Jeanetta Churchill is blasting the air conditioning in her Baltimore row house. A massive heat wave just swept through the city, with temperatures topping 100 degrees. "I don't even want to see what my power bill is this coming month," she says.
Keeping cool in the summer months isn't just a matter of comfort, says Churchill. It helps her manage the symptoms of her bipolar disorder. Churchill says if she doesn't keep her house cool enough to sleep through the night, she can spiral into a manic episode with fits of rapid talking, irrational purchases, or even suicidal thoughts.
She's not alone. For the nearly 1 in 5 adults who experience mental illness, heat can be dangerous, according to Ken Duckworth, medical director for the National Alliance on Mental Illness.
Duckworth says prescribed medications are a major factor. If a patient is on anti-psychotics, for example, the medication can interfere with the body's ability to regulate temperature, leading to dehydration or heat stroke, he says.
"Heat is hard on human beings. Extreme temperatures are hard on human beings," Duckworth said. "The particular vulnerability is if you're taking psychiatric medicines, that can actually make the condition higher risk for you."
One example is Lithium, a drug used to treat bipolar disorder, which Duckworth says can increase the risk of dehydration, especially on hotter days.
Andrea Landry-Brown used to take Lithium and several other drugs to manage her post-traumatic stress disorder, bipolar disorder and anxiety. When she lived in California, the combination of heat and prescription medicines ramped up her symptoms in a way she'd never experienced before.
"I'm driving down the street and I literally saw people walking in front of my car," Landry-Brown says. As she stopped to wait for the people she saw to pass, her kids in the backseat told her to keep moving.
"I'm like, 'You don't see all [the] people in the street?' She says her kids responded, "'Mom, there's nobody there.'"
She was hallucinating - an incident Landry-Brown, who now lives in Baltimore, says she thinks was caused by the combination of the medications she was taking and the summer heat.
Data backs up the relationship between heat and mental health too. An analysis by the University of Maryland's Howard Center for Investigative Journalism found emergency response calls relating to psychiatric conditions increased nearly 40% in Baltimore in the summer of 2018, when the heat index spiked above 103.
"On hotter days we do see a larger volume of patients, and since it comes in fits and spurts here, that can sometimes be close to overwhelming," says Dr. Reginald Brown, chair of emergency medicine at Bon Secours Baltimore Hospital on the west side of the city. "Any extreme conditions in the weather we'll see a lot more of our behavioral health patients as well, which will also divert some of our care and stretch our resources."
Often, mental health patients are struggling with more than a mental illness. Studies have linked heat and increased drug overdoses, as well as heightened effects of alcohol poisoning - and the Howard Center found calls relating to substance abuse more than doubled during dangerous heat in the summer of 2018.
Edgar Wiggins, founding executive director of Baltimore Crisis Response Inc, says 3 out of 4 of their patients in a behavioral health crisis also suffer from substance abuse.
"These are people that are vulnerable and essentially can get into trouble before they know it," Wiggins says, adding that the heat can also exacerbate medical conditions like diabetes or chronic obstructive pulmonary disorder.
"So if you've got a chronic behavioral health condition, chances are you're not taking care of or managing your diabetes, or your hypertension. So if you want to add to that temperatures of over 100 degrees with this vulnerable population, it really puts them at risk," Wiggins says.
As the threat of climate change increases, Duckworth says its effects on mental health can't be ignored. He says when he was trained, it wasn't a big part of the conversation in the medical community.
"I think that now, you just have to think more creatively about how the weather is impacting your patient," says Duckworth. "It's impossible not to think about our climate."
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A new investigation shows that low-income neighborhoods are hotter than wealthier ones in dozens of big cities across the country. This investigation is from NPR and the University of Maryland's Howard Center for Investigative Journalism. And it shows that the heat impacts physical health but also that it might have an effect on mental health. Here's NPR's Nora Eckert.
NORA ECKERT, BYLINE: In Jeanetta Churchill's Baltimore row house, the air conditioning is blasting. She relied on it more than usual when a blistering heat wave swept through Baltimore this summer.
JEANETTA CHURCHILL: I don't even want to see what my power bill is this coming month.
ECKERT: But keeping cool isn't just a matter of comfort for her. It's a way to manage her bipolar disorder.
CHURCHILL: Heat is a challenge for me when it comes to my mental health. When I get too hot, it's hard for me to sleep, and when I don't get enough sleep, that can trip me over into mania.
ECKERT: There are a few signs she's entering a manic episode - rapid speech, irrational purchases or bouts of anger. Sometimes, her episodes spiral more seriously.
CHURCHILL: I have at times had suicidal ideation - not attempt but just my mind was racing so fast, it was out of control.
ECKERT: Heat can be a stressor for most people, but Ken Duckworth, medical director for the National Alliance on Mental Illness, says people with severe mental illnesses are hit harder than most.
KEN DUCKWORTH: In the summertime, heat waves are a risk for people with serious mental illnesses like schizophrenia, schizoaffective disorder and bipolar.
ECKERT: One of the main reasons is medication. Drugs used to manage severe mental illnesses can have dangerous side effects in the heat, like dehydration or heat stroke.
DUCKWORTH: They reduce your body's ability to modulate temperature.
ECKERT: For Andrea Landry-Brown, these side effects hit hard. When she was living in California, on one particularly hot summer day, she says it got up to 110 degrees. She was driving with her kids in the backseat when she started hallucinating.
ANDREA LANDRY-BROWN: I'm driving down the street, and I literally saw people walking in front of my car.
ECKERT: It was a side effect of the medications she took for PTSD, anxiety and bipolar disorder. She'd been sensitive to medications in the past, but she thinks the heat sent her over the edge.
LANDRY-BROWN: The heat would just make it worse. Whatever the side effects were, it was just that much worse.
ECKERT: NPR and the University of Maryland's Howard Center looked at connections between heat and health in Baltimore. The Howard Center analyzed emergency response data from the summer of 2018 and found that calls for psychiatric conditions increased by nearly 40% when the heat index spiked over 103.
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ECKERT: Baltimore Crisis Response, Inc. receives hundreds of calls every day.
UNIDENTIFIED PERSON: Any psychotic symptoms? Are you currently hallucinating, hearing voices?
ECKERT: Their founding executive director, Edgar Wiggins, says although many of their patients experience mental illness, that's usually not the only health condition they're dealing with.
EDGAR WIGGINS: If you've got a chronic behavioral health condition, chances are you're not taking care of or managing your diabetes or your hypertension. So if you want to add to that temperatures of over 100 degrees with this vulnerable population, it really puts them at risk.
ECKERT: Wiggins says 3 out of 4 of their mental health patients also abuse substances. And according to the Howard Center, calls relating to substance abuse more than doubled in extreme heat. Dr. Duckworth from the National Alliance on Mental Illness says the risks of heat are only getting more urgent.
DUCKWORTH: These are risks that you need to be mindful of as you contend with, you know, what is likely to be an increasing run of extremely hot days.
ECKERT: And while climate change wasn't a big part of his training in medical school, he says it's impossible for the field to ignore now. Nora Eckert, NPR News. Transcript provided by NPR, Copyright NPR.