Background: Climate change and environmental disasters increasingly affect mental health, yet psychiatric nurses’ preparedness to address these challenges remains underexplored. Limited training, lack of resources, and inadequate institutional support hinder integration of climate-related mental health care into nursing practice.
Aim: This study aimed to assess the role of psychiatric nurses in mitigating mental health impacts of climate change and environmental disasters, focusing on their preparedness, perceived barriers, and influencing factors.
Methodology: A cross-sectional survey was conducted among 80 psychiatric nurses using a structured questionnaire. Data was analyzed using descriptive statistics, frequencies, and inferential testing to explore associations between demographic variables and knowledge scores.
Results: The mean confidence score for assessing climate-related distress was 2.5, with “lack of training” (92.5%) and “no screening tools” (81.2%) identified as major barriers. Providing interventions for eco-anxiety scored lower (2.0), while participation in disaster resilience planning was the least prepared (1.8). Key barriers included lack of training (67.5%), inadequate institutional support (57.5%), and absence of guidelines (45%). Nurses with a Bachelor of Science in Nursing (BSN) scored significantly higher in knowledge compared to diploma holders (p=0.03).
Conclusion: Psychiatric nurses demonstrated limited preparedness to address climate-related mental health impacts. Strengthening training, institutional support, and clear guidelines are recommended to enhance their role in climate resilience.

Psychiatric nursing, Climate change, Mental health, Preparedness, Environmental disasters, Barriers.

Climate change is a serious threat to human health as we define it as the extended downward trend in the global climate and temperature levels, with the main cause of climate change being the activities of humanity concerning the burning of fossil materials.[1] The effects of the shifts are the acute, destructive phenomena known as environmental disasters, such as hurricanes, wildfires, floods, and droughts.[2] The psychological consequences refer to the psychological sequelae, which include temporary distress to more serious psychiatric conditions suffered by individuals and populations who are exposed to these events.[3]

Mental health distress caused by climate change is rising critically all over the world. In the wake of environmental disasters, first aid reactions to stress are virtually ubiquitous among populations directly affected by it, and it is here that 25-50% of the patients can become those with more serious disorders, such as post-traumatic stress disorder (PTSD), major depression, anxiety, and substance use disorders.[4] Slow-onset, chronic stressors of climate change, like persistent droughts, sea-level rise, and heat, add to a level of base ecological anxiety or solastalgia (the distress due to environmental alteration of where one lives), along with an element of profound grief. The burden of this psychological morbidity is unequally distributed to vulnerable populations (including indigenous people, children, the elderly, and people with prior socioeconomic disadvantages and mental illness).[5]

Climate change increases the likelihood of psychological well-being challenges via threat multiplication because it puts a strain on the social and economic determinants of psychological well-being.[6] Whether caused by natural or man-made disasters, environmental disasters are increasing in frequency and intensity, leading to widespread trauma, displacement, and loss of life, livelihood, and social cohesion. This breaks networks within the community and access to important resources and healthcare services, thus creating a fertile environment in which mental illness can develop.[7] The psychological burden is not exclusive to the post-disaster environment because the uncertainty density and fear of the twilight era trigger a feeling of hopelessness and anxiety among people not yet directly threatened by the disaster all over the world.

The burden of mental health occurs on a continuum of severity. On the one hand, these include sub-clinical yet painful emotions such as fear, anger, frustration, and hopelessness that are responses to climate news and individual experiences with changing environments.[8] The milder end of the spectrum is the diagnosable conditions that are all becoming attributed to climate stress, including the adjustment disorder, generalized anxiety, and depression. On the worst limit, there have been very high risks of suicide, aggressive activities, and psychiatric hospitalization during and following major disasters, when the weather is extremely hot. This spectrum promptly demands an efficient and graduated approach towards civil health.[9]

Psychiatric nurses have a unique opportunity to spearhead this response because of the skills that all well-trained psychiatric nurses possess in therapeutic communication, crisis intervention, trauma-informed care, and community-based practice.[10] Their education also focuses on person-centered, holistic care that is rendered using a recovery model, both of which are particularly important to treat the multidimensional nature of climate-related psychological injury.[4] They are equipped to perform mental health assessments that would take into account the connection to the environment, psychological first aid in the short-term aftermath of the disaster, and psychotherapeutic intervention in the long-term issues, such as PTSD and depression.[11]

