Mental Health and Well-Being

The casual pathways linking climate change hazards to mental health are multifaceted. Figure 4.1 describes how climate change negatively affects mental, physical, and community health. In the centre of this figure are the geophysical impacts of climate change, which amplify pre-existing social, individual, and physical health inequities. The interactions among climate hazards and pre-existing health inequities can lead to a host of mental, physical, and community health outcomes.

Exposure to climate hazards may trigger direct mental health impacts, such as depression, grief, or PTSD (Clayton et al., 2014; Dodge et al., 2016; Clayton et al., 2017; Hayes & Poland, 2018; Middleton et al., 2020b). Psychological reactions may also occur as a result of experiencing physical health impacts, such as heat stress, vector-borne disease, or injury (Berry et al., 2010a; Clayton et al., 2017) or impacts on community well-being, such as economic disruptions, displacement, and a loss of social cohesion (Berry et al., 2010a; Agnew, 2012; Cunsolo Willox et al., 2013a; Cunsolo Willox et al., 2013b; Sahni et al., 2016; Clayton et al., 2017; Miles-Novelo & Anderson, 2019). Disruption of social cohesion and resource scarcity can significantly affect health and related services for those who already have mental health problems and/or substance use disorder (Dodgen et al., 2016; Clayton et al., 2017). After experiencing climate stressors, some people may experience a combination of both affirmative mental health outcomes and mental problems or illness (Weissbecker, 2011; Hayes & Poland, 2018; Hayes et al., 2020). Affirmative outcomes can include a sense of optimism for the future, compassion, and altruism for others who have been affected by climate hazards, and a sense of meaning or purpose in one’s life. Post-traumatic growth (PTG) can result from an increase in social cohesion after a climate disaster (Edwards & Wiseman, 2011; Ramsay & Manderson, 2011).

In the literature, three timeframes related to the onset of psychosocial responses from acute hazards have been identified. They include immediate effects (hours, days, weeks), mid-range effects (six months to a year), and long-term effects (2.5 years and beyond) (Tunstall et al., 2006; Fritze et al., 2008; Anderson et al., 2017; Clayton et al., 2017). Immediate effects of acute, extreme weather events can include acute trauma, a normal response to a disaster (e.g., “normal reactions to abnormal situations”) in which the traumatic reaction tends to subside once security and safety are established (Fritze et al., 2008). However, this is not always the case, as higher rates of more severe mental health concerns, such as suicide, have been reported in relation to acute climate change hazards such as extreme heat events (Carleton, 2017; Burke et al., 2018). Some mental health impacts can also extend over the medium- and long-term; those most commonly identified in the literature include anxiety, depression, PTSD, and drug and alcohol misuse, which can occur any time during ongoing climatic stressors or well after a climate-related extreme event has ended. They may also be related to the awareness of the threats posed by a changing climate (Fritze et al., 2008; Dodgen et al., 2016; Clayton et al., 2017). Notably, there are no key timeframes specified in the literature related to slow-onset hazards. People exposed to these hazards may experience an ongoing lost sense of place and/or distress from displacement, economic insecurity, food insecurity, and water insecurity.

The majority of studies in the climate change and mental health literature examine the mental health outcomes of acute hazards, such as flooding, extreme heat events, wildfires, and hurricanes. Exposure to acute disasters can trigger a host of mental health outcomes, including PTSD, major depressive disorder, anxiety, complicated grief, survivor guilt, recovery fatigue, and suicidal ideation or attempts (Berry et al., 2010a; Berry et al., 2011; Doherty & Clayton, 2011; Reser & Swim, 2011; Weissbecker, 2011; Cunsolo Willox et al., 2012; Stanke et al., 2012; Cunsolo Willox et al., 2013b; Bourque & Cunsolo Willox et al., 2014; O’Brien et al., 2014; Harper et al., 2015; Durkalec et al., 2016; Gifford & Gifford, 2016; Clayton et al., 2017; Mantoura et al., 2017; Dodd et al., 2018; Hayes et al., 2018a; Clayton, 2020; Clayton & Karazsia, 2020; Middleton et al., 2020a; Middleton et al., 2020b). In many cases, people exposed to acute disasters experience relatively little distress or only brief experiences with mental illness or mental health challenges, and instead demonstrate significant resilience (Bonanno, 2004). There is also evidence that suggests that people who are not exposed to acute hazards can experience mental health outcomes, such as vicarious trauma, secondary stress, and/or compassion fatigue for those whose lives have been disrupted by extreme events (Lambert & Lawson, 2013; Naturale, 2015). These forms of indirect distress are often due to close connection with people exposed to extreme events, media coverage of survivor experiences, or caring for survivors in a professional capacity (Naturale, 2015). The following sections provide information on specific hazards and mental health outcomes, with a focus on literature that is specific to Canada and/or relevant to the Canadian context.

4.4.3.1 Flooding

Flooding has become the most frequent type of disaster globally, and risks of flooding are projected to increase as a result of the impacts of climate change in Canada (Alderman et al., 2012; Stanke et al., 2012; IPCC, 2014; Fernandez et al., 2015; UNISDR, 2015; Zhang et al., 2019). Evidence suggests that flooding can significantly affect mental health, and its effects can include increased levels of PTSD, general distress, depression, and anxiety among flood survivors (Alderman et al., 2012; Berry et al., 2014; Fernandez et al., 2015; Sahni et al., 2016; Waite et al., 2017). People exposed to flooding events may also experience an enhanced sense of community, compassion, and altruism, as community members come together to support one another in the wake of a disaster (Weissbecker, 2011; Hetherington et al., 2018; Hayes et al., 2020). These affirmative mental health outcomes may co-occur with poor mental health outcomes, such as anxiety or general distress (Weissbecker, 2011; Hayes et al., 2020). People do not need to be directly exposed to a flood to experience poor mental health outcomes. For example, a study based in England by Waite et al. (2017) surveyed 2126 people to understand the effects of flooding on mental health. Respondents included individuals whose homes had been flooded and those who were disrupted by the flood (e.g., could not travel to work), but whose homes were not directly flooded (Waite et al., 2017). Psychological morbidity was highest among respondents directly affected by flooding (622), with PTSD being the most commonly reported impact (36.2%), followed by anxiety (28.3%), and depression (20.1%) (Waite et al., 2017). Interestingly, those who were disrupted by the flood, but who had not directly experienced flooding (1099), also experienced PTSD (15.2%), anxiety (10.7%), and depression (9.6%) related to the flood event (Waite et al., 2017).

