You shouldn’t have to cope alone

A heat wave brings familiar collective grumbling. We make jokes about ice baths, grouse about sleepless nights, and trade tips about creative ways to cool down.

The silent struggles we face, however, tell a more complicated story about how humans fare when subjected to extremely hot temperatures. A new study published in JAMA Psychiatry illuminates how such heat is associated with a noticeable uptick in emergency department visits for mental health treatment. Previous studies on the subject have yielded similar results: There’s something about heat waves that lead to worse mental health, whether that’s judged by self-reported measures or, in this study, an analysis of medical claims for urgent hospital visits.

The findings bolster the case that extreme heat related to climate change takes a toll not just on the body, but also the spirit and mind. While this might be of particular concern for vulnerable populations with limited access to cool shelter, like farm workers or the unhoused, the association holds true for people who have access to private insurance and Medicare, according to the JAMA Psychiatry study. Using data collected over a 10-year period from more than 2 million patients, the researchers found that days with extreme heat were associated with increased emergency department visits for mental health conditions like substance misuse, anxiety, schizophrenia, and self-harm. That span of time represents several of the warmest years on record in the United States.

Humans want to be resilient in the face of adversity, so they crack jokes about heat exhaustion or jerry-rig a swamp cooler in their bedroom. They might wave away mounting anxiety as overreaction or pour another glass of wine to dull the edge of making it through another triple-digit day without air conditioning. But this study and the others that preceded it should be a wakeup call to anyone who thinks extreme heat is bearable with the right attitude. Coping skills are always valuable, but what we ultimately need are more adaptive and resilient systems that help shield everyone from the physical, emotional, and psychological toll of extreme heat.

While the study’s authors couldn’t conclude how extreme temperatures worsen mental health, they suggest sensible explanations: disrupted sleep, daytime discomfort or irritation, and an “increase in hopelessness, maladaptive anxiety, and stress attributable to the anticipation of climate change and associated extreme events.” Anyone who’s waited for their home to cool off without the assistance of air conditioning during an extended heat wave knows the desperation can lead to anxious questioning about the future: How will my children survive a warming planet? Should I even have children if this is the world they’ll inherit?

The researchers also speculate that an emergency department could be a refuge on a scorching summer day; the price of admission is to see a doctor about a mental health condition that needs treatment anyway. If patients are indeed using the ER to escape the heat, it represents the crux of this momentous problem. Turning to the ER is a resourceful, if expensive, strategy, but we need preventive, equitable solutions that focus on our collective health. This could include more cooling centers and transportation to reach them, as well as initiatives to reduce the absorption of heat by manmade materials like cement, asphalt, and brick in urban areas through measures like increased tree canopies and green roofs, so that people can remain comfortable in heightened temperatures.

In a co-authored editorial that accompanies the JAMA Psychiatry study, data scientist Dr. Nick Obradovich, who was not involved in the study, argues that it’s vital to understand how extreme heat affects mental health so that public policies can precisely target ways to help people. If the main factor is sleep, then scientists and legislators could evaluate how best to improve the quality of a good night’s rest on a hot day. In the future, that could potentially lead to the widespread adoption of architectural practices like passive cooling or building codes that encourage energy efficiency, which reflect the importance of cool nighttime temperatures. We won’t know these answers, though, until we study the questions.

Obradovich also suggests that by looking exclusively at mental health diagnoses available in medical records, we may miss emotional and psychological turmoil that hasn’t— or won’t — rise to the clinical level. Imagine, for example, the stressed single parent trying to stay patient with a screaming toddler in an overheated house during a summer of heat waves. Or a lonesome senior who feels trapped and scared in the midst of record-high temperatures. Even if these experiences don’t lead to an official diagnosis, they influence people’s well-being. Writ large, temperature spikes can send a shockwave of angst through households.

“When you sum total the effect of a million people being a bit more grumpy than they otherwise would on any given day, that’s something worth paying attention to as well,” Obradovich, senior research scientist and principal investigator at the Max Planck Institute for Human Development, told Mashable.

People with resources may seek therapy to help process these feelings, or turn to other practices like mindfulness and meditation. They may resort to what Obradovich calls private adaptations: installing air conditioning, moving to a region less affected by extreme heat, or simply skipping town when a heat dome arrives. Obradovich says there’s no sense in feeling shame, or shaming others, for making these choices. It’s vital that people stay cool, but we must also pursue adaptations that benefit everyone while minimizing carbon emissions and ultimately moving away from energy systems that rely on carbon-emitting fossil fuels.

This is an individual responsibility as much as people can influence politics and the marketplace through their pocketbook, activism, and ballot. Beyond that, this problem is one that elected officials whose duty it is to protect and serve people must solve. They should continue to prevent heat-related deaths while also acknowledging, and providing resources for, the mental health toll of extreme temperatures. Whether that’s through free or subsidized therapy sessions with climate-aware psychologists, or funding for community-led mental health interventions like support groups, or sponsoring fresh ideas that spring from the inventiveness of their constituents, it’s time to imagine alternatives to pretending we’re all going to be fine. The problem is at our doorsteps now, and will only start knocking louder.