Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ
ISSN 2612-2138
Research Note
Will Including Health at COP28 Mean
Transformation of Global Mental Health Action?
And will Mental Health Professionals transform to
help achieve it?
Paul Illingworth
De Montfort University. Leicester, England, UK
Abstract
Introduction:
For the first time COP28 have included Public Health in their climate change
discussions. Given progress on
climate change has many hurdles, from domestic, economic
and corporate pressures, it is pertinent to explore what impact this inclusion might have and
what specific challenges there might be in relation to global mental health.
Purpose: This positioning paper considers whether the implication of the inclusion of Health at
COP28 might bring about transformation in the way Global Mental Health is addressed. It also
considers how it might transform how mental health professionals, but also all others involved in
working with people with mental health issues, transform mental health. The paper considers
challenges to be faced going forward and potential solutions. The author acknowledges they
are sharing their position on this subject, but in doing so, hopes to generate wider discussion.
Methodology:
As this is a positioning paper, data has been derived from the argument and
counter argument within the paper. Therefore, there is a possibility of the risk of bias.
Results: Plans to improve mental health globally have focused on replicating a Western, Global
North model. Despite over 10 years of the WHO Mental Health Action Plan, there continues to
be a growing mental health pandemic, worsened by Covid-19. Mental ill- health is caused by
multiple factors, many ar
e national, regional and even localized. The Western Global North
model does not factor this in sufficiently to bring about improvement.
Conclusion: This paper evaluated whether by including ‘Health’ at the recent COP28, it would
help transform Global Mental Health. What became clear, after reviewing previous policies and
action plans, was that significant change and improvement had not occurred. Policy makers
and professionals approach needs to focus on preventing mental ill-health rather than treating
after the event. Additionally, decolonisation of policies and professionals education is required
to co-create sustainable resilience with people/communities and reduce mental ill-health.
Keywords
Mental Health, Climate Change, Global Health, Mental Health Prevention, Decolonize
Address for correspondence:
Paul Illingworth, Leicester School of Allied Health Sciences, Faculty of Health & Life
Sciences. De Montfort University. Leicester. England, UK
E-mail: paul.illingworth@dmu.ac.uk
This work is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International
License (CC BY-NC 4.0).
©Copyright: Illingworth, 2024
Publisher: Sciendo (De Gruyter)
DOI: https://doi.org/10.56508/mhgcj.v7i1.187
Submitted for publication: 01
March 2024
Revised: 01 May 2024
Accepted for publication: 08
May 2024
5
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Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ
ISSN 2612-2138
Introduction
I
n December 2023, what has been suggested
as a ‘momentous declaration’, at the 28th
conference of parties of the United Nations
Framework Convention in Dubai, perhaps better
known as COP28, occurred. Momentous
because public health was included in climate
change discussions, astonishingly, for the first
time. The declaration, was signed by over 120
countries, and emphasized links between climate
change and the effect on health.
Additionally, a large funding support, around
US $1 billion, was discussed for ‘mitigation and
implementation’ of programs intended for
environmental determinants of health,
emphasizing the transformation of health
systems, and ultimately protecting those at risk.
The aims of these are to prepare healthcare
systems, to be able to manage climate change
impact on health and acknowledged
government’s role in protecting the health of its
people.
While the above is welcome and
encouraging, it is important to reflect. The Paris
Agreement, signed in 2015 at COP21, had
nations promise to decrease their carbon
footprint, with the aim to limit global temperature
rise to 1.5C against pre-industrial levels. However,
the UN reported, that in 2023 alone, this was
broken on 86 days.
Extreme weather events are increasing in
frequency and the 2023 Lancet’s Countdown
Health and Climate Change report (Romanello et
al 2023), stated fatal infectious diseases are
increasing, resulting from climate change. They
did not emphasize mental ill-health was also
increasing. Questions remain unanswered,
namely:
Will including health result in reducing
mental ill-health, given limits on global
temperature rises has not?
Are mental health workers prepared for
this?
There is mounting evidence climate change
has a direct impact on human health. In
particular, climate change impacts on mental
health globally. Climate and global mental
health, are probably two of the most substantial
and demanding global challenges currently
faced.
By including health in the action agenda for
climate change, there is now an increased focus
to inform and educate globally, everyone about
the means of reducing the risks that climate
change poses to human health. But those
working in the area of mental health must
champion it and ensure that mental health is
central to this. The WHO Comprehensive Mental
Health Action Plan (WHO 2021) was first published
in 2013. We need to question whether global
mental health has significantly improved since
the first version? If not why? Is the model used the
right one, for what is a multifactorial issue?
