Psychosocial adaptation to climate change in High River, Alberta: implications for policy and practice

Abstract

Objectives

Psychosocial adaptation to climate change-related events remains understudied. We sought to assess how the psychosocial consequences of a major event were addressed via public health responses (e.g., programs, policies, and practices) that aimed to enhance, protect, and promote mental health.

Methods

We report on a study of health and social service responses to the long-term mental health impacts of the 2013 Southern Alberta flood, in High River, Alberta. Qualitative research methods included (i) telephone interviews (n = 14) with key informant health and social services leaders, (ii) four focus group sessions with front-line health and social services workers (n = 14), and (iii) semi-structured interviews with a sample of community members (n = 18) who experienced the flood. We conducted a descriptive thematic analysis, with a focus on participants’ perceptions and experiences.

Results

Findings of this study suggest (1) the long-term psychosocial impacts of extreme weather and climate change require sustained recovery interventions rooted in local knowledge and interdisciplinary action; (2) there are unintended consequences related to psychosocial interventions that can incite complex emotions and impact psychosocial recovery; and (3) perceptions of mental health care, among people exposed to climate-related trauma, can guide climate change and mental health response and recovery interventions.

Conclusion

Based on this initial exploration, policy and practice opportunities for public health to enhance psychosocial adaptation to our changing climate are highlighted.

Introduction

The risks and impacts of climate change on psychosocial health1 are well documented (Cunsolo and Ellis 2018; Cunsolo Willox et al. 2013; Clayton and Manning 2018). Climate hazards have been linked to post-traumatic stress disorder (PTSD), depression, anxiety, helplessness, fear, worry, suicide, violence, aggression, substance use problems, vicarious trauma, and intensified symptoms of pre-existing mental health conditions (Cunsolo and Ellis 2018; Cunsolo Willox et al. 2013; Clayton and Manning 2018; Berry et al. 2010; Carleton 2017). The literature also notes that climate change is a threat multiplier disproportionately impacting those already facing health inequities (Berry et al. 2010; Clayton and Manning 2018; Cunsolo and Ellis 2018). Notably too, there are affirmative mental health outcomes related to climate change hazards, such as the sense of community, altruism, compassion, and sense of meaning that sometimes flow from experiencing an acute weather event (Weissbecker 2011). While the study of mental health and climate change is growing, little has been written about interventions (e.g., programs, policies, and practices) that seek to enhance, protect, and promote psychosocial health and support psychosocial adaptation, particularly as it relates to enhancing health equity (but see Hayes et al. 2019 for a review).

We address this gap here with an exploration of health and social service responses to the long-term mental health impacts of the 2013 Southern Alberta flood in High River, Alberta, with a particular focus on learning about and hearing from those most at risk. We provide an overview of the health and social services responses and highlight the community-level impacts of these response interventions in High River. We then discuss the capacity of these response interventions to support psychosocial adaptation. Our research was influenced by Political Ecology (PE), a theoretical approach that guides critical inquiry into how socio-political conditions shape the human-environment relationship (Watts 2015), and the lived experiences of those most marginalized2 in society based on health inequities (see Hayes 2019, pp. 98–110 for further elaboration).

On June 19, 2013, the entire town of High River, consisting of approximately 13,000 people, was ordered to evacuate (Hurlbert 2018). The flood resulted in four reported deaths, 5 years of intensive infrastructure rebuilding, and reports of lingering mental health effects (Sahni et al. 2016; Haney and McDonald-Harker 2017). Although climate change was only one contributor to the Southern Alberta flood, we know that the likelihood, frequency, and intensity of flooding are on the rise around the globe due to climate change (Pacharui and Meyer 2014). It is worth noting that High River has experienced a number of flooding events over the last 25 years and the town is located in an active floodway, putting the town at risk for future flooding events, likely to increase in frequency with continuing climate change (Hurlbert 2018; Sahni et al. 2016). Our case study examines the 2013 flood within the broader conversation on climate change and psychosocial health, with an eye to informing policy and practice in other jurisdictions facing future extreme weather events. Specifically, our research questions were: What have been the health and social service responses to the long-term consequences of the 2013 flood in High River, Alberta? And how can an understanding of these responses support community-level psychosocial health promotion in a changing climate?

