AUGUST/SEPTEMBER 2022

inside: NEWS FEATURES RESOURCES VOL 42 #4

Mental Health

• Making mental
health
nursing
Sustainable
• COPING With
ECO-ANXIETY
• THE WORK OF
CLIMATE CARES
• The NURSES
SUSTAINABILITY CLIMATE
CHALLENGE
and mental Health • STUDENT
Special Issue PART 2 PERSPECTIVE

News: Air pollution FOUND TO increase the risk of dementia


INTRODUCTION
WE NEED SUSTAINABILITY,
NOT CLIMATE FATALISM
Stephen McKenna-Lawson, lecturer in mental health nursing,
Swansea University
T
he politics of climate change has
historically involved a binary
choice: to believe or to deny.
In contemporary times, as both the
debate and the planet broil, it seems
the affirmative choice has developed
an overtly, at times overwhelming,
psychological dimension – and not a
positive one. To believe is now to be
frightened. The affirmative has, in a
Nietzschean vocabulary, almost become a
form of life-denial. There is evidence for
this everywhere.
In June of this year, The New York
Times opinion section accepted letters
under the heading ‘Is it Ethical to Have
Children in a Climate Crisis?’ There is
growing acknowledgement that the
angst related to perceptions of ecological
emergency may be discreet and deserving
of its own label – climate or eco anxiety
– defined broadly as “heightened
emotional, mental or somatic distress
in response to dangerous changes in
the climate system”. The burden of this
falls more on the younger generation,
who are already seeking record levels of
psychological help.
This is no surprise when you consider
the language used. ‘Climate change’ has
become ‘climate catastrophe’. I have
already used words such as ‘emergency’
and ‘dangerous’. However, from the
point of view of professionals concerned
primarily with improving how people feel
and manage in life, we must ask whether
this sort of discourse – one oriented
towards the negative – is pragmatically
useful when it comes to achieving
significant structural change.
That is not to say we should be apathetic
towards the world, and only entertain
adaptations to it, no matter how horrible
it seems. This would proffer ignorance,
moral bankruptcy and betray the critical
consciousness baked into the history of
2 MENTAL HEALTH NURSING August/September 2022
mental health nursing. But politically
speaking, a discourse of despair that
produces guilt and demotivation must
be questioned if the goal is change
and rescue, not dread and inertia. Put
differently, nurses would not use guilt or
shame as a therapeutic tool when working
with individuals, so why would we indulge
such narratives on a macro scale?
There is term, a model, that already
exists within healthcare that can guide
us here: salutogenesis. This describes
a paradigm of healthcare focused on
health and wellbeing, rather than disease
(pathogenesis). If we reflect on the
climate discourse, loud voices and images
often promote the latter. To paraphrase
Agent Smith in The Matrix: “The planet
is sick, humans are the disease.” While
holding certain truths around carbon
emissions to be self-evident, untempered
fatalism quickly becomes self-defeating.
Conversely, there is arguably great
value of the language of sustainability as
a salutogenic dimension of the climate
discussion. As a model of thought and call
to action, it promotes agency and hope.
These are well-established themes of
good nursing, central premises to any
philosophy of care, and as such reveals
nursing to be well placed to adopt if not
lead green initiatives in the 21st century. n
AUGUST/SEPTEMBER 2022
inside: NEWS FEATURES RESOURCES VOL 42 #4
Mental Health
hands# stop the war from Pixabay
Anja-#pray for ukraine# #helping
• Making mental
health
nursing
Sustainable
• COPING With
ECO-ANXIETY
• THE WORK OF
CLIMATE CARES
• The NURSES
SUSTAINABILITY CLIMATE
CHALLENGE
and mental Health
• STUDENT
Special Issue PART 2 PERSPECTIVE
News: Air pollution FOUND TO increase the risk of dementia
Editor: Phil Harris
mhneditor@gmail.com
Editorial board
•฀ Hollie Roblin, clinical team manager,
Leeds and York Partnership NHS
Foundation Trust, and chair of editorial
board
•฀ Evri Anagnostara, head of nursing,
Barnet, Enfield and Haringey Mental
Health NHS Trust
•฀ Mark Brown, development director,
Social Spider Community Interest
Company
•฀ Terez Burrows, deputy modern matron,
Rampton High Secure Hospital
•฀ Lawrence Benson, senior lecturer in
healthcare management and policy,
University of Manchester, and service
user representative
•฀ Vanessa Gilmartin Garrity, mental
health nurse and independent
consultant
•฀ Joanna Johnston, mental health nurse
•฀ Steven Jones, Professor (mental
health), University of Chester
•฀ Donna Kemp, lecturer, University of
Huddersfield
•฀ Nicky Lambert, director of teaching
and learning/associate Professor,
Middlesex University
•฀ Stephen McKenna-Lawson, lecturer,
Swansea University
•฀ Athia Manawar, senior nurse practice
placement facilitator, Tees Esk Wear
Valleys Foundation Trust
•฀ Dave Munday, lead professional officer,
Health Sector, Unite the Union
•฀ Neil Murphy, senior lecturer,
University of Salford
•฀ Emily Prescott, mental health nurse,
care homes sector
•฀ Mike Ramsay, lecturer in nursing
(mental health)/postqualifying BSc
lead, University of Dundee
•฀ Jonathon Slater, trainee approved
clinician, Nottinghamshire NHS
Foundation Trust
Publisher
Mental Health Nurses Association
©MHNA 2022
Advertising
Mental Health Nurses Association
mhneditor@gmail.com
Subscriptions
MHN is free to members of the Mental
Health Nurses Association. Annual
subscription (six issues/one volume) for
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(VAT and postage included). No part-
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payable to Unite the union) to:
MHN subscriptions, PO Box 35,
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Tel: 01580 883844 Email: mhn@c-cms.com
The views expressed in Mental Health
Nursing are not necessarily those of the
publisher nor of the editor, except where
expressly stated. While every care has
been taken in compiling this publication
and the statements it contains, neither the
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ISSN 1353-0283 (online version ISSN 2043-7051)
 SUSTAINABILITY
Special issue

CONTENTS
04
NEWS
• Report says young people need flexible support • Mental
health waiting times are harming young people, survey finds
• Air pollution increases the risk of dementia • Extra funding
for mental health services as part of winter planning
14
06 WHAT KIND OF ‘GREEN’
MENTAL HEALTH NURSES
NHS PAY AWARD 2022/23 FAQS SHOULD WE BE?
Unite the Union’s responses to frequently asked
Simon Hall reflects on the challenges posed
questions about this year’s NHS pay award
by environment changes and the options
available to mental health nurses

08
THE NURSES CLIMATE CHALLENGE: 16
LEADING THE FIGHT AGAINST
CLIMATE COLLAPSE,
CLIMATE CHANGE
ECO ANXIETY AND MENTAL
Anna Fuhrmann outlines the impacts of climate HEALTH NURSING
change and how nurses can act to address it
Fred Ehresmann reports on the climate
change literature and its relation to mental
health nursing
10
SUSTAINABILITY IN
MENTAL HEALTH NURSING 18
STUDENT FOCUS:
Stefi Barna and Siobhan Parslow-Williams describe
how mental health nurses can play a key role in WE CAN TAKE SMALL STEPS
improving health outcomes using the sustainability TO HELP SAVE THE PLANET
in quality improvement framework
Mike Palmer considers the actions students and
staff can take to improve sustainability

20
CLIMATE CARES: PUSHING FOR
ACTION AT THE BORDERLANDS
OF CLIMATE CHANGE AND
MENTAL HEALTH
Jessica Newberry Le Vay and James Diffey report
on the joint initiative that is bringing together a
multidisciplinary team to better understand and
support mental health in the climate crisis

