We must acknowledge that Australia’s rural and remote communities are facing many challenges that can contribute to inequality in mental health care. These areas face not only limited services, fewer available professionals, and poorer access to primary and acute care, but also greater exposure and vulnerability to environmental adversity (such as severe drought, floods and heatwaves).
Much of the research evidence shows the frequency and prevalence of post-traumatic stress disorder (PTSD), depression and anxiety among adults following flood events; or significant increases in psychological distress, or stress and anxiety, because of drought-related financial hardship or lack of water. The overall picture from the existing research is that climate extremes are negatively associated with mental health. But there are stills gaps on this topic.
Climate extremes are discussed mostly within the health frameworks of emergency and disaster management, especially following separate and distinct disaster events. In fact, extreme climate-related events are complicated and may combine and concurrently affect mental health outcomes. They can co-occur (for example heatwaves and bushfires) or occur close together (for example heatwaves can follow droughts, or storms followed by floods). But our knowledge is still limited about the mental health impacts of combined climate extremes in hazard-prone areas in a given timeframe.
We may think about the possibility that the number and severity of an individual climate extreme does not necessarily lead to problems for mental health, but the sequencing or timing of climate extremes can be enough to cause problems. This is because people may be exposed simultaneously to primary stressors (such as floods or drought) and secondary stressors (indirectly related to initial climate events, for example evacuation, financial hardship, infrastructure interruption).
So, the questions are: how can we provide adequate welfare, psychosocial and mental healthcare responses for an extended timeframe after disasters; or how can we improve the mental resilience of communities in disaster-prone areas? The answer to these questions depends very much on the local situation in terms of climate extreme exposure and available resources, which varies significantly in space and time and is why the research gaps remain.
Perhaps the overwhelming message in this story is that one should not view a disaster as an individual event, but instead as a combination of multiple extremes over time, especially in the context of climate change. Having a better understanding of how a combination of climate events affects mental health is fundamental for mainstreaming mental health care in socioeconomic development and climate resilience strategies in rural and remote areas.
This is also in line with joint recommendations by the World Health Organization to mental health and climate change actors, in a 2022 policy brief, that mental health and psychosocial support (MHPSS) ‘should be integrated more broadly into climate change strategies and plans aiming to strengthen climate resilience and/or to promote the co-benefits of prevention and mitigation actions. Likewise, climate change should also be integrated into mental health strategies and plans, including MHPSS.’