An Environmental Psychiatrist Explains Earth Anxiety As We Celebrate Earth Day

240415_Conversations_Belkin_01.mp3

Speaker 1 [00:00:04] We mark Earth Day 2024, with scientists telling us in April we've had
record heat in many locations around the world after we just experienced the hottest
March on record. This is on top of 2023 being the warmest year recorded. Our guest says
it's time to accept climate change. It's making some of us depressed and anxious.

Speaker 2 [00:00:26] And now we're increasingly, reading about, the effects, mental
health effects of anticipation of these of these things. You mentioned climate anxiety and
so forth. There's, data on use in particular, globally, that, even daily experienced, intrusive
anxiety, about climate change is, the norm.

Speaker 3 [00:00:55] Yet there are ways to cope. Doctor Gary Belkin is an acclaimed
psychiatrist who founded and leads the Brilliant Minds Institute, which aims to bring
attention to what he calls the social climate crisis.

Speaker 2 [00:01:07] If we care for each other, we exponentially raise our ability to care
for the planet. That it's really that social fabric that is is is a necessary factor.

Speaker 3 [00:01:16] And this is conversations on health care.

Speaker 1 [00:01:27] Well, doctor Balcomb, welcome to Conversations on Health Care.

Speaker 2 [00:01:31] Thank you. Thank you very much for paying attention to this issue.

Speaker 1 [00:01:34] Yeah. That's great. And speaking of paying attention, I think anyone
who is is bound to get upset by climate change news. And you're raising the awareness of
the effects on mental health, what some call climate change related depression. What
have you could share with our audience, your perspective?

Speaker 2 [00:01:53] Yeah. So I think first just to say that, we have more than enough
evidence to know, for example, that extreme weather events heat, and the damages that
come from, from those, elevate, mental health illnesses. We've known this for decades. It,
makes every social. And these things make every social determinant of mental health
worse. And now we're increasingly, reading about, the effects, mental health effects of
anticipation of these of these things. You mentioned climate anxiety and so forth. There's,
data on youth in particular, globally, that, even daily experience of intrusive anxiety, about
climate change is, the norm, that, this is affecting youth emotionally, emotionally in terms
of, having a foreshortened sense of, of their future. But what I have been trying to focus on
is, is not, just the fact that there is more mental health morbidity for our systems and
practitioners to be aware of and to worry about and to be ready for, but what are the social
impacts, of this? Because there is some evidence that even people who are, let's say
climate anxiety. The more interesting question is what does that do to them in terms of, the
choices that they make? But also in their, motivation and mobilization to act on these
issues. And it seems like that may be a mixed bag. It affects people, and negatively, but it
also motivates people, and fuels, their, motivation to act.

Speaker 3 [00:03:44] Well, Doctor Belkin, I think along those lines, you write about the
concept of psychological tipping points. What hope can give way to hopelessness and a
sense of responsibility to retreat by those with the power to avert a worsening crisis?
Certainly. You know, all of us, one hopes, on an individual level, are doing what we can
do. But the UN executive secretary for climate change, has said that politicians seem to

indeed be retreating, from the issue. Perhaps because of that sense of hopelessness, and
retreat. What's the strategy for turning around these politicians or taking it out of the
political realm? What's the strategy for reversing hopelessness and retreat into a more
activist stance?

Speaker 2 [00:04:29] Well, I think the first thing we have to do is just appreciate the
psychological dimensions of all of this, that it can, diminish hope and some drive
motivation in others, that it acts at individual levels of, particularly those more, directly
facing these issues in terms of real added risk of mental illness and, and, and even
intergenerational effects of that. But also the mental level at a societal level. The things
that you just mentioned, that quote you took from me was motivated by a meeting. I was in
a call with colleagues, actually, in India during a recent heatwaves there. Who who made
the remark that they were talking as a mental health community about what happens when
there's mass hopelessness. And I think that's the kinds of questions that we have to start
asking and appreciating that there's a whole psychological dimension to this, how societies
acts at how leaders act, whether it's denial or whether it's truth telling. We really have to
appreciate that dimension of things and surface them. There is no simple formula about
whether it helps or hinders action or not, whether it provokes denial or, grasping with
reality. But the first step is to actually appreciate that this is an issue that is affecting, the
psyche of humanity. And to understand that more clearly, the United Nations development
programs, a recent human development report they wrote talked about a global assault on
mental health, that is hampering the ability of humanity to problem solve. And that's why
we have to pay attention to.

