Climate Adaptation Must be Led by People with Psychosocial and Mental-Health Related Disabilities

Ellen Spannagel (she/her) is a 2021 Social Connectedness Fellow working with Human Rights Watch. She is a second year BCL/JD student at McGill’s Faculty of Law and holds a Bachelor of Journalism and Humanities from Carleton University. She is passionate about climate justice that is disability-inclusive and centers gender, sexual, and romantic minorities and how this interacts with legal frameworks. She is also passionate about storytelling and the ways in which knowledge is built, translated, and shared across regions and communities. Ellen grew up in Calgary, Alberta, and enjoys spending her free time outdoors.

A third of heat-deaths are tied to climate change. 

Between 1991-2018, 37% of warm-season heat-related deaths across 43 countries could be attributed to climate change, and “increased mortality is evident across every continent.”

Over 719 deaths have been reported from last week’s heat wave in British Columbia.

In cities, residents who live in areas with a higher urban heat island effect, or a phenomenon where urban areas are hotter than rural surroundings, are disproportionately harmed.

But the fact that climate change has specific and disproportionate impacts on people with psychosocial and mental-health related disabilities is often absent from climate change discourse.

As a May 2021 study found, “people with pre-existing mental illness, particularly psychosis, dementia and substance abuse, have a two to three times higher risk of death during heat waves than people without.” This is explained, in part, by the impact of medication relevant to certain psychosocial and mental-health related disabilities on the body’s ability to thermoregulate. 

In Canada, over 2-million people aged 15 and over have a mental-health related disability, which is defined as experiencing limitations with “daily activities because of difficulties with an emotional, psychological or mental health condition (e.g., anxiety, depression, bipolar disorder, substance abuse, anorexia, schizotypal disorders, etc.).”

During the Montreal heat waves of 2018, 72% of the 66 people who died lived with chronic diseases, and 18% had alcohol or drug addiction. Strikingly, 25 percent of the people who died had schizophrenia. 

These deaths are troubling given that the increased impact of heat waves on mental health and people with psychosocial disabilities is not news in Canada.  

A 2012 study in Quebec highlighted that increases in temperature and humidity were associated with an increased use of emergency departments for mental and psychological problems, particularly in cities.

Similarly, a 2014 study in Toronto found a 149% increase in daily ER visits over a period of 7 days after initial exposure to high temperature for people with schizophrenia and schizotypal and delusional disorders. 

The existence of this data was not enough to save those who died during the 2018 heat wave in Montreal, and has informed few changes to the city’s action plan.

The city’s 2019 Intervention Plan acknowledged the specific impacts of heat waves on mental health and on people with specific psychosocial disabilities. But the strategies were limited to the inclusion of infographics targeted at these populations, or encouraging the general population to identify people who are “suffering from physical or mental issues” and help accompany them towards an air-conditioned environment.  

Further, the Intervention Plan is only available in French. This is ironic given that  Montreal’s Climate Adaptation Plan highlights that “certain immigrants may be more vulnerable to heat waves because of their inability to speak and understand French and English” and may not be “reached by the heat wave advisories and recommended response measures.”

But where Montreal’s approach is most critically lacking is in its failure to tackle the broader relationship between social connectedness and people with psychosocial disabilities and mental-health related disabilities. 

Studies have shown that public messaging and education directed at those most at-risk may not be effective as a result of social isolation and the lack of strong social networks, but also socioeconomic factors. For example, people who rarely leave their place of residence, or don’t have access to a cell phone. 

Canadians with mental health-related disabilities are more likely to live alone, to rent their homes and to live in subsidized housing than those without disabilities. It is estimated that 45% of all unhoused people in Canada are disabled or diagnosed with a mental-health related disability.

These situations of isolation and a lack of support can’t be discussed without examining the violent role of ableism: people with mental health-related disabilities in Canada “experience more repeat violence, more violence at the hands of someone they know, and live with more known risk factors for violent victimization than the general population.”

Directives asking neighbours to check-in on one another have also been shown to be lacking.

A Montreal study found that “from 21 reported heat-related community deaths of people with mental illnesses, of which many lived alone, 14 were contacted 24 h prior to their death by health care professionals, family members, neighbors and friends.”

A better approach would be to prioritize incorporating community mental health support in the response to extreme weather events, such as heat waves, and invest in the “development of appropriate individual and community support, tailored to the range of psychological needs.” 

While this is essential in the context of heat waves, this is also critical in context of the rise of climate anxiety. 

We need a robust approach to heat wave adaptation that centres people with psychosocial disabilities, and an approach  prioritizing mental health in all areas. This extends to providing housing and paid sick leave for people with psychosocial or mental-health related disabilities, and their caregivers and service providers, among other measures.

Take a look at your own city or borough’s heat wave strategy! In climate adaptation plans, people with disabilities are often included in the preamble, or as part of a list of vulnerable people, without specific and targeted measures. Be critical about how your local strategies are meeting the needs of people with disabilities and involving them in the process. 

It is our responsibility to advocate for a climate-resilient society, to deepen our understanding of what it truly means to belong in a community, and to disrupt ableism at its roots.

For more information on the intersection of disability and climate change in Canada, check-out the work of the Disability-Inclusive Climate Action Research Program and for a global overview, watch  CBM Global Disability Inclusion’s video on disability inclusive climate justice.