employees.

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Waking up to sleep in secure mental health services

White crumpled blankets
Photo by Krista Mangulsone on Unsplash

On a basic level, all humans really need to survive is air, water, food and sleep. We need to sleep every night to give our body important R&R, among many other things. And research has shown how getting a good night’s sleep is crucial for our mental health and wellbeing.

When we sleep well, we’re more likely to have greater concentration, be in a better mood and get things done. In contrast, when we don’t, we can really see and feel the opposite effect. While we all have a poor night’s sleep from time to time, we know that people in prison and forensic mental health hospitals in the UK struggle more than most. Yet sleep has seemingly stayed off the radar and isn’t prioritised in these areas.

That’s why we believed it was important to get together and tell people in these settings about the importance of sleep. We also wanted to inform our brand-new research proposal on managing sleep problems better in secure environments.

Giving importance to sleep in a secure hospital

Our research group originally came together after the Forensic Aspects of Sleep: Research and Development conference in Middlesbrough. We applied for and won around £10,000 from the NHS Research Capability Funding to establish a new cross-disciplinary forensic research group.

The resulting team is a collaboration between Tees, Esk Wear Valley (TEWV) NHS Foundation Trust, University of York and Imperial College London. People in our group have varied professional and lived experiences, including psychiatry, clinical academia, sleep, senior psychiatric nursing and service users. We’ve met five times in the last year in a medium secure hospital in Middlesbrough, where we recently held an event to engage the public about sleep.

The sleep research group
Our research group (Lindsay third from left)

Engaging inpatients in sleep

On 21st January 2020, we ran a half-day forensic sleep public engagement event within the secure grounds of the forensic psychiatric hospital. We wanted to increase awareness of the importance of sleep to TEWV staff, but also to include as many voices as possible in taking our work forward to inform our research.

The event brought together patients, clinicians, senior managers and commissioners. We set up four different areas that people were free to explore. These were: 1) our research group’s journey so far, 2) how we measure sleep, 3) why sleep is important and 4) Imperial’s ‘People’s Research Café’ to inform our next steps.

The Café gives people the chance to meet researchers and exchange ideas on projects, and it was the first time it had been run in a secure environment. Both patients and staff really engaged with this activity. Once they relaxed, and got going, they couldn’t wait to tell us about issues related to getting a good night’s sleep in the hospital and how we could use research to improve patients’ sleep. One of the main issues raised was the amount of noise. Noises ranged from the window slats being opened every hour at night for safety checks, to staff talking at night unaware their voices echoed down the corridor.

Lindsay and a colleague at the sleep workshop
Lindsay (left) with Amanda hosting the Café.

A huge success

Post it notes from the sleep workshop
Feedback from the event

We expected there to be numerous barriers to conducting this event in the secure hospital because of the hospital security regulations. But thanks to considerable prep work and discussions with the security staff, many things we anticipated could raise problems weren’t an issue. For example, pens were counted before and after the event, we used sticky Velcro rather than Blu Tac to reduce security risks and we all had to be escorted within the setting.

The feedback from the attendees and our team shows the event was a huge success. Everyone said the event was helpful for learning something new about sleep, with people describing it as “informative”, “engaging” and “interesting”. Reflecting on the event, Dr Amanda Perry from the University of York said, “Talking to patients and staff over coffee was an opportunity to share ideas, worries and challenges in relation to the management of sleep in secure environments. Everyone I spoke to had a vested interest in making sleep better for all patients in this environment.”

Dr Anne Aboaja, Forensic Psychiatrist at TEWV NHS Foundation Trust and Forensic Sleep Research Group lead said, “The People’s Research Café experience was successful, and it was great to learn about this methodology.”

Next steps

We will now collate everything we learnt from the People’s Research Café into usable data to inform our research grant proposal. We’re currently writing a commissioned piece of work on the topic of sleep in mental health settings for the journal BJPsych Advances and conducting a scoping review on sleep interventions for the same setting. Our protocol is under review at JBI Evidence Synthesis.

We also hope to hold a similar in the future but covering multiple smaller research projects in one go. We’re excited about the next steps in this relatively new field and will continue to work with patients and staff so that what we do is informed by and tailored to their needs.

Dr Lindsay Dewa is a Research Associate in IGHI’s Patient Safety Translational Research Centre

It’s time to talk about mental health

Hands of two people taking with coffeeIt’s estimated that one in four adults will experience a mental health problem in any given year. Despite this, there remains a stigma attached to opening up and speaking about our mental wellbeing.

Today, we’re marking Time to Talk Day, encouraging us all to have a conversation about how we’re feeling. We asked four experts at IGHI about their experiences, insights and advice on speaking up about mental health.

