Chapter 4. Supporting Clients

Many patients, especially young people, are experiencing climate change-related mental health distress. They might not use the term “eco-anxiety,” but they express worry about the future, grief over environmental losses, or anger at inaction. As care providers in Canada (particularly here in British Columbia), it’s important to recognize these climate-linked emotions and support patients in a way that is compassionate, trauma-informed, and empowering. This chapter focuses on practical approaches for health and social care providers to support individuals—especially youth—coping with climate distress. We’ll discuss how to identify climate anxiety, offer applied strategies (from screening questions to social prescribing), consider developmental impacts on youth, and emphasize strength-based care that nurtures hope and resilience. An “In Focus” case example will illustrate how a community in B.C. put these principles into action. Let’s dive in, with the goal of helping patients feel heard, validated, and supported in the face of climate change challenges.

Recognizing Climate Distress in Youth

It helps to first understand what climate-related distress can look like. Young patients may present with familiar symptoms—anxiety, low mood, irritability, or trouble sleeping—but if you listen closely, their worries about the planet or the future might be a driving factor. A landmark 2021 survey of 10,000 youth (ages 16–25) across ten countries found that 59% were “very” or “extremely” worried about climate change, and over 45% said these feelings negatively affected their daily life and functioning (1). More than half reported feeling sad, anxious, angry, powerless, helpless, or guilty about climate change (1). In Canada, surveys have revealed similar patterns of distress. The Mental Health Commission of Canada notes that while eco-anxiety is not a formal diagnosis, it is characterized by a range of symptoms such as persistent worry, **“fatalistic” thinking (e.g. “why bother trying if it’s too late?”), guilt about one’s carbon footprint, and even physical effects like insomnia or loss of appetite (2). Crucially, youth often feel they will bear the brunt of climate impacts, which can fuel fear for their future (2).

Climate distress can manifest in diverse ways. For some young people, it’s general anxiety and dread when they think about rising temperatures or extreme weather. Others experience profound grief over the loss of species or the natural world (“eco-grief”). Anger is also common—often directed at older generations or governments perceived to be failing to act (2). For example, a patient might express anger that “those in power aren’t doing enough, and it’s not fair that we have to deal with this.” These feelings are often intensely personal. One B.C. provider shared that a university student became hopeless about the “futility” of her environmental science studies, saying it felt like “we already know the problem… we need to stop burning fossil fuels” (3). Another case described a teen whose climate anxiety contributed to disordered eating; she felt compelled to eliminate carbon-intensive foods in an attempt to personally fight the crisis (3). These examples show that climate concerns can intertwine with other mental health issues or health behaviors.

Importantly, we should recognize that climate anxiety, in and of itself, is not a pathology or mental illness (1). In fact, many researchers emphasize that feeling distressed about climate change is a rational response to a genuine existential threat (1). In other words, your patient’s anxiety is coming from a real place—our warming planet—and it often reflects empathy and concern for others and the environment. As the Lancet’s climate-anxiety study noted, this distress is an “understandable and even healthy response” to the threat, and can motivate constructive action (1). However, when that worry becomes overwhelming or constant, it can impair functioning and well-being (3). Some youth report difficulty focusing on school or planning for milestones because they feel “the future is frightening” or even that “humanity is doomed” (1). At its worst, unchecked climate despair might lead to depression, hopelessness, or avoidance of important life activities (for instance, some youth even question whether they should have children in such an uncertain future (3)). That’s where we, as care providers, have a role: to identify when climate distress is affecting a patient’s mental health and step in with support.

