Mental Health Is Melting: How extreme heat hurts vulnerable communities
By Ifanyi Olele
Imagine your patient describing how oppressive the heat feels in their neighborhood. The pavement radiates heat, and there are no trees in sight to offer shade. The humidity feels like a weight on their body. Inside their home is no better, failing to offer refuge from the inferno. Perhaps they have an inefficient air conditioner or fan, or none at all. Or maybe they forgo air conditioning because they can’t afford to pay their soaring electric bills.
This is not just your patient complaining about their life — this is psychological distress laid bare.
The Impact of Heat on Emotional and Psychological Well-being
We know that heat is the deadliest climate impact, killing more Americans each year than floods, hurricanes, and tornadoes combined. But the mental health impacts of heat are less well-known.
As a psychiatrist who has worked in low-income neighborhoods in Washington, D.C. and Maryland, I have seen the mental health effects of heat firsthand. Rising temperatures can fuel anxiety, sleep disturbances, restlessness, and emotional exhaustion. Heat stress can intensify already present psychiatric symptoms for those struggling with disorders such as bipolar disorder, post-traumatic stress disorder, and schizophrenia. The heat may be more than just uncomfortable for your patients — it can be destabilizing.
This is not just a public health issue, but a mental health emergency that has been driven by history, policy, and design.
Why Are Some Communities Always Hot?
The emergency is acute in “urban heat islands,” which experience significantly higher temperatures compared to surrounding regions. Many of these areas are found in low-income and historically marginalized communities.
These heat patterns are not by accident. Unfortunately, they reflect historical systemic disinvestment, discriminatory housing policies, and environmental neglect. Racist practices such as redlining left Black neighborhoods with more concrete and fewer green spaces, so those neighborhoods are often much hotter than more affluent areas. And, as climate change turns up the heat, those neighborhoods will suffer even more. As psychiatric providers, we may not fully realize how these policies can continue to shape the lived experiences of our patients in these communities.
Extreme heat can jeopardize the mental health of our patients living in urban heat islands. Elevated temperatures can lead to increased aggression, cognitive impairment, and anxiety. Excessive nighttime heat can disrupt sleep patterns. One study found that a 1° C increase in monthly average temperature correlated with a 0.7% increase in suicide rates in U.S. counties. Another study examined the association between hot days and substance-related suicides in British Columbia, Canada, revealing that heat exposure significantly increased the risk of suicide via self-poisoning. If extreme heat can bother an emotionally stable person, imagine how it can negatively impact a person already dealing with trauma, financial stress, and moderate-to-severe psychiatric conditions.
Short-Term Fixes Versus Long-Term Solutions
Purchasing air conditioners (AC) for residents in affected communities is a necessary short-term fix. However, it is not a long-term solution for heat exposure and climate injustice. The price of staying cool with AC can become a financial burden due to rising electrical bills — in fact, Black households already face energy burdens 43% higher than white households. For many families, running the AC can mean cutting back on groceries, medications, or gas. That choice creates a kind of emotional taxation and constant calculation under pressure. And what happens when the power goes out during a heat wave? Box fans and window units are just band-aids for a bigger problem.
These stressors do not show up on intake forms but may show up in our patients presenting as overwhelmed, dysregulated, and exhausted. We need long-term, climate-informed mental health solutions. The good news is that we are not powerless: intentional investments can yield meaningful solutions.
How Can Communities and Mental Health Professionals Help?
Local government leadership can invest in tree-planting programs in historically redlined and heat-burdened zip codes. A 2019 study of 97 U.S. cities found that urban tree cover helps avoid 245–346 deaths annually. Urban areas with sufficient tree cover also prevent some 100,000 heat-related doctor visits per year. In addition to tree-planting programs, there should be investment in heat island solutions, such as cool pavements and green and cool roofs.
We, as providers, should advocate for public health policies to view climate threats as mental health risks. This would provide cause for local health departments to train and equip us with additional skills and education to serve our patients in environmentally vulnerable communities. Mental health professionals should be part of resilience planning and serve as frontline responders to heat events, similar to the support given during floods and fires.
Psychiatric providers should also be included in resilience planning at the city and county level. We can assist in shaping solutions that integrate emotional support with environmental adaption. For example, city and county officials can invest in resilience hubs in the hottest and most under-resourced neighborhoods. These facilities can offer cool air and emotional support during heat waves.
Mental health is melting. It’s past time we treat climate change not only as an environmental issue, but as a threat to the mind, body, and spirit. Imagine residents of former urban heat islands enjoying shaded areas and cool air during summer heatwaves — that is climate justice. Proper resources for vulnerable communities can contribute to fewer medical and psychiatric emergencies, lower energy costs, and less discomfort in extreme heat. Climate justice isn’t just about keeping places cool; it is about restoring dignity and peace of mind to our vulnerable patients.
Ifeanyi Olele, DO, MBA, MS, is a psychiatrist and a Climate Health Equity Fellow with the Medical Society Consortium on Climate and Health.
This article was published in collaboration with the Island Press Short-Form Program, which is supported by the Freedom Together Foundation, The Kresge Foundation, and The Summit Foundation. It was originally published July 16, 2025 in MedPage Today.
