Eco-spiritual Well-Being: Exploring Flora’s Psychological Impact through the Lens of the Qurʾan and Contemporary Research

Nurses suffering in silence: Addressing the stigma of mental health in nursing and healthcare.

Objective: COVID-19 restrictions precipitated rapid work practice changes for family and mental health practitioners, including care via telehealth and secondary exposures to COVID-19 induced violence in client. This descriptive study aimed to examine stress and health among practitioners during COVID-19 restrictions. Method: Participants, recruited via professional networks, were 320 maternal and child health (MCH), child and youth mental health (CYMH) and adult mental health (AMH) practitioners from Victoria, Australia. Participants reported family violence among cases, workplace stress, and mental and physical health problems during COVID-19 restrictions, via an online survey. Results: Rising family violence incidence, including emotional abuse and serious threats against a woman (>25%), child emotional abuse/neglect, and child exposure to family violence were reported. Higher violence was reported by CYMH and AMH than MCH practitioners. We found increases in practitioner stress due to workplace practice changes and exposure to family violence. Highest stress was among CYMH and AHM practitioners. Participants reported worsening mental (63.2%) and physical (51.2%) health. Negative affect was higher among CYMH than MCH participants. Conclusion: Findings demonstrate pressure on family and mental health workforces during COVID-19. Provision of training and support to manage secondary stress from exposures to trauma and changing workplace practices is indicated. KEY POINTS What is already known about this topic: (1) Family and mental health practitioners’ mental health is below normative levels due to exposure to secondary traumatic stress exposure and associated compassion fatigue. (2) Periods of natural and community disaster elevate pressure and distress among mental health professionals and contribute to risk for workforce attrition and among client families are also associated with increased risks for intimate partner violence due to financial pressures and inadequate and confined housing. (3) Concerns about family violence during COVID-19 lockdown restrictions have arisen from publicly available reports of increases in emergency department domestic violence-related injuries and urgent applications to the Family Courts, but research data pertaining to levels of family violence during COVID-19 are scarce. What this study adds: (1) Family and mental health practitioners, especially those in child/youth and adult mental health sectors, reported increased proportions of caseloads in which incidents of family violence occurred during stage-3 COVID-19 lockdown restrictions in Victoria, Australia, contributing to exposure of practitioners to secondary trauma. (2) Practitioners reported higher workplace stress (due to changed work practices and family violence) during COVID-19 restrictions and greater stress was related to greater negative affect, sleep problems, headaches, and gastrointestinal problems. (3) Urgent attention to training and support of family and mental health workers providing care to distressed families during periods of community and natural disaster is indicated.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Overcoming Stigma: Asking for and Receiving Mental Health Support.

Increasing concerns among mental health care professionals have focused on the impact of young people's use of digital technology and social media on their mental well-being. It has been recommended that the use of digital technology and social media be routinely explored during mental health clinical consultations with young people. Whether these conversations occur and how they are experienced by both clinicians and young people are currently unknown. This study aimed to explore mental health practitioners' and young people's experiences of talking about young people's web-based activities related to their mental health during clinical consultations. Web-based activities include use of social media, websites, and messaging. Our aim was to identify barriers to effective communication and examples of good practice. In particular, we wanted to obtain the views of young people, who are underrepresented in studies, on their social media and digital technology use related to mental health. A qualitative study was conducted using focus groups (11 participants across 3 groups) with young people aged 16 to 24 years and interviews (n=8) and focus groups (7 participants across 2 groups) with mental health practitioners in the United Kingdom. Young people had experience of mental health problems and support provided by statutory mental health services or third-sector organizations. Practitioners worked in children and young people's mental health services, statutory services, or third-sector organizations such as a university counseling service. Thematic analysis was used to analyze the data. Practitioners and young people agreed that talking about young people's web-based activities and their impact on mental health is important. Mental health practitioners varied in their confidence in doing this and were keen to have more guidance. Young people said that practitioners seldom asked about their web-based activities, but when asked, they often felt judged or misunderstood. This stopped them from disclosing difficult web-based experiences and precluded useful conversations about web-based safety and how to access appropriate web-based support. Young people supported the idea of guidance or training for practitioners and were enthusiastic about sharing their experiences and being involved in the training or guidance provided to practitioners. Practitioners would benefit from structured guidance and professional development to enable them to support young people in feeling more willing to disclose and talk about their web-based experiences and their impact on their mental health. This is reflected in practitioners' desire for guidance to improve their confidence and skills to safely support young people in navigating the challenges of the web-based world. Young people want to feel comfortable discussing their web-based activities during their consultations with mental health practitioners, both in tackling the challenges and using the opportunity to discuss their experiences, gain support, and develop coping strategies related to web-based safety.