Methods

A range of qualitative methods were employed, including (i) telephone interviews (n = 14) with key informant health and social services leaders; (ii) four focus group sessions with front-line health and social services workers (n = 14); and (iii) semi-structured interviews with a sample of community members (n = 18) (see Hayes 2019). This research was approved by the University of Toronto Ethics Board, the University of Alberta Ethics Board, and Alberta Health Services ethics.

Participants in the telephone interviews included key informants from core community services (i.e., public health, primary care, and social services focused on community care in High River before, during, and after the flood), and response agencies from outside of High River that provided health and social services support for a short period of time during and after the flood. These key informants included public health professionals (at the municipal, regional, and provincial levels), government officials, emergency management professionals, public safety professionals, and faith-based representatives who were in leadership roles. Participants were asked about their professional roles and the background of the organization they worked for; the psychosocial impact of the 2013 flood on High River residents; the psychosocial needs of those most in need of support following the flood; the types of psychosocial supports available to High River residents before, during, and after the flood; perceived barriers for people accessing psychosocial supports; their perceptions of climate change impacts to mental health; and (if any) their organization’s approach to addressing mental health consequences of climate change.

Focus group participants included both core, community service representatives and response services representatives, such as teachers, emergency response personnel, mental health practitioners, regional public health practitioners, and social services providers. Focus groups differed from key informant interviews as key informants were in leadership roles, whereas focus group participants were front-line workers providing psychosocial support. Participants were asked to identify community psychosocial assets (i.e., any person, entity, organization, or practitioner that provided social or psychological care) before, during, and after the flood (up until July 2018). Similar to the key informant interviews, participants were also asked to identify any resources that address the broader problem of climate change and to identify how these resources address the issue of climate change and mental health.

Semi-structured interviews took place with High River community members who self-identified as marginalized, which is to say, as one or more of the following: low socio-economic status, female, youth, elderly, pre-existing health concerns, and racialized. While recognizing that this categorization is a limited downstream tool for participant selection that does not adequately highlight the structural nature of health inequities (Katz et al. 2019), explicit inclusion of the perspectives of marginalized group members was key because of their greater risk of experiencing negative psychosocial outcomes (Clayton and Manning 2018). It is important to reflect here that a core component of our research methodology and analytic approach was to hear from those who self-identified as marginalized, and we explored the socio-political conditions that shape health inequities and marginalization, as discussed in Hayes (2019, pp. 98–110).

The topics discussed in these interviews pertained to experiences living in High River; how the environment in High River has changed; and the type and availability of resources (people, places, policies) available to support the well-being and mental health of High River residents before, during, and after the flood (up until July 2018). Participants were also asked about their perceptions of these resources (e.g., the availability and/or effectiveness of these resources), their perceptions of climate change impacting mental health, and perceptions of how resources to support mental health and well-being could be improved.

All interviews were digitally recorded. Key informant and semi-structured interviews averaged 1 h in length, and all were transcribed verbatim. Focus group sessions averaged 3–4 h each and detailed notes were made from the digital recordings.

Analysis

We took a descriptive approach to thematic analysis, with a focus on participants’ perceptions and experiences, sticking closely to their own words. Broadly, thematic analysis is described as an analysis method “for identifying, analyzing and reporting patterns (themes) within data” (Braun and Clarke 2006, p. 79). We rely upon Braun and Clarke’s (2006) approach to thematic analysis, which includes familiarizing oneself with the data; generating initial codes; searching for themes; reviewing themes; defining and naming themes; and producing the report. It should be noted here that there are some fundamental challenges of thematic analysis, namely what should “count” as a theme? (Braun and Clarke 2006). We understood a theme to “count” if a pattern emerged a number of times from a number of voices. After noting reoccurring patterns, the following questions were asked: what is this all about? What are the unsaid, or silenced, themes that ought to be considered? Posing these questions allowed us not only to look for reoccurring themes but also to consider what and who might be overlooked. Themes were “counted” not only based on prevalence but also upon a broader reflection of what appeared to be missing, hidden, or experienced by only one or some of our participants.

We developed analytic codes that reflected the perceptions and experiences of participants across the different sources (see Hayes 2019). The lead author (KH) reviewed all of the data and established initial code books for each data set. Contributing authors reviewed a sample of the data and provided suggested amendments. The lead author worked with the contributing authors to solidify each code book and coded all of the data after the author team agreed that a point of conceptual depth with the coding had been reached.

