As the mercury continues to rise across cities and states, many of us can feel the effects of extreme heat in the country. News headlines are also abuzz with statistics on how hot it is. The India Meteorological Department, for instance, said that the country's average maximum temperature recorded in March 2022 is the highest ever in the last 122 years for the period between 1901 and 2022.
The effects of heatwaves—when the maximum temperature of a station reaches 40 °C in the plains and 30 °C for hilly regions, or when it is at least 4.5 degrees Celsius above the normal—can now be felt across states. Apart from the impact of such high temperatures on physical health like exhaustion, heatstroke, lethargy, and dehydration, different studies have now recognised the effects of heat waves and extreme heat on mental health.
The sixth assessment report of the Intergovernmental Panel on the Climate Change 2022: Impacts, Adaptation and Vulnerability suggested that extreme heat has negative impacts on mental health, wellbeing, life satisfaction, happiness, cognitive performance, and aggression. In its chapter titled Health, Wellbeing, and the Changing Structure of Communities, it said, "Children and adolescents, particularly girls, as well as people with existing mental, physical, and medical challenges and elderly people, are particularly at risk." The Lancet, in its 2021 report, on climate change, had also indicated the impact of extreme heat on mental health across the world. "Increases in heat extremes that are related to climate change pose diverse risks to mental health globally, ranging from altered affective states to increased mental health-related hospital admissions and suicidality," it said.
Mimansa Singh Tanwar, a clinical psychologist at the Department of Mental Health and Behavioural Sciences, Fortis Healthcare, points out that our environment and ecosystem are vital for our mental health. According to her, the recurrent unpredictability of environmental change has a significant impact on our day-to-day life. Some of these impacts are related to feelings of irritability, anger, and social isolation, which can even lead to anxiety and mood disorders."[When] you are getting exposed to something again and again, which is not conducive, it is going to have an impact on your mental health, and it is going to make you more predisposed to having a mental illness," remarks Tanwar.
Tanwar explains that experiencing physical exhaustion and feeling restless on a physiological level due to the extreme heat can also add to the anxiety. Similarly, not being able to connect with the outdoors and your social circle because of heat can lead to feelings of sadness and exacerbates mood disorders. She adds that these effects of extreme heat can be multifaceted and often have a lot to do with socio-economic factors. For example, Mumbai-based psychiatrist and psychotherapist Dr Ruksheda Syeda says extreme heat directly impacts depression and anxiety. "What has been noticed also is that there is an increase in suicide rates—not just suicidal attempts—but death by suicides," she notes.
According to a 2021 review of epidemiological studies on heat exposure and mental health outcomes, there is a 2.2 per cent increase in mental health-related mortality with a rise in temperature of just one-degree celsius. Moreover, India also witnesses many farmer suicides due to indebtedness and crop failures due to scorching heat, poor rainfall, and other extreme weather events. So, there will be socio-economic stressors due to heatwaves on marginalised communities as measures like gender stress, poverty and economics, access to care, and quality of living affect mental health. "Whenever we're looking at marginal communities, and generally, minority communities, [they] are always the ones who are more affected," says Dr Ruksheda. She takes the examples of people living in ghettoes and other cramped living situations in urban areas, which may witness more violence and crime due to increased stressors because of heat.
There is also a barrier from the patient side to addressing these concerns. She explains that there is a mistrust of the system and professionals among gender and religious minorities who fear discrimination while accessing healthcare, especially mental healthcare. "With increasing climate change impacts, we're going to see increasing health impacts and mental health impacts, which is then going to become a vicious cycle. Whenever I have a mental health issue, then my quality of life and my ability to take care of myself also reduce a little bit. So, that makes it much more challenging for me to get better and improve my overall life," adds Dr Ruksheda.
So, what can be done to address these gaps and lack of awareness of the impact of adverse weather conditions like heat waves on mental health? At a policy level, Dr Ruksheda advocates for systematic changes like better city planning, equitable distribution of healthcare, and better work conditions, both in terms of workspaces and working hours.
Along with policy-level changes and planning, some changes on an individual and community level are also required. Tanwar calls for a perception change where there should be an understanding that nature is a resource that we need and that we need to value. "So, psychologically, when you are looking at it as just me and my environment, you are just becoming another consumer. But we are not recognising the fact that all of us are actually contributing to it," she said. For individuals, she says that the environment is a part of ensuring positive mental health as a skill, work-life balance, and connection with nature. From a public health policy perspective, Tanwar points out the importance of insurance-- without financial assistance, it isn't easy to access mental healthcare and treatment.
Dr Rukshida advises that people take some practical measures like becoming aware of heatwave-related symptoms, recognising how to take care of the elderly and children during extreme heat, and getting in touch with local physicians and public health centres for preventative measures. She urges people to understand that climate change has a biological underpinning, and it will change our bodies. "If we know and recognise these definite biological changes, I think, individually, we will also be more responsible towards climate change and towards helping ourselves."