Flooding can exacerbate pre-existing mental health conditions and contribute to new ones (Stanke et al., 2012). The impacts of floods can include increased substance misuse, increased family violence after the flood exposure, and effects on sleep, which can lead to poor mental health outcomes (Burton et al., 2016; Sahni et al., 2016). Broader psychosocial health outcomes associated with flooding are often related to job insecurity and economic insecurity from flood damage to homes and businesses that strain individuals’ and families’ sense of place and livelihoods.

There is also evidence to suggest long-term mental health and psychosocial effects of experiencing flooding, including anxiety when it rains many years after experiencing a flooding event; reduced sense of security, including fears and anxiety about experiencing another extreme event; stress of living in floodplains; financial stress and family breakdown related to housing insecurity and/or economic insecurity from rebuilding; and lost sense of place due to displacement from flooding (Burton et al., 2016; Decent & Feltmate, 2018; Hayes et al., 2020).

4.4.3.2 Extreme Heat Events

There is a growing body of literature documenting the mental health impacts from exposure to extreme heat events. These impacts include increased mood and behavioural distress; exacerbated mental illness; and increased risk of aggression, violence, and suicide (Anderson & Jané-Llopis, 2011; Agnew, 2012; Vida et al., 2012; Bélanger et al., 2014; Dixon et al., 2014; Wang et al., 2014; Ding et al., 2016; Dodgen et al., 2016; Obradovich et al., 2018; Thompson et al., 2018; Kaiser et al., 2019; Miles-Novelo & Anderson, 2019). People who tend to be at greater risk of poor mental health outcomes from exposure to extreme heat include the elderly, people with chronic physiological conditions, and people with pre-existing mental health conditions, including those taking psychotropic medications that affect thermoregulation (Price et al., 2013; Bélanger et al., 2014; Wang et al., 2014; Trang et al., 2016; Anderson et al., 2017). Some mental illnesses may be associated with inefficient physiological reactions to extreme heat, which make it harder for the body to cool down (Trang et al., 2016). Also, some medications may predispose people to heat illnesses (Health Canada, 2011), as they can inhibit important physiological reactions and/or cause cognitive impairment that may affect judgment and limit the uptake of protective measures. In addition, people with mental illness may face greater challenges in adapting because of cognitive impairment (e.g., not seeking shade) and/or socio-economic barriers, which disproportionately affect people with mental illness (Cusack et al., 2011; Page et al., 2012; Price et al., 2013; Bélanger et al., 2014; Wang et al., 2014; Dodgen et al., 2016; Trang et al., 2016; Anderson et al. 2017).

Higher temperatures may also be linked with violence (including suicide) and aggression (Stephen et al., 1999; Anderson & Jané-Llopis, 2011; Agnew, 2012; Dixon et al., 2014; Dodgen et al., 2016; Thompson et al., 2018; Kim et al., 2019; Miles-Novelo & Anderson, 2019). A 2019 study analyzed the association between the daily mean temperature and incidence of suicide for 341 locations in 12 countries and found that the pooled excess relative risk (1.46, 95% confidence interval [CI] 1.25 to 1.70) for suicide for 26 Canadian locations (1986 to 1999) was highest at a daily mean temperature of 24.2°C (Kim et al., 2019). It is important to note that this temperature is at the 99th percentile; however, as climate change progresses, reaching this threshold more often is likely. This may result in an increased number of suicides, depending on the levels of acclimatization and adaptation. Some Canadian locations have higher increases in the relative risk than the pooled value at different temperatures, including Oshawa, with a relative risk of 3.80 (95% CI 1.06 to 13.59) at 24.9°C; Ottawa, with a relative risk of 2.44 (95% CI 1.18 to 5.02) at 25.9°C; and Toronto, with a relative risk of 1.75 (95% CI 1.18 to 2.59) at 26.5°C (Kim et al., 2019).

Extreme heat also poses strain on systems that support mental health and well-being. Increased ambulance calls, emergency department visits, calls to telehealth and other helplines, and/or increases in people seeking outpatient care for mental health–related reasons during periods of extreme heat have been observed (Basu et al., 2018). In addition, drug storage in extreme temperatures may affect the efficacy of medications  (De Winter et al., 2013; Armenian et al., 2017).

4.4.3.3 Wildfires

The research on the mental health impacts of wildfires has grown in recent years, likely due to the increase in wildfire disasters  (particularly in communities in Western Canada). Similar to the research on flooding, the main mental health impacts of wildfires include increased risk of PTSD, anxiety (including generalized anxiety disorder), worry, and depression (Hutton, 2005; Eisenman et al., 2015; Yusa et al., 2015; Klinkenberg, 2017; Agyapong et al., 2018; Dodd et al., 2018). Wildfires can also lead to population displacement, damage to infrastructure, loss of property, threats to food security, and respiratory conditions, which can result in exacerbated or the onset of psychological distress (including anxiety, stress, and PTSD) (Hutton, 2005; Yusa et al., 2015; Dodd et al., 2018). Recent findings from a study on the 2016 wildfire in Fort McMurray, Alberta, revealed significant increases in PTSD. Findings revealed 60% of respondents self-reported symptoms of PTSD, while 29% were formally diagnosed with PTSD (Klinkenberg, 2017). Another 26% of respondents highlighted experiences of depression and 36% noted experiences of insomnia (Klinkenberg, 2017). Researchers comparing youth exposed to the Fort McMurray wildfires to controls in Red Deer, Alberta, found that depression scores, suicidal thinking, and increased tobacco use were significantly higher in the youth from Fort McMurray (Brown et al., 2019).

A study published in 2018 of the health impacts of wildfires in the Northwest Territories between June and August of 2014 revealed that displacement and evacuation related to the wildfires resulted in increased stress, fear, and long-term mental and emotional trauma (Dodd et al., 2018). Indigenous Peoples’ mental health and well-being was at particular risk because the fires disrupted land-based activities and cultural practices that are essential to the livelihoods in many of these communities (Dodd et al., 2018).

4.4.3.4 Hurricanes

There is limited literature documenting the mental health outcomes related to hurricanes in Canada, as hurricane exposure is relatively low compared to that in the U.S., for example. The primary mental health impacts from hurricanes that have been documented in studies outside of Canada include increased risk of PTSD and anxiety and mood disorders (Galea et al., 2007; Kessler et al., 2008; Whaley, 2009; Zwiebach et al., 2010; Ferré et al., 2019; Orengo-Aguayo et al., 2019). The literature also highlights long-term effects, including affirmative outcomes such as a sense of resilience. Negative outcomes include, for example, lingering depression and PTSD (Rhodes & Chan, 2010; Pitts, 2015; Ferré et al., 2019).

