Europe has learned to count the people extreme heat kills. It has barely begun to count what that heat does to the minds of those who live through it.
Deaths are only “the tip of the iceberg”, says Francesca Racioppi, Head of Office at the World Health Organization (WHO) European Centre for Environment and Health. Around 14,000 people had already died in Europe’s early heatwaves this season, “not even one-fourth” of the way through it. Below that tally, she says, lies “a lot of disease and the effects on mental health in particular are not yet fully understood and fully quantified”.
A new policy brief puts numbers to the neglect. Of 143 heat action plans examined worldwide, 57 per cent mention mental health. Only 14 per cent include concrete steps to address it. People with existing mental health conditions are named as an at-risk group in just 18 per cent.
The brief, “Protecting mental health from extreme heat”, comes from United for Global Mental Health with the Climate Cares Centre at Imperial College London and the University of Oxford and Columbia University. It reviewed plans across 40 countries.
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The effects on mental health in particular are not yet fully understood and fully quantified.
— Francesca Racioppi, Head of Office, World Health Organization (WHO) European Centre for Environment and Health
The hidden toll
Heat harms the mind, not just the body. Research collected in the brief links higher temperatures to more hospital admissions for psychiatric disorders, higher suicide risk, and greater mortality among people with mental illness.
The starkest figure comes from Canada. During the 2021 “heat dome” in British Columbia, people living with schizophrenia faced a threefold increase in mortality risk.
The human scale is brutal. “More than 600 people died in five days, and 150 were people living with schizophrenia,” says Samantha Green, a family doctor in Toronto who contributed to the report. “Just a shocking number.”
The quieter harm is everywhere. Heat robs people of sleep, concentration and the ability to study or work, Ms Racioppi says. This summer, with the heat arriving early, several countries closed schools and daycare centres or changed their hours.
Counting deaths, not despair
The deepest failure is measurement. Europe counts heat deaths. It does not count what heat does to the mind.
An analysis of European heat surveillance systems, cited in the brief, found no examples of mental health impact monitoring. Not one. “If you don’t have a measure or measures, you don’t see the problem,” Ms Racioppi says.
Nida Wasim, who contributed to the report and is a member of the United for Global Mental Health’s Lived Experience Advisory Group for climate change and the environment, describes a chain reaction. “If we don’t recognise it, we don’t measure it. And if we don’t measure it, we don’t plan.” Heat plans chase the visible, physical harms, she says, and miss “the human experience of living through heat.”
Every jurisdiction that runs a heat health warning system should have at least one mental health indicator.
— Kimberly Humphrey, SA Health, Government of South Australia
The fix can be small. “Every jurisdiction that runs a heat health warning system should have at least one mental health indicator,” says Kimberly Humphrey, a senior emergency and public health doctor with SA Health, Government of South Australia who contributed to the report. Add it before the next season, she argues.
Yet the one national plan that committed to such research, the US National Heat Strategy, has been removed from the government website.
Four recommendations
The brief sets out four recommendations for policymakers. Recognise heat’s impact on mental health. Name people with severe conditions as those at highest risk. Monitor the impacts. And resource tailored, evidence-informed action.
For report contributor Emer O’Connell, Greater London Authority, UK, the fourth matters most. Ms O’Connell leads on health and resilience for the Greater London Authority, and previously ran the UK Health Security Agency’s extreme events team. The evidence, she argues, “has long surpassed” the threshold for action.
What already works
Solutions exist, and several are in Europe. In London, Ms O’Connell is embedding heat-risk management into the care pathways for people with severe mental illness, under the Heat Ready London plan. In Barcelona, green roofs and a network of cool refuges protect residents while supporting community mental health. Vienna’s 2022 heat plan, the brief’s model European example, names anxiety, depression and risks for people with schizophrenia and dementia.
Beyond Europe, South Australia runs free daily welfare calls during heat alerts. A one-week activation costs about 500,000 Australian dollars and returns two to three dollars for every one spent, Ms Humphrey says, “quite compelling if you’re making that pitch to finance ministers.”
In Bangladesh, the Red Cross reached 15,000 people with psychosocial support in 13 days. The speed shows what fast, targeted action can achieve when mental health is built into a heat response from the start.
Why it matters
The warning lands in a brutal European summer. The region is warming at about twice the global average.
The WHO published its first brief on climate and mental health only in 2022, “the day before yesterday” in public-health time. Mental health, Ms Racioppi says, is “the new kid on the block”. But “we need to accelerate the pace.”
As new plans are developed, mental health must be included from the start.
— Olivia Biermann, lead author of the brief
Around 160 countries still have no heat action plan at all, says Olivia Biermann, who led the brief. “As new plans are developed, mental health must be included from the start.”