Due to the multifaceted nature of mental ill-
health, it is essential that the full range of people,
professions, groups etc. are included in any
preparation and future development which aims
to protect the mental health of people. However,
for the purpose of this paper, the focus will mainly
be of mental health professionals. What role
mental health professionals play in this should be
debated and resultant actions implemented.
Mental health professionals are, for the most part
educated to treat/care for people once they
have become mentally ill. Whereas Public
(Mental) Health is about promoting and
protecting mental health as well as emotional
well-being. It does this by working with society,
across all populations to co-ordinate actions.
The multifaceted nature of mental health can
be evidenced by the following example. It has
been predicted that climate change will lead to
job losses for example, and a decrease in
agricultural productivity is already happening. As
a consequence, fewer people will be needed, or
available, to harvest crops, a role many families
globally rely on for income. Without income it will
lead to people not having sufficient food to eat,
money to pay for necessities and ultimately,
families can become homeless and this will in
turn lead to greater poverty, neglect and possibly
abuse.
As more people become exposed to
prolonged heat, drought, fires, rising ocean
levels, etc., it will inevitably result in more mental
ill-health. Climate change already results in a
wide range of symptoms which has led, in recent
years, to a growth in interest around areas which
have been labelled, eco-anxiety, eco-distress,
climate-anxiety, and solastalgia. The latter being
a label that put simply means - depression or
distress resulting from environmental change.
Research into the associated effect of climate
change on mental health has begun in these
areas for constructive responses on how to care
and support people with these conditions. We
should be questioning whether that is the only
approach!
The WHO (2022) reported “…1 in every 8
people, or 970 million people…” worldwide lived
with a mental illness. They added, that due to the
COVIC-19 pandemic, estimates of 26-28%
increases in anxiety and depressive disorders had
occurred. Conceivably, more worryingly, they
recognized, “…effective prevention and
treatment options exist,” but most people “…do
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ISSN 2612-2138
not have access to effective care”, and that
“many people also experience stigma,
discrimination and violations of human rights”.
Patel et al (2018) foretold these would increase;
adding, comparatively little money was paid
globally on mental health and requested a
growth in spend to help reduce this escalating
burden of ill health. But is the money spent in a
way that truly benefits communities in need of it,
in a way they need it?
There is already rising unmet mental health
needs globally. There has always been an unmet
need for mental health care. That unmet need is
growing. It has been known for some time that
around 75% of mental illnesses start before the
age of 24 (Kessler et al 2005). Yet child and
adolescent mental health care has been, and
continues to be, poorly resourced. Given the
growing number of children and young people
reporting mental health problems, especially
since the Covid-19 pandemic, it must raise
further alarm. We are unable to meet the mental
health needs now, what will happen in 5, 10, 15
or 20 years from now?
Reductions in global emissions and global
mental ill-health will be reliant, not just on a global
commitment to manage carbon footprints. Every
effort must be made to prevent the negative
impact of the climate on people’s mental health,
rather than waiting until they are suffering and
then offering interventions/care. We should all
hold centrally the adage ‘prevention is better
than cure’.
Global Climate Mental Health
C
urrent education, for most mental health
professionals is predominantly illness/ill-health
focused. It is also chiefly based on the individual.
The WHO stated that everyone should ‘have
access to the full range of quality health services
they need, when and where they need them,
without financial hardship’ (WHO 2023), this
appears to imply that an illness model is the
‘quality health service’. Yet globally, this, what the
WHO might define as a quality health service is
not always available. Should there be one single
model, the western health service model that is
championed, available globally? Or are
alternative approaches as good as, or perhaps
more relevant? There is growing evidence that
alternative approaches can work. Two examples
are; (Fernando et al 2021) Friendship Bench; and
(Raghaven et al 2021) Community Theatre.
It is vital mental health professionals
remember people with mental health
problems/illnesses are not a homogenous group.
And that, varied disciplines, not just those in the
health and social care arena, but environmental
groups, communities and communities etc.,
need to be actively engaged in the solutions.
Note the emphasis on plural.
Health workers need to remember, many
communities and even some governments,
stigmatize mental illness. Many communities do
not have terms to describe their mental state,
that would be understood in other parts of the
world, mainly western societies. There are still a
number of countries where suicide is illegal!