Much of the literature documenting the mental health impacts of hurricanes is focused on the experiences of Hurricane Katrina and Hurricane Maria survivors. Hurricane Katrina was a Category 5 hurricane that struck the Gulf Coast of the U.S. in 2005, devastating the city of New Orleans (Whaley, 2009). It has been estimated that 20% to 35% of survivors experienced some form of mental health impact following Hurricane Katrina (Whaley, 2009). Nearly half (47.7%) of marginalized community members of New Orleans (mainly low-income, African-American women) showed probable signs of PTSD (Rhodes & Chan, 2010). This rate is significantly higher than the representative sample obtained by Kessler et al. (2008), which showed the prevalence of PTSD among the population at large who were affected by the hurricane to be between 14% and 20% (Kessler et al., 2008). Moreover, a 31.2% prevalence of anxiety and mood disorders among Hurricane Katrina survivors was observed (Kessler et al., 2008).

Similar to the findings on the mental health impacts of Hurricane Katrina, researchers exploring the impacts of Hurricane Maria, which struck Puerto Rico in 2017, found clinically significant increases in depression, anxiety, and PTSD among two-thirds of the 74 households surveyed six months after the event (Ferré et al., 2019). When looking at the mental health impacts of Hurricane Maria survivors who relocated to Florida, researchers found that adaptation and adjustment to a new environment added psychological burdens  (Scaramutti et al., 2019). Therefore, adaptation efforts that lead to displacement do not always correlate with affirmative mental health outcomes (see section 4.4.5.1 Migration and Displacement).

In Canada, Hurricane Igor, which struck the Eastern coast of Newfoundland in 2010, was one of the most devastating hurricanes in Canadian history, reaching a Category 4 status (Gosse, 2010; Insurance Board of Canada, 2010; Pitts, 2015). While there are no known empirical investigations of the mental health impacts of this hurricane, there were reports documenting the psychosocial toll of loss and destruction (Gosse, 2010; Insurance Board of Canada, 2010). There was also one media report, five years after the hurricane, that documented psychosocial outcomes among community members in Clarenville and the Bonavista Peninsula in Newfoundland. These outcomes included an increased sense of community and resilience in the wake of the hurricane and in the months and years that followed the rebuilding efforts (Pitts, 2015).

Climate change impacts on mental health may also occur as result of slow-onset hazards, such as drought, melting sea ice, and sea-level rise.

4.4.4.1 Drought

Climate change is expected to continue to increase the risk of drought in Canada (Bush & Lemmen, 2019). Drought can affect livelihoods, socio-economic status, drinking water resources, food availability, and respiratory function (Vins et al., 2015; Watts et. al., 2017). As a consequence of these impacts, drought can also affect mental health (Yusa et al., 2015; Bard, 2017). The literature documenting the mental health impacts of drought highlights the secondary impacts from drought-related income, water, and food insecurity. These mental health impacts include increased risk of suicide, lost sense of place, and general despair (Nicholls et al., 2006; Polin et al., 2011; Rigby et al., 2011; Hanigan et al., 2012; Bryant & Granham, 2015).

Those at greatest risk of experiencing poor mental health outcomes from drought include land-based workers (in the current research literature, land-based workers tended to be male and farmers), rural dwellers, and Indigenous Peoples (Rigby et al., 2011; O’Brien et al., 2014; Bryant & Granham, 2015; Powers et al., 2015; Flecther & Knuttila, 2016; Ellis & Albrecht, 2017). People involved in the agricultural industry are among the most commonly affected by the mental health impacts of drought because their economic livelihoods depend on environmental conditions (Vins et al., 2015; Ellis & Albrecht, 2017). For example, Ellis and Albrecht (2017) found that climate change contributed to increased worry and place-based distress, and also increased the perceived risk of depression and suicide among farmers in Australia. These outcomes emerged as a result of a lost sense of identity, deep emotional links to family farms, feelings of failure due to the inability to protect the land, and an understanding of ecological destruction occurring in their community (Ellis & Albrecht, 2017).

Emotional responses to drought can be complex, involving both negative and positive effects. For example, in a study of drought impacts among First Peoples of Australia in New South Wales, Rigby et al. (2011) found impacts on culture and place, in particular, the inability to conduct cultural practices and displacement from traditional lands, which led to feelings of despair (Rigby et al., 2011). Noting the complexity of psychosocial responses to drought, authors also found that “the drought prompted increased love of and concern for land and a renewed enthusiasm for expressing connectedness to land through all forms of art” (Rigby et al., 2011, p. 249).

Droughts place significant psychosocial burdens on people because they tend to last longer than other extreme weather events, they tend to be more geographically expansive, and, thus, they have wide-ranging economic impacts. Furthermore, ecological recovery tends to be slow (Yusa et al., 2015; Fletcher & Knuttila, 2016).

4.4.4.2 Melting Sea Ice and Sea-Level Rise

The mental health impacts of melting sea ice and sea-level rise are a growing field of study, and much of the Canadian literature is focused on sea-ice decline in Northern communities. This is the region of Canada where the most rapid warming is being experienced, particularly in remote Inuit and First Nations communities (Bush & Lemmen, 2019). The mental health impacts from melting sea ice and sea-level rise include psychosocial distress related to food insecurity, a lost sense of place and identity, increased stress and anxiety from unsafe travel conditions, and increased substance use (Cunsolo Willox et al., 2012; Cunsolo Willox et al., 2013a; Cunsolo Willox et al., 2013b; Asugeni et al., 2015; Durkalec et al., 2015; Harper et al., 2015). For example, it has been documented that warming temperatures and melting sea ice caused a variety of strong emotional reactions, including fear, anxiety, sadness, anger, frustration, stress, and distress among Nunatsiavut Inuit (Cunsolo Willox et al., 2012; Cunsolo Willox et al., 2013a; Cunsolo Willox et al., 2013b; Durkalec et al., 2015; Harper et al., 2015). Changing weather patterns and sea ice thickness and extent affected community members’ abilities to travel and to participate in traditional food-gathering methods, thus affecting food security. These impacts affected the sense of place and identity, as cultural practices were disrupted by the lack of access to stable and safe ice (Cunsolo Willox et al., 2012; Cunsolo Willox et al., 2013a; Cunsolo Willox et al., 2013b; Harper et al., 2015). Mental health problems, suicidal ideation, family stress, and increased drug and alcohol use were often associated with this disrupted sense of place and identity (Cunsolo Willox et al., 2012).

