First Steps Women’s Centre

Dr Daniel Maughan is a consultant psychiatrist working for the Early Intervention Service at Oxford Health NHS Foundation Trust. He is also the Associate Registrar for Sustainability at the Royal College of Psychiatrists, where he heads up a programme of work looking to improve the sustainability of mental health services. He has published widely on the impacts of climate change on mental health, as well as how to best estimate the carbon footprint of health care.

I am the RCPsych Associate Registrar for Sustainability. Most of you will scratch your heads thinking, ‘What on earth does one of them do?’ The answer to this question can be as long as you like but, in its shortest form, is: I try to reduce the environmental impacts of mental health care. 

What a bizarre thing to do, I hear you say. Why not get an estates person who deals with electricity and gas supplies to do that?

Well, the reason is that climate change is essentially a human health problem and I truly believe that it is healthcare professionals’ responsibility to start engaging with both the significant health effects of climate change and the appallingly large carbon footprint of health care.

The World Health Organization has recognised climate change as the greatest threat to human health in the 21st century. Climate change is principally caused by human activity and the world’s ecological systems are increasingly threatened by population growth.

Changing patterns of disease and mortality will result from uncertainty over food and water supplies, and extremes of climate. Some communities will suffer directly, and the ensuing population migration will then affect many other regions, including the UK.

The NHS, with 25 million tonnes of carbon each year, is the single largest emitter of greenhouse gases in the UK public sector.

Its emissions alone are equivalent to the total emissions of a medium-sized eastern European country.

Mental health services account for 1.47 million tonnes of this (7% of the total), which is the equivalent of burning 630,000 litres of petrol per year.

This is mainly down to the fact that mental health care requires a lot more specialty prescriptions.

The average in-patient admission has a carbon footprint of 479kg. This is equivalent to the footprint from driving from Land’s End to John O’ Groats two and a half times.

The Climate Change Act 2008 set out a NHS carbon reduction target of 80% over 30 years. The government has, through the Carbon Reduction Commitment Scheme, made it a legal requirement for large healthcare organisations to reduce their emissions to avoid financial penalties. Some organisations are already facing these penalties.

The majority of the mental health service’s impact on the environment comes not from energy or transport but, surprisingly, from the manufacture of medication.

Buildings and energy use only account for 17% of the NHS’s carbon footprint, while clinical factors account for the majority, including pharmaceuticals (22%), medical devices and equipment (13%) and travel.

If we think that 50% of people with serious mental illness do not take their tablets and the amount of other waste that happens in health care, we quickly see how much we could reduce our carbon footprint if we all cast a critical eye over what we waste.

In addition, prescribing less medication and offering more non-pharmaceutical treatments is not only better for the environment, but reflects the wishes of many people who access mental health services.

A response from all clinicians – in whatever area they work in – is therefore critical for the NHS to meet the Climate Change Act 2008 target and everyone working in health care needs to review their clinical practices.

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