August/September 2022 MENTAL HEALTH NURSING 3

 NEWS
Report says young people need flexible support
Offering flexible support without the need
for bureaucratic eligibility criteria can be
an effective way to engage young people
so that they get the right support for their
mental health, according to a new report.
‘Someone To Talk To’ by the Centre
for Mental Health is the result of an
independent evaluation of an initiative
from Centre 33, a young people’s charity in
Cambridgeshire and Peterborough.
The report explores the impact of
providing more bespoke support to young
people who may need more holistic,
Mental health waiting times are harming young people, survey finds
Thousands of young people are being left
waiting so long for mental health support
or treatment that they have attempted to
take their own lives, according to research
conducted by the charity YoungMinds.
Almost 14,000 young people aged under
25 completed a survey the charity used for
a government consultation on a ten-year
strategy for mental health
More than one in four young people
(26%) said they had tried to take their own
life as a result of having to wait for mental
health support, and more than four in
ten (44%) waited more than a month for
mental health support after seeking it and
almost one in 10 (9%) young people were
turned away. Over half of young people
(58%) said their mental health got worse
4 MENTAL HEALTH NURSING August/September 2022
flexible intensive or longer-term help. This
includes those who face barriers to support
due to health inequalities and for example
might be homeless or estranged from their
families.
The report finds that the Someone
To Talk To pilot service reached young
people without the need for restrictive
eligibility criteria. Young people and their
engagement worker together chose
whether to use that or Centre 33’s more
structured regular offer.
The young people who chose the
Someone To Talk To pilot had a more
significant and complex range of needs and
health inequalities than those who didn’t.
The pilot offered young people more
choice and control about the kind of
support they received for their mental
health, where they go for it and how often
they attend. While waiting for talking
therapy, Centre 33 checked in with young
people through drop-in, phone calls and
text, and after they finished they were able
to stay in touch.
The young people who used the pilot
benefited from greater and significant
improvements to their mental health, with
the biggest benefits felt by those that had
more contact with Centre 33.
while they were waiting for support.
The figures come as latest NHS data
shows 66,389 young people aged 19
and under were referred to child and
adolescent mental health services in April,
a 109% rise from the 31,720 referred in the
same month before the pandemic.
The survey also revealed that more than
a third of young people (37%) said they did
not feel supported by their GP when they
tried to access mental health support or
advice, and that more than two-thirds of
young people (71%) said they experienced
problems with their relationships with
family and friends as a result of having to
wait for mental health support.
As a result, the charity has launched an
‘End The Wait’ campaign, which calls on
The report concludes that mental health
services for young people will work better if
they are more flexible, with a more varied
offer of support and with more choices for
young people about what help they get,
where and for how long.
Centre for Mental Health chief executive
Sarah Hughes said: “Young people with
mental health difficulties are not ‘hard to
reach’ as they are sometimes labelled. Too
often, services don’t reach out or they’re
not flexible enough. Centre 33’s Someone
To Talk To initiative shows that with the
right offer of support, young people
are easy to reach, and they use services
according to what they actually need.
“We need to look again at how mental
health services work to ensure they don’t
exclude young people whose lives are more
complex and who need more bespoke
support. Services should offer young
people more choices about the support
they get and how they want to access it.
No one size fits all, and for young people
it’s especially important that mental health
support is compassionate, consistent and
responsive to what’s going on in their lives.”
The report can be viewed at: https://
www.centreformentalhealth.org.uk/
publications/someone-to-talk-to.
the government to end the crisis in young
people’s mental health.
Emma Thomas, chief executive of
YoungMinds, said: “These numbers paint
a shocking picture of the situation young
people in this country face when it comes
to their mental health.
“We have also seen this reflected in calls
to our parents’ helpline, with an increasing
number of people saying their child has
attempted to take their own life and still
isn’t receiving the right care.
“For years, politicians have promised
that they will get a grip of the situation,
including a recent commitment to a ten
year plan. But the reality is that with every
month of inaction, things are getting
rapidly worse for young people.”

