- Increased emergency department and hospitalization for patients with preexisting psychiatric illness during heat waves.10,11
- Preexisting mental illness alone increases the risk of mortality during extreme heat events by 2 to 3 times.12,13
- Patients with schizophrenia might have underlying impairments in thermoregulation that are intrinsic to the disease. Such impairments would explain the perplexing sight of psychotic patients bundled up in layers on hot days.14
- Psychiatric medications (antipsychotics, anticholinergics, and antidepressants) have the potential to impair the body’s heat regulatory functioning; lithium affects fluid homeostasis.15
The negative effects of climate change are not equally distributed, and people with mental illness are among the most vulnerable. Given the predictable future of extreme heat waves (potentially increasing the population exposure by four- to sixfold by midcentury),1 we must do everything we can to educate our patients so that they take preventive measures to protect themselves from the adverse effects of extreme heat.
3. “.” Centers for Disease Control and Prevention.
5. Personal communication.
9. U.S. Global Change Research Program, 2016. “Chapters 8 and 9.
Strategies for patients, communities
Part of the job of mental health professionals is psychoeducation, or teaching patients and families about the health risks tied to the psychological and physical impacts of heat exposure. Also, we should provide advice about effective management of psychiatric medications – such as monitoring lithium levels and considering medication dose adjustments – to reduce risks. Another key step is engaging caregivers, case managers, visiting nurses, and family members so that they closely monitor vulnerable populations. Providing information about the availability of respite care and cooling centers is another concrete step clinicians can take to help minimize the impact of extreme heat on patients.
Information that can be shared with patients about the threat include:
- A brochure from the Climate Psychiatry Alliance that offers specific ways to keep cool in extreme heat.
- A guidebook produced by the Environmental Protection Agency and the Centers for Disease Control and Prevention that explains what people can do to prepare for extreme heat.
- More extensive interventions can be found at https://www.climatepsychiatry.org/what-to-do/.
Dr. Cooper is in private practice and is affiliated with the department of psychiatry at the University of California, San Francisco. She is a Distinguished Life Fellow of the American Psychiatric Association.