As noted above, all data sets were analyzed individually first. Then, the entire data set was analyzed together to respond to the research questions. Emergent themes were identified by asking: what terms are participants using to describe their experiences? What is this an example of? What themes are consistent within each data set? What themes are consistent across the data sets? If there were any discrepancies among researchers about emergent themes, researchers would discuss these discrepancies, review the data, and re-establish congruent themes. Where appropriate, we have combined findings from all of our participants to discuss common themes, while also highlighting findings that particularly reflected the needs of marginalized community members.

Results

Three themes emerged in connection with our initial research questions. First, our analysis revealed a key difference between response interventions and recovery interventions, with long-term psychosocial impacts of extreme weather and climate change requiring sustained recovery interventions.3 Second, we uncovered unintended consequences related to psychosocial interventions that incited complex emotions and impacted psychosocial recovery. Finally, our research suggests that perceptions of mental health care, among people exposed to climate-related trauma, can guide climate change and mental health response and recovery interventions. Quotes from Key Informants are noted as [KI], while quotes from our semi-structured interviews with a sample of Community Members are noted as [CM].

Navigating response and recovery

Key informant interview participants and focus group participants distinguished two types of interventions. Response interventions were characterized as temporary interventions by organizations and groups that were parachuted into the community after the flood for a limited period of time (anywhere from weeks, months, to 1–3 years) to respond to the disaster and provide “emergency” services to support psychosocial well-being. Recovery interventions, in contrast, were described as core community interventions by organizations and groups that were in the community before and after the flood to support long-term psychosocial adaptation.

A key challenge identified by many respondents was that psychosocial coping resources left the community before mental health needs related to the flood were fully met. For example, one interview participant commented:

“they [response aid agencies] come in, and for two years, they save the world, and then they walk away, but we all know that two years after a natural disaster, two to five years is when it’s the worst because after two years, everybody walks away.” [CM 2].

Emphasizing this, one key informant respondent exclaimed:

“Why are we funding for three years for mental health after a major disaster? Why does it end? They have the studies, they know that the time of the disaster and the aftermath of the cleaning-up, you are not back in your home, they are saying that there are youth —that when it rains— children are still climbing into bed with their mom and dad, so why, why does all of that [funding] go away?” [KI 14].

Many participants noted the long-term mental health consequences associated with flooding, including the psychosocial toll of displacement and rebuilding, grief and loss associated with the loss of possessions or pets, and fears over mold exposure and of another flood occurring. These psychosocial outcomes tended to linger well after response interventions had left the community, and were reported as current ongoing concerns during this research, 5 years after the 2013 flood.

While response interventions may not have had the staying power that many community members wanted, the community members did appreciate how quickly services were mobilized. Some also felt that interventions from outside of the community were more accessible insofar as some community members may be less likely to seek support for mental health from people in the community with whom they are acquainted, or if there were existing barriers to entry within core services.

Most key informants and focus group participants also noted that core mental health services that provided recovery support were, and continue to be, grossly underfunded. One respondent simply stated: “there needs to be more dollars available for psychosocial support in a general sense”, regardless of a disaster or not [KI 5]. Noting the challenge of continuous care, one key informant from a core service group highlighted that her organization set up a subsidized mental health care service after the funded mental health care resources left. She noted that her organization had to rely upon a portion of the subsidized funding coming from a private, anonymous donor. She commented that this funding will not be around forever and that there is a need to find sustained funding sources to help people in the community in their flood recovery, and also to address pre-existing mental health needs.

Unintended consequences

Many key informants and focus group respondents from core community organizations indicated that response initiatives—while necessary in the immediate aftermath of an extreme weather event—could sometimes be harmful to longer-term psychosocial recovery. They noted that some psychosocial response intervention groups, particularly disaster management groups, had little or no training in mental health first aid or psychological first aid and recovery.

