Photo credit: H M Shahidul Islam/iStock, BARC IED, & Humanitarian photographer working for UN Agencies/iStock

Written by Saima Akhtar Afsha and Tabassum Amina (BRAC Institute of Educational Development, BRAC University)

Asma (full name withheld) lives with her family on a precarious char (sandbar) in the Karatoya River in Rajshahi, in north Bangladesh. She has no fixed address: seven times now, she and her husband have rebuilt their home from salvaged bricks, and watched it crumble again into the river during the monsoons. Rather than uprooting themselves entirely from the community and moving to an informal settlement in a city, as thousands do in Bangladesh each day, they have come to accept that this will happen again. They stay on and pay the heavy toll extracted by an increasingly fickle and dangerous monsoon because they know that life will not necessarily be better in the city, where they will be the “chorua” (a derogatory word for people living on chars). The constant loss of their home and belongings continues to extract a heavy mental toll.

Sheuly (full name withheld) and her family, meanwhile, were forced to migrate to Mongla from another part of Khulna district. Any hope they brought to the city has long since dissipated. Mongla is severely affected by rising levels of salinity, resulting in an acute shortage of drinking water and soil on which to grow food. Employment is hard to come by – for women, but also for men. Children have no incentive to go to school, and child marriage and anti-social activity by young people is rampant. Sheuly finds solace in her friendships with the other women in the settlement, but her stress levels – and those of her family and friends – are constantly high.

Floods and river erosion are not alien to people in Bangladesh, although the increasing severity and frequency are attributed to climate change. While community cohesion has always been a strong adaptive response to deal with these disasters, acknowledging the mental health impacts of constant loss and sustained stress is often a social taboo.

Groups already affected by social inequalities, such as those with existing mental illness or living in poorer countries, are more likely to be affected by climate change, less likely to have access to support and resources to mitigate against the emotional impacts of climate change, and at higher risk of negative mental health and well-being outcomes. The effects of climate change on mental health are therefore a driver and compounder of health and social inequality.

Recognizing the severe impacts of mental health on physical health, the Global Center on Adaptation (GCA) is working with BRAC, an international development organization based in Bangladesh, and Columbia University’s Billion Minds Institute project, to document the psychological impacts of climate change on poor and vulnerable communities in Bangladesh. GCA and BRAC are supporting communities to develop locally led People’s Adaptation Plans in secondary cities, to inform investments by international financial institutions. With support from the Billion Minds Institute, communities developing such plans will be encouraged to explore the psychological impacts of climate change on the poor, through the community-led vulnerability profiling and enumeration that takes place during this planning process.

Efforts are also underway to explore potential ways to address these impacts, learning from efforts to deal with mental health impacts in the broader development context. The BRAC Institute of Educational Development (BRAC IED), for example, trains and hires women from within the community to serve as “paracounselors”. Women aged between 20–35 years with empathy and motivation, as well as social, communication, and rapport-building skills, are recruited from within the community as field staff. They undergo a five-day basic training program that provides basic knowledge of mental health and psychosocial support. They are taught methods such as rapport-building; observation; interviewing; data and information collection; analysis and assessment; and safety and safeguarding.

Each trainee is then paired with an experienced psychologist for handholding and supervision. The psychologists provide experiential learning opportunities by sharing their experiences and allowing the trainees to observe sessions. Following a 15-day handholding session, trainees are assessed on their knowledge and skills before they are allowed to attend to the psychosocial well-being of members of their community.

Where BRAC IED has existing programs, the paracounselors identify individuals to support through observation and informal conversations. In areas without programs, they visit individuals based on referrals. The paracounselors are popular in their communities, and their services are sought after. They receive continuous skills development through group supervision and refresher training, as well as psychosocial support when needed.

BRAC IED’s paracounselors report high levels of hopelessness, fatalism, fear, anxiety, sleeplessness, and a persistent sense of loss among people living in areas affected by extreme and slow-onset climate impacts. This is borne out by a 2023 study in Bangladesh, which found that individuals experiencing a 1°C higher temperature had a 21% higher probability of reporting an anxiety disorder, with a 24% higher likelihood of experiencing both depression and an anxiety disorder at the same time. The study notes that mental health conditions can have physiological manifestations for individuals, increasing out-of-pocket expenses while negatively impacting quality of life and productivity. At a national level, these effects can lead to an increased financial burden on healthcare, hinder economic growth, and raise levels of poverty.