Earlier this summer, the child actor from ‘ALF’, Benji Gregory, age 46, was found dead along with his service dog in a parked car in the Arizona heat. His passing highlights the deadly threat of extreme heat, each year made more intense by climate change. Heat kills more people than all other weather-related events combined.
Growing attention to the problem, given the urgency of the crisis, means that steps are being taken to protect people. There was however an under-recognized detail of Mr. Gregory’s death: his family indicated he lived with bipolar disorder and depression. Over 14 million people in the U.S struggle with a serious mental illness, such as schizophrenia and bipolar disorder, and are much more likely to succumb to extreme heat. But unlike Mr. Gregory, most are dying hidden from view, at home and isolated. Poverty, stigma, and the relative invisibility of mental health disabilities compared to physical disabilities means that this group is particularly marginalized. Heat-related deaths are preventable; we must address the specific barriers people with mental illness face as we adapt to our heating planet.
Hot summer, four CT heat waves so far, many thunderstorms. A sign of things to come.
Many studies looking at deaths during heat events have found that mental illness increases the risk of death. Conversely, heat exacerbates mental illness. A study of the unprecedented 2021 West Coast heat dome found that the odds of death was over three times greater than normal for people with schizophrenia, much greater than conditions such as asthma, heart disease, and diabetes. Researchers are trying to understand why heat and mental illness is such a dangerous combination. One reason is that people with schizophrenia can have cognitive impairment, which may make it difficult for people to recognize symptoms of heat illness or know how to stay safe (and heat can make people confused, making it even more difficult). It is thought that medications used to treat these illnesses affect thermoregulation which increases the risk of heat. People with mental illness already die prematurely due to years of chronic medical conditions, and substance use disorders. As a society we too easily neglect, and spend relatively few research dollars, to address the root causes of their health disparities, making heat all the more dangerous, and their deaths all the more tragic.
To be sure, other populations are vulnerable to extreme heat, and healthcare providers and public health researchers are raising the alarm. This summer the news media has highlighted the risks of hot weather for those with other medical conditions, those experiencing homelessness, and the elderly. However, from our experience working at a community mental health center which treats low-income people with serious mental illness, one of us is a psychiatrist, the other a mental health researcher – we see that many are living in dangerously hot apartments, without adequate support to help them stay safe and healthy.
Simple steps at home can save lives, such as lowering shades, drinking plenty of water, showering, and ideally using air conditioning to cool down; the Climate Psychiatry Alliance has created tools to guide people appropriately. But getting this information to people who need it most and supporting them to take these steps is challenging. While problematic from a climate standpoint, air conditioning is the single most protective factor against heat-related illness or death. However many people with serious mental illness cannot afford to buy a unit or the electricity to run it; people with such conditions are more than twice as likely as others to live in deep poverty.
Cities are developing heat action plans to prepare for extreme heat. If there is a power outage, which is increasingly common due to extreme weather, or power shortages on very hot days, then people are advised to go to a cooling center. An online survey of cities’ plans found that they mainly use passive, technology-based means to communicate information about cooling centers to the public. Many people with serious mental illness lack access to this type of media, struggle with transportation, or do not feel comfortable using cooling centers. While most plans recognize the need for targeted outreach to at-risk groups, researchers found that only minimal practical outreach plans were in place, leaving people who need help the most at risk.
Steps that are already being taken to protect vulnerable populations will also protect people with serious mental illness. Maps are being created to identify vulnerable places and racial disparities to inform equitable adaptations. Ongoing efforts to protect people who are unhoused and build more safe, affordable housing, are critical. The pressure is on for states to implement electricity shut-off protections during the summer, in addition to winter. Currently only 19 states do this. More funding for the LIHEAP program, that helps people to pay their electricity bills, is essential. A project in Connecticut, spearheaded by the state’s Green Bank, is developing building codes for affordable housing facilities, where many elderly people and people with disabilities live. These codes will include plans and infrastructure to protect vulnerable residents during power outages. The authors of this op-ed have been collecting stories from people with serious mental illness to ensure that their experiences inform those new codes. We need more research to know what actually works when it comes to outreach and resilience.
In our view, community mental health systems and other Certified Community Behavioral Health Clinics across the country are well positioned to provide outreach prior to and during extreme heat, and to work with community partners to build resilience. But this requires resources, not just tools, but also time and money. And to make sure that the support provided is appropriate, providers, people living with serious mental illness, and their family members must be at the table when heat action plans are created. By strengthening our mental health systems and community partnerships, including people with relevant lived expertise in developing solutions, increasing safe, affordable housing and creating targeted public health policies with a focus on health equity, we can and must save lives.
Caroline Dumont is a community psychiatrist and Assistant Clinical Professor of Psychiatry at Yale School of Medicine, in the Department of Psychiatry. Annie Harper is a cultural anthropologist and Assistant Professor in the Yale School of Medicine’s Department of Psychiatry.