Speaker 1 [00:06:13] You know, speaking, problem solving. You know, you highlight the
value of strengthening the social fabric of communities, and you're doing this work through
your, through, Cop Squared. I wonder if you could share a little bit about that, but I really
love, it's focused on awareness, advocacy and action, but also sort of underscoring of that.
oh. And add another, all of us. Right. It's it's about we all have to be working together on
these things. Can you tell us a little more about the work that's going on there?

Speaker 2 [00:06:49] Yeah, exactly. And it tries to connect these to, dots, so to speak, that
these mental health effects that, that we know well at an individual level in terms of more
illness, morbidity, etc., particularly in the face of direct threats. But also this what is this
social effect? How does that roll up into affecting communal capacity and social fabric and
collective efficacy? To, to act together and to problem solve? So what square tries to do,
which stands for care of people times planet. So the p squared, kind of implying that if we
care for each other, we exponentially raise our ability to care for the planet, that it's really
that social fabric that is, is is a necessary factor. And so to look at mental health from both
levels is micro macro A levels. So we brought together what's now about I don't know I
think it we're at 460 organizations and growing who have self-identified as acting on caring
about trying to do something about researching these kinds of, multi dimensions to mental
health, which as a field, we rarely do right. Our community mental health systems, mental
health policy has really focused on very specific illnesses, certain kinds of care for it. Done
in certain places. What this enlarge view of how mental health is pressuring mental health
at every level, at social performance and in individual health levels. We have to really we
think about how we deploy the tools of, of mental health. And that's really what Cop
Squared has been about. And taking things we know, that really put in the water, mental
health promotion prevention and not just in, isolated clinics and the kind of practice
systems that we've relied on to date, we need to think about the mental health of
communities and in a whole, whole different way.

Speaker 1 [00:08:46] You know, I'm thinking, a couple of thoughts here, certainly about,
the work of Robert Putnam, a sort of bowling alone where he really sort of talks about the
cultivation of social capital. We're we're bowling a lot, but we're not bowling together in, in
leagues. And then you've got Vivek Murthy, who's really talking about social isolation.
That's sort of happening. I'm wondering how you looked at, the impact of Covid as a force
multiplier on all these sort of events that are happening. And then obviously in the
backdrop, huge backdrop is the environmental changes that are going on. But there's this
has been sort of mounting for a while. And has a couple of forces come into play here.

Speaker 2 [00:09:33] Yeah. No. So a little perspective on me and how I got to where
where I am in this conversation. As I'm a psychiatrist, I've mostly done public health and
policy roles. I ran large systems. I was deputy health commissioner for New York City. I've
really seen mental health as an approach it as a community asset. How do we build it that
way, and how do we appreciate just how true that is of mental health being a community
asset? And look at it that way. It's instrumental for all sorts of things. So when we look at
intergenerational poverty, when we look at community violence, we there there are always
mental health issues at the root, either as accelerants of them or as the consequences of
them. And so how do we do mental health in ways that actually address it as that, that
accelerator, that, that, that lubricant of either social change or or worsening progress. And
so that's what I've been about. And I learned, all right. Unlearned most of my community
mental health working in the global South, in sub-Saharan Africa, in the Caribbean,
working with health NGOs, working with development and anti-poverty efforts that that
approach health as this either social strengthener or this, social casualty of these
problems. And I thought, you know, we have to address mental health that way. And the
way they were doing health was skilling up community members to do most of the work.
So it really was collaborative. It was co-creative, but it was also capacity building and
strengthened the ability for schools and, and households and, daycare centers and job
training programs and the faith communities to be equipped to be the front lines of mental
health that they are. And there's now a huge evidence base on what's been called task
sharing that, a lot of the skills that we've reserved for professionals to care for people, but
also a lot of the skills to implement prevention and promotion methods, resilience building
methods can be done by laypeople. And so when I was New York City, when I was the,
deputy health commissioner here, I took all that global self-learning and we put it on the
streets of New York City and showed that this is doable. This is scalable, and it's the way
to connect those dots. We have to we we have to reimagine the real estate of where
mental health happens. And it's everywhere in the community. And we would do that.
Getting back to your question, we should do that anyway. Irrespective of climate change.
It's just a better mental health approach. And I have to tell you, I've been arguing for this
for a decade or so. Covet has been a game changer and people appreciating that, oh,
mental health is about the social fabric and whether we save that and whether we can rely
on that and lean on that. So we need very new approaches to deploy our mental health
tools for social fabric building. Then the way we, you know, organized mental health care.
Now.