BackgroundChildren and young people (CYP) who have experienced statutory care are among the most disadvantaged in society and have higher prevalence of mental disorders than the general population. This has...

Caitlyn Donaldson, Policy Officer at the Royal Society for Public Health, looks at positive mental wellbeing and how it is being promoted through the work of the RSPH.Mental health and wellbeing is increasingly becoming key topic for the RSPH, and we support the recent NHS Mandate for England1 which states that there needs to be parity between mental and physical health, acknowledging that there can be 'No health without mental health'2The WHO defines mental health as a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contribution to his or her community. As in the WHO's definition of health (a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity) mental health is not just the absence of illness, but requires an additional positive 'something' to be present in the individual. Thus, the concept of an individual's mental health state is increasingly being uncoupled from mental illness, and being seen to consist of psychological, emotional and social components.The highest state of subjective wellbeing is seen by many experts as the place where emotional, psychological and social wellbeing are combined, enabling individuals to flourish.3 Thus, rather than simply focusing on preventing and treating mental illness, there is potential to actively promote positive mental health.Mental health and wellbeing impacts upon an individual's physical health, relationships, education, work and ability to reach their potential. At population level, it has consequences for the country's economy, levels of crime, drug and alcohol dependence and homelessness,4 and as Friedli states: health is also key pathway through which social inequality impacts on health.5Many of the key determinants of mental health are located within social and economic domains,6 which provides opportunity for intervention.In 2011 nef published report to address the question of how flourishing mental health could be promoted and increased.7 The result was their five ways to wellbeing: 'connect'; 'be active'; 'take notice'; 'keep learning'; and 'give'. These five ways are easily applied at individual, community, organizational and strategic levels; and evidence suggests that they are being used in many different settings to encourage improved mental wellbeing.The RSPH believes that policymakers at national and local level have responsibility to ensure that policies help address, not increase, inequalities in mental health and wellbeing. The Department of Health's mental health implementation framework8 provides an important perspective on translating policy into practical actions for improving mental health and we support the use of mental wellbeing impact assessment (MWIA), to ensure that policy, programme, service or project has maximum equitable impact on people's mental wellbeing - at individual, community or national level. We also endorse the Guidance for Commissioning Public Mental Health Services,9 which provides the rationale for spending on mental health and also explains what good quality public mental health interventions look like. …

The COVID-19 pandemic has affected many aspects of people's lives. Lockdown measures to reduce the spread of COVID-19 have been more stringent for those aged over 70, at highest risk for the disease. Here, we examine whether home garden usage is associated with self-reported mental and physical wellbeing in older adults, during COVID-19 lockdown in Scotland. This study analysed data from 171 individuals (mean age 84 ± 0.5 years) from the Lothian Birth Cohort 1936 study who completed an online survey approximately two months after lockdown commenced (May/June, 2020), and reported having access to a home garden. The survey also included items on garden activities (gardening, relaxing), frequency of garden usage during lockdown, and measures of self-rated physical health, emotional and mental health, anxiety about COVID-19, and sleep quality. Ordinal regression models were adjusted for sex, living alone, education, occupational social class, anxiety and depressive symptoms, body mass index, and history of diabetes and cardiovascular disease. Neither gardening nor relaxing in the garden were associated with health outcomes. However, higher frequency of garden usage during lockdown was associated with better self-rated physical health (P = 0.005), emotional and mental health (P = 0.04), sleep quality (P = 0.03), and a composite health score (P = 0.001), after adjusting for covariates. None of the garden measures were associated with perceived change in physical health, mental and emotional health, or sleep quality, from pre-lockdown levels. The results of the current study provide support for positive health benefits of spending time in a garden—though associations may be bidirectional—and suggest that domestic gardens could be a potential health resource during the COVID-19 pandemic.