Air pollution increases the risk of dementia
Ralf Kunze from Pixabay
Air pollution increases the risk of
developing dementia, according to a
review of evidence by a governmental
expert group.
The Committee on the Medical
Effects of Air Pollutants (COMEAP) has
published its findings after reviewing
more than 70 studies on how exposure
to emissions affect the brain.
COMEAP has concluded that
air pollution increases the risk of
accelerated cognitive decline and of
Extra funding for mental health services as part of winter planning
The NHS has announced additional
funding for the winter, including £10
million earmarked for supporting
mental health services.
The plans were announced by NHS
England as a way to boost capacity and
resilience in preparation of the busy
winter period.
They include plans to deploy mental
health professionals in 999 call centres
so that people experiencing a mental
health crisis can be directed towards
appropriate services.
Health and social care secretary
Steve Barclay said: “To prepare for
what could be a challenging winter,
I am working closely with the NHS at
pace to ensure we are ready for the
pressures ahead.
“By increasing capacity, boosting
NHS 111 and 999 support, tackling
delayed discharge and using new
innovations such as virtual wards, we
can help patients get the care they
developing dementia in older people.
This is thought to be caused by
pollutants entering the circulatory
system and affecting blood flow to the
brain. The committee has called for
further research to help develop the
evidence.
There is a well-established evidence
base showing that exposure to air
pollution increases the risk of heart
disease.
According to NHS England figures,
there are an estimate 850,000 people in
the UK with dementia. After the age of
65, the likelihood of developing dementia
roughly doubles every five years.
Gavin Thomson of Friends of
the Earth Scotland said: “Today’s
report from the UK government is
further evidence that air pollution is
devastating for human health, and it’s
really worrying to see the links with
need, when they need it.”
Responding to the announcement,
Paul Farmer, chief executive of the
charity Mind, said: “At this point nobody
is in any doubt there is an incredibly
difficult winter on the horizon for health
services, particularly for mental health.
“On top of usual seasonal pressures
the colder months bring, A&Es are
already regularly showing signs of
intense strain, with mental health bed
occupancy consistently at 95%, which is
10% above safe levels.
“We are also seeing a cost of living
crisis hurting household finances,
which will only increase the need for
mental health support, particularly as
difficulties intensify over the winter.
“In light of the challenging winter
we will likely all face, we welcome the
announcement today of additional
support for the NHS, in particular the
extra £10 million earmarked for mental
health services.
August/September 2022 MENTAL HEALTH NURSING
NEWS
dementia being strengthened.
“We have known for a long time
that traffic fumes cause asthma and
heart conditions, and evidence has
been growing about the risk that tiny
particles – from exhaust fumes, tyres
and brakes – pose to our cognitive
health.
“It is particularly dangerous for
young children, the elderly, and people
with pre-existing health conditions.
“To improve air quality in our
communities and neighbourhoods, we
need significant investment in public
transport so that everyone can access
it, while providing more space for
walking, wheeling and cycling.”
The COMEAP report can be viewed
at: https://assets.publishing.service.
gov.uk/government/uploads/system/
uploads/attachment_data/file/1090376/
COMEAP-dementia-report-2022.pdf.
“However, the UK government
cannot be complacent. £10 million
is not nearly enough to address the
fundamental issues our mental health
services face – years of underfunding,
a crumbling estate and widespread
staffing issues.
“We need to see long term,
systematic reform – not yearly sticking
plasters – to address the underlying
issues our mental health services
face.”
kristamonique from Pixabay
5
 Frequently Asked Questions
FAQs – NHS Pay Award 2022/23 (England)
1. What is the pay award for NHS workers in England
for 2022/23?
• The NHS Pay Review Body (PRB) recommendation is for a pay
rise effective from 1 April 2022, for all Agenda for Change staff
at the full time equivalent salary, of £1,400.
• This pay rise will be increased to 4 percent for staff at the top
of band 6 and all those on band 7.
• This 4 percent uplift will not be applied to bands 8 and 9.
• This increase will include the National Living wage adjustment
made on 1 April 2022, which applied to Bands 1 and 2. This
means the £1,400 increase will be applied on top of the
National Living Wage adjustment made in April earlier this year.
2. How is NHS Pay in England determined?
NHS pay in England is imposed not negotiated.
Health unions do not negotiate with the government on NHS pay
in England, Wales and Northern Ireland. Instead, the UK
government uses the NHS Pay Review Body (PRB) process to
make decisions on NHS staff pay awards. Unite submits evidence
to the PRB report, the PRB then writes a report for the UK
Government, who then decide whether to implement the
recommendations for England.
Governments in Wales and Northern Ireland make the same
decision for NHS workers in their Countries, while the Scottish
Government negotiates NHS pay with trade unions.
3. What is Unite in Health's view of the pay award?
Unite along with other recognised Trade Unions submitted
evidence to the PRB asking for an inflation busting pay rise for
NHS workers which would address the staffing crisis in the NHS.
With real inflation (RPI) running at over 11 percent, the
government’s imposed £1,400 pay award for NHS staff, which
works out at just 4 percent for many, amounts to a ‘massive
national pay cut’. It will also lead to more NHS cuts, as there’s no
extra money from the Treasury to fund it.
We believe enough is enough and NHS workers shouldn’t accept
another year of a below inflation pay rise. As our General
Secretary, Sharon Graham has said “This is a kick in the teeth to
NHS workers from the Government”.
4. Will the pay increase impact on universal credit?
There is a possibility that the pay rise may have an impact on
universal credit and we would advise you seek expert advice on
this if this concerns you. Unite is not able to provide expert advice
on universal credit.
5. What is happening to my pension?
Pension contributions will change for some NHS workers in
October. Some people will pay more, some less and some stay the
same. Please refer to the link below for more information:
www.nhsemployers.org/publications/nhs-pension-scheme-
member-contributions
unitetheunion1 @unitetheunion
6 MENTAL HEALTH NURSING August/September 2022
6. What will happen next and how can we show this
pay award is not good enough for NHS workers in
England?
At this stage, your union, Unite is consulting you on whether you
and your colleagues would be prepared to take strike action or
action short of a strike over the government’s pitiful pay award of
£1,400, which works out at just 4% for many.
7. What are the time scales for the consultative
ballot?
The consultative ballot will run between Monday 8th August and
Sunday 11th September 2022. Unite is recommending you vote
yes to taking industrial action so that we can make the
government listen and negotiate a better deal.
8. How will the ballot be conducted?
It will be an online ballot and every member will be sent a unique
code to allow them to vote. The ballot will ask you three questions
and will also give you an opportunity to update the details Unite
holds on you. As well as being emailed, some members will be
sent a letter in the post with a QR code that will allow members to
access their ballot paper who have no email address registered
with Unite. In addition to this, text messages will be sent out with
the link to the ballot once voting starts to those who have not
voted. We hope that this will ensure that all members will be able
to access the ballot.
9. I do not have access to the internet; can I vote?
You will be able to vote. In the first instance speak to a Unite rep
who should be able to assist you access to the internet, or do ask a
family member or close friend with access to the internet to assist
you. Failing this contact your local Unite Regional office and a
member of Unite staff should be able to assist.
10. What is a consultative ballot?
A consultative ballot is conducted to find out your views. If the
collective view is to oppose the settlement and take Industrial
action we are required by law to hold another ballot which has to
be conducted by post and is conducted by a neutral third party.
Only after the second legal postal ballot can any action be taken.
11. Will my employer find out how I vote?
Certainly not. The UK Government and the NHS employers will be
informed of the result of the ballot but no personal information
or voting preference will be disclosed.
FAIR PAY
for nhs workers
@unitetheunion Unitetheunion
FAQS
12. What happens if members vote yes for industrial
over the pay award?
Since this is a consultative ballot, if a majority of members vote
yes for action, a legal industrial action ballot will follow. Industrial
action ballots are required by law to be carried out by post. We
will need as many members as possible to vote for industrial
action in order to surpass the high hurdles to take industrial
action as established by recent Government anti trade union laws.
13. What happens if we vote no to taking action in the
consultative ballot?
If a majority vote no to taking industrial action, this is akin to
accepting the pay award and Unite would not be able to proceed
to a legal industrial action ballot.
14. What does industrial action involve, does this just
mean ‘going on strike’?
Industrial action can mean anything that will affect service
delivery up to, and including, strike action. This could mean no
unpaid overtime worked, taking statutory breaks, reporting
unsafe staffing levels, an overtime ban, work to your current job
description or a targeted approach for full strike action.
15. Do I get paid if I’m on strike?
No, you will not be entitled to pay whilst you are on strike.
However, Unite has a strike fund to support members taking of
strike and each member can claim up to £70 per day for taking
strike action.
16. Can I be disciplined for going on strike?
Absolutely not, this is a worker’s right as long as the strike action
is conducted lawfully. Please let your local Unite workplace
representative know if you believe you will be treated less
favourably at work for taking industrial action, since this is
unlawful.
17. Can I be struck off my professional register for
taking strike action?
Not at all. The different registration bodies and regulators will all
produce their statements regarding Industrial action. These
bodies all recognise and acknowledge the right to strike and
registrants’ democratic right to express their legal right to take
industrial action. Registrant and regulatory bodies will also
remind us that standards and codes should also be followed as
much a possible.
18. Do I need to tell my manager that I intend to go on
strike?
There is no requirement or obligation to inform your manager of
your intention to take industrial action.
19. I’m worried about public perception of NHS workers
who choose to strike
The public are behind you! From the recent poll conducted by the
joint health union’s campaign “With NHS Staff” 55 percent of
respondents support a pay rise of at least 9 percent and 58
percent of respondents believe NHS staff would be justified in
taking Industrial action if they received a below inflation pay rise.
It’s important to note that Unite will provide a ‘life and limb’ and
emergency cover to ensure no patients are put at risk. There is no
point in any industrial action if it does not cause some level of
disruption and inconvenience, but rest assured emergency
unitetheunion1 @unitetheunion
procedures will not be impacted. You will be aware of the level of
discontent throughout the whole of the UK currently where all
workers are standing up for themselves in securing decent pay.
This applies to all sectors of the economy so why should the NHS
be any different? Clapping on doorsteps doesn’t pay the bills! We
have faced years of mediocre pay rises which have resulted in a
pay cut in real terms year on year. Workers are now saying
‘enough is enough’ and now is the time to demand more,
especially during an unprecedented cost of living crisis.
20. If we go on strike, what will be expected of me?
If you are asked to take industrial action we would expect the
members to collectively adhere to the action, that being action
short of strike or strike. If strike action is called we would expect
our members not to attend work if your service is part of the
action. You will also be asked to attend peaceful demonstrations
and picket lines to show solidarity and support for the action.
21. Anything else we should know?
Due to current trade union legislation (except in Northern
Ireland) the UK Government have attempted to make it difficult
for members to take action by applying specific thresholds to be
met before action could take place. Unite will take stock
following the consultative ballot and look to target specific areas
to take effective industrial action rather than all of the NHS. Unite
will support members 100% on the decisions you make. Anything
that Unite does will be driven by our members’ decisions in
workplaces across the country.
22. So what can I do now and what happens next?
Get VOTE ready: The Unite in Health consultative ballot takes
place between Monday 8th August and Sunday 11th
September 2022. Check you can VOTE by making sure your
Unite membership details are up-to-date. Go to MyUnite
Talk to your colleagues about why their vote matters. Put up a
campaign poster in your workplace.
• Organise workplace stalls, ‘tea break’ chats and branch
meetings. Talk to your Unite official to order a supply of
materials.
• Talk to your Unite reps for more ideas on how to get the vote
out in your workplace!
• Keep checking your email and reading your texts from us!
If you do not receive a ballot paper either by text, email or post or
know of members who haven’t, please make sure your current
contact details are up to date by contacting your local Unite
District or Regional office, details provided by clicking the
following link www.unitetheunion.org/what-we-do/
unite-in-your-region. We strongly urge you to vote for action
in the consultative ballot and show to the Government “Enough
is enough”.
Pay us like you Care
FAIR PAY
for nhs workers
@unitetheunion Unitetheunion
August/September 2022 MENTAL HEALTH NURSING 7
 SUSTAINABILITY
Special issue
The Nurses Climate Challenge:
leading the fight against
climate change
C
limate change is the greatest
public health threat of the 21st
century. It already negatively
affects patient and community health
and has an impact on nurses’ work.
Extreme weather events, changing
disease patterns, and the increasing
socioeconomic impacts of climate
change put nurses and other health
professionals at the forefront of
fighting the health impacts of our
changing climate.
The healthcare sector is at the
frontline of climate change, bearing
the costs of increased disease and more
frequent extreme weather events. The
pressure created by climate change
will also increase the workload and
psychological stress on healthcare
professionals.
Climate change threatens our
health
The health impacts of climate change
include increased respiratory and
cardiovascular disease, injuries, and
premature deaths related to extreme
weather events. Changing access to
food and water supplies as well as
the increased spread of waterborne
illnesses and other infectious diseases
also add to the increasing health
burden. Climate change also threatens
mental health through post-traumatic
stress, worsening socioeconomic
determinants of health, solastalgia
(distress from environmental change),
and ecoanxiety.
These health impacts affect us all,
8 MENTAL HEALTH NURSING August/September 2022
Anna Fuhrmann
but are more severe for the already
vulnerable such as elderly people and
those with pre-existing physical and
mental conditions.
The effects of climate change will
get worse in the next decades as
temperatures are projected to increase
by more than 1.5ºC (see https://www.
ipcc.ch/sr15), which will have an
immense impact on human health and
wellbeing.
How can nurses act on
climate change?
As one of the most trusted professions
(and making up more than 50% of the
healthcare workforce worldwide),
nurses play a critical role in health
promotion, disease prevention,
delivering primary and community
care, and hold a vital role in educating
patients and healthcare professionals
about climate solutions.
As nurses, we need to learn
about climate change and its health
implications to protect our patients
and communities. We have to empower
each other to acquire the necessary
knowledge and speak up by advocating
and teaching others. We need to learn
how to reduce the environmental
impact of our own work, as well as
how we can protect our vulnerable
patients from climate change effects.
To support this learning and
sharing of knowledge and expertise,
Health Care Without Harm (https://
noharm-europe.org) created the
Nurses Climate Challenge (https://
eur.nursesclimatechallenge.org/en).
It supports nurses in educating their
colleagues and communities about the
health impacts of climate change.
Launched in January 2021, the
Nurses Climate Challenge (NCC)
Europe provides resources tailored
to nurses working in the European
healthcare sector, such as theoretical
knowledge on climate and health,
education and advocacy material, and
practical measures to integrate climate
knowledge into nursing practice.
Alongside these resources, the NCC
Europe also serves as a networking
opportunity for nurses to share their
experiences, successes, and challenges.
Creating a climate-smart
healthcare system
Nursing practice itself also needs to
change – by mitigating emissions from
healthcare delivery, adapting our
care, and making healthcare climate
resilient.
Ironically, the very sector
responsible for healing people is also
contributing to climate change. It is
estimated to account for 4.4% of global
net emissions (see https://noharm-
europe.org/content/global/health-care-
climate-footprint-report), which, if it
were a country, would make it the fifth
biggest emitter in the world.
With this level of emissions and
vast consumption of resources, raw
materials, and products, the healthcare
sector damages the environment and
undermines our health.

