Introduction by Croakey: On World Mental Health Day, it is timely to consider the many ways that climate change harms mental health and wellbeing, and the importance of comprehensive responses across multiple portfolios and sectors.
Eloise Scott, a Registered Mental Health Nurse living and working in Naarm/Melbourne with 18 years’ experience in both acute and community mental health settings, is concerned about the disproportionate risks of global heating for people with lived experience of mental distress.
After reviewing 59 policy documents in the areas of climate change, health and housing, as well as heatwave emergency plans at national, state and territory levels, Scott has some clear advice for policymakers – including that “policy consultation and co-design with people with lived experience of emotional distress and people with lived experience of climate change impact is essential moving forward”.
She also stresses the importance of Health in All Policies approaches.
Eloise Scott writes:
It’s not yet summer, and already warnings have been issued about the impacts of heat upon the health and wellbeing of Australians. But the needs of one group of people are often neglected by such messaging and related policy responses.
As a mental health nurse in a residential program, I work closely with people with lived experience of emotional distress. The people I work with, and their welfare is close to my heart, and I have become increasingly concerned about their wellbeing as global warming escalates.
I acknowledge the contested nature of language used to describe people with lived experience of emotional distress, a specific but diverse group of people, and the stigma and trauma of biomedical labelling and diagnoses. Throughout this article, people with lived experience of emotional distress refers to those with experiences consistent with schizophrenia, schizoaffective disorder, bipolar affective disorder, major depression, complex post-traumatic stress disorder and other mental illness.
Some of the people I work with have repeatedly returned to the program for respite from their accommodation and sometimes because of prolonged periods of heat. Their levels of emotional distress respond varyingly to psychotropics and medicalised interventions; however, their response to safe, clean and thermoregulated accommodation is unwaveringly positive.
After the Intergovernmental Panel for Climate Change (IPPC) sixth assessment report (AR6) reported that the last decade will be the coolest this century, I began to think more about how heatwaves will impact the wellbeing of the individuals that access my workplace.
I could foresee heatwaves’ impact on their mental and physical health. I questioned whether Australia has sufficient national, state and territory climate change, health, and public housing policies to support people with lived experience of emotional distress.
I considered if Aboriginal and Torres Strait Islander peoples were included across these key policy areas too. I was curious to know about the inclusion of these two priority populations in emergency heatwave management plans.
As part a Global Health Capstone project at the University of Sydney, I undertook a scoping review of climate change, health and housing policy and heatwave emergency plans at national, state and territory levels – examining 59 documents in total.
I reviewed the documents through an ecological framework. This approach recognises that individuals are not separate entities, and that health and mental wellbeing is interconnected through relationships, organisations, communities, policies, and society.
The review found that:
- People with lived experience of emotional distress, as a specific but diverse group, are frequently forgotten in policy.
- Policies consistently identify Aboriginal and Torres Strait Islander peoples as a priority population but not in the context of their lived experience of emotional distress.
- Currently, most adaptation measures in public housing are considered maladaptation until Australian energy is fossil fuel free.
- Health in All Policies is recommended as mandatory policy framework.
- Policy consultation and co-design with people with lived experience of emotional distress and people with lived experience of climate change impact is essential moving forward.
Heatwaves, housing and health
In Australia, heatwaves result in more fatalities than all other natural disasters combined. Heatwaves are escalating in duration, intensity, and frequency, progressively getting hotter each year.
Housing is essential in protecting humans against the health impacts of heatwaves. Adequate housing is a human right and a social determinant of health.
People with lived experience of emotional distress are vulnerable to heatwave effects and significant correlations exist between heat and the exacerbation of distress.
Aboriginal and Torres Strait Islander peoples, whose mental distress and adverse physical health outcomes remain disproportionately high, are at risk of heatwave impacts.
People with lived experience of emotional distress and Aboriginal and Torres Strait Islander peoples frequently experience poverty, resulting in access to cheaper housing stock that does not have adequate ventilation and thermal ventilation comfort.
