Geopsychiatry,global vulnerability,mitigation and psychiatry

Crises across the world are having a huge mental health impact on millions of people’s lives and are fuelling the burden of global poverty. There is a growing global awareness that geopolitical factors such as climate change, pandemics, conflict, natural and manmade disasters, displacement and erosion of human rights play a major role in the mental health and wellbeing of individuals.

The World Bank Group Report Poverty and Shared Prosperity 2020 (World Bank Group, 2020) estimated that COVID-19 would have added as many as 150 million more people categorised as ‘extreme poor’ by the end of 2021, with eight out of 10 ‘new poor’ residents being in middle-income countries. By 2030, an estimated 80% of the world’s extreme poor would live in fragile states (Organisation for Economic Co-operation and Development, 2018). The COVID-19 pandemic is aggravating insecurity in vulnerable and fragile countries and territories and adding to the global burden of displacement as more people move to get out of an extreme poverty trap.

In addition, COVID-19 is having a significant impact on people’s mental health. A World Health Organization (WHO, 2022) scientific brief indicated that rates of already common conditions like depression and anxiety went up by more than 25% in the first year of the pandemic, adding to the nearly1 billion people who were already living with a mental disorder.

The climate crisis is affecting different parts of the world differently and not all countries are equally responsible for the climate changes now or historically. The world’s poorest countries already suffer the most from ongoing climate change and are the least able to afford mitigation and adaptation measures (Brookings Institution, 2021). A third of the world population is now exposed to climatic conditions that produce deadly heat waves. People from low and lower middle-income countries are five times more likely to be displaced by extreme weather. An estimated 2 billion people – about one-fifth of the world’s population – may become climate refugees from rising seas by 2100 (Geisler & Currens, 2017).

Over the past decade, international migration has been increasingly weaponised as ‘a political tool’ to undermine cohesion and aiming to divide communities on the issue of migration, discounting the significant benefits that migration brings to the communities and ignoring our worldwide migration histories. Global migration flows are shaped by geopolitical processes including those reflected in, and responding to, collective violence, political unrest, food insecurity, colonisation, climate change and environmental degradation. In the spring of 2022, approximately 90 million people were forcibly displaced. The conflict in Ukraine has resulted in more than 6 million people displaced. 85% of refugees have been hosted in low- and middle-income countries, 73% in neighbouring countries with just 7% hosted in high income countries. The United Nations Refugee Agency (UNHCR, 2021b) has reported that forced displacement has doubled in the last decade. 68% of refugees and forced migrants displaced abroad came from just five countries, according to the UNHCR mid-year trends report (UNHCR, 2021a). 6.8 million came from Syria, 4.1 million from Venezuela, 2.6 million from Afghanistan, 2.2 million from South Sudan and 1.1 million people from Myanmar. Forced displacement and migration reflect a wider context from countries or regions where people are facing major geopolitical challenges.

Immigrants, refugees and asylum seekers are likely to experience high rates of psychiatric disorders, for example, they are likely to report up to 10 times more post-traumatic stress symptoms than the general population (Fazel et al., 2005). It is also known that post-traumatic stress and distress, in general, are associated with substance abuse and functional impairment (Roberts et al., 2016). The pandemic, the war in Ukraine and protracted conflicts in Afghanistan, Ethiopia and Syria have increased the need for mental health services and psychosocial support in these regions. A WHO review of 129 studies in 39 countries showed that among people who have experienced war or other conflict in the previous 10 years, one in five people (22%) had depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia (Charlson et al., 2019).

There are no binary approaches that could solve these complex and enmeshed challenges in psychiatry. The Compassion, Action, Pragmatism and Evidence (CAPE) Vulnerability Index (Persaud et al., 2021; Torales et al., 2021) is a global index that highlights the need for assistance in countries with a high degree of vulnerability and how these vulnerabilities may play a critical role in mental health. It is time for a new global mental health order and to find a new approach to tackle today’s most stubborn and urgent development challenges. Psychiatry is now being located in a new Geopsychiatry modern intersectoral field (Castaldelli-Maia & Bhugra, 2022) which focuses on the effects of climate change, disasters, globalisation, population growth and movements, urban agglomeration, agricultural production, industrialisation, geopolitics, socioeconomic transformation and cultural practices as they affect the mental health and illness process. Geopsychiatry offers this new inter-national mental health dimension; using this pluralistic approach frames mental health and in particular mental illnesses as being under the ongoing influence of geographically-rooted systems of political influence and policy making. It considers certain aspects of mental health as being influenced by local, regional and national policies acting in tandem and in relation with social exposures (Persaud & Bhugra, 2022). Policy-making, research and clinical practice should focus on actions that prevent, mitigate and respond to the mental ill health arising from these global crises and international factors. If these were to be achieved it could be an important addition in explain health, illness and health-care delivery and their complex relationships from a supranational and international viewpoint.