4.4.5.1 Migration and Displacement

People exposed to climate hazards may be subject to job losses (particularly land-based workers), food and water insecurity, and forced migration, all of which can impact psychosocial health (Fritze et al., 2008; Agnew, 2012; Vins et al., 2015). Global displacement due to climate change is projected to vary from 25 million to 1 billion by 2050; however, 200 million is the most frequently cited estimate (IEHS, 2015). In addition to the effects of being displaced, migrants often face psychosocial impacts related to racism and discrimination experienced by many people in their new host countries or when people are displaced within a country (Gleick, 2014).

Acute and slow-onset hazards due to climate change interact with existing socio-economic and political conditions to drive increases in voluntary and forced migration (Schwerdtle et al., 2017). In response to hazards related to climate change, not all populations migrate voluntarily, and some populations are not able to do so at all (Black et al., 2011). Some populations experiencing climate-related impacts may choose not to migrate, but rather to adopt other adaptation strategies (Black et al., 2011). Others may choose temporary migration with planned return or circular mobility between home and new host areas. “Trapped populations” represent those who are unable or less able to migrate because of social, political, or economic conditions, despite high vulnerability to climate change hazards (Bogic et al., 2015). These populations often live in low-resource settings (within or outside of Canada) and already experience various health inequities. Populations exposed to climate hazards who are unable to relocate remain at heightened or increased risk of mental health impacts of climate change (Foresight: Migration and Global Environmental Change, 2011). Climate-related migration can involve adverse health impacts but may also include positive impacts on health and well-being. For example, a review by Schwerdtle et al. (2017) on climate change and migration, which included case studies from various countries, described how voluntary, planned relocation can be an effective adaptation if it is based on the consent of migrating communities, if it improves the standards of living, and if used as a last resort.

In Canada, displacement related to climate change is an important issue, particularly for Indigenous communities. For example, the 2011 Manitoba flood displaced residents of Lake St. Martin First Nation in Manitoba for over six years (Macyshon, 2017). Approximately 7% of the evacuees never returned home, and some of these cases were due to suicide and homelessness (Macyshon, 2017). Substance misuse may also be related to displacement. The health director of the Montreal Lake Cree Nation in Saskatchewan suggested that increased use of crystal methamphetamine by 600 community members is related to a 2015 wildfire evacuation that displaced the entire community of 1200 people (Zakreski, 2019). The psychosocial effects of displacement related to climate change can therefore include increased rates of suicide, homelessness, and substance misuse among Indigenous communities that are impacted by evacuations caused by extreme weather events in Canada (Box 4.1). However, more research is needed to better understand these impacts.

4.4.5.2 Impacts on Health Systems and Facilities

Climate change also has implications for mental health services, treatment, and facilities. For example, mental health care facilities may be inaccessible due to infrastructure damage to buildings or roads following acute climate hazard events (Hasket et al., 2008; Osofsky et al., 2010; Clayton et al., 2017). Further, mental health professionals may be unable to reach health care facilities to provide services because of damage to their own property, personal injuries, or damage to infrastructure between their dwellings and health facilities. For the same reasons, people may be unable to access prescription medication to treat pre-existing mental health disorders (Balbus et al., 2013).

Many communities in Canada may not have access to mental health care facilities or practitioners on site even before a climate-related hazard, particularly in rural and remote areas (Cunsolo Willox et al., 2013b; Petrasek MacDonald et al., 2015; Moroz et al., 2020). In such cases, mental health care is often introduced in a community after the event for a short period of time and long-term mental health care needs are often not met (Hayes et al., 2020).

Clayton et al. (2017) noted that, where cities have set plans in place to enhance or build resilient infrastructure to support climate change and health needs, they often overlook mental health infrastructure (including mental health care facilities and wellness services). Enhancing access to and expanding mental health services can support psychosocial resilience to climate change (Box 4.2).

4.4.5.3 Loss and Damage

The United Nations Framework Convention on Climate Change (UNFCCC) highlights the community-wide negative impacts of loss and damage related to climate change (Tschakert et al., 2017; UNFCCC, 2020). Loss and damage refer to physical losses and damage to environmental resources, biodiversity, properties, businesses, and infrastructure from slow-onset and acute climate hazards. There is a growing body of literature that highlights how climate-related loss and damage affects psychosocial well-being (Barnett et al., 2016; Tschakert et al., 2017; Cunsolo & Ellis, 2018; Tschakert et al., 2019). As noted earlier, a lost sense of place, particularly among Indigenous Peoples in Canada and globally, is tied to a loss of culture, identity, and connectedness to the land and land-based activities; thus, the psychosocial effects of loss are myriad and complex (Rigby et al., 2011; Cunsolo Willox et al., 2012; Tam et al., 2013; Cunsolo & Ellis, 2018; Middleton et al., 2020a; Middleton et al., 2020b). For example, Tam et al. (2013) assessed how climate change affected well-being in a First Nation community in the Western region of James Bay, and found that both slow-onset hazards (e.g., increased temperatures, changes in the timing of seasons, etc.) and acute hazards (e.g., flooding events) led to the loss of traditional harvesting practices, damaged the winter road, and disrupted the behaviour of animals. Similarly, in Nunatsiavut, Labrador, it was found that disruptions from increasing temperatures, melting sea ice, and shifting plant and wildlife patterns, as well as subsequent impacts on food and cultural security, resulted in decreased sense of place, diminished cultural continuity, and concerns about loss of place-based connections moving forward (Cunsolo Willox et al., 2012; Cunsolo Willox et al., 2013a; Cunsolo Willox et al., 2013b; Middleton et al., 2020a). These experiences of loss, damage, and disruption subsequently led to socio-economic challenges and food insecurity that affected the communities’ psychosocial well-being (Tam et al., 2013).

In a systematic analysis, entitled One thousand ways to experience loss, Tschakert et al. (2019) documented the many ways people and communities experience climate-related loss and damage through a comparative review of over 100 case studies. An array of negative emotional outcomes, including sadness, worry, trauma, depression, and suicidal ideation, a lost sense of place, a lost sense of safety, feeling homesick in one’s home environment (solastalgia), grief, and loss of identity were identified (Tschakert et al., 2019). Further, a systematic literature review of climate-sensitive mental health outcomes for Indigenous Peoples globally found that changing place attachments and food systems can lead to diverse, interconnected, and overlapping emotional and psychological outcomes (Middleton et al., 2020b). The authors of this study highlight that there is no one single or simple relationship between climate stressors and intangible loss and damage and that climate-related harm is “mediated by personal circumstance, culture, and socio-economic context” (Tschakert et al., 2019, p. 69). An overview of how health inequities — based on biological, cultural, social, and environmental determinants of health — influence climate-related exposures, risks, and impacts is provided in the following section.