Aim/Purpose: Although the high rates of stress and psychological distress in graduate students has been well-documented, Canadian samples are underrepresented in the extant literature. The present study explores prevalence rates of burnout and psychological distress in a sample of psychology master’s and doctoral students at a university in a large urban Canadian city, as well as factors relating to their well-being, social support and stress. Background: There are economic and productivity setbacks stemming from high stress and mental health challenges. Burnout and psychological distress of graduate students are associated with hindered academic progress, mental and physical health challenges, and reduced productivity. Further, emotionally exhausted doctoral students are at heightened risk for non-completion of their degrees. Methodology: Sixty-two psychology graduate students completed an online survey that assessed burnout, psychological distress (anxiety, depression, and stress symptoms), perceived social support, collegiate sense of community, financial strain, and rank-ordered nine domains of graduate school stressors. Contribution: The present paper contributes to the body of knowledge that graduate students residing in an urban Canadian city experience high rates of burnout and psychological distress. High levels of social support outside the academe were not protective factors in mitigating burnout. Findings: Participants reported high levels of perceived social support and sense of community. However, over half (60%) of respondents met criteria for burnout, and one in three students met criteria for problematic levels of stress, anxiety, and/or depression. In a rank ordering question, “thesis, dissertation or other research”, “classwork” and “finances” ranked in the top three most stressful aspects of graduate school for respondents. Recommendations for Practitioners: Graduate students experience unique stressors related to their mental health and well-being that differ from undergraduate students and young working professionals. Mental health practitioners may be better equipped to support graduate students with knowledge of these specific factors impacting mental health and well-being. Recommendation for Researchers: Based on these findings, four areas of recommendations for psychology graduate institutions and training programs are discussed. These recommendations highlight the need for change across systemic levels and call for integrative efforts to improve wellbeing for psychology graduate students. Impact on Society: Enhancement of doctoral student well-being could contribute to long-term benefits in academia and in higher education. Future Research: The study took place before the emergence of COVID-19, which has undoubtably impacted graduate students globally. Research on student experiences during this unprecedented time is needed, as are additional supports (e.g., virtual programming to reduce social isolation; contingency plans for data collection).

In multicultural and multilingual Australia, mental health practitioners (MHPs) are increasingly attending to the psychological needs of culturally and linguistically diverse (CALD) people. Most clinical interactions occur in English, which is the CALD clients’ non-native language, making it a challenging task for clients and practitioners. Language is the main vehicle of assessment, diagnosis, and treatment in most Western models of mental health care. Even so, minimal attention has been paid in policy, research, and practice to MHPs’ language diversity related competence to work effectively with CALD clients. To address this gap, this research aimed to conceptualise, define, and operationalise the novel construct of cross-lingual competence and to develop a reliable and valid psychometric instrument to measure it - the Cross-lingual Competence Scale (CLCS). This research was conceptually and theoretically grounded on Sue et al.’s (1996; 1982) metatheory of multicultural therapy and counselling and their tripartite model, and on research findings from the fields of multicultural psychotherapy and psycholinguistic. On these bases, the domains of awareness, knowledge and skills were argued to be central to the cross-lingual competence construct. Study 1 generated the initial set of items for the CLCS and explored its factor structure through exploratory factor analysis (EFA). Data was collected from in-training and fully registered MHPs (n = 155) in Australia through an online survey containing 61 items and additional measures of MHPs’ multicultural and general competence. Exploratory Factor Analysis did not support the hypothesised structure based on the tripartite conceptualisation; instead, a novel factorial structure representing three distinct concepts emerged: a. MHPs’ Self-perceptions of Competence (SPC); b. MHPs’ Knowledge of Barriers for Clients (KBC); and c. MHPs’ Knowledge of Barriers for MHPs (KBP). The emergent factor structure of the CLCS provided evidence of a new and strong organising concept for self-assessments of competence: self-perceptions of competence and factual knowledge. Importantly, the KBC and KBP subscales were positively associated to one another but unrelated to the SPC subscale, suggesting that the two overarching domains (perceptions and factual knowledge) are unrelated. Thus MHPs’ estimates of their own cross-lingual competence to effectively work with CALD clients were discrepant from their demonstrable knowledge necessary for competent work. The initial assessment of validity further highlighted this discrepancy showing that the SPC subscale converged with all criterion measures of competence reporting MHPs’ self-perceptions, while the KBC and KBP subscales did not. Study 2 aimed to confirm the factor structure of the CLCS and further assess its reliability and convergent validity in a new sample of Australian MHPs (n = 257). Through CFA competing models were tested. The findings from Study 2 closely replicated those of Study 1, supporting the hypothesis that the 3-factor structure would be the best fit for the data. This outcome lent support to the overarching distinction between self-perceptions and factual knowledge. The final version of the CLCS had 23 items and each subscale had good reliability and validity. Study 3 sought to identify predictors of MHPs’ cross-lingual competence as measured by the three subscales of the CLCS exploring the following individual characteristics: ethnic status, language status, professional status, exposure to work with CALD clients, and multicultural training. Based on the combined samples from studies 1 and 2 (n = 412) data was analysed through t-tests and hierarchical multiple regression. Study 3 results showed that MHPs who belonged to an ethnic minority, were bilingual, worked with CALD clients frequently, were fully registered, and had multicultural training reported higher levels of self-perceived competence than their counterparts. When analysed collectively, all these individual characteristics except for ethnic status, predicted MHPs’ self-perceptions of competence. On the other hand, knowledge of barriers for clients was only predicted by engagement with CALD clients, while knowledge of barriers for MHPs was predicted by engagement with CALD clients and language status. Indeed, engagement with CALD clients was the only significant predictor across all three subscales. Overall this research contributes to theory, research and practice of multicultural psychotherapy in several ways. First, it has contributed an innovative construct to the field of cross--cultural psychotherapy, cross--lingual competence. Second, it has developed a reliable and valid measure of MHPs’ cross-lingual competence composed of three subscales each one with good psychometric properties to be used for various purposes. Third, it has established cross-lingual competence as a construct that is related but distinct from multicultural competence requiring specific attention and assessment. Finally, it has shed light into individual characteristics that predict cross-lingual competence and potential means to promote cross-lingual competence among CALD and non-CALD MHPs. Theoretical and practical implications for future research into development and assessment of cross-lingual competence are discussed.

