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Heat Health Awareness: Why it’s Important for Persons with Substance Use Disorders and Mental Health Conditions, Caregivers and Health Care Providers

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Last year, amidst one of the warmest global summers recorded, the Biden Administration launched as a “a one-stop hub on heat and health for the nation.” The website provides information on at-risk groups, tools and resources, and ways to prepare for extreme heat. is overseen by the National Integrated Heat Health Information System (NIHHIS), an interagency collaboration that includes the National Oceanic and Atmospheric Administration, Centers for Disease Control and Prevention (CDC), Federal Emergency Management Agency, Administration for Strategic Preparedness and Response and the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA was a founding member of NIHHIS. As NIHHIS plans for its annual social media campaign, it’s important to note SAMHSA’s role and why heat awareness is important for the behavioral health community.

Key Take Aways - Heat Health

  1. More people die in heat-related weather events than in other types of extreme weather events.
  2. Risks of heat-related illnesses or death begin even before “extreme heat” emergencies are declared, as ambient temperatures rise.
  3. People with behavioral health conditions are among those at highest risk of heat-related illnesses or death from extreme temperatures, including heat waves. Psychotropic medications may increase risk, and use of alcohol and other substances also can place people at more risk of harm.
  4. Sleep loss during periods of prolonged, extreme heat may be a contributing stressor for mental health and substance use conditions.
  5. During a heat event, if a person is facing a barrier to accessing air conditioned or cooler environments (such as during a blackout),one good way to cool down is to take a bath or shower.
  6. People who are unhoused, housing insecure, or lower income (and therefore perhaps unable to afford air conditioning) face higher risks during extreme heat.

Climate Change Impacts Mental Health and Substance Use

Climate change is already having significant impacts on mental health and substance use. A 2021 report by the environmental group ecoAmerica and the American Psychological Association (APA) describes growing “climate anxiety” among those concerned that climate change will impact their lives and those of their friends and loved ones. Many young people, as those likely to experience the most intense climate-change-related impacts in their lifetime, are especially concerned about the impact of climate change. For instance, a June 2022 Oregon report that included a literature review and focus groups found that youth “are experiencing feelings of hopelessness, despair, anxiety and frustration about climate change.” Many report feelings of anger and not being taken seriously by adults.

Climate-related natural disasters, the ecoAmerica/APA report observes, can cause post-traumatic stress disorder, anxiety, and depression, as well as undermine strong social connections. Heat itself impacts both the body and mind, making it a “physiological and psychological stressor.”

Extreme Heat Can Be Dangerous for Those with Behavioral Health Conditions

The importance of health providers, government agencies, and communities paying attention to the risks of extreme heat and climate change were underscored by a 2021 heat wave on the West Coast, including Washington and Oregon as well as parts of Canada. The heat wave, described by researchers as “unprecedented,” led to record-setting temperatures in the last week of June 2021 as what the media called a ‘heat dome’ covered the region. There is a 50 percent chance that such events become a “yearly occurrence by 2050,” according to one research team. An analysis of the event by Multnomah County (OR), which includes Portland, attributed 69 deaths to the extreme heat during that time. Those most vulnerable included older adults, homeless or those at-risk of homelessness, and those living in multi-family buildings. A similar analysis in Washington attributed 100 deaths statewide to the heat wave. Emergency department use increased across the region. A study published by British Columbia public health researchers found those with schizophrenia were among those at highest risk during the heat wave. And while those with schizophrenia were especially vulnerable, those with other conditions such as depression and substance use disorder also faced increased risks of death. Other researchers have found emergency department visits related to mental health conditions and substance use disorders may increase more often than those for other conditions during a heat wave. Those in at-risk groups such as homeless populations, some of whom may have substance use conditions or mental health disorders, may be especially at risk.

