Climate change is bound to have an impact on human health and wellbeing, possibly in ways we might not even be aware of yet. In the context of mental health, the climate crisis not only directly affects us through increased exposure to potentially traumatic incidents such as extreme weather events and natural disasters, but also gives rise to psychological responses, including but not limited to climate anxiety. Furthermore, climate change also indirectly worsens established social determinants of mental health (i.e., poverty).
The International Panel on Climate Change report (2022) expressed “high confidence” in climate change’s detrimental impact on mental health in assessed regions, aligning with the World Health Organization’s assertion that it increasingly affects people, influencing their mental wellbeing in ever stronger and long-lasting ways.
Yet, the impact of climate change on mental health has received comparably less attention than other health aspects, leading to calls for more research and implementation. Furthermore, existing recommendations in this area lack formal consensus and peer-reviewed validation. Alford and colleagues (2023) aim to address this gap by establishing cross-sectoral recommendations involving research, policy, healthcare, and the third sector with an emphasis on collaboration. The recommendations aim to provide a starting point for leaders to create tailored action plans, recognising the diverse impacts of climate change on mental health globally.
The study employed a modified Delphi methodology, a widely recognised research technique aimed at achieving consensus among a panel of experts. This method involved the iterative process of posing rounds of questions to the expert panel until a consensus within the group was reached. The Delphi process has previously proven effective in fields like climate change and mental health and, thus, was the chosen research design.
To participate in the study, individuals had to meet several criteria, including having a minimum of one year’s experience in and affiliation with an organisation related to mental health or climate change within relevant sectors, fluency in English, and being over 18 years old. Recruitment of participants was done through a combination of snowball and purposive sampling via authors’ networks, whilst aiming for a wide representation across sectors and demographics.
The study’s target sample size was set at 35 participants based on prior Delphi studies. The authors exceeded the target and a total of 61 were recruited. The initial survey aimed to develop a set of recommendations for prioritisation in the second round. This survey included published recommendations from Lawrance et al. (2022), categorised by sectors into healthcare, policymaking, research, and third sector/community organisations. Participants were asked to suggest edits and express whether each recommendation should be included in the subsequent prioritisation exercise.
Qualitative and quantitative feedback, including over 350 comments, was analysed in multiple rounds by the research team. Items required over 50% agreement for inclusion in the second survey, which was based on earlier studies, survey data, and free-text responses. Two authors reviewed and edited the recommendations based on qualitative feedback. This process involved simplifying language, removing unnecessary examples, separating distinct recommendations, merging similar ones, and adjusting content based on participant feedback. All authors then reached a consensus on the revised recommendations, which were categorised by sector and presented to participants in a second survey. Participants had to rate the importance and feasibility on a five-point scale and could provide justifications for their ratings. Additionally, participants selected their top three priorities within each sector in a subsequent stage.
Participants’ Likert scale responses from the final survey were grouped into “agree” (scores of 4 – agree and 5 – strongly agree), “neutral” (scores of 3 – neither agree nor disagree) and “disagree” (scores of 1 – strongly disagree and 2 – disagree). Recommendations with less than 75% agreement were considered to lack consensus. The top three recommendations for each sector were determined by the highest share of participant votes in the prioritisation exercise.
36 recommendations were developed, including 7 novel ones, across different sectors. All initial recommendations were included in the prioritization exercise. The final Delphi survey results highlighted the top three priorities for each sector.
All recommendations were deemed important with over 90% agreement. The top priorities included:
- building sustainable and climate-resilient healthcare systems to mitigate climate change impacts,
- involving those with lived experience of climate change impacts,
- raising awareness of mental health impacts, and
- strengthening mental healthcare systems.
However, there was greater variability in feasibility ratings.
- integrating mental health impacts into national climate plans was the top priority,
- followed by community-driven climate policies, and
- active participation of those affected by climate change in policy development.
- Interdisciplinary research on climate change’s impact on mental health was the highest priority,
- followed by effective programmes and interventions.
The feasibility of these recommendations varied, with concerns about resource availability and programme effectiveness.
- Incorporating mental health into emergency responses was a top priority,
- along with cross-organizational collaborations and identifying implementation gaps in climate action.