The Nurses Climate Challenge
Europe collects resources and practical
solutions to empower nurses to fight
climate change. It is crucial to share
knowledge and good examples with
our colleagues around the world to
encourage replication and reduce the
negative impacts of climate change on
our patients.
Nurses need to use their potential
and become leaders to initiate the
changes needed in health systems and
society. The NCC Europe provides a
growing set of free, comprehensive,
and easy-to-use resources. Healthcare
needs to both become resilient to
climate change and reduce its own
negative impact.
As nurses, we are one of the most
trusted professions in Europe and
worldwide, and we can use this trust
to advocate for climate action and
teach others about the urgency of our
situation.
Not only is it important for practising
nurses to become knowledgeable and
to act, but nursing curricula across
Europe have to integrate the new
challenges and opportunities posed by
climate change to adequately prepare
the next generation of nurses.
As future nurses, nursing students
will face the full impacts of climate
change in their work and, in the next
decades, will have to care for patients
who are suffering from the health
issues climate change creates. It is
extremely important to teach them
now about the challenges they will
encounter when they start practising.
The future of climate-smart
nursing
Planetary health, sustainability and
climate change are not yet commonly
taught in nursing schools and
universities across Europe.
To encourage the inclusion of
this important content, Health Care
Without Harm Europe, together with
ten nursing schools from across
Europe, has developed the Nursing
School Commitment.
Through the Nursing School
Commitment, nursing educators are
pledging to include sustainability and
planetary health in nursing education.
Existing courses can be supplemented
August/September 2022 MENTAL HEALTH NURSING
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with knowledge on environmental
determinants and climate effects on
the health of specific patient groups.
The transferability of sustainability
competencies into practice should
be encouraged and climate change,
health, and health promotion can be
integrated into clinical teaching.
Nurses must come together and
take a leading role in fighting climate
change and its impacts on our patients.
We are trusted and educated to realise
the potential of early preventative
action. As nurses, we always think
systemically, with our patients’ social
and physical health environments in
mind when supporting their healing.
We need to start integrating
environmental and long-term impacts
of climate change into our practice to
keep our patients and communities
healthy. We need to start connecting
across Europe to teach and learn, and
find the best solutions for climate-
smart nursing practice. n
Anna Fuhrmann is a climate officer at
Health Care Without Harm Europe and
a paediatric nurse
Nurses Climate Challenge Europe, 2021
9
 SUSTAINABILITY
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Sustainability in
mental health nursing
Abstract
With the goal of decarbonisation
and carbon neutrality in the health
sector by 2045, health professionals
must implement systemic changes
in their clinical practice to reduce
carbon use, while meeting equity
targets and improving health
outcomes. Sustainable healthcare
practices address the socio-ecological
determinants that undermine
population health, help clinicians
intervene as early as possible in
the disease process, deliver ‘lean’
healthcare pathways and reduce the
‘triple bottom line’ costs of healthcare
provision, in order to benefit patients,
populations and the environment.
Mental health nurses can play a key
role in improving health outcomes
using the sustainability in quality
improvement (SusQI) framework.
Key words
Sustainable value, quality
improvement, SusQI, prevention,
patient self-care, lean care pathways,
low carbon treatments
G
lobal warming, biodiversity
loss and the chemical pollution
of air, land and water are
fundamentally undermining the
environmental conditions that support
human life on Earth.
The destruction of the global natural
environment has been recognised as
the largest threat to human health and
wellbeing in the 21st century and is
already affecting population health
around the world (Watts et al, 2015).
Already we are seeing extreme-
weather related morbidity and
mortality from flooding, storms and
10 MENTAL HEALTH NURSING August/September 2022
Siobhan Parslow-Williams
Stefi Barna
fires; unplanned mass migration due to
weather and resource related conflict;
and increases in infectious and non-
communicable disease.
Globally, healthcare has a carbon
footprint of 2 gigatonnes of CO2,
equivalent to the annual greenhouse
gas emissions of 514 coal-fired power
plants. The health system produces 5%
of the European Union’s CO2 emissions,
approximately 7% of Australia’s, and
in the US it may contribute as much as
10%. If the global health care sector
were a country itself, it would be the
fifth largest greenhouse gas emitter on
the planet.
The UN Agenda 2030 Sustainable
Development Goals have called for the
“mobilisation of all available resources,
participation of all countries, all
stakeholders and all people” to work
toward more sustainable futures.
To meet national Paris Agreement
goals, 50 countries have committed to
creating climate-resilient, low carbon,
sustainable health systems, including
14 countries that have set a target date
of reaching net zero emissions by 2050
or earlier (Wise, 2021; NHS Net Zero
Expert Panel, 2020).
While climate change is no doubt the
most important health threat of the
century, it also presents the “greatest
opportunity to redefine the social
and environmental determinants of
health” (Watts et al, 2015), calling each
and every healthcare professional
and department to drastically reduce
carbon use, while meeting equity
targets and improving health outcomes.
This article explores the role mental
health nurses can play in reducing
carbon emissions. It takes into
consideration the aspects of healthcare
most damaging to planetary health
(see Figure 1), and applies principles of
sustainable clinical practice healthcare
to guide nurses and departments to
make sustainable change both locally
and nationally.
Sustainable healthcare
An environmentally sustainable
healthcare system offers high-quality
services in the present without
compromising the ability to meet the
health needs of the future, reduces
the health system’s contribution to
the climate crisis, creates resilience
to extreme weather and offers an
unprecedented opportunity to protect
the health of our patients, populations,
and planet.
The term sustainable healthcare
evokes for many people energy-
efficient buildings and renewable
energy sources. However, Figure 1
reminds us that the energy efficiency of
buildings will only deliver a tiny wedge
of the carbon reduction required for a
net zero system.
The sustainable value equation
(Figure 2) (Mortimer et al, 2018) is a
useful tool for calculating outcomes
for patients as well as populations,
and to weigh them against a ‘triple
bottom line’ of financial, as well as
environmental and social impacts or
costs (Mortimer et al, 2018).
Financial costs can be calculated by
 SUSTAINABILITY
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asking whether the desired outcome is Minimising waste of medications, Glossary

affordable in the present moment, and consumables, and energy. Digital
in the future. health tools such as telemedicine, Sustainable healthcare: A health
Environmental costs attempt to mobile health and e-health offer either system that maintains or restores
health for current generations while
measure and internalise the damage a substitute for, or complement to,
minimising harm to the environment
done to the natural environment by a in-person visits. In the UK 5% of all and ensuring the health of future
procedure or pathway. road traffic is related to the health generations.
Social impacts consider whether the system, therefore reducing patient
Carbon footprint: A measure of
intervention is accessible to all and and staff travel can lower the carbon
the amount of carbon-containing
consider whether hospital activities footprint of healthcare. Walking, taking greenhouse gases released into
that help individual patients also public transport, cycling etc instead of the environment by an activity or
undermine the health of families, driving not only has benefits for the process, usually expressed as the
carers, staff, the local community, and environment, but is beneficial to health equivalent of kilograms of carbon
dioxide.
vulnerable groups. and wellbeing too.
Mortimer’s model for a Sustainable healthcare can be
transformation of clinical practice practised across all specialties using Building on existing frameworks for
(Figure 3) offers a useful guide for the principles for sustainable clinical quality improvement such as PDSA
planning interventions, with four practice (Figure 4). (Plan, Do, Study, Act), the sustainability
principles: in quality improvement framework
1. Prevention: Tackling the biological The sustainability in quality (SusQI) guides nurses to plan and
and socioeconomic determinants of improvement framework measure the triple bottom line of
health to promote health and prevent Quality management and quality transformative clinical practices
illness; healthcare is after all at its improvement processes offer an (Mortimer et al, 2018).There are four
most sustainable level when it is not opportunity to maximise sustainable steps in this process (see Figure 5).
required. Paying special attention to value and the triple bottom line in Step 1: Set goals. Consider the
promoting wellbeing, preventing ill- the areas of sustainable healthcare procedures or pathways with the
health and the changing health and described above. best potential to improve health
care needs of people, for example using
social and green prescribing. Nature
Figure 1. Delivering a net zero NHS (NHS Net Zero Expert Panel, 2020)
can be a powerful therapeutic tool and
access to green space is an important
social determinant of health.
2. Patient self-care: Patient
empowerment for self-care is central
to mental healthcare, and lifestyle
changes that favour one’s own health
are often favourable from a climate
and resource perspective as well.
Teaching patients about their illness,
self-care and non-pharmaceutical
interventions they can use can reduce
the use of medications. This can be
achieved through high-quality peer
support and shared decision making.
3. Lean care pathways: Streamlining
care, minimising low-value
activities, and removing unnecessary
procedures, such as undertaking
regular medication reviews to tackle
polypharmacy and overprescribing.
4. Low carbon treatment
alternatives: Using effective
treatments and medical technologies Reproduced with permission of Greener NHS
with lower environmental impact.

August/September 2022 MENTAL HEALTH NURSING 11

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Figure 2. Sustainable value (Mortimer et al, 2018)
Reproduced with permission of the Centre for Sustainable Healthcare
outcomes while also reducing
financial and environmental costs and
adding positive social value at every
opportunity.
Step 2: Study the system. Before
implementing any change, carefully
examine how the system works
currently, i.e. the people and steps
involved in a particular treatment
or intervention. This should include
understanding how and where
environmental, social and financial
resources are being used, highlighting
problems and opportunities for
improvement.
Step 3: Design the improvement
effort. Design and test ‘change ideas’
for sustainable value, including
patients, carers, and external
stakeholders in early planning to
identify issues and avoid unintended
consequences.
Step 4: Measure impact. Select
appropriate metrics for the desired
outcomes. Consider potential positive
and negative outcomes for each of
the variables in the sustainable value
equation.
Figure 3. Principles of sustainable healthcare (Mortimer, 2010)
12 MENTAL HEALTH NURSING August/September 2022
How can mental health
nurses make a difference?
Nurses make up the majority of
healthcare workforce and are key
leaders within the organisation. The
RCN released a position statement in
October 2019 saying ‘Nurses have a duty
to protect and promote public health
in the face of these threats and have
a unique and vital role to play. Their
expertise, diverse roles and the trust
invested in them mean they can be
leaders in protecting the health of the
public from the consequences of climate
change’.
So what could mental health nurses
do to help? Here are five suggestions
for individual, local and system level
actions mental health nurses could take.
1. Take individual action
The global nursing workforce is the
biggest healthcare workforce in the
world. Nurses taking individual and
community action can have a big
impact.
The Alliance of Nurses for Healthy
Environments has begun a new
movement called Nurses Drawdown
and asks nurses to pledge to take action
in five key areas. For more information
and to join the movement visit the
website https://envirn.org.
2. Join a network such as the Green
Nurse Network
This informal network gives nurses
an opportunity to connect with other
likeminded nurses working to tackle the
climate emergency.
Visit https://networks.
sustainablehealthcare.org.uk/network/
green-nurse-network, and follow them
on Twitter @Greennurse.
3. Make changes within your scope of
professional practice
Changes could include certain elements
of practice or whole care pathways.
For example, conducting a sustainable
quality improvement project focusing
on the principles of sustainable
healthcare.
For example, could some
appointments be done remotely using
online methods such as Microsoft
Teams? These changes could reduce
travel emissions, staff time and the
associated financial costs.
Other possible projects could explore
reducing overprescribing and the
introduction of green and/or social
prescribing.
These changes could improve patient
outcomes, reduce travel emissions,
reduce staff time and lower the
associated financial costs. For resources
on how to do a SusQI project go to
https://www.susqi.org.
4. Take system-level action
You could ask your trust or organisation
to publicly declare a climate emergency,
if they haven’t done so already. To
find out how to do this visit: https://
healthdeclares.org, which can give you
information.
You could also ask your trust to sign
up to the award-winning Green Ward
Competition, which is a leadership
and engagement programme
aimed at cutting carbon, improving
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patient care and saving money. Figure 4. Driver diagram of sustainable healthcare principles
For more information visit: https://
sustainablehealthcare.org.uk/green-
ward-competition.