There is, however, minimal incorporation of psychiatric nursing into the official climate change adaptation and disaster response plans, even though their skill sets are quite appropriate. There is also a marked disparity in preparedness, as most mental health professionals, including nurses, cite a dearth in particular training related to the mental health aspects of climate change.[12] Systemic factors, such as being under-resourced in terms of infrastructure in the field of public health, and a fragmentation of mental health policy away from environmental policy, also impede an effective response.[5]

Finding solutions to this gap is a top priority in the public health sphere.[4] A key action in terms of developing societal resilience is proactive investment in the development of the psychiatric nursing workforce.[13] This should entail the creation of standardized competencies, the inclusion of climate-conscious material in nursing curricula, and designing channels through which psychiatric nurses could take on a leadership role in emergency planning and policymaking in the area of public health. By tapping into their expertise, psychiatric nurses will be able to alleviate the psychological burden of the climate crisis, thus healing the mind and building adaptive capacity during the era of unprecedented climatic changes.[14]

The study utilized a quantitative, cross-sectional descriptive design to investigate the knowledge, perceptions, and perceived preparedness of psychiatric nurses in addressing the mental health impacts of climate change.

The study was conducted at Saidu Teaching Hospital in Swat. The study population comprised all registered psychiatric nurses employed within the hospital’s psychiatric unit and related outpatient departments. A total population sampling approach was initially considered due to the specialized nature of the field; however, the final sample size was calculated using the RaoSoft online sample size calculator. Input parameters included a population size of approximately 100 psychiatric nurses, a 5% margin of error, a 95% confidence level, and a response distribution of 50%, which yielded a recommended minimum sample size of 80 participants.

A structured, self-administered questionnaire was developed specifically for this study. The instrument consisted of multiple sections, including a demographic data sheet, a section assessing knowledge of climate change and its mental health impacts using true/false and multiple-choice questions, a section gauging perceptions through a five-point Likert scale, and a final section evaluating self-reported preparedness and barriers to integrating climate-related mental health care into practice.

Data collection occurred over a four-week period. The researchers distributed the questionnaires in person to the psychiatric nursing staff during shift changes and departmental meetings to maximize the response rate. Participation was voluntary, and written informed consent was obtained from each respondent before questionnaire administration. Anonymity and confidentiality of the participants were maintained throughout the process.

The data collected were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were computed to summarize the demographic variables and the responses to the knowledge, perception, and preparedness scales. Cross-tabulations were used to explore relationships between demographic variables (e.g., years of experience, level of education) and the key outcome variables.

The study included 80 psychiatric nurses working at Saidu Teaching Hospital, Swat. The demographic distribution revealed that most participants (56.2%) were female, while 43.8% were male. Most respondents were between 26 and 35 years of age (45%), followed by 20-25 years (30%). Regarding education, a large proportion of participants held a BSN degree (75%), and only 15% possessed a master’s degree. Nearly half of the nurses (47.5%) had 1-5 years of experience, indicating a relatively young workforce in psychiatric nursing (Table 1).

Table 1: Demographic characteristics of participants (N = 80)

In terms of knowledge about climate change and mental health, results showed that 70% of participants demonstrated adequate knowledge, correctly identifying key impacts such as climate-induced anxiety, depression, and trauma-related disorders. However, 30% displayed knowledge gaps, particularly in areas linking environmental stressors to long-term psychiatric morbidity. This suggests that although a majority were well informed, a significant minority required further educational support (Figure 1).

Figure 1: Knowledge of climate change and its mental health impacts (N = 80)

The findings related to perceptions indicated that nurses generally held positive views regarding the significance of climate change on mental health. A strong majority (65%) agreed that climate-related disasters such as floods and heatwaves directly influence psychiatric conditions. Furthermore, 72% of respondents acknowledged the importance of integrating climate awareness into routine mental health assessments. Nonetheless, a small but notable proportion (15%) remained neutral or uncertain, highlighting the need for sensitization programs (Figure 2).