The severe impact of conflicts-which often occur in chaotic and unstable environments-has on mental health, both for people and communities. South-East Asia incurs a disproportionately significant invisible cost to mental health due to persistent political instability, global conflicts, and terrorism.1 These events may induce anxiety and stress, which may culminate in an array of mental health issues, including depression, post-traumatic stress disorder (PTSD), and generalized anxiety disorders. These circumstances are rendered more catastrophic by the continuous threat of violence, displacement, and loss, which makes it challenging for people to retain their resilience in terms of mental health. For example, the prolonged conflict in Kashmir has had a significant impact on people’s mental health in the region.2 Several psychological wounds are the result of sustained violence and uncertainty. Similarly, millions of people in the region have experienced suffering and grief because of terrorism and political unrest.2 Communities impacted by these crises in these areas have a cumulative strain on their mental health.3 The general well-being of these communities is declining due to various factors, including increased stress levels, restricted access to healthcare, and an atmosphere of uncertainty.4 The visible psychological impact on people and their neighbours underscores the importance of acknowledging the broader implications of these crises on mental health. To develop and maintain mental health resilience amid these challenges, people must learn coping mechanisms.5 Recognizing the seriousness of this issue is crucial, but so is offering those impacted resources and assistance. Numerous therapies and coping mechanisms may be helpful. Teaching individuals about the psychological consequences of political unrest and violence is one of academia’s most essential roles. Academic institutions may reduce stigma, increase awareness, and encourage people to seek assistance by conducting research and implementing educational programmes.6 To assist people and communities in overcoming trauma and developing resilience, mental health practitioners can provide psychosocial interventions like counselling and therapy.7 For those impacted, establishing support systems within communities may be a beneficial resource. These networks may allow people access to mental health experts and a safe atmosphere to discuss their feelings and experiences. Mental health professionals can conduct workshops on resilience building, and these sessions can offer valuable strategies and skills to improve psychological resilience in the face of hardship.8 Access to Services for Mental Health is imperative for governments and non-governmental organizations to guarantee that mental health treatments are easily accessible to individuals who require them.9 This involves encouraging the education and placement of mental health specialists in conflict-affected regions. Understanding and resolving the mental health issues brought on by political unrest and violence are critical tasks for academia. Research in this area is crucial to clarify the intricate relationship between political instability and mental health. Scholars can make the following contributions: Research and Data Analysis: Academic institutions might research to understand better the psychological impacts of political unrest and violence in Pakistan and South-east Asia.10 We can determine patterns and risk factors by gathering information and examining the mental health conditions of impacted groups. Policy Recommendations: Based on their research, academia might advocate policies to facilitate better access to mental health care in places affected by violence.11 When tackling the mental health problem, countries and international organizations can follow these guidelines. Public Awareness Initiatives: To de-stigmatize mental health concerns and motivate people to seek therapy, academia may initiate public awareness initiatives. Advertisements might also inform the public about the distinct symptoms and signs of diseases linked to trauma. Training and Capacity Building: Educational establishments have the potential to provide instruction to mental health professionals who can work in areas of conflict. The training may concentrate on culturally aware methods and the difficulties brought on by trauma associated with conflicts.9 There cannot be denying the relationship between political unrest, global conflicts, and terrorism and the impact they have on mental health. These situations have a profound impact on people and communities, frequently resulting in severe mental health problems. In addition to academia’s active participation, coping methods and treatments can assist in lessening these difficulties and support individuals who require it. Prioritizing mental health as the foundation of resilience is crucial as we address the ongoing conflicts in these areas. To address this critical issue and ensure that people and communities can manage the storm of political transition with their mental health, academic research, community support, and government policy must collaborate.