Some participants also noted that in the aftermath of a disaster, training in mental health first aid ought to extend beyond social and health services and include anyone who is interacting with disaster survivors. Speaking to this, one participant noted how the housekeeping and kitchen staff at the large temporary shelter for displaced flood victims needed to be trained in mental health first aid during an intensive 3-h in-service session because: “they were getting folks who were telling them they don’t want to live anymore” [KI 13]. This respondent went on to note that her organization built a relationship with all support staff who were in contact with flood victims and “taught them about grief and loss about the impact of trauma, about how to be compassionate but how to have boundaries” [KI 13].

Many participants admitted to feeling conflicted about the aid they received from temporary response organizations. They expressed gratitude for aid, and simultaneously also expressed concern about the manner in which aid was given. As one key informant stated: “it’s a challenge to talk about because you never want to seem ungrateful and we are certainly not ungrateful. We had amazing supports and resources here; but we also have to be able to say it still could have been a bit better” [KI 1].

Furthermore, many participants expressed concern about the continuity of care from outside organizations. One key informant told us: “patients felt like – ok, now who am I going to talk to? Now, I have to start all over, I have to go through all the trauma again with somebody local, you know?” [KI 12]. Respondents emphasized that these challenges stemmed from a lack of continuity built into response aid agencies’ protocols with regard to how they withdraw their services from a community (e.g., when funding has discontinued) and this may have hindered long-term psychosocial recovery for some in the community.

Other issues that emerged pertained to opportunities and resources being diverted away from the community to outside agencies. One key informant, from a local psychosocial aid organization, told us: “for a lot of the service providers it was actually an additional stress. So, as difficult as it was to have your home and business impacted by the flood, now you felt like you were protecting your job because there were other people coming in to do your work” [KI 1]. Corroborating this, another participant noted: “We have all these resources that are non-for profits that are struggling for funding, so I would have liked to have seen those places complemented with funding…instead of competition coming in” [KI 15]. In a similar vein, one key informant noted: “millions and millions and millions of dollars went to agencies outside of High River…went into training for people who were only here for a short time; not into our local staff” [KI 1]. Focus group participants also emphasized this point, noting that donations given to international or national aid organizations—intended for recovery efforts in the Town of High River—rarely went directly to the community.

The majority of key informants and focus group respondents, particularly those in core community service roles, expressed gratitude for outside agencies supporting their community when their own agencies were inaccessible or unavailable during and after the flood; however, there was concurrent concern over the lack of local capacity building on the part of outside response intervention organizations. One respondent reflected on the challenges of working with outside organizations, stating: “it was one thing not to be in the driver seat of our recovery, but we had to hold on to the bumper for months, if not years.” [KI 1]. She went on to highlight the importance of letting “the local community be leaders”, adding: “There are going to be times that they [the local community] can’t lead because maybe they don’t have the expertise or maybe they are impacted themselves”, but that this can be navigated more effectively by response intervention organizations by “building local capacity whenever possible” [KI 1].

A respondent from an outside response organization echoed this and highlighted the importance of coordinating outside efforts alongside existing community-based efforts. After her agency was awarded a (provincial) government contract to support psychosocial response after the flood, she soon realized that the contract was awarded without consultation with community-based not-for-profits. She elaborated:

“When we were asked and given the contract, we had assumed that the government had spoken with the not-for-profits in High River and that we were coming in as a big help. What we realized, is that the not-for-profits were not consulted at all”… “we thought that everyone was on the same page, not that the government had gone and done this without collaborating with the people who are on the ground in High River before and after.” [KI 13].

Overwhelmingly, respondents noted that engagement with the local community and community capacity building were key elements missing from the flood response that contributed to unintended, negative consequences.

Perceptions of psychosocial interventions

We explored perceptions of mental health care available in the community (before, during, and after the flood) among people exposed to the flood, in particular, to gain insight from marginalized community members, who tend to be most at risk and impacted by climate-related trauma. What we found, through semi-structured interviews with a sample of marginalized community members, was that concerns centered around issues related to communication in the immediate aftermath of the flood, and access to, and awareness of, psychosocial resources. Participants also provided evaluations of specific interventions that they perceived to help or hinder psychosocial well-being. These core themes are explored in detail below.

1. Communication

During the interviews, many participants highlighted the lack of communication the day of the flood. In particular, this was due to a lack of an early warning system to warn people of the severity of the flood waters. One respondent noted that there used to be an early warning system, and there now is, but during the time of the flood, the system was unavailable, and volunteers went door-to-door to tell people to evacuate. However, he noted, “they definitely didn’t have enough volunteers” to get people to evacuate in time [CM 5].