There is a large body of literature documenting climate change impacts on the mental health of Indigenous Peoples in Canada and globally, with a specific focus on Indigenous Peoples in remote Australia (Shipley & Berry, 2010; Bardsley & Wiseman, 2012; Green & Minchin, 2014; O’Brien et al., 2014; Bowles, 2015) and Inuit Nunangat in Canada (Cameron, 2012; Cunsolo Willox et al., 2012; Ford, 2012; Cunsolo Willox et al., 2013a; Cunsolo Willox et al., 2013b; Durkalec et al., 2015; Harper et al., 2015; Ford et al., 2016). Indigenous Peoples in these distinct geographic locations are on the front lines of a changing climate and are bearing witness to the loss or degradation of land, which can take a toll on individual and collective well-being (Cunsolo Willox et al., 2012; Tam et al., 2013; Cunsolo Willox et al., 2014; Middleton et al., 2020b).

Compounding the impacts of a rapidly changing climate are the ongoing legacies and traumas stemming from colonization, land dispossession, residential schools, forced relocation, racism, social exclusion, and the continued marginalization of First Nations, Inuit, and Métis peoples in Canada (Kirmayer et al., 2009; Cameron, 2012; Ford, 2012). There is also a lack of culturally relevant health services for many First Nations, Inuit, and Métis peoples in Canada, leading to systematic and cultural barriers to service access and uptake (see Chapter 2: Climate Change and Indigenous Peoples’ Health in Canada). It is also well understood that Indigenous Peoples have a greater burden of chronic physical illness as a result of experiencing systemic health inequities that can exacerbate climate-related mental ill health outcomes (Earle, 2013; ITK, 2016).

Evidence suggests that  women⁴ tend to be more prone to anxiety, worry, and PTSD related to a changing climate (Tunstall et al., 2006; Lowe et al., 2013; Dodgen et al., 2016; Clayton et al., 2017). The literature also suggests that women tend to be at greater risk from climate changes as a result of gender-based marginalization (Fletcher & Knuttila, 2016; Williams et al., 2018). In particular, women tend to be in caregiving roles, which are typically undervalued and underpaid, and, in these roles, women are at greater risk of experiencing compassion fatigue, particularly during periods of exposure (or vicarious exposure) to climate hazards (Hayes, 2019). Pacheco (2020) also highlights that pregnant people are at greater risk of heat-induced illnesses and nutritional deficiencies, which are exacerbated by climate-related heat events and food insecurity.

Studies indicate that men also experience mental health impacts of climate change. For example, Cunsolo Willox et al.’s (2012) work in Northern Inuit communities in Nunatsiavut found that middle-aged men often suffered the most from changing environmental conditions because they were unable to provide food for family and community, with resulting negative effects on sense of place and identity (Durkalec et al., 2015). Further, as discussed previously, there is an increased risk of suicide among male farmers during times of drought (Hanigan et al., 2012). It is important to consider the role of gender-based socialization related to seeking mental health care (Tunstall et al., 2006). The literature suggests that the issue may be less about who is affected and more about who is socialized to engage in help-seeking behaviours and who has access to mental health services (Tunstall et al., 2006; Alston & Kent, 2008; Berry et al., 2011; Polain et al., 2011; Granham, 2015).

Children, youth, and older adults tend to be at greater risk from the psychosocial impacts of a changing climate because they are more dependent on others to maintain their health and well-being (Lowe et al., 2013; Clayton et al., 2014). Limited evidence suggests that pregnant people exposed to climate change stressors may have children with increased risks of intrauterine growth retardation, low birth weight, and prematurity (Pacheco, 2020). Among other types of long-term adverse effects, climate change may lead to psychosocial impacts, such as attention deficit hyperactivity disorder, autism spectrum disorder, and other neurodevelopmental disorders; cognitive deficits; mood disorders; and schizophrenia (Pacheco, 2020).

Experiences of anxiety and feelings of impending doom related to climate change can also affect children (Tucci et al., 2007; Fritze et al., 2008; Ojala, 2012). A survey of Australian children by Tucci et al. (2007) noted that one in four children were so concerned about the global threat of climate change that they believed the world would end before they reached adulthood. Children may also be at increased risk of long-term trauma and anxiety from extreme weather events (Simpson et al., 2011: Brown et al., 2019; Roberts et al., 2019). The concerns of children and youth over climate change may be more prevalent because they think more about their future, they have less agency and control in their lives and behaviours, and they have more time to focus on the issue (Ojala, 2012; Clayton, 2020).

People living with low socio-economic status are at higher risk of the health impacts of climate change (see Chapter 9: Climate Change and Health Equity), including effects on mental health. For example, homeless people tend to live in urban and suburban areas where there is greater exposure to extreme temperatures, which can disproportionately affect people with pre-existing mental health conditions who have difficulty with thermoregulation (Dodgen et al., 2016). People who are homeless are at greater risk of vector-borne diseases because they spend large portions of time outdoors in precarious weather and in areas where host vectors may be more prevalent (Dodgen et al., 2016). Vector-borne diseases, such as West Nile virus and Lyme disease, may compound mental health issues for people with pre-existing mental health illness by contributing to cognitive, neurological, and mental health problems (Dodgen et al., 2016). While the current base of research on the mental health implications of climate change among the homeless and those living with low socio-economic status in Canada is limited, socio-economic status is recognized as a predictor of poor mental health outcomes (Hudson, 2005).

People with pre-existing health conditions, including mental health issues, are at greater risk for the mental health impacts of a changing climate (Cusack et al., 2011; Dodgen et al., 2016). For example, in the U.S., veterans with mental illness were 6.8 times more likely to suffer from exacerbated mental illness after Hurricane Katrina compared to veterans with no pre-existing mental health conditions (Dodgen et al., 2016). Further, people with severe mental illness are extremely vulnerable during climate hazards, and their needs can often be overlooked in emergencies (Jones et al., 2009). Individuals with pre-existing mental health issues are at increased risk for other morbidities and mortality. Mental health care and social resources to support well-being (such as support groups) are required during and after climate hazard exposures among this target population.