How can providers screen for or recognize climate-related distress? Start by creating an opening for conversations about it. You might gently ask questions during psychosocial assessments, like: “Are you finding yourself worried about big issues like climate change or the environment?” or “Do concerns about the future (such as climate change) ever keep you up at night?” Many young people feel relieved just to have an adult acknowledge this topic. Pay attention to comments that hint at climate fears—like a teen saying they feel “helpless about the planet” or a patient expressing intense anxiety during wildfire season. In B.C., this is especially relevant: patients may directly experience climate impacts such as smoky summers from wildfires, heat domes, or flooding. If a patient has been through a climate-related disaster (e.g. their home was flooded or they were evacuated due to fires), approach those experiences as you would other traumas: ask about their safety, listen for signs of post-traumatic stress (nightmares, hypervigilance), and recognize that climate events can leave psychological scars. Even indirect exposures, like watching relentless news about ice caps or drought, can contribute to anxiety. It can be useful to add a query about environmental worries when discussing stressors, especially with adolescents. For instance, some providers have started including climate-related questions in mental health intake forms or teen check-ups, normalizing the conversation. The key is to not assume patients will volunteer these thoughts—many young people feel that climate anxiety is not “valid” or fear being dismissed, so they stay quiet until asked. By signaling your openness (“A lot of people, especially young folks, are feeling stressed about climate change lately—how about you?”), you give permission for them to share.

Once climate distress is on your radar, assess its impact and severity. Is the patient occasionally worried, or is it a daily preoccupation? Gently gauge how much these feelings interfere with their life: “Do you find these climate worries are affecting your sleep, mood, or ability to enjoy things?” For example, a teen who can’t concentrate in school or a young adult having frequent panic attacks about the future likely needs extra support. Markers that someone might need additional help include: persistent anxiety that doesn’t respond to usual coping, feelings of despair or hopelessness, withdrawal from friends or activities, or any talk of self-harm or nihilism connected to climate fears. One red flag is “functional impairment” – if the person is so consumed by climate anxiety that they struggle to carry out normal routines (school, work, socializing; 1). Another is when climate distress exacerbates other mental health conditions (as in the earlier eating disorder example, or worsening depression/anxiety in someone with a history of those issues). In such cases, it’s important to address the climate themes in addition to standard treatment. In short, take climate-related emotions seriously. As one commentary put it, we shouldn’t minimize these feelings just because climate anxiety is an “expected” reaction to the state of the world; when a patient is suffering or impaired by it, it warrants our attention (3).

Trauma-Informed and Empathetic Care

Approaching climate-distressed patients with a trauma-informed mindset means recognizing that, for many, climate change feels like a slow-moving disaster or an ongoing trauma. This is especially true if they have lived through climate-related events (like losing a home to wildfire) or if they carry generational trauma related to land and environment (as is the case in some Indigenous communities). A trauma-informed approach involves ensuring the patient feels safe, heard, and not judged when sharing their climate fears. It also means validating their feelings and avoiding any dismissal or trivialization. For example, if a young person says, “I’m terrified we’re not going to have a livable planet in 20 years,” an instinct might be to reassure them that things will be okay. But jumping to “Oh, don’t worry, I’m sure it’ll work out” can inadvertently shut them down. Instead, a trauma-informed, empathetic response would be: “That sounds really scary and overwhelming. I can understand why you feel that way given what you’ve heard and seen.” Validation is powerful. You are telling the patient that their feelings make sense – because they do.

From there, you can gently help them cope and regain a sense of control, much like you would with any anxiety but with awareness of the climate context. Use active listening: let them elaborate on their concerns. Often, just describing their fears to a compassionate listener can bring relief. Remember that climate distress can carry a sense of grief and loss – loss of certainty about the future, or mourning the damage to a beloved place. Acknowledge those losses (“It’s okay to grieve for the forests we lost to the fires – that grief shows how much you care”). Also be aware of the anger and betrayal many youth feel toward institutions. These emotions might come out in sessions; try not to get defensive on behalf of older generations or “society.” Instead, empathize and perhaps channel that anger: “You have every right to be angry. That energy can be a force for change – we just need to manage it so it doesn’t eat you up inside.” This aligns with a strengths-based framing, where you help the patient see their emotional response as understandable and even potentially constructive, rather than as a sign of “something wrong with them.”