In January 2023, The Australian Council of Social Service (ACOSS) collected data via the ACOSS 2023 Heat Survey online and published the following results:
- The average Australian home performs at 1.7 out of 10 possible stars for energy efficiency.
- 62.1% of respondents struggle to keep their homes cool in summer.
- 89.4% report that high temperatures negatively impact their physical and mental health.
- 83.2% are finding it more challenging to pay energy bills affecting their ability to cool their homes.
- 97% avoid certain activities due to heat.
- 63.4% report going without essentials (food and medical care) due to energy costs.
- 67.6% report going into debt to pay energy costs.
(Note from Croakey: the figures above were corrected on 13 October after a production error resulted in incorrect figures being published initially).
Policy analysis
The National Climate Resilience and Adaptation Strategy is the only climate change policy recognising the impacts of climate change on health highlighting the interconnectedness of the natural environment, the built environment and the health of individuals and communities; however, work has now commenced on a National Health and Climate Strategy.
Yet the National Climate Resilience and Adaptation Strategy fails to specify public housing in its adaptation plan. Every other state and territory include adaptation measures for current public housing and plans to build more climate-resilient public housing.
Unfortunately, adaptation measures for current public housing relies on retrofitting air conditioning, which could be framed as maladaptation. When applied in this instance, maladaptation highlights that air conditioning increases external ambient temperatures, particularly in urban areas adding to heat island effects.
Furthermore, air conditioning in Australia, until all energy is renewable, draws on fossil fuel use to create energy. As energy costs continue to skyrocket across Australia, despite energy concessions and rebate schemes, using air conditioning effectively will remain out of reach for many. Currently, air conditioning in public housing (as a general rule) is installed after an application is lodged along with a supporting letter from a medical professional, and this is only available for a number of stipulated medical conditions.
Apart from the National Climate Resilience and Adaptation Strategy, only the Northern Territory (NT) and Western Australia (WA) mention climate change impacts on health within their own climate change and adaptation strategies. This finding is alarming due to the number of significant climate-related events that have impacted Australian’s physical and mental health.
What is truly shocking is that one in every five Australians experiences mental distress at some point in their lifetime and people with lived experience of mental distress are not included as a priority population within the national, state or territory climate policies; particularly when cohorts that have chronic health conditions, disability and Aboriginal and Torres Strait Islander peoples are consistently mentioned.
People with lived experience of mental distress often have similar physical comorbidities that fall under the banner of chronic health conditions and psychosocial disability.
Furthermore, people with lived experience of emotional distress are three times more likely to die from heatwaves than the general population, are at risk of exacerbation of their symptoms and associated distress due to heat, may have difficulty regulating their body temperature due to psychotropic medications and be residing in poorly thermo-regulated accommodation.
Clearly this is evidence that people with lived experience of emotional distress ought to be a priority population within climate policy. Some may argue that people with lived experience of mental distress have their own policies and plans, yet it speaks to the ongoing siloing of health approaches; as if mental health is still separate from physical health.
Health policy is climate change policy
The Australian Capital Territory (ACT), the NT and NSW failed to include climate change and heatwave effects on health within their health plans. Yet, it is encouraging that they are in the minority. Again, the impact on people with lived experience of mental distress was primarily missed, except for the ACT, NT, and WA.
The determinants of health were frequently referenced as a framework for health. Public housing was included in health policy across National, Victoria (VIC), TAS, NT and WA; however, VIC has the only health policy that identified opportunities to improve the thermal comfort of public housing. Tasmania was the only jurisdiction not to include Aboriginal and Torres Strait Islander people’s health as a priority in these plans.
Housing policy is health policy
Housing as a determinant of health is referenced in all housing policies except for Tasmania. People with lived experience of mental distress are not explicitly mentioned at all yet are a distinctly vulnerable population within the public housing milieu.
Aboriginal and Torres Strait Islander peoples are included as a priority population within housing policy.