5. Education
Learn more about sustainable
healthcare. Educate your colleagues
about the impacts of climate change on
health.
The Nurses Climate Challenge
provides tools and information
about the role of the nurse and
climate change: see: https://
nursesclimatechallenge.org.
Learn how to implement
environmental changes in practice.
The Centre for Sustainable Healthcare
offers various practical online resources
and courses aimed at healthcare
professionals on its website at: https://
sustainablehealthcare.org.uk/courses.
By taking action individually and
professionally mental health nurses Figure 5. The four steps of SusQI
could make a big difference and help
make healthcare sustainable now and in
the future.

Conclusion
Sustainable healthcare addresses
the socio-ecological determinants
that undermine population health,
intervenes as early as possible in
the disease process, delivers ‘lean’
healthcare pathways, and overall
reduces the environmental and socio-
economic costs of healthcare provision,
benefiting patients, populations, and the
environment.
Within the health system, mental
health care contributes significantly to
sustainable practice through its reliance
on non-pharmacological, low-cost and
low-carbon treatments that empower
patients for self-management (Palstam
et al, 2021).
The carbon footprint of mental
healthcare can be reduced, particularly
in the areas of pharmaceuticals,
procurement, care pathways, and travel.
Concepts such as the sustainable value
equation can guide sustainable clinical
decision-making by revealing which
techniques and processes are the most
polluting, and which can most improve
quality of care.
Evaluations of healthcare
interventions from a triple bottom line
perspective are rare and need to be
conducted more frequently to guide
sustainable clinical decision-making.
Tools such as the sustainability in
quality improvement framework are
available to design, measure and report
changes in clinical operations to facilitate
a socially, economically and ecologically
sustainable healthcare (Centre for
Sustainable Healthcare, 2022).
By generating evidence for clinical
decision making over the coming
decade, mental health nursing can make
a significant contribution to achieving a
net zero health sector by 2045 (NHS Net
Zero Expert Panel, 2020). n
Siobhan Parslow-Williams is the quality
improvement education lead and Stefi
Barna is the education director for the
Centre for Sustainable Healthcare
References
Centre for Sustainable Healthcare. (2022) Sustainable Quality
Improvement. SusQI. (Available at: https://www.susqi.org
(Accessed 16 May 2022).
Mortimer F. (2010) The sustainable physician. Clin Med 10(2):
D110-111.
Mortimer F, Isherwood J, Wilkinson A, Vaux E. (2018)
Sustainability in quality improvement: redefining value. Futur
Healthc J 5(2): 88. doi:10.7861/FUTUREHOSP.5-2-88.
NHS Net Zero Expert Panel. (2020) Delivering a “Net Zero”
National Health Service. Available at: https://www.england.
nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/
delivering-a-net-zero-national-health-service.pdf (Accessed 16
May 2022).
Palstam A, Andersson M, Lange E, Grenholm A. (2021) A Call to
Include a Perspective of Sustainable Development in Physical
Therapy Research. Phys Ther 101(3). doi:10.1093/PTJ/
PZAA228.
Watts N, Adger WN, Agnolucci P et al. (2015) Health and climate
change: policy responses to protect public health. Lancet
386(10006): 1861-1914. doi:10.1016/S0140-6736(15)60854-6.
Wise J. (2021) COP26: Fifty countries commit to climate resilient
and low carbon health systems. BMJ 375: n2734. doi:10.1136/
BMJ.N2734.

August/September 2022 MENTAL HEALTH NURSING 13

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What kind of ‘green’

mental health nurses
should we be?
Simon Hall

T
he question posed by the title of
this article is important as we
face the growing climate crisis
and consider what we can do to help.
A good starting point that I often
refer to, is an article by Gunasekara et
al (2014), which explores what makes
an excellent mental health nurse.
In our everyday roles we make it our
business to learn about each person’s
hopes, goals, strengths, and aspirations,
and to do what we can to encourage
progress along the ‘recovery path’. So
it’s important to consider how we can
make this recovery path greener.
It firstly means that as a profession
we will need to recognise and respond
to ‘climate anxiety’ and other related
conditions that are linked to climate
change (Kameg, 2020).
Hence, I would not be surprised
in the future if the ‘Recovery Star’
(Mackeith and Burns, 2010) grew a
new arm based on climate concerns or
amendments made to its user manual
to capture this phenomena.
real obstacle (Murali and Oyebode,
2004), but it can still be a aspiration.
Yet even this sounds defeatist.
Shouldn’t being green and aiming for
sustainable practice be a human right
or a way of life for us all?
Rising to the challenge
Previously our profession has
considered and met significant
dilemmas, although maybe not with
not such a global impact.
It was not so long ago when we
addressed tackling the challenge of
smoking, especially in our inpatient
units, and now after systematic change
we are now thankfully saving lives by
banning smoking.
I do remember the counter
arguments proposed at the time, that
people have the right to smoke and to
live their live as they wish.
This notion of ‘interfering’ around
choice was a strong one, but we do
now offer legitimate alternatives and
that is important.
It is important to consider what
our choices are around this climate
emergency? We need to explore ways
of doing things differently and we have
a moral duty to do what we can to
influence and encourage any greener
practices.
This can start by us being really
positive role models. As mental health
nurses we always give and share a bit
about ourselves and maybe we can
start the change to being greener by
looking at ourselves and colleagues.
I suspect there are significant

Wanting to be ‘green’
The hardest concept for mental health
nursing is probably dealing with the
Anja-#pray for ukraine# #helping hands# stop the war from Pixabay

aspirational component of wanting to

be ‘green’.
Do we ever ask the service users and
their families under our care whether
this is a ‘hope’ that they have? When it
comes to economics and social mobility
we are acutely aware for a number of
our service users and their families
that economically being ‘green’ is a