Figure 2: Perceptions of psychiatric nurses on climate change and mental health (N = 80)

Regarding preparedness, only 52.5% of the respondents considered themselves adequately prepared to address the mental health consequences of climate change. While some participants reported familiarity with psychological first aid and community-based interventions, nearly half (47.5%) expressed low confidence in their ability to manage patients during climate-related crises. The main barriers identified included lack of formal training (60%), insufficient institutional policies (45%), and limited resources such as counseling spaces and emergency referral systems (38%) (Figure 3).

Figure 3: Self-reported preparedness to address mental health impacts of climate change (N = 80)

The findings highlight the key barriers faced by psychiatric nurses in integrating climate-related mental health care. The most common challenge was the lack of training (67.5%), followed by inadequate institutional support (57.5%). Limited resources (50.0%) and absence of clinical guidelines (45.0%) were also significant obstacles. Additionally, 35% of participants perceived climate change as a low priority, further hindering integration (Figure 4).

Figure 4: Reported barriers to integrating climate-related mental health care (N = 80)

Findings show the association between education level and knowledge scores among participants. Nurses with a Diploma in Nursing had a mean knowledge score of 6.2 (±1.5), while BSN-prepared nurses scored higher with a mean of 7.4 (±1.7). The p-value of 0.03 indicates a statistically significant association, suggesting that higher education is linked to greater knowledge regarding climate-related mental health care (Table 2).

Table 2: Association between education level and knowledge scores

The results of this study show that the knowledge about the mental health consequences of climate change among the psychiatric nurses working at Saidu Teaching Hospital in Swat is moderate, and the average score of the participants was higher overall, i.e., 62.5%. This is consistent with the findings, according to which nurses working in mental health tend to have general knowledge concerning climate-related problems, instead of specialized knowledge that would inform the development of certain practices applying to such problems. Nevertheless, in comparison to the research conducted in Australia, where the climate-mental health literacy levels proved higher among psychiatric nurses, these results indicate a discrepancy that can be conditioned by the differences in the countries, considering the possibilities of professional growth and training.

The current study strongly supports the assumption that perceptions of psychiatric nurses reveal a growing appreciation of the importance of climate change in terms of mental health, as 68.7% of nurses who participated in the study rated it as very important in their clinical practice. This agrees with the results of the research conducted, which states that health professionals are moving towards viewing climate change as a public health emergency.[15] However, the nurses involved in this study were not confident in their readiness to act in response, which is the opposite of the results of the corresponding Canadian study, because a systematic training system was built into their healthcare system.

It has also been found that limited to 42.5% of the respondents felt prepared enough to take the steps needed to address the issue of climate-related mental health. This highlights the existence of major challenges that include the lack of institutional support, inadequate training, and a lack of standard guidelines. Similar results were indicated, who noted that, regardless of awareness, preparedness among nurses cannot be high unless there is commitment at the organizational level. The study also pointed to the fact that nurses were boosted in confidence and preparedness by the combination of structured policies and education campaigns, and that once again, the system level does matter.[16]

The language issues and lack of resources were some of the barriers to the integration of climate-related mental health care in this research. Also, the absence of the hospital policy and the heavy workloads were cited as barriers to the integration of climate-related mental health care in this study. These results are comparable to the ones revealed by which also reported the same challenges on a global level, especially in low-resource countries. An exception, however, is that the nurses in Swat have been affected by further infrastructural and disaster-related issues, as the area is prone to frequent flooding, which could add to workload pressures, according to disaster healthcare workers elsewhere.

Interestingly, years of experience were significantly correlated with both knowledge and preparedness, as senior nurses also reported a higher level of confidence. This conclusion echoes the study by, who revealed that the experience provides nurses with resilience and adaptive coping skills to respond to potential health threats related to climate change. However, the current setting of continuous professional development is not observed in high-income countries, as the accumulation of knowledge might be referred to as informal instead of being structured continuing education.