Perhaps, also, as Kleinman (1977) noted, over 40
years ago, some cultures have a tendency
towards physical symptoms, as portrayed in
Chinese traditional literature, physical metaphors
are often seen as the norm, consequently
physical, being perceived more appropriately
than psychological symptoms. Additionally,
research by Parker et al (2001) compared
Australian and Malaysian Chinese, concluding
the latter tended to site physical, not
psychological complaints.
Other societies somatise mental illness also,
but that might be for different reasons. Illingworth
(2021 p3) described their own experience, when
nursing a male in the UK, who was originally born
in South Asia, and used the term, ‘my heart is
falling’. It wasn’t until the man’s daughter visited
and explained, that from where they were from,
there was no word for depression and he meant
he was depressed. But this could also be a way
of the community/society, he had originated
from, minimising or avoiding stigma. People may
feel more comfortable saying they have a heart
problem than a mental illness.
Is waiting until people are suffering mental ill-
health before helping, what should be done?
Climate Changes impact on mental health is
multifactorial, affecting the social and
environmental determinants of mental health.
Preventing people from suffering (some) mental
health problems is not and should not be just to
role of mental health professional. The World
Health Organisations (WHO) Mental Health Action
Plan stated, “Mental health preparedness and
response for the Covid-19 pandemic,” (WHO,
2021) recommended “… a whole-of-society
approach to promote, protect and care for
mental health”. Mental health professionals need
to be familiar with the wider issues and work with
agencies/organisations who would not be directly
seen as key to helping to ensure peoples mental
wellbeing.
Anyone, anywhere globally, from
whatever culture or gender-, high-, middle- or
low-income countries, in urban or rural areas, are
at risk of developing mental ill-health. However,
they are clearly not a homogenous group.
Consequently, utilising one model, will not work.
Years of perpetuating the western model has not
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ISSN 2612-2138
shown significant improvement in global mental
health. So why do the WHO/UN and Governments
keep pledging money to continue the same? As
Mascayano et al (2015) reported, over 80% of
people in Low- and Middle-Income Countries
(LMICs), needing mental health care, do not get
the effective treatment they need. This is, in part,
due to insufficient qualified mental health
professionals’ and social inequalities, but also the
stigma accompanying mental illness.
Meskell (2005 p82) although discussing
archaeological impact on communities,
suggested, that whether in a High-Middle Impact
Country (HMIC) or LMIC, localised communities,
“… are not passive constituencies there for our
intellectual mining, nor are they there awaiting
our theoretical insights into their situations or
histories. They are directly enmeshed in their own
critical reformulations, political negotiations, and
constitutions of theory and interpretation”.
Conclusion
This
paper evaluated whether, by including
‘Health’ at the recent COP28, it would help
transform Global Mental Health. What became
clear, after reviewing previous International,
National, Regional and Local policies, and action
plans, was that significant change and
improvement had not occurred globally over
several years. The West, including; the UN, WHO,
Governments and Professional bodies,
perpetuate the same or similar policies/plans
founded on Western models. No attempts
appear to have been made to decolonize the
plans or professionals’ education, to help LMICs.
By just including ‘Health’ at COP28 it is unlikely any
real and meaningful transformation will result.
Instead of establishing action policies and
plans based on Western models, there must be a
focus on discourse and co-creation with grassroot
organisations, local communities, non-
governmental organizations (NGOs) and
institutions. Environmentalists, architects,
community groups, charities, indigenous groups,
amongst others, must all play a significant and
positive role in helping to co-create individual,
families, communities and societies resilience to
the impact of climate change and other major
events/disasters on everyone’s mental health.
This paper contributes to the wider discussion
on decolonising health care and improving
global mental health. There is very little research
undertaken by health professionals into grass root
thinking of how, their education can better
prepare them for preventing individuals,
communities and societies from being negatively
impacted by disasters.
R
ecommendations:
Change how Policy makers
and
professionals’ approach mental ill-health resulting
from disasters from treating after the event to
resilience building.
Prepare practitioners differently for
working on the front line of Global public/mental
health.
Decolonise approaches to Global Mental
Health.
Transform how people adapt to climat
e
change, in a sustainable way and reduce mental
ill-health.
Undertake research to develop the ideas
proposed in this article.
Conflict of interest
The author declares that he has not conflicts
of interest.
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