14 MENTAL HEALTH NURSING August/September 2022


numbers of mental health nurses
who choose the humble bicycle as
their main mode of transport or make
conscious efforts to reduce their plastic
use as two possible examples from
many.
I think as a collective of
professionals, my impression is that we
do have a social consciousness about
climate change and that we do care
about this.
Learning from the past
If we look into our past, we might
find some answers there on how to be
greener.
I have looked to see if there has been
a study on a calculated eco footprint of
our old asylums compared to modern
day inpatient hospitals, but I couldn’t
find one.
My opinion is that our old hospitals
were self-sufficient in many ways with
many growing and nurturing produce
on site, having onsite laundries, and
the majority of staff were local and
could walk or cycle to work.
Now, many hospital sites rely on
important deliveries from afar, staff
run the gauntlet daily for car parking
spaces and all the green space has gone
What can we learn from this?
Options for being greener
practitioners
The pandemic had a big impact for
community mental health nursing,
as more mental health nurses and
colleagues worked from home and
reached out to support those in need
via various digital platforms.
The growth of telehealth in mental
health is diverse and has its benefits
in terms of increasing access to mental
services and reducing costs (Touris et
al, 2020).
However, I actually don’t think
more digitally remote working is the
‘Eureka’ solution to the climate crisis.
I think we need to do the opposite, by
having mental health nurses physically
going out and connecting more to our
greener spaces with our service users
and their families.
“Fear of the climate
emergency is
real and we
should not try to
sugar-coat it”
I believe this will create a bigger
‘social’ emotional tie to save our
planet. As a collective we can make a
difference in collaboration with our
service users, as mutual role models.
This may sound controversial, but I
am not convinced how conventional
cognitive behavioural therapy will
work with climate anxiety as the
reality is that the planet we live in, is
in a climate emergency.
The fear is real and maybe even
more controversial is that we should
not even try to sugar-coat it.
Hence, we might need to explore
how we adapt our entire therapy
portfolio to address this eco-anxiety
(Bauldon and Jachens, 2021), and we
need to start now.
From this we need to review and
modernise mental health nursing
education on two fronts.
Firstly, we need to recognise that
our future nursing students will come
into our profession with a passion
about climate preservation and some
will come into nursing with lived
experience of climate anxiety.
Secondly we need to teach
interventions to support others who
experience this.
Currently, one of the things we are
now looking at is creating simple
family based simulations that
encourage our nursing students to
have eco-anxiety conversations, and
potentially to look to develop the use
of the Hogg Eco-Anxiety Scale into our
practice (Hogg et al, 2021).
Developing solutions
On reflection, since moving to
academia, I do miss the green benefits
of the early intervention for psychosis
allotment group and sharing the
August/September 2022 MENTAL HEALTH NURSING
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produce with our service users and
their families.
I miss the walking groups as a way of
connecting our service users and their
families with nature, yet for some it
was just great mechanism at providing
a safe space for others to connect with
themselves.
Thus I can see the introduction of
horticulture therapy and its benefits
into the mental health nursing
curriculum having a bigger impact on
recovery and the climate emergency
than some of the skills required
on their the current skills passport
(Gonzalex et al, 2010; Howarth et al,
2016; Howarth et al, 2018).
Maybe that is the clue we have
from our nursing past, so it is more
of a reintroduction of what worked in
the past rather than spending all our
efforts creating something radically
new.
Mental health nursing values the
importance of connecting our service
users to the world and more than ever
it needs to have a full tint of green. n
Simon Hall is a mental health nurse
and senior teaching fellow at the
University of Southampton
@Simon4Hall
References
Bauden P, Jachens L. (2021) A Scoping Review of Interventions
for the Treatment of Eco-Anxiety. International Journal of
Environmental Research and Public Health 18: 9636-54.
Gonzalez MT, Hartig T, Patil G. (2010) Therapeutic horticulture
in clinical depression: A prospective study. Research and
Theory for Nursing Practice 23: 312-28.
Gunasekara I, Pentland T, Rodgers T, Patterson S. (2014) What
makes an excellent mental health nurse? A pragmatic inquiry
initiated and conducted by people with lived experience of
service use. International Journal of Mental Health Nursing
23(2): 101-9.
Hogg T, Stanley S, O’Brien L, Wilson M, Watsford C. (2021)
The Hogg Eco-Anxiety Scale: Development and validation
of a multidimensional scale. Global Environmental Change
71: 1-10.
Howarth M, Rogers M, Withnell N, McQuarrie C. (2018)
Growing spaces: an evaluation of the mental health recovery
programme using mixed methods. Journal of Research in
Nursing 23(6): 476-89.
Howarth M, Withnell N, McQuarrie C. (2016) The Influence
of therapeutic horticulture on social integration. Journal of
Public Mental Health 15(3): 136-40.
Kameg B. (2020) Climate Change and Mental Health –
Implications for Nurses. Journal of Psychosocial Nursing
58(9): 25-30.
MacKeith J, Burns S. (2010) The Recovery Star: Organisation
Guide. Second edition. Mental Health Providers Forum:
London.
Murali V, Oyebode F. (2004) Poverty, social inequality and mental
health. Advances in Psychiatric Treatment 10: 216-24.
Torous J, Jän Myrick K, Rauseo-Ricupero N, Firth J. (2020)
Digital Mental Health and COVID-19: Using Technology
Today to Accelerate the Curve on Access and Quality
Tomorrow. JMIR Mental Health 7(3): e18848.
15
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Climate collapse,
eco anxiety and
mental health nursing
O
ne bed-time in the late summer
of 2018 my youngest daughter,
then eight years old, told me
of a planet that is dying and her fears
that she would not live long enough
to experience being a teenager or a
grown-up.
Somehow, I felt that this was not a
conversation that was going to end
with the words “Don’t you worry,
everything’s going to be fine.” The
deployment of a Dad joke – “The planet
will probably still be alive on Saturday
when we go for hot chocolate” – bought
me the time that I would need to play
catch-up and deploy a suitably well
informed and reassuring response.
To say that the subsequent four years
have been a bit of an emotional roller-
coaster ride could win medals for
understatement.
The world of climate science
literature really is not for the faint-
hearted. However, I discovered quickly
that a path has already been made
through the complex and growing
maze of information that is available.
From a range of papers proposing
clear links between climate change
and its impacts on mental health (for
example Tromble et al, 2017; Hayes et
al, 2018; Kameg, 2020) to suggestions
that climate change and its future
impacts to be core components in
nurse education (for example Leffers
et al, 2017; Rosa and Upvall, 2019)
and clamouring for the World Health
Organization to declare the climate
emergency to be an international
16 MENTAL HEALTH NURSING August/September 2022
Fred Ehresmann
public health crisis (Harmer et al,
2020), academics and practitioners are
certainly adding their voices to the
sounding of the alarm.
The size of the challenge
So, what have I made of all the reading
so far? The latest report from the
Intergovernmental Panel on Climate
Change (2022) confirms that the jury is
now officially in.
Anthropogenic climate change is
under way to such an extent that we
are facing a species-wide challenge
that, given the underwhelming
international response from those with
the power and resources to make a
difference, could result in catastrophic
consequences.
Theories abound not only about
how we have ended up in this mess
and what needs to happen next, but
also what may well happen should
responses continue to be inadequate.
For some, civilisational collapse and
human extinction in the near term are
inevitably on the table (McPherson,
2020; Ozarko, 2018).
For others, we are on the threshold
of a major transformation of human
consciousness that represents the
next evolutionary leap for our species
(Patten, 2017).
Between these two poles there
seems to be a range of positions
and narratives. I am still unsure
as to whether we are talking
hospice nursing or midwifery with
complications.
“Planet Earth is
triaged onto a
waiting list, with the
paramedics trying
to keep it going”
In any event, we as a species seem to
be in the deepest of trouble. To use a
medical metaphor, if our home planet
were a patient, there would be a crash
team, tubes, bleeping machines, an
army of nurses and a small gaggle of
specialist consultants on hand. What
we have is planet Earth triaged onto a
waiting list, with the paramedics trying
to keep it going and pushed up the list
as a matter of urgency.
Psychological trauma
While I have used a metaphor drawn
from physical medicine, we know
that where there is physical trauma,
psychological trauma is often not
far behind, and working with people
who are experiencing psychological
trauma is the bread-and-butter work
of the mental health nurse (Isobel and
Delgado, 2018; Menschner and Maul,
2016).
We are all facing an international
public health crisis and, as the
recent pandemic has demonstrated,
nurses from all disciplines are on the
frontline.
As a mental health nurse who has