In trauma-informed care, we also consider empowerment and collaboration. Rather than prescribing a one-size-fits-all solution, work with the patient to co-create a coping plan (3). For instance, ask them what usually helps when they feel overwhelmed, or what values are important to them in facing this issue. Many young people deeply value nature, community, and justice – these values can become anchors in their coping strategies. You might say, “It sounds like protecting nature is really important to you. How can we use that as a strength? What if we find ways for you to connect with nature or contribute to something positive for the environment? Would that help you feel a bit more in control?” This kind of conversation turns distress into a pathway for action or meaning, which can be very therapeutic. It’s also important to provide clear reassurance without false hope. Avoid doom-and-gloom or Pollyanna-ish guarantees. Instead, focus on realistic hope: “Yes, climate change is a serious challenge. And there are a lot of people working on solutions. There are steps we can all take, and changes are happening. Let’s talk about what you can do and how to keep these worries from paralyzing you.” By doing so, you validate the concern but also remind them that the story isn’t solely catastrophic inevitability.

Cultural sensitivity and equity are vital components of being trauma-informed in the climate context. Remember that not all patients experience climate distress in the same way. Indigenous youth, for example, may have deep spiritual and cultural connections to the land; environmental loss for them can be tied to loss of identity or ancestral trauma. Newcomer families or refugees might have left regions already devastated by climate impacts and carry those traumatic memories. Patients from marginalized communities may feel anxiety and acute injustice, knowing that disadvantaged groups often suffer more in climate disasters. Being mindful of these layers means tailoring your approach: incorporate the patient’s cultural practices for healing if appropriate (perhaps an Elder or cultural mentor can be part of the support plan for an Indigenous youth), and acknowledge injustice when the patient brings it up (e.g., “You’re right that climate change affects some communities more than others. That unfairness is real, and it makes your anger and frustration completely valid.”). These acknowledgments can be deeply affirming and are in line with trauma-informed principles of trustworthiness and transparency (honesty about realities) and cultural humility.

Pathways to Support and Resilience

After validating and understanding the patient’s climate-related distress, the next step is to explore concrete strategies and resources to help them cope. This is where providers can get creative and collaborative, drawing on tools like social prescribing, community referrals, and therapeutic interventions that resonate with climate concerns. The goal is not to eliminate the patient’s climate anxiety (indeed, a certain amount of concern is constructive and probably here to stay), but to prevent it from becoming overwhelming and to channel it into healthy, meaningful outlets. In helping patients develop a coping plan, consider a few key avenues:

Communicate with Empathy and Scientific Rigor

In confronting climate change, healthcare providers have a dual responsibility: we must communicate about this crisis with empathy and compassion, while also upholding the highest standards of scientific accuracy and rigor. This dual role is vital to maintaining public trust and motivating constructive action. Patients, colleagues, and communities look to us for guidance in confusing times – and how we deliver the message matters.

Empathy is essential. Climate change can be frightening and overwhelming for many people. Patients may experience anxiety about the future, grief for a lost environment or hometown, or trauma after surviving a disaster. When we talk about climate-related health risks, it’s important to meet people where they are emotionally. This means listening to their concerns and feelings, acknowledging the real stress or loss they may be experiencing, and responding with genuine compassion. For example, a farmer who lost crops to drought or a family displaced by a wildfire doesn’t just need statistics on climate trends – they need their healthcare providers to validate their experience (“This must be very difficult for you”) and offer support or resources to help cope. Communicating with empathy also means being culturally sensitive. Indigenous patients, for instance, may frame climate impacts in terms of loss of land, species, or cultural practices; recognizing and respecting these values is part of empathetic communication. By demonstrating that we care and are there to help (not to lecture or judge), we strengthen the therapeutic relationship. Research shows that when healthcare professionals communicate with empathy, patient trust and adherence improve (2). In the context of climate, empathy can help overcome feelings of helplessness – people are more likely to engage in solutions when they feel understood and supported rather than blamed or alone.