BackgroundIt has been argued that though correlated with mental health, mental well-being is a distinct entity. Despite the wealth of literature on mental health, less is known about mental well-being. Mental health is something experienced by individuals, whereas mental well-being can be assessed at the population level. Accordingly it is important to differentiate the individual and population level factors (environmental and social) that could be associated with mental health and well-being, and as people living in deprived areas have a higher prevalence of poor mental health, these relationships should be compared across different levels of neighbourhood deprivation.MethodsA cross-sectional representative random sample of 1,209 adults from 62 Super Output Areas (SOAs) in Belfast, Northern Ireland (Feb 2010 – Jan 2011) were recruited in the PARC Study. Interview-administered questionnaires recorded data on socio-demographic characteristics, health-related behaviours, individual social capital, self-rated health, mental health (SF-8) and mental well-being (WEMWBS). Multi-variable linear regression analyses, with inclusion of clustering by SOAs, were used to explore the associations between individual and perceived community characteristics and mental health and mental well-being, and to investigate how these associations differed by the level of neighbourhood deprivation.ResultsThirty-eight and 30 % of variability in the measures of mental well-being and mental health, respectively, could be explained by individual factors and the perceived community characteristics. In the total sample and stratified by neighbourhood deprivation, age, marital status and self-rated health were associated with both mental health and well-being, with the ‘social connections’ and local area satisfaction elements of social capital also emerging as explanatory variables. An increase of +1 in EQ-5D-3 L was associated with +1SD of the population mean in both mental health and well-being. Similarly, a change from ‘very dissatisfied’ to ‘very satisfied’ for local area satisfaction would result in +8.75 for mental well-being, but only in the more affluent of areas.ConclusionsSelf-rated health was associated with both mental health and mental well-being. Of the individual social capital explanatory variables, ‘social connections’ was more important for mental well-being. Although similarities in the explanatory variables of mental health and mental well-being exist, socio-ecological interventions designed to improve them may not have equivalent impacts in rich and poor neighbourhoods.

In today’s fast paced world, children face many challenges that put their mental and emotional health at risk, including abuse, carelessness and financial difficulties which will also affect them later in life. We present this paper because we believe that ensuring the mental and emotional well-being of children is essential to safeguard their overall health and future potential. This paper reviews how we can support children’s mental and emotional health by overcoming barriers such as social judgements, insufficient resources and weak support from society. This paper also focusses on addressing the unique mental and emotional health needs of children by combining mental health support along with child protection activities. It will also discuss the innovative solutions, including community-based mental health programs, the use of technology for early detection and the importance of promoting strong family and caregiver support systems. A key part of the discussion is importance of partnerships among governments, NGO’s, mental health professionals and schools working together to build a stronger support system. By highlighting collaborative and sustainable approaches, this presentation aims to inspire new strategies that prioritize children’s mental and emotional well-being, ensuring a safer and healthier future for all.

