Abstract
Introduction
The climate emergency holds profound and immediate threats to our health and wellbeing. The World Health Organization (2021) has estimated the impact on the social and environmental determinants of health; direct damage-costs to healthcare may reach two to four billion per annum by 2030.
A recent Lancet report highlighted inequities in the climate crisis, illustrating how socioeconomically disadvantaged and vulnerable communities will be overburdened (Romanello et al., 2021). Correspondingly, others depict climate change as a threat amplifier, which will exacerbate existing disparities (Kjellstrom & McMichael, 2013). Psychiatrists have identified similar paradigms, with marginalised groups disproportionately affected (Cianconi et al., 2020; Hayes et al., 2018).
People living in detention constitute some of the most vulnerable individuals in society and climate change will worsen their already precarious circumstances. As general clinical interventions and preventive measures amidst the clinical emergency remain underdeveloped (Obradovich & Minor, 2022), we wish to emphasise social psychiatry’s importance in shaping sustainable solutions within detention settings.
Climate change and detention facilities
The relationship between mental health in detention facilities and climate change is underreported and additional research and education is required. For some, incarcerated individuals may seem peripheral, or even deserving of their fate. However, people living in detention exhibit elevated rates of physical and psychiatric morbidities compared to the general population (Bebbington et al., 2017; Fazel et al., 2016). Significantly, this is evident in Africa, a continent which may be acutely engandered by climate change; for instance, in a sample of South African offenders, there was a 54.7% lifetime prevalence of mental health disorders (Modupi et al., 2020).
Despite these realities, provision of psychiatric support within detention-based frameworks is challenging (Simpson et al., 2022) and inadequacies have been discussed (Metzner & Fellner, 2010), with COVID-19 further destabilising conditions (Ogunwale et al., 2020). Non-equivalence of care inside detention settings also heightens this scenario of disadvantage (Niveau, 2007; Wilson, 2004). Analogous patterns are evident in low- and middle-income regions, which are susceptible to climate shocks; worryingly, these account for around 70% of the global incarcerated population (Gureje & Abdulmalik, 2019).
Climate change and extreme weather events will intensify systematic deficiencies. Risks of severe temperature exposure (both hot and cold) for individuals living in detention have been underlined (Motanya & Valera, 2016; Skarha et al., 2020), and abject conditions in solitary confinement can only be imagined, particularly for those with psychiatric morbidities. Mass incarceration and overcrowding could escalate the spread of communicable diseases, undermining insufficient infrastructure. Equally alarming is the location of detention settings near toxic sites, exposing offenders to environmental contaminants (Bradshaw, 2018). Further, extreme weather events raise human rights concerns. During Hurricane Katrina, authorities abandoned people living in detention, with rising floodwater and depleting resources (Frenkiel, 2006). More recently, flooding in Cambodia provoked questions about essential provisions for offenders (Dara, 2020).
Within this context and from an intergenerational justice perspective (Meyer, 2021), future generations may conceivably consider mass incarceration as a moral burden and as anachronistic as non-renewables. This is pertinent given the apparent carbon footprint and ecological pollution of detention settings. Researchers have linked higher numbers of incarcerated individuals to increased carbon emissions (McGee et al., 2021). Others have discussed how sewage from detention facilities has contaminated local ecosystems (Prins & Story, 2020).
Additional ethical concerns arise when one recalls that detention centres in some jurisdictions (notably the United States) are commercial enterprises, relying on an increasing number of offenders to maximise financial margins; is there therefore no consequentialist comparison between for-profit incarceration and for-profit fossil fuels? Moreover, there are also accounts of ecologically harmful industries, like the mass harvesting of palm oil, exploiting offenders as forced labour (Pattison, 2020).
Mental health approaches and the role of psychiatrists
Given the associations between adverse physical and social environments in detention settings and mental health issues (Calles-Rubiales & Ibáñez Del Prado, 2020; Nurse et al., 2003; Penal Reform International, 2017), climate change will have devastating implications for psychiatric support within incarcerated populations. Accordingly, our discipline has an important part to play in urging authorities and non-governmental organisations to prevent a potential mental health emergency. Amidst the climate crisis, governments and relevant agencies must institute appropriate evacuation procedures for offenders, sufficient temperature controls and ensure ongoing provisions of psychiatric and medical care with clear emphasis on care equivalence. Presently, the signs are not promising; for example, lawmakers in Western Australia recently stalled on introducing effective heat mitigation measures in a facility which can reach 50.5°C (de Kruijff, 2022). In New York, incarcerated offenders faced freezing temperatures with inadequate thermal clothing or protection (Asgarian, 2019).
More significantly, perhaps it might take something as devastating as the climate emergency to shift the needle on a timeworn debate about mass incarceration in global society. In distinct jurisdictions, there are high recidivism rates following periods in detention (Yukhnenko et al., 2020), especially for individuals with mental illnesses (Chang et al., 2015; Lovell et al., 2002). Consequently, the climate crisis has entailed cautious calls for the abolition of incarceration as a penal policy (Purdum et al., 2021). Such discussions go far beyond the scope of this editorial, but seem unlikely given heterogeneous legal systems and ideologies worldwide.
Nonetheless, to inform sustainable alternatives to mass incarceration for vulnerable groups amidst the climate emergency, we should utilise the extensive evidence-base in our field. In the authors’ opinion, it is essential that we reemphasise community-based interventions, enhanced parole procedures and aspects of social psychiatry relevant to offenders with mental health conditions. For instance, stable housing (Saddichha et al., 2014), gainful employment (perhaps in green economic sectors?; Hamilton et al., 2015) and social networks (Swinkels et al., 2020), should be prioritised.
Substance and alcohol use disorders require sufficient treatment given their correlates with recidivism (de Andrade et al., 2018), and therapeutic communities, which have good efficacy, should be utilised (Beaudry et al., 2021). Further, studies suggest that forensic outpatient care (day clinics or ambulatory care) may reduce recidivism in offenders with mental disorders, whilst improving general functioning levels and the severity of psychopathology (Krammer et al., 2020). Regardless of the adopted approach, all practices must be predicated on individual gender-based and socioeconomic circumstances (Kjelsberg & Friestad, 2008).
Concluding remarks
The climate crisis will severely affect people living in detention with mental health disorders. Rising temperatures and extreme weather events will aggravate pre-existing deficiencies in care. Equally, we cannot overlook the potential ecological damage and carbon footprint of detention facilities. Psychiatrists should recognise the risks of climate change for offenders and continue to advocate for alternative interventions to mass incarceration given their centrality to safeguarding the mental health and healthcare of these marginalised constituencies.
As the climate emergency intensifies and precipitates potentially lethal consequences for our society and our world, the following conviction is especially pertinent: all psychiatry is social psychiatry. Now more than ever, the human rights of vulnerable individuals must be protected. The eyes of future generations are upon us.
