Preventing heat-related illness in people with severe and persistent mental illness: a quality improvement educational intervention

Climate change poses severe health risks to people with severe and persistent mental illness (SPMI), particularly from extreme heat events. People living with schizophrenia had three-fold higher mortality during the 2021 heat dome event in British Columbia. Multiple factors increase vulnerability, including thermoregulation impairment from neuroleptic medications and neurobiological changes, cognitive symptoms affecting risk comprehension, social isolation, comorbid physical conditions, housing instability, and barriers to accessing cooling resources due to stigma and poverty.

This pilot quality improvement study addressed knowledge gaps among frontline mental health providers in Ontario, Canada. We delivered 20-minute educational presentations to 26 mental health teams, including Assertive Community Treatment (ACT) Teams, Flexible ACT, and Intensive Case Management teams. Pre- and post-surveys assessed knowledge, attitudes, and skills among 102 participants (primarily nurses, social workers, and community mental health workers). We provided practical resources including air conditioner funding application templates, resource lists, and visual reminder stickers for clients.

Post-intervention surveys from 44 participants demonstrated increased knowledge of heat-related risks, improved confidence in recognizing heat exhaustion and heat stroke symptoms, and enhanced comfort in prevention and intervention strategies. Participants identified needs for visual aids and systemic solutions like maximum indoor temperature bylaws.

While clinician education is necessary, systemic interventions, client-focused education co-created with peers, community health checks, and universal protections are essential to protect the most vulnerable. Future work must include people with lived experience in program design and pursue policy-level advocacy for comprehensive climate adaptation. Extreme heat poses an increased risk of morbidity and mortality to people living with SPMI. Psychiatrists and mental health service teams must be better prepared to protect people from the health consequences of extreme heat