The impacts of climate change on housing are only referenced by the ACT, NSW, VIC, NT, and QLD. Implications of heatwaves in current public housing and for future construction to consider heatwave effects were only addressed by WA, VIC, and NSW. VIC, TAS and QLD only touched upon thermoregulation within public housing.
The National Construction Code (NCC) is a set of technical provisions that provide a uniform approach to the design and construction of all new buildings and structures throughout Australia, providing energy efficiency provisions to manage heat transfer through the building to minimise heat and cooling loads. All housing policies except ACT and SA refer to the NCC for future public housing construction.
In 2021, the Bushfire & Natural Hazards CRC published a report addressing NSW heatwaves and construction codes, criticising the NCC’s then iteration. The report highlighted that the heavy reliance on air conditioning for cooling was risky due to the potential for power grid overload, that key vulnerable population needs were not included, and that no consideration for different climate conditions, geographic areas and weather systems was addressed.
The NCC 2022 was then amended to include improved thermal performance in keeping with the Nationwide House Energy Rating Scheme (NaTHERS) to a minimum of 7 stars (out of 10) for all new homes constructed. However, the ongoing reliance on electricity remains highly problematic due to rising energy costs and fossil fuel use.
Heatwave help
Tasmania is the only state with no heatwave management plan separate from or within their state-wide disaster management plan, and the current version of the National Disaster Risk Reduction Framework (next due mid-2023) does not include heatwaves, only floods and bushfires.
Each state or territory plan uniformly refers to ‘vulnerable populations’ that identify the elderly and young children are the most at risk of adverse outcomes related to heatwaves; some include pregnant women, outdoor workers, and those with chronic health conditions, which is a broad catch-all term.
WA, VIC, SA, and QLD highlight both people with lived experience of mental distress and Aboriginal and Torres Strait Islander peoples as at-risk populations further to the cohorts already mentioned.
WA, QLD, and VIC identified that those taking psychotropic medications face an increased risk from heat. VIC and WA advised that living in public housing is another risk factor during heat waves. VIC, QLD, and WA’s heatwave plans outlined supports available before, during and after heatwaves for people with lived experience of mental distress and Aboriginal and Torres Strait Islander peoples.
Health in all policies – lived experience too
A Health in All Policies (HiAP) approach recognises that health and mental wellbeing are highly complicated and interconnected and are best understood through the Determinants of Health. HiAP also aligns with an ecological approach to understanding an individual’s health being affected by external factors beyond themselves, by who and where they were born, their community, government, policy, and society.
The outcome of this scoping review of climate change, health and housing policy demonstrates that HiAP must be the mandatory framework for all future policy within these domains, if not a lens that all Australian policy be considered through.
As a nation, our health and wellbeing are inextricably connected to our economy, environment, health, education, industry, infrastructure, agriculture, the safety of our neighbourhoods, cities, and our country.
People with lived experience of mental distress are experts in their journeys and needs, yet it is remarkable that there isn’t engagement of this diverse community across all policy areas.
Furthermore, people with lived experience of climate change embedded across policy development and implementation would only serve to enrich the depth and nuance of crucial policy areas.
This review has highlighted that the voice of those disproportionately affected by climate change, poor health and poor housing require a seat at the table during policy development that directly affects them.
If Australia is to move towards a HiAP approach, there must be input from people with lived experience of mental distress and people with lived experience of climate change. This is especially important and relevant in the current context of the Federal Department of Health and Aged Care development of the National Health and Climate Strategy.
Eloise Scott is a Registered Mental Health Nurse living and working in Naarm with 18 years’ experience in both acute and community mental health settings. She completed her Master of Global Health in June 2023 at the University of Sydney. Eloise is passionate about her work with people with lived experience of mental distress and their disproportionate struggles in the face of climate change in Australia.
Declaration from Croakey: Editor-in-chief Dr Melissa Sweet supervised Eloise Scott’s Master of Global Health Capstone project at the University of Sydney.
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