been talking increasingly regularly
with people who have been profoundly
impacted by our climate and ecological
crises, I am forced to ask myself ‘what
does mental health actually mean in a
context that is so unstable and where
the future seems to look so bleak?’
With the term ‘eco anxiety’ entering
the narrative, and the arrival of the
Hogg Eco-Anxiety Scale (Hogg et al,
2021), the pathologising of people’s
genuine and valid fears for the future
seems to be under way.
Waiting in the wings are fledgling
recommendations for the ‘treatment’
of eco anxiety (Borden and Jachens,
2021). While some of the initial
findings are promising and the absence
of a pharmacological approach
reassuring, the use of the word
‘treatment’ is still a bit of a worry.
Perhaps eco anxiety is the kind of
term that brings an air of familiarity
to an emerging phenomenon that is
unfamiliar, perhaps bringing a sense of
reassurance to practitioners seeking to
know how best to respond.
Joanna Macy (1995) rather more
aptly uses the term ‘environmental
despair’. In subsequent writing, for
example Macy and Brown (2014), this
environmental despair is not packed
neatly into a pathological framework,
but rather more eloquently and
thoughtfully discussed from an eco-
systemic perspective.
The excruciatingly painful
experiences of environmental despair
are seen as a sign of healthy awakening
to, and empathy for, the distress and
suffering of a world – human and non-
human – that is in freefall destruction,
and a gateway to meaningful action.
“We are all facing
an international
public health crisis,
and nurses from all
disciplines are on
the frontline”
Woodbury (2019) suggests an
alternative formulation of ‘climate
trauma’ that speaks to the enormity of
what climate scientists are predicting
is ahead for us if we continue to act
with the ongoing inadequate level of
changes that are required to steer us
away from catastrophe.
As we know, trauma responses are
not conceptualised as pathology but as
adaptations and attempts to continue
functioning – sane responses to insane
circumstances.
The relevance of mental
health nursing
Arguably, climate breakdown and
the predicted consequences raise
challenging questions about the
relevance of mental health nursing
beyond holding the keys, doing the obs,
dishing out the meds and supervising
people in the community.
Perhaps predictably, the
psychologists and psychotherapists
seem to have grasped the nettle
first and started the process of
organising a coherent response to an
increasingly alarming situation, having
organised themselves into The Climate
Psychology Alliance.
They appear to have the full backing
and climate-literacy of their regulatory
bodies that the Nursing and Midwifery
Council simply seems unable to
muster.
Sadly, and arguably predictably,
the NMC doesn’t appear to have
the stomach to engage with the
issue beyond relegating it to a
cursory mention of ‘sustainability’
in its labyrinthine and of course
spectacularly vague new standards.
Once again, mental health nurses
appear to have been thrown under
the bus of real world events in the
ongoing rush to create the perfect
generic ‘portable nurse’ and the NMC’s
obsession with justifying its own
relevance.
On this one, our regulator has clearly
taken its eye completely off the ball.
For want of anywhere else to go, I
have been invited to shelter with the
August/September 2022 MENTAL HEALTH NURSING
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Special issue
Climate Psychology Alliance from the
oncoming storm.
Finally, I seem to have found
somewhere to roll up my sleeves and
get stuck in with ‘climate cafes’ and
their free therapeutic outreach service.
They’ve been very kind and very
welcoming. But it can be a bit lonely
being the only mental health nurse in
the village. Anyone else fancy joining
me? n
Fred Ehresmann is a mental health
nurse specialising in working with
children, young people and their
families, and is a senior lecturer
in mental health nursing at the
University of the West of England.
He is a member of the Climate
Psychology Alliance (see https://www.
climatepsychologyalliance.org)
References
Bauden P, Jachens L. (2021) A Scoping Review of Interventions
for the Treatment of Eco-Anxiety. International Journal of
Environmental Research and Public Health. 18: 9636-54
https://doi.org/10.3390/ijerph18189636.
Kameg B. (2020) Climate Change and Mental Health –
Implications for Nurses. Journal of Psychosocial Nursing
58(9): 25-30).
Harmer A, Eder B, Gepp S, Leetz A, van de Pas R. (2020) WHO
should declare climate change a public health emergency.
BMJ 368 https://doi.org/10.1136/bmj.m797.
Hayes K, Blashki G, Wiseman J, Burke S, Reifels L. (2018)
Climate change and mental health: risks, impacts and priority
actions. International Journal of Mental Health Systems
12(28) https://doi.org/10.1186/s13033-018-0210-6.
Hogg T, Stanley S, O’Brien L, Wilson M, Watsford C. (2021)
The Hogg Eco-Anxiety Scale: Development and validation
of a multidimensional scale. Global Environmental
Change 71: 102391-401. https://doi.org/10.1016/j.
gloenvcha.2021.102391.
Isobel S, Delgado C. (2018) Safe and collaborative
communication skills: a step towards Mental Health Nurses
implementing trauma informed care. Archives of Psychiatric
Nursing 33(2): 291-6.
Leffers J, Levy R, Nicholas P, Sweeney C. (2017) Mandate for
the Nursing Profession to Address Climate Change Through
Nursing Education. Journal of Nursing Scholarship 49(6):
679-87.
Macy J. (1995) Working through environmental despair. In:
Roszak T, Gomes M, Kanner A. (Eds.). Ecopsychology:
Restoring the Earth/Healing the Mind. Counterpoint:
London.
Macy J, Brown M. (2014) Coming back to life: the updated
guide to the Work That Reconnects. New Society Publishers:
London.
McPherson G. (2020) Extinction foretold, extinction ignored.
Nature Bats Last. https://guymcpherson.com/extinction_
foretold_extinction_ignored.
Menschner C, Maul A. (2016) Issue brief: Key ingredients for
successful trauma-informed care implementation. Centre for
Healthcare Strategies: Robert Wood Johnson Foundation.
https://www.chcs.org/media/ATC_whitepaper_040616.pdf.
Ozarko D. (2018) Beyond hope: letting go of a world in collapse.
Deb Ozarko Publishing: London.
Patten T. (2017) A new republic of the heart: a guide to inner
work for holistic change: awakening into evolutionary
activism. A guide to inner work for holistic change (Sacred
Activism). North Atlantic Books.
Rosa W, Upvall M. (2018) The case for a paradigm shift: from
global to planetary nursing. Nursing Forum 54: 165-70.
Trombley J, Chalupka S, Anderko L. (2017) Climate Change and
Mental Health. American Journal of Nursing 117(4): 44-52.
17
 SUSTAINABILITY
Special issue
We can take small steps
to help save the planet
Mike Palmer considers the actions students and staff can take to improve sustainability
W
hen I agreed to write an
article on the environment
and sustainability from
the student perspective, my initial
reaction was to question how much
our profession can do to influence or
reduce negative impacts and improve
sustainability.
Luckily, my supportive university
mentors Julia Parkhouse and Stephen
McKenna-Lawson were on hand with
some excellent articles and advice, and
as I did my research I realised there
was a lack of awareness on my part,
which I was keen to overcome. Finding
out more has been a positive learning
journey.
Climate change and sustainability are
obviously massive issues with many
moving parts at local, national and
international levels.
A well-quoted figure is that the NHS
contributes between 4-5.5% of all the
UK’s carbon emissions and that around
80% of consumables relate to treatment
and care (Gallagher and Dix, 2020).
Collectively, as over 60% of the NHS
workforce are nurses, it’s possible to see
our current and future importance in
helping to reduce these figures. Working
together we can have a massive impact.
Breaking it down
With an issue so large and complex, I
think the best approach is to break it
down into simpler parts. We could start
with awareness and education.
Climate change/sustainability
education is something that needs
to be incorporated at all educational
levels to develop awareness and
stimulate discussion. I’m aware
that some universities are already
18 MENTAL HEALTH NURSING August/September 2022
incorporating this into their nursing
courses. However, this needs to be
done across the board and be an
important part of the curriculum so
students can understand the vast effect
that providing healthcare has on the
environment.
Should an amendment be added to the
NMC Code and Future Nurse Standards
for example? I feel that students can
be empowered to identify and suggest
possible improvements to workplace
practice by providing them with strong
sustainability education, as suggested by
Aronsson et al (2020).
We all could be advocates for more
environmentally sustainable practices,
not just for our patients (Richardson,
2020). Sustainable healthcare needs to
involve patients and make them more
aware of the issues facing the NHS
and the UK in the future. Could this
form part of the health promotion and
public health work that we engage in as
nurses?
There is the acronym MECC, standing
for Make Every Contact Count, for
improving patient health. Perhaps
adding an extra E for Environment to
the end would be useful.
STUDENT FOCUS
Do we have any green champions
at the university level currently? At a
ward level, more sustainability/green
champions are being created in some
NHS trusts, which is a positive step.
This needs to be implemented across all
trusts though, and best practice shared.
There is a strong argument for nurses
to be included in discussions at board
level and in executive roles (Butterfield
et al, 2021). Nurses have exceptionally
important contributions to make as
independent practitioners.
At Swansea University, we have
a student leadership academy that
enables students to develop and think
about their leadership skills. Perhaps
we could have an environment and
sustainability academy and develop the
next generation of green champions,
innovators and climate-literate nurses.
I recently undertook learning
disability champion training on a
placement, which significantly raised
my awareness and understanding of
the issue. Something similar on the
environment and sustainability would
be equally beneficial for students.
NHS Wales has set ambitious goals
of being net zero/carbon neutral by
Arek Socha from Pixabay

A focus for students
Welcome to the student focus section of Mental Health Nursing. Articles in these
pages provide news, discussion and information on the issues most prevalent for us
as students, as we work towards our mental health nurse qualification. If you have
any ideas or contributions for this section, please contact mhneditor@gmail.com.
2030. Interestingly, on 18 July the UK
government’s net zero plans by 2050
were declared unlawful by the High
Court, considering them too vague to
ensure that statutory targets would
be met. This is going to need the
involvement, engagement, innovation
and ideas of NHS personnel at all levels.
Is there more we can do at the
university level to drive environmental
innovation and education within
nursing and be leaders in this field? For
example, the Swansea Univesity student
union is running a sustainability
scheme providing free reusable
menstrual cups and reusable sanitary
pads to students over the summer. The
benefits to the environment even in the
case of one person over non-reusable
products certainly adds up over a length
of time.
We need this kind of innovation
and brainstorming to be taking
place everywhere. We all have more
creativity and innovation in us than we
recognise, and sometimes just need that
encouragement and empowerment to
contribute. There may be many valid
and vital suggestions that could chip
away at the issue.
Practical steps
At a practical level we can all focus on
our contributions as individuals. A lot
of our day-to-day activities have a large
cumulative carbon footprint, so we need
to think about what can be omitted and
what can be replaced. Can we practise
in more sustainable ways?
Ways of further facilitating carpooling
and active travel need to be explored.
Students can be quite good with
carpooling, mainly due to the triple win
of saving money, not having to drive
and helping the environment.
We need to look for these kinds of
wins to encourage people to change
behaviours by linking them to things
people value. One of my psychological
lecturers, Tony Duffy, suggests that we
get up in the morning to work towards
and pursue things we value, and the key
to helping people make positive changes
in their health lies in linking them to
goals they value individually.
I would say the same principle can
apply to environment and sustainability
– how can we link these important
subjects to other things we might value?
The NHS currently has a cycle to work
scheme, so perhaps we should increase
incentives for people wanting to invest
in electric bikes, or to try electric bikes
in work for example.
The NHS has a sustainability day
on 4 June, which ties in with World
Environment Day. This is certainly
something that could be further
developed and embedded to increase
staff awareness and health promotion.
There is a large amount of literature
on improvements at a ward level,
such as reusable personal protective
equipment, appropriate glove usage,
reduced packaging, gases from inhalers
and reusable incontinence pads.
An observation from my own
experience is the need to significantly
lower the amount of unnecessary
artificial lighting used in the working
environment during daytime hours, and
also to consider the increased use of red
lights during the night.
We are becoming more aware of the
harmful effects of artificial light and
its stimulatory effects on the nervous
system, particularly on people with
autistic traits. We could save money
and improve the work space while
also improving the effect on the
environment at large.
At a strategic level there definitely
August/September 2022 MENTAL HEALTH NURSING
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needs to be an accelerated move
towards reusable energy, in terms of
investing heavily in solar power to
provide electricity, for example.
A third-year nursing student Dominic
Smith signposted me to the excellent
example of Castle Hill hospital in Hull,
which is now self-sufficient during
daytime hours for electricity, which is
currently saving between £250-300,000
per month after investing in solar
power following a grant. The long-term
potential financial and environmental
savings of such moves are staggering.
Another example is vehicles – should
all new pool/ward cars be electric
or hybrid? A new Tesla costs around
£44,000, so it may still be out of reach
of a lot of nurses for their own personal
vehicle, but for a ward/pool car over
time that investment could pay for itself,
considering the amount of mileage
that community psychiatric nurses do
over the course of a week or for patient
transfers on the ward.
Looking ahead
I feel I’ve only touched the surface of
this topic. While you might not find me
out in front of the Houses of Parliament
campaigning soon, you will definitely
find me trying to contribute and discuss
ways we can make nursing practice
more environmentally friendly and
sustainable in the future.
Having been on this learning journey
I now feel we can all make a positive
contribution. There are steps we can
take individually and collectively, and
it is important that we begin by making
the topic a larger part of our day-to-day
conversations within nursing. n
Mike Palmer is a mental health nursing
student at Swansea University
References
Aronsson J, Clarke D, Grose J, Richardson J. (2020) Student nurses
exposed to sustainability education can challenge practice: A
cohort study. Nursing & Health Sciences 22(3): 803-11.
Butterfield P, Leffers J, Vásquez MD. (2021) Nursing’s pivotal role in
global climate action. BMJ 373: n1049.
Gallagher R, Dix A. (2020) Sustainability 1: can nurses reduce the
environmental impact of healthcare? Nursing Times 116(9): 29.
Richardson, J. (2020). ‘Nurses can be leaders and activists as well as
carers’. Nursing Times. Available at: https://www.nursingtimes.
net/opinion/nurses-can-be-leaders-and-activists-as-well-as-carers-
02-09-2020/#:~:text=The%20coronavirus%20pandemic%20
highlights%20the,social%2C%20environmental%20and%20
health%20justice (Accessed 1 July 2022).
19
 SUSTAINABILITY
Special issue
Climate Cares: pushing
for action at the
borderlands of climate
change and mental health
M
ental health and climate
change are often considered
to be among the world’s most
pressing issues. Although they have
a complex bidirectional relationship
(climate change affects our mental
health and our mental health affects
our response to climate change), their
interconnections are not yet sufficiently
considered in policy and practice – to
the detriment of mental health outcomes
and our climate response around the
world.
In recent years, the term ‘climate crisis’
has been preferred to ‘climate change’, to
reflect the urgency of the issue.
PublicDomainPictures from Pixabay
20 MENTAL HEALTH NURSING August/September 2022
Jessica Newberry Le Vay
James Diffey
The impacts of the climate
crisis on mental health
The climate crisis can have many
different impacts on our mental health
and wellbeing. These can be grouped
broadly into direct effects (following
experiences of extreme weather events
such as heatwaves and floods) and
indirect effects (resulting from an
awareness of the impacts the climate
crisis is having).
Emotional responses may look like
intense feelings of worry, sadness,
grief, disillusionment, anger or
hopelessness.
Although these feelings may be
“Climate change
is an upsetting
issue for people
to engage with for
many reasons”
uncomfortable, and may sometimes
result in diagnoses of conditions
such as generalised anxiety disorder,
depression or post-traumatic stress
disorder, they are not necessarily
signs of a ‘disorder’. Indeed, these
feelings are often signs that a person
understands and cares about the
unequal causes and impacts of the
climate crisis.
Climate change is an upsetting issue
for people to engage with for many
reasons. Not least, it challenges our
beliefs about the role of individuals,
corporations, and politicians in society.
For young people, it also includes an
intergenerational element – they have
contributed the least to the climate
crisis, they have the least power
to address it, and they will need to
experience its impacts for the majority
of their lives.
The impacts of the climate crisis on
mental health and wellbeing outcomes
are difficult to measure, and there is still
much that we don’t know about them.