Speaker 3 [00:12:22] Of course, everything that you say I hear also through the lens of
primary care as well as behavioral health, it's the same kind of set of issues around the
task, sharing around getting it out, into the community. But we have a unique position,
within health care in terms of being able to perhaps press some of the levers that create
change. And I, I'm going to, quote I think something that you wrote, for the American
Psychiatric Association, about a climate reckoning, which was to say our prevailing
paradigms of knowledge and practice are not adequate. We're more focused inward and
outward through a narrowing circle of interest. The foci revolve around a basic pattern of

waiting for people battered by the world to come to us for brief visits. I'm curious how your
colleagues, respond to that and how how you think about organizing, also training the next
generation to flip that paradigm, knowing that we also have people who have very real
mental illness that also need those individual visits and treatments. How how do you want
the profession itself to evolve, including training the next generation, which I think is on all
of our minds these days.

Speaker 2 [00:13:37] Yeah. I mean, my profession, which I love. I love being a
psychiatrist, but I've seen it increasingly, retreat into a box of, very narrow biological
paradigms and a business model that, really restricts, the, the use and the places and the
range and scope of, of the skills that they could deploy. Very hyper medicalized model that
we box ourselves into. And it's a real shame and it's real sad. It aims way too low for what
our skill sets can do to benefit, society. And so, for example, this kind of test sharing
approach, which we did in New York City, I would, I would do site visits and a lot of these
efforts. There was one effort that seed granted funding between community based
organizations of all sorts who, got funding to identify. What did they think, were the mental
health priorities of the people that they saw, and then they would choose a behavioral
partner to help coach and skill them and support them and back them up. So it really
changed, a lot of things, the hierarchy of knowledge that how partnerships, who set the
problem agenda, etc. and I have to tell you, I would do site visits with these. And I
remember meeting one place, which was for a drop in runaway youth in New York City
that trained peer coaches like 20 somethings to be, basically, more sophisticated,
psychotherapists to youth who were young teenagers, and a psychiatrist who would
supervise the peer coach, the peer counselor. And so I was in a session with them and the
psychiatrist said, you know, if you ever said to me that I would supervise some
nonprofessional person who's going to take care of some at risk youth that I would never
see, I'd say you were crazy. And she paused and, almost holding back tears, said, this is
the most rewarding work I've ever done. My skills reach further, reaches people who
would. I never see that we our system never touches and who would not come to me
otherwise. And this is liberating. And I think as a profession, we have to demand this
approach. And society needs to appreciate what, how, how it is not getting the return on
investment on our profession by boxing us, in these roles. I'm working now with a large
health system in York City to actually who really wants to adopt these shared approaches
as its business model because it's realizing that it is paying at the other end for the lack of
a front end of community action and engagement with people early on. And I do think that
in my experience, it's not about the professional culture, it's not about it's about the it's
about the business model. And you know what? We can change the business model.

Speaker 1 [00:16:22] Well, there's so much, so much to unpack there. Certainly the whole
issue of workforce training and training, a different, in a different technique, these
community health workers could be, very useful in terms of that. Very excited about the
work that you've done. On the streets in, in New York City. But I do want to sort of pull the
thread a little more on public policy that you and your colleagues want to leverage public
policy to deal with climate change. Yet the Yale Climate Opinion Survey says only 46% of
American adults think global warming will really personally harm them. How do you make
change in that backdrop? Or do you necessarily say, I'm not going to follow polls and
follow, you know, the general data that I see and and proceed forward? I'm not running an
election here. I'm trying to really address, the critical issues that people are dealing with.