At the same time, we must act with scientific rigor and honesty. Climate change is a highly politicized topic, but our credibility comes from our commitment to evidence and truth. As care providers, we are trained to interpret data and apply it to patient care; we should approach climate information with the same rigor. That means staying up-to-date on reputable science (such as major reports from bodies like the IPCC or Canada’s national climate assessments) and being clear about what we do and don’t know. For example, we can confidently explain that greenhouse gas emissions from human activities are causing global warming and that this warming is driving health hazards like extreme heat and changing infectious disease patterns – these facts are backed by overwhelming evidence. But we should also be careful not to overstate or catastrophize beyond what the science supports. Acting with scientific rigor might involve explaining risks in concrete terms (“this region’s average summer temperature has increased by 2°C over the past decades, which has led to more heat strokes (3)”) and avoiding unsupported claims. It also involves objectivity and transparency – if a patient asks about an uncertain area (for instance, “Will climate change definitely cause this disease to spread here?”), it’s okay to explain the uncertainty while still emphasizing preparation. By communicating what the evidence says, we build trust. And trust is the currency that allows our messages to be heard.

Balancing empathy and science is not always easy, but it is powerful. One effective approach is storytelling grounded in data. We can share real examples of climate–health impacts that resonate emotionally, and back them up with facts. For instance, telling the story of an elderly patient who suffered during a heatwave can illustrate the human face of climate change, while epidemiological data can reinforce that such events are becoming more common. Studies suggest that highlighting individual stories, in combination with clear information about risks and solutions, can inspire people and policymakers to support climate action (7). In practice, this might look like a physician giving a community talk who starts with a patient anecdote (with permission or made anonymous) about treating heat exhaustion in last summer’s heat emergency, then discussing the broader trend of rising temperatures and how community members can stay safe. The takeaway is that our communication should not be dry or purely academic, nor should it be alarmist without guidance – it should be engaging, compassionate, and credible. If we speak from the heart and from the evidence, we can cut through polarization and help people understand that addressing climate change is about protecting the ones we love and the values we care about.

Finally, empathy and scientific rigor together compel us to advocate for climate justice. We communicate with compassion not only to individual patients, but also when engaging the public or decision-makers about climate policy. We must amplify the voices of those most affected, and do so grounded in facts about inequities. This bridging of human stories and hard data can drive home why urgent action is needed. As health professionals, when we say “climate change is harming my patients, and here’s the evidence,” people listen. It is a profound responsibility – and an opportunity to help change the trajectory of this crisis.

Facilitate Connection and Collective Action

One of the most effective antidotes to despair is finding community. Research suggests that building a sense of community and taking collective action can reduce the mental health impacts of climate anxiety (2, 3). When patients realize they are not alone in their fears and that others are working toward solutions, the burden eases. As providers, we can encourage patients to connect with like-minded peers or groups. For a young person, that might mean joining a local climate action club, a youth environmental group, or even just a supportive online forum. Social prescribing can be useful here: for example, you might “prescribe” attendance at a local climate café – a gathering where people share their feelings about climate change in a supportive setting. Climate cafés (including one recently launched in Vancouver) provide a safe, non-judgmental space for people to express eco-anxieties and solidarity (4). Participants often report relief in voicing fears and hearing “me too” from others. These are not therapy sessions per se, but they are therapeutic in effect. Likewise, structured peer support programs exist, such as the Good Grief Network, which runs a 10-step group for processing climate grief and anxiety. In these groups, participants move from despair to active hope over weekly sessions (3). As a provider, you could refer an interested patient to a Good Grief group (they operate online and in-person) or even use some of their principles in individual therapy (for instance, discussing the “10 steps to resilience” framework). The core idea is to break the isolation that often amplifies climate distress (5). Humans cope better with stress when we do it together. So, connecting your patient to a community—be it a volunteer team planting trees, a youth climate council, or a support circle—can be a turning point. One mixed-methods study found that young adults who engaged in collective climate action felt less cognitive and emotional burden; pooling efforts countered their sense of hopelessness (3). In practice, this might mean helping a patient find a local initiative that fits their interests or even suggesting they start one with friends (some have found empowerment in organizing park clean-ups or school sustainability projects, for example).