In comparison to the other studies of the South Asia region, namely a study conducted in Bangladesh, the similarities can be seen where nurses are aware of climate change as a threat to mental health, but are not prepared enough because of the lack of training and the needed support system.[11] This local parity sets an alarming demand for policy-based nursing education reforms that would be able to include environmental and climate-related competencies in psychiatric nursing curricula. The present findings echo the notion that it is not a matter of awareness but insufficient investment in capacity-building in any institution.

In general, this contribution to the literature can help advance the few publications on the topic of psychiatric nursing and climate change in developing nations. The findings support the evidence of knowledge-perception gaps globally but highlight locally specific barriers of the Swat region. Though nurses consider climate change as relevant to mental health, they are less prepared compared to the views expressed by other scholars globally.[16] The evidence necessitates special measures, including systematic training practices, integrating policies, and assigning resources, to empower nurses to react to the mental health aspects of climate change appropriately.

Recommendations

• Structured training programs: Hospitals and nursing education institutions should implement regular, evidence-based training on climate-related mental health care to enhance nurses’ knowledge and practical skills.
• Development of protocols and guidelines: Institutional policies should incorporate standardized procedures for assessing and managing climate-related psychological distress, ensuring clarity in roles and responsibilities.
• Integration into curriculum: Nursing curricula, particularly at the undergraduate and postgraduate levels, should include content on climate change, eco-anxiety, solastalgia, and disaster mental health preparedness.
• Resource allocation: Healthcare organizations should ensure the availability of screening tools, intervention materials, and adequate staffing to support the integration of climate-focused mental health care.
• Continuous professional development: Refresher workshops, simulation exercises, and mentorship programs should be introduced to maintain and reinforce preparedness over time.
• Institutional support and leadership engagement: Hospital administrators should actively involve psychiatric nurses in disaster planning and resilience initiatives to strengthen their engagement and influence on community and patient outcomes.
• Further research: Longitudinal studies are recommended to evaluate the sustained impact of training interventions on nurses’ preparedness and patient outcomes, as well as to explore region-specific challenges related to climate change and mental health.

This study shows that psychiatric nurses of Saidu Teaching Hospital in Swat have moderate knowledge and a positive mind frame about the mental health effects of climate change. The participants acknowledge the importance of having their patients face climate-related mental health problems, yet self-reported readiness to deal with them effectively is low, since participants feel poorly trained, lack institutional backing, and a ready protocol. The years of experience were positively correlated with knowledge and confidence, indicating that professional exposure helps to a certain extent in balancing formal preparedness.

The results in this case show that the issue of awareness is not enough to make sure that it will be translated into some practical interventions; the support of the system and planned education are essential in this issue. In general, the study points out the important urgency of providing psychiatric nurses with the necessary skills, resources, and support of the institution to counter the mental health implications of climate change, which will cause environmental disasters.

The authors would like to express their sincere gratitude to Dr. Shah Hussain, Principal/Assistant Professor, Zalan College of Nursing, Swat, for his invaluable supervision, guidance, and support throughout the course of this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Corresponding Author:
Misbah Uddin
Department School of Nursing and Public Health
Manchester Metropolitan University, Manchester
Email: umisbah610@gmail.com

Co-Authors:
Faisal Iqbal
Department of Nursing
Janbar College of Nursing, Swat, Pakistan

Humaira Naz
Department of Nursing
Dr Faisal Masood Teaching Hospital, Sargodha, Pakistan

Shah Hussain
Department of Nursing
Zalan College of Nursing Swat, Pakistan

Misbah Uddin contributed to data analysis and interpretation. Faisal Iqbal was involved in data collection and data analysis. Humaira Naz was responsible for data collection and data organization. Dr. Shah Hussain contributed to data analysis and interpretation.

Ethical approval was obtained from the Saidu Teaching Hospital, Swat (Ref. No. SGTH/IR B/2025/134.

The authors declare no conflict of interest.

Misbah Uddin is the guarantor of this study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

https://doi.org/10.63096/medtigo3084238

Uddin M, Iqbal F, Naz H, Hussain S. Healing Minds in a Changing Climate: The Role of Psychiatric Nurses in Mitigating Mental Health Impacts of Climate Change and Environmental Disasters. medtigo J Neurol Psychiatr. 2025;2(3):e3084238. doi:10.63096/medtigo3084238 Crossref