{"id":49783,"date":"2021-03-10T19:53:26","date_gmt":"2021-03-10T18:53:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49783"},"modified":"2021-03-17T18:02:08","modified_gmt":"2021-03-17T17:02:08","slug":"richard-smith-emotional-distress-not-mental-health-and-climate-change","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/10\/richard-smith-emotional-distress-not-mental-health-and-climate-change\/","title":{"rendered":"Richard Smith: Emotional distress (not mental health) and climate change"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The main thing I learnt from a webinar on mental health and climate change <a href=\"https:\/\/climatecares.co.uk\/\">organized by Climate Cares <\/a><\/span><span style=\"font-weight: 400\">is that we should stop talking about mental health and use instead words like \u201cemotional wellbeing\u201d or \u201cemotional distress.\u201d Indeed, the phrase \u201cmental health\u201d is more broadly out of control when it puts in the same bracket princes of the realm who have mental health problems and people living with schizophrenia.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The obvious objection to the phrase \u201cmental health\u201d is that it pathologises or medicalises. It is entirely rational to feel emotional distress about the climate crisis or about the gross injustices in the world, structural racism, or the covid-19 pandemic. Indeed, it might be more pathological not to feel distress.<\/span> <span style=\"font-weight: 400\">\u201cHanging on in quiet desperation is the English way,\u201d sang Pink Floyd.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Unfortunately framing a problem as a health problem leads to responses of services, specialists, counselling, and drugs. But are they the right response to \u201cthe stress associated with homeschooling children while sustaining work, indebtedness, loneliness\u2026relationships that fatally cracked, and grief,\u201d as <\/span><a href=\"https:\/\/www.ft.com\/content\/88c8f248-acde-42cb-bc2a-bb9a95c031d9\"><span style=\"font-weight: 400\">an article in the <\/span><i><span style=\"font-weight: 400\">Financial Times<\/span><\/i><\/a><span style=\"font-weight: 400\">, entitled \u201cExperts fear mental illness crisis in covid\u2019s wake,\u201d describes?<\/span> <span style=\"font-weight: 400\">Are they the right response to floods, heatwaves, and climate breakdown?<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cThe government has vowed an extra \u00a3500m spending on mental health services this year to address waiting times for specialists,\u201d reports the <\/span><i><span style=\"font-weight: 400\">Financial Times<\/span><\/i><span style=\"font-weight: 400\">. But what can specialists do for loneliness, indebtedness, broken relationships, grief, or the distress that follows your house being flooded and the fear that it will be flooded again? How can specialists help young people who feel that their future has been taken away from them by a climate catastrophe that comes closer every day? They can call it \u201ceco-anxiety\u201d or \u201csolastalgia\u201d and debate inserting it into the next volume of the <\/span><i><span style=\"font-weight: 400\">Diagnostic and Statistical Manual of Mental Disorders<\/span><\/i><span style=\"font-weight: 400\">, but how will that help anybody?<\/span><\/p>\n<p><span style=\"font-weight: 400\">A young woman at the workshop described the relief she felt when a psychologist described the distress she was feeling about climate change as a normal response. She didn\u2019t have a \u201cmental health problem,\u201d she was distressed by the state of the world.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Drugs and counselling are the two main tools of mental health services, and neither can help with the emotional distress that follows from being repeatedly flooded. Doctors wrote 71 million prescriptions for antidepressants in 2018, <\/span><a href=\"https:\/\/www.bmj.com\/content\/364\/bmj.l1508\"><span style=\"font-weight: 400\">almost a doubling from 36 million in 2008<\/span><\/a><span style=\"font-weight: 400\">. <\/span><span style=\"font-weight: 400\">Almost a fifth of the population of England (17% of the adult population) was taking an antidepressant in 2018, while 3% were taking benzodiazepines, 3%<\/span> <span style=\"font-weight: 400\">gabapentinoids, and <a href=\"https:\/\/www.gov.uk\/government\/publications\/prescribed-medicines-review-report\/prescribed-medicines-review-summary\">13% opioid pain medicines<\/a>.<\/span><span style=\"font-weight: 400\"> Many people have become dependent on these drugs. They may be receiving little benefit from the drugs, but suffer greatly if they try to stop them.<\/span><\/p>\n<p><span style=\"font-weight: 400\">After every disaster there is a loud call for counselling. It is understandable that people should want to help and do something, but <a href=\"https:\/\/www.bmj.com\/content\/bmj\/suppl\/2017\/06\/30\/357.jun21_2.j2981.DC1\/BP_emergency_response.pdf\">systematic reviews<\/a> have shown that most people don\u2019t need professional counselling.<\/span><span style=\"font-weight: 400\">\u00a0Indeed, professional counselling might suck them into sickness services and prolong their distress.