Speaker 2 [00:17:20] Well, first of all, I'd note that the Yale poll, those results are a mirror
image from five years ago. And and so there has been a real shift in recent years. And I
think it follows data that people are most describing impact on their lives and emotional

effects, depending on their exposure to, to these climate effects. And increasingly, that is
becoming more of the country. I was on a National Academy of Science study committee
looking at the Gulf region, of the, of the United States. And we did site visits and meetings
with community members. And, you know, mental health just is, is is is everywhere. I
mean, we are we're going to see more of this and we're going to see it as a scale and
infecting and affecting communities in ways that the kind of strategies we're talking about
are going to be seen as more essential. And I just think we should stay ahead of the curve
because the curve is not slowing down. It's accelerating.

Speaker 3 [00:18:19] Well, I know the, you know, we always think, systematic review and
health care is one of this, you know, Quinones of getting to the, answers. And, I know
there is a systematic review of climate change in mental health studies with a couple of
interesting reports. One was that people who struggle with their mental health due to
things like droughts or rising temperatures may not get the kind of attention, as those who
survive a major kind of mass event, like a, hurricane, tropical storms, or wildfires, that we
just don't recognize, the toll it's taking out of them. The trauma related conditions, such as
PTSD were absent from most of the studies. And that some aspects of climate change
elicit just sort of mixed or no responses from participants in terms of, I think, recognizing it.
So I guess, my my question to you is, do you think, as a society, particularly around that
first one, paying attention to people who are experiencing the day to day in their
neighborhood in New York City, in rural America, are getting the kind of attention to the
impact of climate change as those who find themselves in the midst of the events that are
on the news 24 hours a day until they've passed.

Speaker 2 [00:19:38] Yeah. I mean, we have data to show that at least people self-report
of degree of emotional, being emotionally affected by climate change is correlated with
their perception of being exposed to it. And it's interesting their perception of being spurs
may or may actually not correlate with, you know, objective measures of exposure like
frequency of storms or storm damage or stuff like that. So there is kind of a subjective
element, perhaps, in people feeling, vulnerable. But it does seem that that perception of at
least of being more exposed to, to these emotional effects. But, you know, I would say is,
you know, you need you see what you, what you, what you look for, and, you know, I don't
know the degree that we have made it, a routine, let's say, for clinicians to ask about
people's worry about this. I think there is a movement within the mental health field for
what's called climate aware therapy that the therapists have to assume, particularly with,
with younger generation patients, that that they're all thinking about it. And and so to start
asking about it.

Speaker 1 [00:20:48] I want to sort of put over here perceptions of exposure and sort of
pivot a little too. We have the Biden administration focusing on positioning climate as an
economic issue, and the administration highlighting the money that will create new jobs in
industry and many communities wondering if that's really compelling. And then the other
sort of point, the communities that we care for, all live in poverty. And, and economics
plays such a role. Race plays such a role in all of this, right? The folks that are highly
impacted are people who live in in very distressed neighborhoods. It's not to say that there
isn't a larger issue affecting everybody, but, race economics plays a role. Do you think the
work that's coming out of the Biden administration is going to impact that, that particular
population, in meaningful ways?

Speaker 2 [00:21:46] Oh, wow. There's a lot of questions there. Yeah. First of all, this
administration has been the first to really, talk about climate justice and just transitions
and, all of that and just the history that most of the climate affected communities and most

damage prone are, are the more disinvested, historically oppressed communities in the
country. So, so that's now whether their policies are the right fit, to to mediating that reality
is complicated. And I think, you know, the, the political aspect of, you know, a green
economy, both wants in some ways, I would say that there are critics in the climate space
who feel like it's it's trying to message that we can have our cake and eat it, too, that we
can we can shift our economy but still have prosperity. And I do think that, avoid certain
trade offs about conception and sustainability and so forth, that that growth, economic
growth for its own sake is part of why we're in this mess. So we need to be careful about
about what we're replacing it with. But more importantly is how do you, if there are jobs?
It's more the transitions in the economy, the movement away from certain jobs to other
jobs, where we have to really be careful that that shift in the economy doesn't yet again
hurt those, you know, with less skills, less education opportunities, less economic, choices,
that they are the ones that benefit the most from those transitions.