Prescribe Nature and Grounding Activities

When a patient feels overwhelmed by global problems, grounding them in local, tangible experiences can restore a sense of stability and calm. A very direct way to do this is through nature exposure. The evidence is robust that time in nature supports mental health: it reduces stress, anxiety, and depression, and improves mood and focus (6). Here in British Columbia, we’re fortunate to have forests, parks, and shorelines as natural healing resources. Consider leveraging PaRx (Park Prescriptions), Canada’s first national evidence-based nature prescription program that started in B.C. PaRx allows licensed health professionals to formally prescribe time in nature to patients as part of their treatment (7). For example, you might write a prescription advising the patient to spend 2 hours a week outdoors (which research suggests is a threshold for boosting well-being (6)). This might sound simple, but it can be powerful. One young patient who struggled with eco-anxiety found that regular hikes and beach walks not only reduced her anxiety in the moment, but rekindled her love for the very environments she feared losing, turning anxiety into motivation to protect those places. Encourage patients to seek out green (or blue) spaces that are accessible to them—whether it’s a local park, community garden, or even tending to houseplants or a backyard. Grounding techniques can accompany this: mindfulness in nature, such as noticing the feel of the breeze or the sound of birds, helps bring their racing thoughts back to the present. Some providers even conduct “walk and talk” sessions outdoors when appropriate, combining therapy with gentle exposure to nature.

Beyond nature, other grounding and wellness activities are important too. Standard self-care strategies—adequate sleep, exercise, and healthy nutrition—should not be overlooked, as they buffer all kinds of anxiety, including climate-related stress. Mindfulness practices or breathing exercises can help manage acute panic triggered by, say, reading the latest climate report. In fact, you can work with patients on media and news consumption habits: many young people “doomscroll” through climate news and end up more anxious (8). Help them set healthy boundaries (maybe recommend they take breaks from climate news or choose one day a week to unplug from those headlines). This isn’t avoidance so much as pacing—continuous immersion in dire news can heighten anxiety without improving one’s ability to act. Instead, suggest they balance it with stories of climate solutions or progress, to foster some hope.

Encourage Meaningful Action (Big or Small)

A recurring theme with climate-distressed youth is a feeling of helplessness, a sense that they personally can’t make a difference. While it’s true that climate change is a massive collective problem, empowering patients to take any level of action can restore agency. This might be personal lifestyle changes (if they’re motivated by that) or, more effectively, joining broader initiatives. Work with the patient to identify actions that align with their interests and values. Are they artistic? Perhaps creating climate-themed art or music can be an outlet (art therapy approaches have been used to transform climate grief into expression). Are they social and passionate? Maybe volunteering with an environmental organization or attending a peaceful climate rally will help—both as action and as community-building. In Canada, there are youth programs like the Youth Climate Corps in B.C., which actually hires young people to work on climate adaptation and environmental projects, providing a constructive avenue for their worry (9). One participant shared that working on tangible projects (like restoring local ecosystems) transformed his anxiety into a sense of purpose, and he developed skills for a climate-focused career in the process (9). Of course, not every patient will join a formal program, but even smaller-scale actions matter. Maybe your patient can start a climate awareness club at their school, or help their family adopt more sustainable practices at home, or write letters advocating for climate policies. The specific action is less important than the psychological effect of action itself: it counters helplessness with efficacy. As one UBC nursing graduate who helped develop a climate anxiety toolkit noted, “doing things like volunteering, building community, or talking about our emotions can mitigate that sense of despair… Realizing what gifts you bring and what you can do in your day-to-day life to fight climate change can recentre your agency” (7). In practice, you might brainstorm with a patient: “What’s one thing you might do that would make you feel a bit more hopeful or in control regarding climate change?” Let them generate ideas, and then support and cheer on even the modest steps. Celebrate their efforts: “That’s great you attended that workshop” or “I’m really impressed you organized that tree-planting event at campus.” Positive reinforcement can help these adaptive behaviors stick.