Back to table of contents Previous article Next article Book ForumFull AccessImproving Mental Health: Four Secrets in Plain SightNoa Heiman, Ph.D.Noa HeimanSearch for more papers by this author, Ph.D.Published Online:1 May 2017https://doi.org/10.1176/appi.ajp.2017.17030260AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by Lloyd I. Sederer, M.D. Washington, D.C., American Psychiatric Association Publishing, 2017, 129 pp., $29.00 (hardcover).In Improving Mental Health: Four Secrets in Plain Sight, Dr. Sederer addresses the costly and alarming state of affairs of mental health by describing four “secrets” that reveal a way to close the science-to-practice gap. These secrets are fundamental ways in which everyday practices can be improved to reduce the discrepancy between what we know and what we do. Dr. Sederer notes that his audiences are mental health practitioners, clinical leaders, graduate students, and patients and their families. The book succeeds in addressing such a wide scope of audience with Dr. Sederer’s clear, down-to-earth, approachable writing.Not to be a plot spoiler, but the four secrets are:1.Behavior serves a purpose.2.The power of attachment.3.Less is more.4.Chronic stress is the enemy.The first secret stresses an often-overlooked insight that behavior that may seem perplexing to a lay observer may actually bear a lot of meaning for a patient. Dr. Sederer encourages anyone interacting with people with mental illness to consider the adaptive function or purpose the illness may have or have had historically. This is a welcome point because so often mental health practitioners, leaders, and patients themselves or their families tend to pathologize without putting themselves in the patient’s shoes or reflecting on the implicit meaning of the illness.The second secret discusses the power of attachment. Dr. Sederer reviews the attachment research and literature and highlights an issue often underestimated by providers and caregivers: the patient’s need for a secure attachment. Providers may ignore how much their care, tone of voice, body language, and other mannerisms can affect a patient’s sense of safety.The third secret is “less is more.” This secret is a true gem offering Dr. Sederer’s humanistic approach. Less is more as a rule is too often overlooked in health care, where providers and caregivers often tend to take an aggressive approach in terms of medication and hospitalizations as a first choice of care. Less reliance on medication, less neglect, less distancing from family, and less clinic- and hospital-based care are what Dr. Sederer prescribes. To Dr. Sederer, less can be replaced by a more comprehensive set of services delivered at homes and in the community with a recovery-oriented view of the future. Less medication and monitoring is more when comprehensive treatment aligns with what the patient is seeking, and less is more when prevention and early intervention are emphasized. According to Dr. Sederer, comprehensive programs will not cost more if hospital and emergency services are reduced. In time, this may also translate to reductions on the criminal justice, shelter, and welfare systems. This secret addresses more the systemic issues of mental health care and its current costly state.The fourth secret is “chronic stress is the enemy.” Dr. Sederer reviews the effects of chronic stress on our physical and emotional health. This is probably the secret/chapter with the most resources and practical advice for the reader.It seems that Dr. Sederer has undertaken two tasks in his book and through his public service:1.To make mental health issues more accessible to the public through his writings in the Huffington Post. In the book, secrets 1 and 2 pertain to this task by offering more of a psychological-formulation insight that is often overlooked in mental health practices.2.Secrets 3 and 4 offer more systemic insights as to how to reduce the science-to-practice gap on a system-wide level, which fit with Dr. Sederer’s role as medical director for the New York state mental health system.While the book does not offer insights or literature that were not already known, Dr. Sederer’s neat, clear, and succinct packaging of this knowledge into a short 100-page book makes these issues very approachable and practical to lay readers and practitioners alike.From the Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byNone Volume 174Issue 5 May 01, 2017Pages 489-489 Metrics KeywordsChronic Psychiatric IllnessCommunity Mental HealthEconomic IssuesStressPDF download History Accepted 1 March 2017 Published online 1 May 2017 Published in print 1 May 2017

Climate change is associated with adverse mental and emotional health outcomes. Social and economic factors are well-known drivers of mental health, yet comparatively few studies examine the social and economic pathways through which climate change affects mental health. There is additionally a lack of research on climate change and mental health in sub-Saharan Africa. This qualitative study aimed to identify potential social and economic pathways through which climate change impacts mental and emotional wellbeing, focusing on a vulnerable population of Kenyan smallholder farmers living with HIV. We conducted in-depth, semi-structured interviews with forty participants to explore their experience of climate change. We used a thematic analytical approach. We find that among our study population of Kenyan smallholder farmers living with HIV, climate change is significantly affecting mental and emotional wellbeing. Respondents universally report some level of climate impact on emotional health including high degrees of stress; fear and concern about the future; and sadness, worry, and anxiety from losing one's home, farm, occupation, or ability to support their family. Climate-related economic insecurity is a main driver of emotional distress. Widespread economic insecurity disrupts systems of communal and family support, which is an additional driver of worsening mental and emotional health. Our study finds that individual adaptive strategies used by farmers in the face of economic and social volatility can deepen economic insecurity and are likely insufficient to protect mental health. Finally, we find that agricultural policies can worsen economic insecurity and other mental health risk factors. Our proposed conceptual model of economic and social pathways relevant for mental health can inform future studies of vulnerable populations and inform health system and policy responses to protect health in a changing climate.