The devastating effects of the climate emergency are increasingly apparent for all to see. Rising temperatures, bush fires, floods, droughts, dying ecosystems and degrading soil demonstrate each day the extent of the crisis gripping the globe. These issues have for far too long been trivialised as affecting just a few animal species or coastal communities. 

But the climate emergency cannot be localised or diminished. If unchecked it will affect the physical and mental health of people across the globe. As food shortages grow and communities are displaced, the physical and mental health of the human population will suffer. 

As we begin to frame the climate and ecological emergency more and more as a health crisis, we must also think about how healthcare can be part of the solution. Currently, the NHS is a major contributor to carbon emissions—in England it accounts for 4–5% of total emissions and is the single largest emitter of greenhouse gases in the UK public sector. 

The Sustainable Development Unit and The Greener NHS Campaign are helping the NHS move to reach net-zero carbon emissions. To support this, the Royal College of Psychiatrists is calling for every NHS health organisation, commissioner, and provider to produce a Green Plan by the end of 2021. These should set out a vision for making services more sustainable.

The covid-19 pandemic has shown us that large-scale public health emergencies can lead to swift, decisive, and collaborative change and that the NHS has the ability to lead this change. The pandemic has also shown us the possibility, and benefit, of taking radical action when required, and the time is now.

Taking a more holistic approach to health creation, health protection, and a service model where prevention is prioritised could be the cultural change healthcare needs. A sustainable and positive vision of mental health services will require a greater understanding, adoption, and integration of preventative principles and interventions. This preventative ethos must be placed at the heart of healthcare.

Keeping patients well is the most sustainable thing we can do as psychiatrists and to this end, social prescribing has the potential to play a substantial part in reframing psychiatric treatment to make it more preventative, holistic, and sustainable. Social prescribing supports the “social” in the biopsychosocial approach and part of its proposed therapeutic benefit is via enhanced connection with nature and communities. It can introduce individuals to activity-based groups in their local area,   ranging from gardening or walking in nature, to football, drama, and knitting.

While prevention of illness should be prioritised in more sustainable healthcare, there is also an issue of how we treat patients who do become ill. Currently procurement (the purchase of medication and medical equipment) accounts for 60% of the carbon footprint of the NHS in England. NHS Psychiatric services need to re-assess current services and interventions to improve their sustainability.

Another cultural change in healthcare must be to increasingly appreciate that the close relationship between nature and our mental health opens up solutions to build a model of healthcare that is sustainable, focused on prevention, and has co-benefits for our planet. A central part of the UK’s 25-year environmental plan should include the integration of green spaces into mental healthcare. This will help provide treatments that are helpful for people suffering from mental illness and could potentially improve public health, including reducing social inequality.

To help achieve this, we are calling for a natural services network to map all sites in a local area that provide opportunities for sustainable interaction with nature and/or activities that preserve the natural environment and promote these to mental health services.

The many ways in which the climate and ecological crisis is impacting on mental health in the UK and globally is clear. 

Swift and decisive action from government and NHS leaders is essential, but individual psychiatrists can also play a part in tackling the environmental problems that we face. A combined effort across the health sector towards a holistic approach to health that reframes our relationship with our planet, nature and all life on earth will help tackle the climate and ecological crises and, by doing so, prioritising the mental health of all.

Adrian James, President of the Royal College of Psychiatrists.

Competing interests: none declared.