Leverage Professional Supports and Referrals

Sometimes, climate distress will exceed what can be managed with self-help and community involvement alone. If you’re a primary care provider and you identify significant anxiety or depression in a patient (climate-related or otherwise), consider involving mental health specialists. Many therapists and counselors are becoming aware of climate anxiety as a legitimate concern. If possible, refer to a counselor who is knowledgeable about eco-distress or at least open to learning about it. (Organizations like the Climate Psychology Alliance and Unthinkable directory list climate-aware therapists (3).) Even if a therapist isn’t specifically trained in climate issues, standard therapeutic approaches can be adapted. For example, Cognitive Behavioral Therapy (CBT) can help challenge catastrophic thoughts (“It’s hopeless, we’re all doomed”) and turn them into balanced thoughts (“I’m worried, but there are things I can do and not every possible outcome is apocalyptic”). Acceptance and Commitment Therapy (ACT) is often a good fit, as it emphasizes accepting difficult emotions while committing to value-driven action – precisely what climate-anxious individuals need. Trauma-focused therapies might be necessary for those with direct disaster trauma (such as EMDR for a patient who narrowly escaped a wildfire). As a provider, don’t hesitate to treat underlying issues with appropriate methods – if a patient has clinical depression or panic disorder exacerbated by climate fears, they may benefit from medication or more intensive therapy, just as they would with any other precipitating stressor. The difference is mostly in content: ensure the mental health professional acknowledges the climate context rather than brushing it off.

In some cases, social workers or community programs can assist. For instance, if a family is struggling after a climate disaster, connecting them with community services (support groups, financial assistance, relocation resources) can alleviate the practical stress that feeds mental distress. School counselors can be looped in for younger patients to provide support in the educational environment. There are also crisis lines and resources emerging for climate anxiety. Kids Help Phone Canada, for example, has messaging acknowledging climate anxiety and encourages youth to reach out if they are in crisis due to eco-related stress (10). Keep handy the contacts for mental health support lines (such as the 24/7 BC Mental Health Support Line at 310-6789, which is available for anxiety including climate-related). The point is not to tackle this alone as the provider; use the network of supports available.

Throughout all these strategies, maintain a hopeful stance. Hope here doesn’t mean false promises or ignoring the reality of climate change. It means highlighting resilience, pointing out positive strides (like community climate initiatives or improvements in sustainable technology), and reinforcing the patient’s own capacity to cope. Hope can be surprisingly contagious. It often starts with small successes: a patient might report that they had their first good night’s sleep after limiting news and taking an evening walk (celebrate that!), or that they felt a weight lift after attending a climate café. These little wins build the resilience muscle. Remind patients of their strengths: “You’re someone who cares deeply. That capacity to care is also what can drive you to find solutions and support others. It’s a strength, even if it feels like a burden at times.” Help them reframe anxiety as caring, grief as love for what’s been lost, anger as passion for justice. This reframing is empowering because it validates the emotion and links it to something positive in them.

Finally, model and promote “active hope.” This concept (popularized by educators and psychologists in the climate field) involves acknowledging the difficulty of the situation while choosing to focus on actions and outcomes you hope to see, rather than succumbing to paralysis. You might share stories of individuals or communities who transformed their eco-anxiety into meaningful advocacy. For example, many youths have followed the example of activist Greta Thunberg, who openly shared that her climate activism helped her cope with her depression and anxiety about climate change (11). Seeing someone channel distress into action and actually feel better as a result can inspire patients. Emphasize that resilience is not about never feeling distress – it’s about feeling and moving through distress, adapting and growing. As one educational initiative on climate mental health put it, “Resiliency is not about the absence of negative emotions; it’s about managing them without letting them get ‘stuck’” (12). We want to help patients keep those emotions flowing toward constructive ends, rather than bogging them down.

The outcome we aim for is patients who feel heard, supported, and more hopeful after our intervention. They should come away knowing that their climate anxiety or grief is not a weird or crazy thing, but a valid response that many others share. They should also leave with some tools or next steps—whether it’s a breathing exercise, a support group link, a nature prescription, or a plan to volunteer—that make them feel a bit more empowered. Even if we can’t change the bigger climate trajectory in the exam room, we can change how a patient copes with it. And that, in turn, can ripple outward: young people who feel supported in their climate concerns often become exactly the kind of resilient, compassionate leaders society needs to face climate challenges head-on.