Heat events also have implications for those who do not have preexisting mental health conditions and substance use disorders. One review, for instance, indicates a relationship between extreme or prolonged heat events and exacerbation of mental health conditions and suicide risks (though more research is needed). Increases in temperatures can lead to disrupted sleep patterns and sleep deprivation, which may contribute to mental health and substance use complications during heat events. For example, a 2022 study “Rising Temperatures Erode Human Sleep Globally” found that per one degree of warming, sleep loss was about twice as high among the elderly compared to younger adults and sleep loss was three times higher among people who are low income. Sleep loss can exacerbate stress and anxiety. Research also shows a relationship between ambient warm temperatures and human emotional states; for example, researchers found worsened expressed sentiments in social media during heat waves. This type of research appears to support other observed and researched relationships between increased warm temperatures and acts of aggression. The relationship between these factors and increased substance use is a growing area of research.

Extreme heat events also interact with social economic status in a variety of ways. People who have lower socioeconomic status have more likelihood to be exposed to extreme heat (e.g., longer periods of being outdoors during wait times for public transportation, financial challenges in paying for home air-conditioning). In attempting to avoid these exposure factors, people with lower socioeconomic factors may also have less ability to access in-person health appointments. As mentioned throughout, along with higher likelihood of exposure, people with chronic health conditions such as serious mental illness or substance use disorder have high susceptibility to worse heat health and behavioral health outcomes in these events.

SAMHSA is Working to Reduce Risks of Extreme Heat for Those At-Risk

Given the increased vulnerability of those individuals that SAMHSA serves, such as people with behavioral health conditions and people experiencing or at risk of homelessness, SAMHSA’s engagement in NIHHIS is vital. SAMHSA staff and experts helped to support the group’s second conference in April. NIHHIS also is developing a federal strategic plan for how federal agencies will work together and with others to lead federal efforts related to extreme heat. The Administration is supporting many other efforts, including an interagency working group focused on coordination and data sharing.

In addition to supporting NIHHIS, SAMHSA has collaborated with the HHS Office of Climate Change and Health Equity (OCCHE), an office in HHS focused on the health impacts of climate change and environmental justice issues, to ensure behavioral health needs are among the Department’s climate change priorities. SAMHSA staff are implementing action items developed through collaboration with OCCHE. SAMHSA worked with OCCHE to develop a public website on climate change and health equity and introduced more climate-related supports into materials from the Disaster Technical Assistance Center (DTAC). SAMHSA also noted the impacts of extreme heat in its 2022 Request for Information (RFI) on climate change and health equity and is in the process of analyzing comments received.

Though a full analysis is still in process, several comments urged SAMHSA to work with federal and other partners to focus on persons with behavioral health conditions, children and youth, people from indigenous communities and communities of color, first responders, climate migrants (those leaving areas due to climate-related circumstances or disasters), people from lower income communities, and others. Respondents noted the importance of more education about the risks of medications, including psychiatric medications, and extreme heat as well as need for additional research on the effects of climate on mental health and substance use and need for evidence-based climate behavioral health adaptation resources.

Responding to such concerns, SAMHSA recently developed a fact sheet titled Tips for People Who Take Medication: Coping with Hot Weather, discussing steps those taking medications for mental health conditions can take to help reduce their risk. SAMHSA also provides input to the CDC and other NIHHIS partners on their extreme-heat-related educational materials.

Examining the groups of those at risk from heat-related disasters, persons with behavioral health conditions, as well as their families/caregivers and providers, should ensure they have a plan for emergencies and disasters, whether a heat wave, hurricane, tornado, or flood. has excellent tools on recognizing signs and symptoms of illness when someone experiences extreme heat and how to help. The website has good advice about how to stay safe during hot weather, such as wearing sunscreen and light clothing, cooling down when needed, drinking water, and avoiding the outdoors when feasible.

Concluding Thoughts

As summer approaches, it can be great to enjoy the outdoors and all that warmer weather has to offer. Yet, when there are extreme temperatures, individuals, families/caregivers, behavioral health providers, and government agencies should try to reduce the risk for people with behavioral health conditions, people experiencing lack of access to stable housing, and others who may be at risk. NIHHIS and provide excellent starting points for actionable ideas on how to help. SAMHSA staff are carefully reviewing comments received in response to the Climate Change RFI. In that review process, SAMHSA staff will discuss internally and with federal and other partners how behavioral health systems and services can increasingly become climate informed.

Acknowledgements: The authors gratefully acknowledge Anne Reim (SAMHSA), Leslie Chae (SAMHSA) and Kimberly McMahon (NOAA) for their review and comments.