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Melting minds: how is the climate crisis affecting our mental health?

A hand emerging out of open water
Photo by Nico Macaspac on Unsplash

By Dr Emma Lawrance, IGHI Mental Health Innovations Fellow

It is the cliche refrain that every new generation hears: “You don’t know how lucky you are. Back in MY day…” [insert terrible circumstance here]. And young people today are indeed lucky in many ways, with new opportunities facilitated by new technologies always emerging. But they also face rising mental health challenges. Levels of emotional distress are increasing in UK youth to the extent it’s oft branded a “crisis”.

The finger of blame is pointed to numerous potential causes – increased pressure in the schooling system, social media and cyberbullying, unstable employment prospects. No-one knows for sure.

Young people today are also facing a global future that looks more uncertain and more challenging for humanity thanks to the impacts of the climate crisis and ecological breakdown. And thanks to hyper-connectivity, the threats to our ecosystems and civilisation itself are now presented to us constantly, through the 24/7 news cycle straight to our pockets. It is young people around the world who are leading the charge on climate action, because they are only too aware of what will happen if they don’t. But what is this awareness doing to their mental health?

A rising tide

A growing number of people are sharing their struggles to process loss, fear and anger about ecological breakdown and the climate crisis. Parents are writing into newspapers, and psychologists are reporting more and more people seeking support for what they are terming “eco-anxiety” or “ecological grief”. The feelings of loss and distress about the transformation of one’s homeland has been termed “solastalgia“. There was an outpouring of ‘me too’ following a character on the TV show “Big Little Lies” hiding in the cupboard in her classroom after learning about climate change.

Young people protesting about climate change
Young people across the world have been striking in protest of human-induced climate change. Photo by Mika Baumeister on Unsplash

Sometimes, the testimonies are of those who find their symptoms of mental illness worsening when confronted with the facts of the climate crisis. For others, such information or experiences generate new symptoms. From a neuroscientific perspective, these difficulties make sense. Neuroscience tells us that those with a tendency to experience anxiety struggle with uncertain situations, and that a lack of control over outcomes can further drive anxiety. Both uncertainty and a lack of control characterise many current global trends.

But beyond these conjectures and anecdotal reports, there are currently more questions than there are answers. What is the prevalence of mental ill-health worsened by concerns over our uncertain future? Who is affected? How? Is this really a factor driving increased emotional distress in children and young people? When is the response of fear and anger unhealthy and unhelpful, and when is it a healthy and rational response to the facts?

There is limited hard evidence here, though a few survey results indicate it warrants attention. A Yale study of US adults found that of those who know climate change is happening, 62% feel afraid and helpless. In the UK a smaller (and perhaps less rigorous) survey found 40% of 16-24 year-olds feel “overwhelmed” by climate change. This echoes another small commissioned US survey revealing 72% of 18-34 year-olds reported negative news stories about the environment sometimes impact their emotional wellbeing.

Bringing hard evidence to a hot topic

The mental health implications of climate change are receiving growing clinical and academic attention. The American Psychological Association issued a 2017 report on “Mental Health and Our Changing Climate“, and a recent issue of Nature Climate Change was dedicated to the mental health implications. These reports are echoed in a flurry of recent papers, media articles and conferences. While the more intangible, indirect links still lack evidence, we know more about the direct impacts of climate change on mental health. Many are shocked to learn that psychiatric medications can impair the body’s ability to regulate temperature, including patients themselves. Heatwaves and atypical weather are linked with worsened mood, more severe symptoms of mental illness and increased episodes and hospitalisations for psychosis and other mental health issues (e.g. see here, here and here). At a local and global scale, are healthcare systems prepared for this?

The picture is complex, and hence effect sizes hard to measure and plan for. With mental health far less understood and generally overlooked compared with physical health issues, it perhaps comes as no surprise that it has been absent from the conversation on climate crisis action and adaption. This needs to change.

The Institute of Global Health Innovation will work with the Grantham Institute to begin to understand what we know, and importantly what we don’t know, about the implications of climate change for mental health. We can work with clinicians, health economists, climate change researchers and public health experts to address these questions. And importantly, work towards solutions. We can work with IGHI’s network of mental health charity partners to understand the impact on the mental health of young people. Only once we have a growing evidence base can we properly account for this in government, in the healthcare system, and in our plans to help individuals and communities adapt to a changing climate. We want to help young people feel lucky again.

A rainbow emerging from clouds on a black background
There is reason to be hopeful for the future. Photo by Makoto Tsuka on Unsplash

Dr Emma Lawrance is the Institute of Global Health Innovation’s mental health innovation fellow. You can read more about her work here.