However, the number of research
publications in this area is increasing,
and increasingly discussions of so-
called ‘eco-anxiety’ are starting to
feature in higher level decision making.
The emotional support
needed for an effective
climate response
The relationship between the climate
crisis and mental health is bidirectional
– the climate crisis both impacts on
and is impacted by different aspects
of our mental health (particularly our
emotional lives, our wellbeing, and
capacity to engage with potentially
upsetting issues like the climate crisis).
Without support to cope with the
difficult emotions that the climate
crisis brings up, most people disengage
from the crisis – either viewing it as too
small (denial) or too large (overwhelm)
to get involved in.
To address the climate crisis (and
other global crises like it) people need
to be supported to engage with the
difficult emotions that arise both from
learning about it and from trying to
take positive action in the face of it
(such as burnout, confusion, disillusion
and disappointment).
What can mental health
professionals do?
Mental health nurses and mental health
systems can support our response to
the climate crisis in many different
ways – by supporting individuals
experiencing climate-related emotions,
by building community resilience, and
by advocating for more sustainable
mental health systems.
“Uncomfortable
emotions in the
climate crisis are
often healthy signs
of our humanity
and compassion”
Supporting people
concerned about the climate
One of these ways is by helping clients
and other mental health professionals
to understand the validity and value of
climate-related emotions.
Large institutions such as the Royal
College of Psychiatrists are increasingly
recognising that feelings of so-
called eco-anxiety (worry about the
environment) are often normal, healthy
and understandable responses to the
climate crisis we face.
Indeed, these feelings can even be
constructive and help us to mobilise
the response to the crisis we need.
Rather than necessarily being a
sign of pathology to be ‘treated’,
uncomfortable emotions in the climate
crisis are often healthy signs of our
humanity and compassion for others.
For instance, sadness can be a sign
of grief over what is being lost, anger
can be a sign of frustration about the
injustice of climate change’s causes
and consequences (which both reflect
poorly on the world’s richest and most
privileged communities), and worry
can simply be a sign that a person is
aware of what is happening in the
world.
These feelings are often great sources
of distress for people around the world,
but seldom do they have the needed
emotional support to engage with the
topic effectively and sustainably –
leaving many people disengaged from
the crisis and, in turn, leaving the
people who do engage with the crisis
feeling overwhelmed and alone.
To learn more about climate-related
feelings and to go on the journey of
exploring your own climate-related
feelings, we recommend looking into
the content of the Royal College of
Psychiatrists (see https://www.rcpsych.
ac.uk/home, including guides for young
people, parents and carers exploring
their climate-related feelings), Hold
This Space (see https://holdthis.space,
an interactive space for exploring
your climate-related feelings), and
Generation Dread’s newsletter about
mental health in the climate crisis
August/September 2022 MENTAL HEALTH NURSING
SUSTAINABILITY
Special issue
About Climate Cares
Climate Cares is a joint initiative from
Imperial College London’s Institute
of Global Health Innovation and
the Grantham Institute for Climate
Change and the Environment.
They are a multidisciplinary team of
researchers, designers, policy experts
and educators, aiming to better
understand and support mental
health in the climate crisis, with the
vision for all individuals, communities
and healthcare systems to have the
knowledge, tools, and resources to
become resilient to the mental health
impacts of climate change.
Climate Cares’ work focuses on
three key workstreams: building
the global evidence base through
research (such as https://papers.
ssrn.com/sol3/papers.cfm?abstract_
id=3847782); raising awareness
of the links between climate,
mental health and wellbeing
through education and cross-
sector, global engagement (see
our briefing paper at https://
www.imperial.ac.uk/grantham/
publications/all-publications/
the-impact-of-climate-change-
on-mental-health-and-emotional-
wellbeing-current-evidence-and-
implications-for-policy-and-practice.
php); developing co-designed
interventions to create supportive
spaces (see https://holdthis.space)
for people to reflect, process
their emotions, envision a better
future and understand their role in
impactful action.
For more information on Climate
Cares’ research, interventions and
engagement work to date, and on
how to get in touch, visit https://
climatecares.co.uk.
21
 SUSTAINABILITY
Special issue

(available at: https://gendread.substack.

com).
“Mental health change and lead the change within
their own organisations, own sectors
Climate Cares (see box on previous nurses can and beyond.
page) is also in the process of publishing
its ‘guided journal’ activity book, which
advocate for Twin crises: common causes,
provides readers with a safe space for climate actions common solutions
exploring your own climate-related The climate and mental health
feelings and finding ways that they and policies” crises share many common causes,
can more meaningfully contribute to and recognising these presents
addressing the climate crisis. Advocating for more opportunities for solutions that can
sustainable mental health help achieve both better mental health
Building community systems and wellbeing and a safer planet.
resilience Health systems are both major Despite growing awareness of the
Building resilient communities contributors to climate change and many links between these crises, there
is essential for both coping with especially vulnerable to its effects. has not yet been sufficient action at this
and acting on the climate crisis – They must simultaneously adapt to intersection.
communities that have the capacity climate change while also reducing Many opportunities exist for mental
to support good mental health and their own emissions. health professionals to learn more and
wellbeing, and to support people to Mental health nurses can advocate get involved in climate-related action
understand and process climate-related for climate actions and policies – of their own, three of which have been
emotions. critically, ones that take into account suggested here.
This looks like connected potential costs and/or benefits to Getting in touch with organisastions
communities with strong social mental health and wellbeing. dedicated to this area can help promote
ties, with capacity to deliver timely, Imperial College London and the an effective collective response to the
accessible, mental health support, World Innovation Summit for Health current crisis, which is simply too big
and to take collective climate action, worked together to publish the key for any of us to handle alone. n
which itself boosts mental health and report ‘Health in the Climate Crisis,’
wellbeing. (see https://2020.wish.org.qa/app/ Jessica Newberry Le Vay is a
Mental health professionals can play uploads/2020/09/IMPJ7849-01-Climate- junior policy fellow, and James
a key role in working beyond their Change-and-Health-WISH2020-201030- Diffey is a researcher and training
clinical practice to support creating WEB.pdf ), which outlines how health psychotherapist at Climate Cares,
more accessible, connected, prevention- leaders at all levels can both be the Imperial College London
based community mental health
support, and equipping communities
with coping and acting skills.
This could be through supporting
green social prescribing – benefiting
connectedness to others, to nature
and climate action – or by working in
existing community infrastructures,
such as schools, to embed better mental
health and wellbeing support.
As trusted voices in their
communities, mental health
professionals can also raise awareness
among patients, their colleagues and
their wider communities on taking
climate action; Imperial’s ‘nine things
you can do for your health and the
planet’ provides examples of this.
Training with the Climate Psychology
Alliance to run your own Climate Cafes
are also a great way to help normalise
concern about the climate crisis.

22 MENTAL HEALTH NURSING August/September 2022

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