<\/span><\/p>\n<p><span style=\"font-weight: 400\">I\u2019ve come belatedly to understand that two of the most powerful influences on health are \u201cagency\u201d and \u201crelationships.\u201d Agency is the capacity to respond to the challenges in your environment, and those who have wealth and education often have more agency than those who have little of either. But agency is not just a capacity of individuals, but of communities and groups. A better response to the distress caused by flooding and the climate crisis than engaging with mental health services is to take action, campaign for better flood protection, or for vigorous action to mitigate climate change; or join Extinction Rebellion.<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cRelationships\u2014the simple human bonds between us\u2014are the foundation of good lives,\u201d writes Hilary Cottam in <\/span><i><span style=\"font-weight: 400\">Radical Help<\/span><\/i><span style=\"font-weight: 400\">. \u201cThey bring us joy, happiness, and a sense of possibility\u2026.Building on relationships enables the growth of further capability: supporting us to learn, contributing to good health and vibrant communities. Without strong bonds with others, or with unhealthy relationships, very few of us can feel fulfilled\u2014or even function.\u201d Agency and relationships are mutually reinforcing: more agency means more relationships.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The state, the NHS, can create neither agency nor relationships. Indeed, they may have greater capacity for destroying than creating them. Something much subtler is needed, and Cottam describes such experiments in <\/span><i><span style=\"font-weight: 400\">Radical Help<\/span><\/i><span style=\"font-weight: 400\">. But when it comes to the distress caused by the climate crisis the state must take the lead. Increasingly politicians are managing the rhetoric, but the necessary actions are not following. \u201cBroken promises and inaction coupled with the enormity of the climate crisis are all beginning to take their toll on children\u2019s mental health,\u201d <a href=\"https:\/\/www.bath.ac.uk\/announcements\/rise-of-eco-anxiety-affecting-more-and-more-children-says-bath-climate-psychologist\/\">writes psychologist Caroline Hickman<\/a>.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">I can see that it isn\u2019t going to be possible to avoid the term \u201cmental health,\u201d and I applaud the lessening of stigma and the aspiration to level up mental health services to the standard of physical health services. But mental health services should concentrate on caring for those who can benefit, not become a substitute for the urgent action that is needed on the climate emergency.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Richard Smith<\/strong> was the editor of <\/span><\/i><span style=\"font-weight: 400\">The BMJ<\/span><i><span style=\"font-weight: 400\"> until 2004.<\/span><\/i><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Competing interest<\/strong>: RS is the unpaid chair of the UK Health Alliance on Climate Change.<\/span><\/em><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The main thing I learnt from a webinar on mental health and climate change organized by Climate Cares is that we should stop talking about mental health and use instead [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/10\/richard-smith-emotional-distress-not-mental-health-and-climate-change\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":46462,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[266,955],"tags":[],"class_list":["post-49783","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-climate-change","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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Hundreds of activists from the Extinction Rebellion climate change movement gathered at Parliament Square, marched to Downing Street, and poured 200 litres of fake blood on the ground. This act of non-violent civil disobedience was carried out to demand from the government direct actions to reduce carbon emissions to zero by 2025, speak the truth about climate change and call for a national citizen\u2019s assembly. For the activists, carrying buckets of \u201cblood\u201d to Downing street and spilling it symbolised the violent destiny which faces today\u2019s children if there is not a policy to tackle climate change, and is an invitation to reflect on what kind of planet the children will have left. 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Hundreds of activists from the Extinction Rebellion climate change movement gathered at Parliament Square, marched to Downing Street, and poured 200 litres of fake blood on the ground. This act of non-violent civil disobedience was carried out to demand from the government direct actions to reduce carbon emissions to zero by 2025, speak the truth about climate change and call for a national citizen\u2019s assembly. For the activists, carrying buckets of \u201cblood\u201d to Downing street and spilling it symbolised the violent destiny which faces today\u2019s children if there is not a policy to tackle climate change, and is an invitation to reflect on what kind of planet the children will have left. 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