People whose occupations are primarily outdoors, or whose economic livelihoods depend on the health of the land and environment, are at greater risk for psychosocial impacts of climate change (Fritze et al., 2008; Costello et al., 2009; Berry et al., 2010a; Clayton et al., 2014; IPCC, 2014). Outdoor labourers who tend to be most at risk include fishers, herders, hunters, and trappers, and people in the tourism industry (Fritze et al., 2008; Costello et al., 2009; Berry et al., 2010a; Clayton et al., 2014; IPCC, 2014).

As climate change affects traditional, resource-based industries and workers who rely on these industries for their livelihoods, these workers may experience emotional distress related to job insecurity. There is anecdotal evidence to suggest that people working in resource-based industries in Alberta, for example, are presenting with severe emotional distress as they contemplate the collapse of the traditional sectors in which they have worked (Mouallen, 2015). Limited evidence also suggests that ecoanxiety can affect people working in the fields of climate science, environmental science, and public health (Clayton, 2018; Pihkala, 2020).

Another occupational group that tends to disproportionately experience the psychosocial impacts of a changing climate are first responders who support health response efforts after extreme events (e.g., hurricanes, floods, wildfires) (Carleton et al., 2017). Dodgen et al. (2016) noted that PTSD rates among first responders range from 13% to 18% four years after responding to an extreme weather event.

There are no known studies in Canada that project the mental health impacts of climate change. However, one study projected the mental health outcomes of climate change under future climate scenarios, focusing on suicide rates related to warming tempearatures in the U.S. and Mexico. Burke et al. (2018) estimated that increased warming by 2050 (under the RCP8.5 scenario) could result in a combined 9000 to 40,000 additional suicides in the U.S and Mexico. For a 1°C increase in monthly average temperatures, mortality by suicide increased by 21% in Mexico and 0.7% in the U.S. (Burke et al., 2018).

In the absence of greater adaptation efforts, the current burden of mental ill health in Canada is likely to rise because many climate-related hazards associated with mental health outcomes are expected to increase in severity and frequency (Bush & Lemmen, 2019; Hayes et al., 2019). As previously noted, the Mental Health Commission of Canada reports that 7.5 million people in Canada experience mental health problems every year (MHCC, 2017). Given the very large number of Canadians who experience mental health problems, the potential increase of illness from future climate change is large.

There are no known studies documenting the projected economic costs of the mental health impacts related to climate change in Canada. It is estimated that 500,000 people in Canada miss work every week due to mental health issues, which costs the Canadian economy approximately $51 billion annually. Psychiatric conditions are the second most expensive health care expenditure in Canada, following closely behind expenditures for cardiovascular disease (CAMH, 2012; PHAC, 2014). Given the high costs of psychiatric conditions to the health system and society, and given the breadth of mental health impacts that can be related to climate change, future costs borne by Canadians are expected to be large as the climate continues to warm.

Adapting to reduce the mental health impacts of climate change requires intersectoral and transdisciplinary actions rooted in integrated and coordinated support and care (Stanke et al., 2012; Hayes et al., 2019). The disciplines that should be involved include a range of health professionals, such as:

• physicians, nurses, mental health specialists (e.g., psychiatrists, psychologists, psychotherapists);
• allied health professionals (e.g., public health workers, pharmacists, social workers, community mental health workers); and
• emergency preparedness professionals (e.g., first responders).

The most effective support for mental health may be through mental health care professionals and formal services such as therapies, counselling, and/or psychotropic medications (Hayes et al., 2018a). For many, mental illness or emotional distress is still highly stigmatized, and people may prefer to support their well-being through informal family or community supports and networks entirely unrelated to formal mental health care (Rodriguez & Kohn, 2008). As a consequence, people may rely on services and supports offered informally, such as exercise, arts-based activities, or groups that provide an enhanced sense of community (Hayes et al., 2018a). There are also a variety of cultural approaches to mental health care that people may rely on — for example, land-based healing practised by many Indigenous Peoples, which brings people out on the land to create, craft, cook, share stories, and connect with the land and with culture (Radu, 2018).

There are a range of interventions to address the psychosocial impacts of climate change, including policy-level responses, programs, and practices, community-based approaches, and other strategies for providing mental health services and supports (Table 4.2). Psychosocial health refers more broadly to the social and psychological components that shape well-being, and mental health is one aspect of the broader definition of psychosocial health. The following sections highlight the broader range of adaptation interventions supporting psychosocial health (Clayton et al., 2017; Hayes & Poland, 2018; Hayes et al., 2018a).

4.7.2.1 Monitoring and Surveillance of Mental Health Impacts

The Toolkit for Post-Disaster Surveillance of Impacts on Mental Health developed by the National Institute of Public Health of Quebec provides guidance to public health officials on monitoring the mental health impacts of major disasters during the recovery phase, which can last months to years after an extreme event (Canuel et al., 2019). This toolkit includes specific data collection instruments to evaluate the mental health impacts of exposures to climate-related hazards. In addition, novel approaches have been, and are being, developed in Indigenous communities to gain a better understanding of the psychosocial impacts of climate change (Box 4.3).

4.7.2.2 Supporting Youth

Youth can be particularly vulnerable to experiences of anxiety, grief, and stress related to climate change, including ecoanxiety and ecogrief. Ray (2020) refers to youth born between the 1990s and the 2000s as “the climate generation,” because of their exposure to the climate crisis over their lives. The Field Guide to Climate Anxiety: How to Keep Your Cool on a Warming Planet (Ray, 2020) is aimed at youth and provides a number of resources for dealing with climate change, including:

• tools to address burnout related to climate activism and the climate crisis;
• techniques to make sense of the climate crisis and to find purpose and meaning in addressing it;
• strategies to enhance collective and individual resilience;
• tools to address potentially negative impacts of climate change media coverage; and
• tips on how to infuse climate justice work with joy, humour, and optimism.

The field guide places individual and collective well-being, along with social and environmental justice, at the centre of these actions. Supporting the well-being of children and youth in their efforts to cope with the impacts of climate change has also been the focus of some Indigenous communities and organizations. Box 4.4 highlights how two organizations from three Island Lake First Nations exposed to a wildfire came together to support the well-being of children.