Speaker 3 [00:23:25] Doctor Belkin, you've had some, strong words of praise for
community health centers, and their efforts, in this arena, I was happy to see, given that
health centers care for 31 million people in the United States and are located all across the
country. But we'd love to hear. Where do you see some of the most successful, community
based health, center or community based health efforts focused on climate change taking
place? Offer us offers up a couple of examples that have really impressed you.

Speaker 2 [00:23:55] Well, what I think is, is really exciting, in a way, is is the way some of
the climate pressures have really, generated inventive and powerful forms of local
organizing and intersectional action, you know, intersecting action. So commuter
coalitions, working with health coalitions. There's, you know, and irrespective of climate,
you know, that's just better community mental health. And, I, I do think that, community
mental health centers, and, and community health centers, primary care folks are in a real
bind because they're always under invested. They're always under under reimbursed, for
the current model of really just barely hanging on to meeting basic needs, primary care
capacity, and people who need chronic medical care, let alone trying to expand into this,
you know, larger community impact model that, that we're talking about. So when I've
worked with these organizations, it's sort of like, you know, learned helplessness. You
mean. You mean you want us to try to expand, you know, more and ask for more? And,
what I'm finding is, is that, and that this organization, this, health system that I mentioned,
New York City, is that there is a way to a business model that allows for that versatility of
community action. And, and, you know, the core direct care services, and it comes through
really being, imaginative about community coalition, relationships of forming relationships
with community organizations that that aren't there because they, they provide some
transactional, you know, social service that, you know, reduces E.R. visits sort of thing,
which is, which has been a road that the federal government has gone down and seeing of
reimbursement can help catalyze, but is really looking at, community, you know, food
pantries and, and, other social service centers and faith communities as really front lines of
health and mental health prevention and promotion. And that's, that's the the step that is
I'm seeing happening in some communities around the country here in New York City. And
government is now following that lead. And so we've got to, you know, build more of those,
hybrid, community health system partnerships that really see shifting as a democratization
of the work of health and mental health care.

Speaker 1 [00:26:25] They may not have the resources, but we've been telling every
organization that we know that you need to be talking about the environment because
young people want to come into your organization. Whatever you're doing, you may be
doing health care, you may be doing food service. You need to frame this up on the

environmental side, and then resources will follow. But if you don't, if you're not in. Climbed
in that direction. We're going to lose a generation of young people, particularly in health
care. I worry about because we're missing the opportunity of talking about the role and the
importance, that, climate is playing in all of our lives and maybe pivoting from that. Young
people are playing such an important role. Talk about that. Obviously, we know the Greta
Thunberg, but there are tens of thousands of young people who are motivated and act in
and acting out on those, concerns and worries, with also hope and aspiration. What are
you seeing?

Speaker 2 [00:27:23] Yeah. You know, surveys of youth globally, seem to have one
common thread, which is, a sense of betrayal by the older generations of governments.
And. You know how that plays out in people entering the medical profession, I assume
plays out, you know, similarly and in other, you know, another paths that people take, it's
on their minds. But also what I worry about is if we don't do what you what you suggest is,
is make it visible and, and and have those conversations, that we could be facing, you
know, intergenerational rifts that that really do start to affect, society in many ways. And, I
give a chorus, to residents, climate psychiatry and, in the fourth year of training and, and
they tell me that this is the first time this topic has come up. And they, you know, some of
them just shrug it off. Others are really angry about it. And I, you know, similar feedback
around really not paying attention in a serious way, not just topically, but in terms of their
role, their working role around socio social determinants of mental health. We have to
catch up with these realities, and how they're affecting mental health and therefore
professional roles and identity or we're, you know, we're going to have, less of a workforce
to count on.

Speaker 3 [00:28:58] Well, Doctor Belkin, thank you so much for your time, for sharing
your insights and your expertise with us. And thanks to our audience for being here.
Please be sure to subscribe to our videos on YouTube, find us on Facebook and under the
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email updates. And you can also share your thoughts and your comments about this
program. Doctor Belkin, thank you again so much and we hope to continue this
conversation with you in the future.

Speaker 2 [00:29:27] Thank you.

Speaker 3 [00:29:32] This copyrighted program is produced by Conversations on
Healthcare and cannot be reproduced or retransmitted in whole or in part, without the
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