Others were concerned over the lack of communication in any other language than English. High River has a large Filipino and Mexican population, who are part of the temporary foreign workers program at a large meat-packing facility near the community. One interview respondent, who volunteered in the aftermath of the flood, relayed her experience listening to the mayor of the town speak at one of the temporary shelters soon after the flood. When the mayor asked this participant how his speech went, she said: “Well, if you look around”, I said, “English is a second language in this room”. I said, “You guys were talking really fast, so, I come and listen as a volunteer and I go back, and I explain as much as I can to them.” [CM 9]. The majority of focus group participants also noted this oversight and highlighted that interpreters had to be brought into response centres “on the fly” to support the populations who spoke little to no English.

Other respondents noted the frustration and anxiety over the unavailability of cell towers during the flooding, which made it difficult to locate loved ones during the evacuation. One community interviewee noted that it took her brother more than 2 days to locate her and her two children; she noted that the only way her brother found them was by driving around to all of the muster stations located throughout Southern Alberta [CM17].

Many respondents also noted their frustration over the lack of media coverage on High River, reportedly the hardest hit community by the flood. One respondent noted: “even though the majority of damage was happening at High River, they were focusing a lot on the small areas of Calgary that were hit” [CM 5]. The lack of media coverage on the community of High River was a consistent frustration from many respondents who were seeking information about the status of their homes and of the town when they were displaced.

• bAccess and awareness

As noted earlier, another key issue among community interviewee participants centered on issues of access to, and awareness of, psychosocial resources. When asked about the availability of mental health care resources, most participants struggled to identify resources. One participant, a youth in the community, noted her lack of awareness of resources in the community, stating: “I’m sure you can go to the hospital, and I guess that there would be someone that can help you there. Private practices, I don’t actually know about what we have” [CM 18]. Another participant who was asked the same question responded: “If they had any programs, it was just not advertised that well”. She went on to highlight that there was a lot of visible community rebuilding taking place and that seemed to take precedence over any sort of need for ‘emotional repair’.” [CM 5].

Another respondent commented that while there are a few remaining core psychosocial resources, many of the services to support psychosocial health have disappeared in recent years. She noted:

“I know that mental health has still got programs going here in High River, and that’s free of charge to my understanding, for anybody that needs it. And of course, Salvation Army is always there for the food bank, which is wonderful. I don’t know that there’s any other resources at this point…. just those two resources are still there, and I don’t know whether it’s true, but it sounds like even the mental health side of things are starting to subside.” [CM 17].

Other participants noted the challenges of accessing resources. For example, one participant who self-identified as having cognitive disabilities, and had two sons with similar cognitive disabilities, noted their struggles in receiving support with insurance claims, donations to help them recover some of their losses, and overall psychosocial support. She stated: “so, we had no access to any sort of agency or any kind of formal program. There was just nothing. I don’t know how people got things”. She went on to say: “But we tried to access them, but they said there was nothing that they could do for us”… “because we talked about, okay, you know, this is our family. We need help…we need help in dealing with this kind of stuff” [CM 10].

Other participants focused less on the accessibility and awareness of formal resources and instead noted the availability of community resources. For example, when asked about what types of resources (mental health care and social services) were available after the flood, the first thing many participants noted was a sense of community.4 One respondent stated: “Well we had each other.” She goes on to highlight a few other aid organizations but primarily highlighted the role of community and social connection with neighbours, friends, and newly formed friendships after the flood [CM 4]. Similarly, other participants noted that the sense of community in High River was, and continues to be, something that the town holds in high regard as protective of psychosocial well-being. A sense of community was brought up numerous times throughout the interviews with residents as a key component to keeping High River afloat before, during, and after the flood.

• cEvaluating psychosocial resources

Having provided an overview of our findings on the differences between response and recovery interventions, unintended consequences related to psychosocial interventions, and perspectives of marginalized community members, we now address the evaluation of psychosocial resources, which falls within the third set of findings.