4.7.2.3 Interactions with the Natural Environment

Much of the current literature exploring new and innovative approaches to addressing the psychosocial impacts of climate change highlights the importance of interactions with the natural environment. Interactions that include practices that preserve the natural environment provide people with a sense of stewardship and personal investment that may help overcome feelings of hopelessness, anxiety, and ecoparalysis. One environmental clinic treated “impatients,” people who were emotionally and physically tired of waiting for legislative interventions on climate change, with “prescriptions” for environmental action (Koger et al., 2011). The clinic provided students with problem-focused coping strategies that enhance well-being through environmental activism (Koger et al., 2011).

Spending time in nature has also been linked with enhanced physical and psychosocial health (Ulrich, 1979). A common practice in Japan to reduce stress and anxiety is shinrin-yoku (“forest bathing”) — a way of connecting deeply with nature. In a study by Lee et al. (2011), authors found that forest bathing resulted in decreased cortisol levels and pulse rates and significantly increased positive feelings.

Indigenous communities have traditionally found psychosocial enhancement through land-based healing practices (Cunsolo Willox et al., 2012; Cunsolo Willox et al., 2013a; Cunsolo Willox et al., 2013b; Petrasek MacDonald et al., 2015; Cunsolo & Ellis, 2018; Middleton et al., 2020a). Land-based healing provides space and opportunity for community members to come together, to learn and impart knowledge about land-based culture and knowledge, and to enhance a sense of community, all of which increase psychosocial well-being (Kirmayer & Valaskakis, 2009; Radu et al., 2014).

Other proposed approaches to build the human–nature relationship that supports psychosocial well-being include ecopsychology, the branch of environmentalism that integrates psychology to support psychosocial well-being and planetary health, and deep ecology practices, which provide people with opportunities to integrate meditative practices in nature to calm the mind and body while building a relationship with nature (Bragg & Reser, 2012). Many new therapies still need to be evaluated for their effectiveness in reducing the psychosocial impacts of climate change.

Greenhouse gas mitigation and adaptation actions to address climate change can produce significant health co-benefits (see Chapter 10: Adaptation and Health System Resilience), including benefits to mental health (City of Toronto, 2019). For example, increasing opportunities in a community for active transportation (e.g., walking, jogging, and biking) have been shown to reduce depression and improve moods (Koger et al., 2011; Whitfield et al., 2017). In addition, community-based environmental stewardship projects that support adaptation and/or efforts to mitigate greenhouse gases can enhance a sense of social cohesion and thus support psychosocial well-being (Koger et al., 2011). Increasing green infrastructure is also an important strategy to mitigate greenhouse gases and adapt to climate change that has been demonstrated to reduce urban heat islands, improve physical health, and support mental well-being (Zupancic et al., 2013; Huang et al., 2017; Health Canada, 2020).

Psychosocial adaptation to the effects of climate change is influenced by a number of factors that may be protective of psychosocial health when they are in place and may hinder psychosocial health when they are absent. These include (Hayes et al., 2019):

• social capital;
• sense of community;
• communication and outreach;
• intersectoral and transdisciplinary collaboration;
• community preparedness;
• government interventions;
• access to resources (financial and physical);
• mental health literacy;
• culturally relevant resources and responses;
• health care training; and
• vulnerability and adaptation assessments.

Figure 4.2 presents factors that influence the psychosocial health impacts of climate change, illustrating how these impacts are mediated by the social and ecological determinants of health, response interventions, and the factors previously identified that influence psychosocial adaptation. While specific Indigenous determinants of health such as food insecurity, colonialism, racism and social exclusion, self-determination, and environmental stewardship are not included in this figure, it is recognized that they are integral to understanding the factors that influence the psychosocial health of Indigenous Peoples experiencing the effects of climate change.

4.7.4.1 Social Capital

Social capital refers to the “networks and resources available to people throughout their connections to others” (Aldrich, 2012, p. 172). Two important dimensions of social capital include the structural dimension, in which people engage and interact in activities, and the cognitive dimension, which encompasses perceptions about trust, social cohesion, and reciprocity (e.g., a sense of community) (Berry et al., 2010b; Aldrich, 2012). Essentially, social capital is both the networks and relationships people form to support one another, as well as perceptions about these networks and relationships. Social capital is of paramount importance in post-disaster recovery, even when compared with economic or other types of assistance (Aldrich, 2012).

Social capital may serve as a protective factor for farmers affected by wildfires and drought. The “Hay West” movement, for example, demonstrated how social capital is not bound by a single geographic location but can benefit farm workers across the country. In 2002, drought-affected Prairie farmers received 64,000 hay bales from farmers in Eastern Canada, who understood the plight of those affected by the drought and sought to support one another (Yusa et al., 2015). Social capital was also identified as an important protective factor in decreasing the risk of suicide among adult female farmers during periods of prolonged or worsening drought in Australia (Hanigan et al., 2012).

4.7.4.2 Sense of Community

A sense of community refers to feelings of belonging and is often referred to as the opposite of feeling isolated (Bajayo, 2012). A sense of community is particularly important when addressing the mental health impacts of climate change, because it can provide space to explore and discuss challenging emotions such as ecological grief and ecoparalysis. Resources that enhance a sense of community have been developed to support people experiencing emotions such as ecoanxiety. For example, the “Ecoanxious” website was created to make people feel less alone in their fears about the climate crisis (Malena-Chan & Gatley, 2020). This forum offers people the opportunity to share their stories of ecoanxiety, learn from others’ experiences, and practise guided meditation (Malena-Chan & Gatley, 2020). The website “Is This How You Feel?” provides an online platform for people to explore how climate change makes them feel (“Is This How You Feel?”, 2020). Additionally, the Good Grief Network, which is a 10-step program to support individuals and communities as they explore and address ecogrief, connects people to build “personal resilience while strengthening community ties” (Schmidt & Lewis-Reau, 2020). The network provides specific tools that can help address the negative impacts of ecogrief, including denial, hopelessness, helplessness, activism fatigue, and burnout (Schmidt & Lewis-Reau, 2020) “Climate and Mind” is a U.S.-based online repository of research and resources for addressing climate-related distress, including a listing of mental health professionals who can support people (Bryant, 2020). This site offers guidance on how to host climate cafés or climate circles, which are informal community gatherings that offer people the opportunity to share and explore feelings of ecoanxiety, ecological grief, and climate-related distress while building a community of support (Bryant, 2020). All of these resources emphasize the importance of fostering a sense of community to support psychosocial resilience.

