Mental Health Climate Connections

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Mental Health Climate Connections
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What we will cover

• Social Determinants of Health
• the environment, climate change and mental
  health 
• Health Improvement and co-benefits
• roles of public health specialists
• roles of clinicians
• Healthcare and carbon
• responsibility of health services to reduce
  carbon emissions?
• role of clinicians in carbon reduction?
• And some examples

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What treatment is indicated?

• Management aims to treat the patient according
• to the cause..
•  
• ..But there are different levels of causation
• 5 WHYS.
• What are the causes of the causes?

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Aetiology Cause Determinants
Depression ? alcohol ? living
circumstances ? occupation, school education,
? family and friends ? socioeconomic
status ? political environment Which
factors does medicine address? ..
? ?
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•  
•  

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Social Determinants of Health

•  "The poor health of the poor, the social
  gradient in health within countries, and the
  marked health inequities between countries are
  caused by the unequal distribution of power,
  income, goods, and services, globally and
  nationally, the consequent unfairness in the
  immediate, visible circumstances of peoples lives
  their access to health care, schools, and
  education, their conditions of work and leisure,
  their homes, communities, towns, or cities and
  their chances of leading a flourishing life.
• This unequal distribution of health-damaging
  experiences is not in any sense a natural
  phenomenon.Together, the structural determinants
  and conditions of daily life constitute the
  social determinants of health."
• (WHO Commission on Social Determinants of Health,
  2008)

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The health gradient

• The difference in life expectancy between two
  parts of Glasgow is 28 years (54y in Carlton vs.
  82y in Lenzie N.) (WHO CSDH)
• There is a gradient of health status from the
  healthiest to the least healthy.
• It is associated with wealth gradient from the
  richest to the poorest.
• money brings health benefits, like access to
  good food and housing
• socioeconomic factors affect health behaviours
• Reducing health inequity means levelling out the
  gradient, and brings benefits to all members of
  society, not just the poorest few.

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• Do you know any medical treatments which could
  reverse the 28y difference in life expectancy
  across Glasgow?
• What are the challenges in modifying social
  determinants of health?

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• Where does climate change fit in?

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Impacts of climate change on mental health

• Disruption of infrastructure and economic systems
  poses risks to mental health
• flooding
• homelessness
• financial stresses
• Impacts on health behaviours, e.g. through higher
  cost of food
•  
•  

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Without mitigation and adaptation, climate
change will increase health inequity especially
through negative effects on the social
determinants of health in the poorest
communities UCL Lancet Commission Managing the
Health Effects of Climate Change May 2009
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Social determinantsof climate change

• Industrialisation
• Consumer society
• Neighbourhoods designed around needs of motorists
• Shift from local to global economy
• Some determinants of climate change are also
  those of mental ill-health

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Tackling the shared determinants of health and
climate change produces environmental and health
"co-benefits"
Determinants
Environmental benefits can also be seen as
indirect health benefits
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Co-benefits

• What changes in an individual or in society could
  co-benefit the environment and mental health?
•  
• ? BIO ?
•  
• ? PSYCHO ?
•  
• ? SOCIAL ?

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BIO

• in large part mediated by genes
•  
• less consumption of drugs, alcohol
• -can reduce resource use, whilst improving
  mental health
•  
• good nutrition
• -can promote better mental health, and
  healthier diets often lower environmental impacts

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PSYCHO

•  
• Natural spaces evidence is mounting Ecotherapy
• Exercise (equivalent to SSRIs in treatment of
  major depression) active travel can reduce car
  use making streets safer and less polluted and
  saving carbon emissions
• Creative occupations? Cooking, carpentry,
  needlework, gardening can help to increase a
  communitys self-reliance and reduce material
  consumption

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SOCIAL

• Reducing social isolation
• community development provides social support and
  concern for local environment?
• more green spaces can result in healthier, more
  equitable societies
• regular employment/occupation
• More equitable societies --gt better mental
  health
• --gt more concern for shared goals, including
  protecting the environment (Wilkinson and
  Pickett)
•  

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Co-benefitsInterventions

• At community level?
• Public health programmes
• Influencing planning, transport and other sectors
• With individuals (clinical care)
• Information to all patients about mental
  wellbeing lifestyle
• Prescribing specific lifestyle changes
• Referring to Green Gyms, community projects,
  occupational therapy

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Mental health care what are its environmental
impacts?

• Travel patients, staff
• Buildings clinics, inpatients, administration
• Interventions - medications
•  

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Carbon footprint for NHS England (2004) 
18 million tonnes CO2   3 of UK total
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Mental health care what are its environmental
impacts?

• Travel patients, staff
• Buildings clinics, inpatients, administration
• Interventions - medications
•  
• How can we reduce the environmental impact whilst
  maximising the quality of patient care?

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Mental health care - improving environmental
impacts (1)

• REDUCING THE NEED FOR CARE tackling the ROOT
  CAUSES to reduce mental illness
• MAKING PEOPLE WELL, NOT JUST "BETTER" than before
•  
• ? BIO 
•  
• ? PSYCHO
•  
• ? SOCIAL  

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Mental health care - improving environmental
impacts (2)

• BEING MORE EFFICIENT
• Continuity of care organise care so that
  patients remain under the same team, even when
  they are in hospital
• Improve communication systems (reduce
  duplication and respond to problems more quickly)
• Find ways to reduce low-value travel (e.g.
  mental health services in Oxford use text
  messages to keep in touch with patients)

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Mental health care - improving environmental
impacts (3)

• CHOOSING SUSTAINABLE MODES OF TREATMENT
• TREATMENT FOR DEPRESSION - Exercise is equivalent
  to SSRIs with longer lasting effect
• Effects of exercise training on older patients
  with major depression (Blumenthal-J et al (1999)
  Archives of Internal Medicine 159(19) p2349)
• Exercise Treatment for Major Depression
  Maintenance of Therapeutic Benefit at 10 Months
  (Babyak-M et al (2000) Psychosomatic Medicine
  62(5) 633-638)
• Pharmaceuticals make up 22 of the NHS carbon
  footprint

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Mental health care - improving environmental
impacts (4)

• CHOOSING SUSTAINABLE MODES OF TREATMENT
• TREATMENT FOR DEPRESSION ecotherapy / natural
  spaces
• Pharmaceuticals make up 22 of the NHS carbon
  footprint

What are the challenges to showing therapeutic
effect with these interventions?
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Supportive and sustainable care(1)

• individuals experience of care
• "talking therapies" v medication
• community care v institutional care
• patients own control over their treatment
  mental health literacy
• skills such as communicating, negotiating, and
  relationship and parenting skills

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Supportive and sustainable care(2)

• strengthening organisations
• making organisations inclusive and responsive
• safe, supportive and sustainable environments
  for health
• strengthening communities
• reducing structural barriers to good mental
  health
• providing environments that are conducive to
  healthy personal and social development of
  individuals and communities

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Learning points

• - Tackling determinants of disease is the basis
  of health improvement.
• - Mental health is particularly influenced by
  social and economic factors, therefore addressing
  social determinants of health, such as living and
  working conditions can
• ?benefit mental health directly
• ?benefit health indirectly, through benefits to
  the environment.
• Carbon reduction in the health service can be in
  line with better management of patients with
  mental illness and better address of mental
  health of all patients
• - For example,
• patient education to reduce healthcare demand
  for self-limiting illness,
• promoting physical activity and spending time in
  green spaces
• facilitating community cohesion