When asked about the resources or services that stood out to participants, the vast majority of respondents commented on the valuable role faith-based institutions played, often in juxtaposition to government resources. For example, one participant noted: “So, I thought the support was really impressive, volunteer support, grassroots’ support. Government support was a nightmare.” He went on to note: “you know, nobody was on your side there, but the volunteers and the community of faith were there for you”. [CM 3]. Another participant highlighted the psychosocial support from one of the faith-based organizations in the community, stating:

“they have always been good about listening. So, they were so good. Like, people must have complained 100 times a day about things, or, you know, sharing sadness, and they never made you think that you were overburdening them or, you know, ‘Shut up, I don’t want to hear another thing’. They were good listeners. But, and then, financially, they were the only ones that really helped us.” [CM 10].

Another key finding from this research was that many participants highlighted the value of non-traditional forms of mental health care like mindfulness, arts-based wellness activities, and community programs focused on relieving stress. Participants spoke about the value of attending classes on mindfulness, lectures on how to use essential oils for calming, or attending calligraphy classes, Tai-chi and yoga sessions, and drum circles. While these approaches were often highlighted as helpful for some in their recovery, others noted that these approaches could be ineffective, especially when the desire and need was for formal care to address trauma. Reflecting on this, one participant stated:

“We had mental health people come into the community about that time. And I can tell you now that when I was going to those one-on-one meetings and group meetings, there was nothing more dehumanizing than being passed around mandalas, especially as an artist. I don’t know what it was. There’s something to me that just revolted to the whole idea that I was supposed to find a Zen moment here and take some time for my stress-level and colour a mandala. And here I was dealing with, you know, the enormous weight of a situation I couldn’t handle by myself and there was no help. No real help.” [CM 14].

Importantly, many participants expressed the desire for well-advertised mental health care that was accessible and available to all. Furthermore, the majority of participants emphasized their desire for long-term interventions that aptly addressed individual mental health needs.

Discussion

In this discussion section, we unpack our findings and highlight the community-level impacts of response interventions, and discuss the capacity of these response interventions to support psychosocial adaptation in a changing climate.

Some participants expressed concern about the stigma of disclosing mental ill-health to fellow community members, a recurrent theme in the rural mental health literature (Judd et al. 2006; Parr 2008). The lack of awareness of mental health resources, difficulties framing mental health problems, or challenges in access (such as after external agency withdrawal in this study), also reflect the landscape of rural mental health care in many locations (Judd et al. 2006; Hull et al. 2017; Bondy and Cole forthcoming). Some authors question concerns about access (Hardy et al. 2011) but most recognize the complexity of mental health care in rural settings (Caxaj 2016).

Similar to Parr’s (2008) findings of the importance of social and emotional capital in the Scottish Highlands, High River participants in this study valued a sense of community, the services provided by faith-based organizations, and other core community services located in High River. The broader disaster mental health literature corroborates the role of community and community-based services (see Patel et al. 2016; Aldrich 2012; Bajayo 2012; Gil-Rivas and Kilmer 2016). For example, in Building Resilience: Social Capital in Post-Disaster Recovery, Aldrich (2012) contends that social capital and a sense of community are critical elements of post-disaster recovery. In fact, Aldrich contends that these elements are more critical than economic assistance or aid groups or governments (Aldrich 2012).

Our research also suggests that receiving aid from response intervention organizations raised a range of conflicting emotions: gratitude, concerns over resource diversion, and limited capacity building by response intervention organizations. Participants’ interest in knowing where and how donations dollars were used is similar to that in many post-disaster communities (National Council of Non-Profits 2019). Furthermore, many wanted capacity built to support the lingering psychosocial consequences related to a changing climate, though few explicitly linked the flood to climate change. Post-disaster researchers have found that community collaboration, empowerment, and community building enhance disaster recovery and long-term resilience (Gil-Rivas and Kilmer 2016; Congues 2014). Gil-Rivas and Kilmer (2016) state that it is “also necessary to build the community’s capacity for informal supports and resources”. One crucial means of doing so is to create opportunities and contexts that facilitate social connectedness and interaction (Gil-Rivas and Kilmer 2016, p. 1326). Similarly, our research findings suggest that informal supports and resources, by way of community connections, was a chief psychosocial protective factor.