4.7.4.3 Communication and Outreach

It is important that messages about the mental health impacts of climate change include actions to support psychosocial well-being (Clayton & Manning, 2018; King et al., 2018). Messages about impending climate risks alone may invoke more fear and anxiety in people, in particular among those with pre-existing mental health issues, and may contribute to mental health problems (Dodgen et al., 2016). Messages that trigger fear may also increase avoidance behaviours; that is, people may feel so overwhelmed that they disengage and avoid messages about climate change as a way to cope (Stern, 2012). Pairing messages about risks from climate hazards with messages about what, where, and how people can support their well-being may help people to feel more empowered and in control of their wellness (Maibach et al., 2011). Trusted sources for this information include health professionals, meteorologists, climatologists, and governments (Zhao et al., 2014). A good example of a communication product is presented in Figure 4.3. This image highlights that ecological grief and anxiety associated with climate change are increasing and identifies health sector responses that can reduce emotional suffering and build resilience.

4.7.4.4 Intersectoral and Transdisciplinary Collaboration

Intersectoral and transdisciplinary collaboration is key to supporting adaptation to the psychosocial impacts of a changing climate (Morrisey & Reser, 2007; Stanke, 2012; Hayes et al., 2019). Mental health care professionals, along with other health and allied health professionals, provide mental health care on the front lines during extreme weather events and disasters. In addition, community groups, faith-based and spiritual institutions, and non-governmental organizations provide a sense of community and support for people experiencing psychosocial outcomes. Emergency preparedness professionals also support adaptation, particularly during these events. The mental health and wellness of these professionals can be seriously affected, as they tend to be more exposed to hazardous events (Carleton et al., 2017). Enhanced collaboration across disciplines and sectors can increase the effectiveness of adaptations to reduce the psychosocial impacts of climate change (Hayes et al., 2020).

4.7.4.5 Government Interventions and Access to Resources

Access to mental health care and social services that support psychosocial health can reduce negative mental health outcomes (MHCC, 2016; Thompson et al., 2018). These resources may include mental health care from medical professionals, or informal support from community-based groups; access to these resources, however, may be affected or disrupted by climate hazards (Hayes et al., 2019).

Government interventions that enhance access (both financial and physical) to psychosocial resources are foundational for enhancing mental health care (Polain et al., 2011; MHCC, 2016; Hayes et al., 2019). Canada’s universal, single-payer health system may not cover many mental health care services, and mental health services vary by province, territory, and region (Goldner et al., 2016). Additionally, although many First Nations and Inuit receive a range of mental health services and supports free of charge as part of the Non-Insured Health Benefits Program, many do not have access to them (Government of Canada, 2020).

Provinces and territories provide outpatient physician services (e.g., primary care and psychiatry) and in-patient mental health care at hospitals. Allied professionals (e.g., nurses, social workers, counsellors, psychotherapists) are often provided at no charge during in-patient care; however, these services may include a fee when they are delivered as outpatient services. Many people in Canada, therefore, may need to pay for mental health services directly or through private insurance in order to access such services (Goldner et al., 2016). Some people may not be able to access mental health care due to financial constraints or simply because there are no mental health care facilities to access (Moroz et al., 2020). The unequal access of some populations in Canada to mental health care services increases their vulnerability to climate change impacts. Enhanced and equitable access to mental health care could improve mental health outcomes in a changing climate.

4.7.4.6 Mental Health Literacy and Mental Health Care Training

There is significant stigma surrounding mental ill health and mental health service use in Canada (Tam, 2019). This barrier can reduce the number of people who seek help for their mental health needs related to the effects of climate change. Developing mental health literacy among the general public can help to reduce this stigma and encourage people who are struggling with the mental health impacts of climate change to seek care (Hayes et al., 2019). Mental health literacy refers to the knowledge of mental health outcomes, factors that influence mental health outcomes, and mental health care management and options (Davis, 2013). Psychological First Aid and mental health First Aid can enhance mental health literacy, by providing guidance and training on how to support people experiencing mental distress.

Efforts to reduce the mental health impacts of climate change include training public health and emergency management officials. Training should focus on the activities required following a disaster, advocated by Neria and Shultz (2012):

• promoting a sense of safety;
• calming anxiety and decreasing physiological arousal;
• increasing self-efficacy and collective efficacy;
• encouraging social support and bonding with others; and
• instilling hope to promote a sense of a positive future.

The application of these approaches may enhance mental health literacy and reduce long-term psychosocial impacts from climate change, especially among populations who experience disproportionate health burdens (Neira & Schultz, 2012).

4.7.4.7 Culturally Relevant Resources and Responses

Adaptation efforts that support psychosocial health need to use culturally relevant and locally appropriate resources. For example, in Canada, increased availability of mental health care is needed in rural farming communities to help reduce impacts from drought. Such care should also be provided by individuals with knowledge of, and experience in, agriculture and should be designed with attention to gendered dimensions that create different experiences for farm men and women (Fletcher & Knuttila, 2016).

Reducing the mental health impacts of climate change in First Nations, Inuit, and Métis communities also requires culturally relevant resources (MHCC, 2016). For example, responding to the mental health and cultural safety needs of Indigenous Peoples following community evacuations from floods and fires requires integrating the First Nations Mental Wellness Continuum⁵ among first responders providing assistance to displaced First Nations populations. It also requires cultural competency training for emergency response personnel, law enforcement, and disaster management specialists at provincial and federal levels (Health Canada, 2015). There is also a need to enhance awareness and support of land-based healing practices relevant to Indigenous communities (Polain et al., 2011; Harper et al., 2015). Noting this, the Yukon’s Climate Change Secretariat report on adaptation actions identified strengthening mental health resources and building or enhancing programs that support Indigenous Peoples’ reconnection to the land as a top priority (Government of Yukon, 2017).

4.7.4.8 Community Preparedness Utilizing Vulnerability and Adaptation Assessments

Community preparedness to support psychosocial health in the aftermath of climate-related hazards, and to prevent the occurance of impacts in the first place, is highly dependent upon a thorough understanding of the risks and vulnerabilities related to community-level climate hazards and an assessment of adaptation opportunities (Morrissey & Reser, 2007; Hayes et al., 2019). For this reason, many communities throughout Canada have conducted climate change and health vulnerability and adaptation assessments (V&As) (see Chapter 10: Adaptation and Health System Resilience). These assessments, often conducted by local, provincial, and territorial health authorities, or Indigenous communities, increase understanding of current and projected impacts of climate change on health, populations most at risk, and adaptation options.

V&As are useful tools to obtain information needed to address the mental health impacts of climate change; however, few V&As incorporate mental health indicators. Hayes and Poland (2018) provide a set of indicators and measurement tools that can be used to analyze climate change impacts on mental health (Table 4.3).