While these recommendations were considered important, there were concerns about feasibility, particularly related to funding and resource availability.
Overall, Alford et al. (2023) highlighted the importance of addressing mental health in the context of climate change across the sectors of healthcare, research, policy, and the third sector. The final recommendations were carefully developed and refined through the input of a diverse cross-sector experts’ group. Notably, they achieved consensus on both their perceived importance and feasibility, creating a framework for action, but some challenges in terms of feasibility and implementation were pointed out.
If we consider the impact of climate change in our societies, the recommendations serve as a crucial guide for coordinated actions nationally and internationally. The study identifies gaps in climate change mental health research and offers pathways to explore further. The recommendations underscore the need to expand the evidence base for successful strategies to respond to climate anxiety and deteriorated well-being as a direct result of natural disasters, encourage cross-sector collaboration, and raise awareness.
Strengths and limitations
The study achieved remarkable diversity with 61 participants from 24 different nationalities, providing a richness of perspectives. The authors made efforts to consider geographic and demographic diversity when recruiting participants which broadens the applicability of the study’s findings. They also successfully balanced gender representation, with an even split between male and female participants, strengthening the validity of the findings. The Delphi process was well-described and followed, ensuring transparency, and enabling reproducibility of the study. Overall, the study presents valuable insight into expert opinions on how to best address the intersection between two important challenges of our times, climate change and mental health.
Nonetheless, participants were recruited from the researchers’ networks, potentially introducing bias. For instance, the exclusion of non-English speakers and all of the study authors being from the Global North may limit the generalisability of these recommendations. Therefore, some important considerations may be specific to this sample and not universally applicable.
The wide range of experience levels among participants prompts reflection on the weight given to recommendations from individuals with varying levels of expertise. Some participants had one year of experience whereas others had over 11 years of experience. Clarification on the criteria for defining an “expert” in this context is necessary. However, considering perspectives from varying degrees of experience may also be considered a strength, if the main aim is to consider a wide range of different perspectives.
Lastly, the agree/disagree values were collapsed into simplified versions rather than keeping the nuance between e.g. ‘strongly agree’ and ‘agree’ answers. It may have been helpful to keep these intact in order to further clarify which statements participants considered the most important ones.
Implications for practice
Arguably, producing a set of concrete implications for practice was the study’s objective. Indeed, the authors provide a clear set of recommendations that can serve as a practical guide for decision-makers across sectors.
When it comes to mental health care, the recommendations recognise that there is no one-size-fits-all solution. They highlight the importance of customising interventions to suit local and regional needs and contexts, ensuring that strategies are relevant, effective, and culturally sensitive. Furthermore, involving communities that are most affected by climate-related mental health is important here.
The biggest challenge may lie in resource allocation and investment. While resource constraints pose challenges, especially in low-resource settings, mental health can be a low priority even in high-resource contexts. Similarly, whilst the importance of tackling climate change is generally recognised, there is also a need to persuade stakeholders to allocate the necessary resources for effective action. This review draws attention to the need for financial support, capacity-building, and the development of toolkits for effective execution in both areas.
Finally, these findings can also be valuable in generating discussions about how to tackle the climate crisis, particularly in the context of mental health. Education and awareness campaigns can help mobilise support and drive action. Raising awareness about the impacts of climate change on mental health and disseminating examples of good practice is the first step to achieving meaningful change in this area. Hopefully, blogging about this paper will aid in that process.
Statement of interests
Ella is the co-founder of a research consultancy EcoNudge, specialising in leveraging behavioural science research to address climate change and sustainability challenges.
Alford, J., Massazza, A., Jennings, N. R., & Lawrance, E. (2023). Developing global recommendations for action on climate change and mental health across sectors: A Delphi-style study. The Journal of Climate Change and Health, 100252.
Lawrance EL, Thompson R, Newberry Le Vay J, Page L, Jennings N. The impact of climate change on mental health and emotional wellbeing: a narrative review of current evidence, and its implications. Int Rev Psychiatry 2022;34(5):443–98. doi: 10.1080/09540261.2022.2128725.