Climate anxiety. When it's good to be worried

Many of the issues mental health nurses face in clinical practice have their origins in societal influences such as stigma, discrimination, racism, colonization, politics, economics, social inequities and other social determinants. As we interact with individual health consumers, we recognize that solutions to the distress and illness lie with addressing these wider factors. Trauma is an example of an adverse life experience with its roots in social factors, but with its effects seen in distress and dysfunction experienced by individuals. An emerging issue causing psychological distress but with its roots in global politics and economics is climate anxiety, defined as a state of "heightened emotional, mental or somatic distress in response to dangerous changes in the climate system" (Climate Psychology Alliance, 2020). Mental health nurses have a role in both the advocacy needed to address climate change and in developing responses to individuals who experience understandable anxiety about the effects of damage to the climate. Climate anxiety is experienced by a wide range of people. It shares the features of accepted anxiety disorders, including subjective distress, rumination, sleep disturbance, somatic disturbance, negative affect and hopelessness. However, it has the defining characteristic that it is grounded in the very real external threat of climate change that carries anticipated disastrous outcomes (Clayton, 2020). The International Council of Nurses (2018) has called on the nursing profession to take action on climate change, a call which has been echoed by mental health nurses (Kameg, 2020). Taking effective action now, however, is our greatest ever challenge given society's current addiction to two of the biggest drivers of climate change, consumerism and financial gain. Our dependence on fossil fuel has unquestionably catapulted our planet into a trajectory of potentially disastrous climate change. This reality is recognized by the Paris Agreement, a legally binding international treaty that brings the world's nations together to formally recognize and address climate change through collective action. The changes we are seeing in our environment are already profound and include unprecedented flooding, drought, forest fires, heat extremes and rising sea levels. We are witnessing health impacts across the globe from higher rates of diseases due to reduced water quality and availability and respiratory disorders secondary to air pollution, through to direct effects of extreme heat, ozone depletion and fire. Climate change is taking an equally significant toll on our mental health. A review of 120 studies exploring the mental health sequalae of climate change found an associated increase in psychological distress, deterioration in mental health, increased mortality among people with pre-existing mental health conditions, and increased psychiatric hospitalizations and suicide rates (Charlson et al., 2021). Ecological disasters themselves bring significant and direct consequences for mental health (Morganstein and Ursano, 2020), for example victims of fire Hooper et al. (2018) and firefighters alike (Counson et al., 2019) experiencing trauma and stress-related mental health problems postdisaster. Climate change also poses threats to health infrastructure and creates challenges for development of health policies through a climate lens (Salas et al., 2020). A recent Australian study identified a clear association between climate anxiety and syndromes of depression and anxiety (Clayton, 2020). However whilst climate anxiety has been shown to contribute to the development of anxiety disorders in vulnerable individuals, we must remain clear it is not in itself a mental disorder, but rather than a real-life stressor. As Dodds (2021, p. 2) notes "climate change is a psychological problem but that does not mean it should be individualized or medicalized." Pathologizing climate anxiety leads us away from an important acknowledgement of the reality of climate change, preventing nurses from providing the necessary effective responses for those seeking our support. Across a range of countries, surveys have identified high proportions of people reporting anxiety about climate change, particularly in countries at greater risk such as Australia, Greenland and Tuvalu (Clayton, 2020; Willox et al., 2013). Climate anxiety is felt much more keenly among youth, who see the issue of climate change as one of great importance due to the anticipated adverse effects it will have on their future lives (Reyes et al., 2021; Searle & Gow, 2010). In preparation for this editorial, an informal discussion was held with eleven young people (aged 14–18). Reflecting the international literature, all expressed serious concern about climate change and expected to encounter its impacts in their future lives. It is unsurprising that climate anxiety is more commonly experienced by youth. Consumerism is thought to produce 60 to 80 per cent of the current impacts we are seeing on our planet (Ivanova et al., 2016) meaning that pressure to consume sees our youth living at a time of great internal conflict. As the generation most targeted by marketers, our youth face an onslaught of daily attempts to get them 'hooked' on new brands and fads for commercial gain. Young people face pressures to conform to a set of ideals and fantasies which drive a desire to consume and are largely incongruent with the behavioural shifts needed to preserve our planet. The tension between pressure to conform to the demands of consumerism and heightened awareness of climate change can lead to an experience of profound cognitive dissonance. Indigenous communities are the worst affected by climate change both in its direct environmental impacts and in the delivery of support in the aftermath of extreme events (Clayton, 2020). A recent UN-backed report has identified higher rates of degradation on land occupied by indigenous communities (Brondizio et al., 2019) who, unsurprisingly, have been reported to experience high levels of climate anxiety. A study of the impact of climate change among the Inuit people of Rigolet, Canada, reported high levels of emotional distress in the face of climate change (Willox et al., 2013), findings that reflect Albrecht et al.'s (2007) notion of "solostalgia," the experience of distress arising from drastic and unwanted changes to the home environment. It is ironic, therefore, that some of the solutions to climate change and to climate anxiety lie with indigenous knowledges and practices. These include reconnection to a more value-based way of living including connecting with communities to mitigate climate change through environmentally sustainable practices. Indigenous models of health focus on the inter-dependence of our personal, whanau (family) and community well-being and on the well-being of our environment (Wilson et al., 2021). Mental health nurses will encounter climate anxiety in clinical practice, with a growing number of people presenting with distress over time. As with other adverse experiences, validation of individuals' perceptions and experiences is critical. Polarized views within the community can mean health consumers may be reluctant to share their concerns for fear of being dismissed or ignored. Beyond listening, nurses can assist by helping people to manage their emotional and behavioural responses to climate anxiety. A solution-focused response could involve drawing on personal beliefs and values to harness the motivational potential of negative emotions. Distress and anger can become helpful motivators for effective and empowering responses to climate change, such as engagement in social activism and activities looking to generate solutions. Individual strategies could include increasing time spent in nature to assist in gaining a greater sense of connection to the natural world. At a societal level, nurses can engage with governments, media, the voluntary sector and professional organizations to address the harmful effects of climate change (International Council of Nurses, 2018). Professional organizations need to inform members of these issues and provide guidelines for practice, such as the extensive guideline on climate change provided for paediatricians (Philipsborn et al., 2021). Climate change is a geopolitical issue, the effects of which are socially distributed and influenced by social determinants such as poverty, discrimination and marginalization that are known to contribute to health disparities. Nursing responses to climate change cannot be limited to improved responses to mental distress, important as that is, but should form part of a wider sociopolitical solution. Nurses need to respond effectively to climate-related distress experienced by health consumers, but also engage in social and policy advocacy to address climate change as a mental health issue. It is time for nurses to fully recognize the realities of climate change and to play our part in the collective action necessary to address its individual and social impacts. Data sharing not applicable to this article as it is not a research report.

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