A key area that we wanted to make sense of through critical reflection of the data was if and how participants related their experiences to climate change. Some made the connection, while others remained skeptical. We speculate that some of our participants may have been ideologically predisposed to overlook the role of climate change (in the context of the 2013 flood), to ignore the climate change problem, given the entrenched role the political economy of the Alberta oil sands (a contributor to anthropogenic climate change) has for Albertans. Extractive energy corporations benefit from the obscuring of climate change linkages and support the current Alberta government in power, which is also reducing social protections that might mitigate marginalization (Hayes 2019, pp. 127–135).

Another reason some of our participants expressed climate skepticism may have been that they found the prospect of going through another flood untenable emotionally or physically. Thus, expressions of climate skepticism may have been rooted in protective behaviours (i.e., unwillingness to experience similar trauma to the 2013 flood).

Taken together, these findings offer initial insights on the challenges and opportunities related to response and recovery interventions following climate-related hazards which can inform psychosocial adaptation policy and practice for public health audiences in a Canadian context. These are listed in Table 1, with the caveat that this case study and its findings are likely more transferable to communities of a similar size and rural context. The first column in Table 1 groups the types of interventions that support the capacity to adapt to psychosocial consequences of climate change. The second column describes potential actions for each type which require public health and intersectoral support. We highlight the importance of both informal and formal mental health care and of intersectoral5 actions to support holistic, long-term psychosocial adaptation to a changing climate. The third column describes the potential outcomes associated with these actions. Our research suggests that successful implementation of the actions listed in the table will require collaborative actions across disciplines, informed by community knowledge and attentive to community needs, tasks to which public health practitioners and policy makers are well suited.

Table 1.

Implications for policy and practice

Adaptive capacity interventions	Public health intersectoral action (policy or practice)	Potential psychosocial adaptation outcomes
Capacity building	• Sustained mental health and social service funding • Government-led consultation* with core community services about the role of response interventions during and after a hazard • Publicly available evaluation of funding and resource allocation to response organizations • Interdisciplinary collaboration among health and social services response and recovery organizations • Engagement and understanding of local knowledge and local capacity • Succession planning between response agencies and core community services • Acknowledgement of the role of community in enhancing psychosocial recovery	• Enhanced consistency of mental health care and social service provision • Opportunities to discuss with, and gain insights from, core community service operators about interim measures when core community services are unavailable • Enhanced transparency of how donations and funding to outside operations operates • Enhanced transitions between response and recovery interventions that support long-term psychosocial well-being in the community • Local capacity building that supports sustained mental health care • Building or enhancing a sense of community before, during, and after an event
Mental health care training	• Training in mental health and psychological first aid and recovery to disaster management professionals, first responders, para-professionals, volunteers and support staff interacting with impacted individuals	• Building the capacity of professionals, para-professionals, and people interacting with impacted individuals to address psychosocial needs before, during, and after an event • Enhanced abilities to respond to psychosocial needs after a disaster
Awareness raising	• Community awareness of psychosocial services and resources  • Target awareness-raising efforts among those most marginalized • In the immediate aftermath of an acute disaster, consider using awareness-raising channels that are broad-ranging, like social media; also consider using traditional awareness-raising channels like posters and advertisements in community hubs and shelters • Ensure media coverage of disasters appropriately covers rural and remote communities and communities who have been most impacted • Target awareness-raising efforts to marginalized groups. In particular, consider the demographic and language abilities of community members and target efforts towards people with disabilities, the under-housed and homeless, and immigrants	• Awareness raising of psychosocial resources (in particular targeting messages to those most at risk to climate-related hazards) • Augmented reach of messages by use of all available communication channels to support safety, security, and well-being
Redundant communication networks	• In the immediate aftermath of an acute disaster, ensure that redundant communication networks are in place to enhance family reunification	• Expedited reunification of families and friends following an acute climate hazard
Provide a multitude of psychosocial intervention options	• Provide access to, and raise awareness of, formal mental health care interventions (e.g., by mental health care professionals) as well as informal mental health care interventions (arts-based approaches, mindfulness strategies, faith-based care)	• Enhanced psychosocial recovery that meets individual needs

*Preferably before a hazard has occurred

Compliance with ethical standards

This research was approved by the University of Toronto Ethics Board, the University of Alberta Ethics Board, and Alberta Health Services ethics.

Conflict of interest

The authors declare that they have no conflict of interest.