Knowledge Check 2: Equity and Interventions
Apply your knowledge of climate justice and clinical interventions:
Question 1: An undocumented farmworker presents with anxiety and depression following crop failures from drought. Which factors create intersecting vulnerabilities for this patient’s mental health? (Select all that apply)
- a) Economic stress from crop loss
b) Fear of seeking help due to immigration status
c) Language barriers
d) All of the above
Click to reveal answer and explanation
Answer: d) All of the above
Explanation: This patient exemplifies intersecting vulnerabilities. As a farmworker, they face occupational stress from climate-related crop failures and economic instability. Their undocumented status creates fear of seeking help and potential ineligibility for disaster assistance. Language barriers may limit access to mental health services and information. Understanding these compounding factors is essential for providing trauma-informed, equity-centered care. Your approach should address immigration-related fears, provide language-appropriate services, and connect to community resources.
Question 2: A 19-year-old college student tells you: “I’m so anxious about climate change that I can barely focus on studying. What’s the point of getting a degree if the world is ending?” What is your BEST initial response?
- a) Climate change is serious, but the world isn’t ending. You need to focus on your studies.
b) Your concern about climate change is completely rational. Let’s talk about whether this anxiety is helping you take action or paralyzing you.
c) You should see a psychiatrist immediately for treatment of your anxiety disorder.
d) Try not to think about climate change so much—it’s affecting your mental health.
Click to reveal answer and explanation
Answer: b) “Your concern about climate change is completely rational. Let’s talk about whether this anxiety is helping you take action or paralyzing you.”
Explanation: This response demonstrates the key therapeutic principles for eco-anxiety: (1) Validation—acknowledging that climate concern is rational and adaptive; (2) Assessment—determining whether the distress is proportional and functional vs. impairing. After validation and assessment, you can explore connecting the patient to climate action and collective efforts. Option A dismisses valid concerns, Option C over-pathologizes a potentially adaptive response, and Option D suggests avoidance rather than healthy engagement.
Question 3: According to research on disaster mental health recovery, which factor is among the STRONGEST predictors of positive mental health outcomes?
- a) Individual wealth and insurance coverage
b) Social capital and community support networks
c) Access to psychiatric medications
d) Distance from the disaster epicenter
Click to reveal answer and explanation
Answer: b) Social capital and community support networks
Explanation: Research consistently demonstrates that social capital and social support are among the strongest predictors of mental health recovery following disasters. Communities with strong social networks, trusted institutions, and collective efficacy experience better mental health outcomes. This is why community resilience interventions—support groups, peer support programs, and social prescribing—are so important. While the other factors can contribute to outcomes, social connection is uniquely powerful for psychological recovery.
⏸️ Pause and Reflect: What is one concrete action you can take—in your clinical practice, your advocacy, or your personal life—to address climate mental health?
Final Integration Exercise
Comprehensive Case: Dr. Chen’s Day
You are Dr. Chen, a family medicine physician in a coastal community. It’s been 4 months since a major hurricane. Today you see:
Patient 1: Marcus, age 12
Mother brings him for “acting out” at school. He’s having nightmares about the hurricane, refuses to sleep alone, and becomes agitated when it rains. The family is still in temporary housing.
Patient 2: Mrs. Johnson, age 68
She feels “lost” since the hurricane destroyed her home of 40 years. She’s living with her daughter but feels like a burden. She’s stopped attending church and her card club. “I just don’t feel like myself anymore,” she says. “That house was my whole life.”
Patient 3: Ahmed, age 22
College student with severe anxiety about climate change that interferes with studying. He’s considering dropping out because “there’s no point in a future career when everything is collapsing.”
Reflection Questions
- What are your primary diagnostic considerations for each patient?
- What screening tools would you use?
- What individual interventions would you recommend?
- How would you address social and practical needs?
- What community resources might be helpful?
- How do equity considerations apply to each case?
Suggested Approaches
Marcus:
- Screening: Use age-appropriate PTSD screening (CPSS-5 – Child PTSD Symptom Scale)^75^
- Diagnosis: Likely PTSD with trauma reminders triggered by rain/weather
- Individual interventions:
- Refer for trauma-focused CBT adapted for children^52^
- Involve parents in treatment—assess their mental health too
- Provide psychoeducation about normal disaster reactions in children
- Social/practical needs: Address housing instability as a major social determinant—temporary housing perpetuates trauma
- Community resources: School-based counseling, pediatric disaster mental health services
- Equity considerations: Families in temporary housing face compounded vulnerabilities; ensure Marcus has equal access to school-based mental health services
Mrs. Johnson:
- Screening: PHQ-9 for depression,^76^ assess for suicidal ideation
- Diagnosis: Major depression with features of solastalgia (grief over lost home/identity) and loss of social supports
- Individual interventions:
- Consider SSRI and/or therapy^48,49^
- Validate her grief: “That house wasn’t just walls—it held 40 years of your memories and identity”
- Social prescribing: Actively work to reconnect her to church and card club
- Social/practical needs: Living situation creating strain; explore housing options that provide autonomy
- Community resources: Senior centers, faith community, disaster recovery support groups
- Equity considerations: Older adults may face barriers to accessing services; may need home visits or transportation assistance
Ahmed:
- Screening: GAD-7^77^ and PHQ-9^76^ to assess for anxiety/depression disorders
- Diagnosis: Generalized Anxiety Disorder with climate change as primary focus
- Individual interventions:
- Validate: “Your concern about climate change is completely rational—it shows you understand what’s happening”^14^
- Assess function: Is the distress impairing his ability to live according to his values?
- Explore action: “What climate actions are you taking? Being involved often helps people feel less helpless”^16^
- Consider CBT or ACT (Acceptance and Commitment Therapy) approaches^50^
- Connect to campus climate action groups—collective action reduces anxiety
- Social/practical needs: If anxiety severely impairs academics, provide disability documentation
- Community resources: Campus mental health services, environmental/sustainability clubs, climate advocacy organizations
- Equity considerations: Young people bear disproportionate burden of climate futures they didn’t create; validate intergenerational injustice while fostering agency^53^