Global Mental Health in Asia Symposium Day 3: Panel 3 Advocacy and action for policy change

[00:00] Okay, so we'll begin with brief opening statements from the panelists where they'll share their work and perspectives on today's topic. Then we'll move on to a discussion followed by an open Q&A with the audience. To start us off, I would like to invite Dr. Vasuntara to share her insights.

[00:20] Over to you. Hello, good afternoon, everyone. It's a pleasure to be here to actually listen to all the research and all the policy, different efficacies until this last session. A bit of a big note about myself. It really feel like coming home. I spent about two decades in academia in Australia before cross over to

[00:40] But really, I was a socio-opodemologist and biostatistician by training. So I don't really have the mental health background. But my first encounter is that we follow up on cohort studies of 100,000 Thai people. We follow to see what are their risk factors and how they end up in death regurgitation.

[01:00] registration 10 years later. And for me, my ICD, which is International Collicification Disease Court, is an intentional and intentional injury, and of course, some of that is a result of mental health issues. I recall during my post-doc being in a basement, a dark basement,

[01:20] figuring out, like you've been, you know, some of these people, you know, a number, last number of people have been feeling of the cohort of questionnaires that they have some of these issues. I wonder like what happened to you? What happened to you? You were just still filling out our questionnaires. Did you seek help when there was any mental health issues? And lastly, was service available?

[01:40] when you were trying to get help. And that was really my cornerstone of when the opportunity came to cross over. I feel like I want to bring some of these questions with me and really see when we are in the place where there's a potential to help fundings, what are the issues? Who are the stakeholders?

[02:00] Just briefly, with the ADP, it's been established since 1967. It's a multilateral bank focusing on sustainable development in Asia. And just in the last two years, we have been trying to be a climate change bank, climate bank in Asia, and that's where our synergy is. Thank you. Thank you. We can move on to...

[02:20] Dr. Rechina. Hi, good afternoon. It's a pleasure to be here with you and to really learn a lot about mental health and climate change and mental health throughout the day. I come from a country, India. India is ranked sixth on the climate risk index. And so as we are the most populous country, we are in the middle of the world.

[02:40] as well, there is a lot of risk as well as a lot of disasters, climate-related disasters that we've endured over the past 30 years, leading to around 80,000-plus deaths. And so climate change is a very real thing for us in many, many forms, ranging from heat stress to flood-related disasters to even

[03:00] other disasters because of a huge coastline that we have. Having said this, my work at PATH is mainly focusing on mental health. We are also working on climate change and at PATH, and I'd like to just quickly summarize that in a couple of lines for you. PATH is an international not-for-profit headquartered in the U.S.

[03:20] say. We've been around for 45 years and have projects in 70 countries. India is just one of them. In India, our main focus has been over the past two decades to work on health technologies, as well as support the national and the state governments in promoting their healthcare programs across a wide range of health priorities, mental health being one of them.

[03:40] and it's a relatively very new entry within PAD. So we bring our strengths from health systems and health technologies for mental health, and our major strategy of working in mental health is closely working with the national and the state governments simply to improve what they have already outlined in their policies and programs to implement on ground. And so we have a lot of questions.

[04:00] would like to be the catalyst that makes that action possible on the ground. And with respect to climate change and mental health, there are many similarities that I see in a country like us. Both of them have tremendous impacts on the population, both of them are very very cross-sectoral. It's not within the purview of probably a single department.

[04:20] Both of them have good policies and programs that have come up in the last two decades with our national action plan for climate change and for mental health. We have a national action plan for climate change and mental health as well and state action plans are being drawn. Having said that, the reality on the ground is the systems are just not strong enough to kind of address the challenges of climate change and mental health.

[04:40] together. So my main message through this opening statement is that while we want to advocate for policy change, probably strengthening of what is actually on the ground and how that's going to happen, given the realities of the capacities, opportunities and challenges that our health workers and communities face at large is going to be more important.

[05:00] as we advocate for change at policy level because it's relatively, in my view, and I could be wrong, but it's relatively easier to write it on a policy document and much more difficult to then say and put it on, put it in action than subsequent years or decades. Thank you. Thank you. Alana?

[05:20] the first thing that I want to say is I'm so grateful to be here. As a young person, I think, not often do youth advocates have the opportunity to kind of take the stage and share their expertise and share their experiences. So I'm really honored to have the opportunity to be here.

[05:40] perspective in the work that I do in terms of youth mental health work. There's young people that I work with that are indirectly affected by climate change and young people who are directly affected by climate change. And I think the way in which you engage youth in those two different spaces are quite different. I think in the first one, it's

[06:00] really about how are you improving or increasing youth in their engagement? And I think part of that stems from emotional pathways. So thinking about how can we develop nature connection? How can we develop that connection with young people and the environment to really encourage them to think about how

[06:20] how they're engaging with the world around them, and I think that really starts with empathy for youth who are indirectly affected by climate change and environmental situations. A lot of the times they are deeply hit by the realities that are facing them.

[06:40] them and their communities and it is something that is affecting, significantly affecting their everyday. To give an example of one of the stories of a young person who I met when I very first started my organization HOPE and I was leading one of the first workshops that I led. It was an online one. It was on Zoom.

[07:00] just doing it from home as a 16 year old in my bedroom. And I had a call with a few young people across the world, all youth advocates, and I was holding a mindfulness session. So I'm a certified yoga instructor and this was just after I'd completed the training. And I held the session.

[07:20] I had some, you know, YouTube music playing in the background, just leading a guided meditation practice with... And I was playing my singing bowls at the same time and I recognized that in that moment, I was very unsure of what I was doing, whether this was the right thing or whether this was even going to be helpful.

[07:40] young people. I wasn't sure if I was qualified to help and make a difference to young people and their mental health. And this young girl, she stayed behind after the session and she told me that earlier that day where she had been living there had been a huge flood and her whole house where she was living was

[08:00] hip waist high in water and she had been so stressed out, so overwhelmed that whole day and for 30 minutes and that was that was how long the session was. For 30 seconds, sorry for 30 minutes she was just able to just take a breath, step out of it and really feel like she could reclaim.

[08:20] some space for herself before going back out and dealing with the rest of the world. So that's just a short story about why I think emotional regulation is so important because youth are going through so much already, especially during adolescence and all these life transitions of being a young person.

[08:40] But particularly when they're impacted by climate change, there are so many things that they're going through. And to give them that support, to manage burnout, to manage stress, allows them and enables them to continue to further their work in a way that's sustainable.

[09:00] Hi. Yeah, I think it's good to have an all-womans panel. I think that was my first observation of the talk, since. So saving the best for today.

[09:20] the last time. I will start with who am I representing or my positionality. So I'm Preeti Sridhar, I'm CEO of an organization called Marivala Health Initiated. We are a grant making, advocacy and capacity building organization based out of India

[09:40] focused on making mental health services accessible to marginalized people. We look at mental health from a psychosocialist and I think therefore I would like to make an opening statement about our journey on mental health and climate change in very, very, very close to the end.

[10:00] Where it started is we were getting proposals from marginalized communities that were getting impacted by climate, but it didn't have the word climate as was globally used. So we have funded projects since 2019 on pharma suicides in drought districts in India. We have

[10:20] funded projects, superior mental health support to communities that have been impacted by cyclones in low resource states in India. We have funded projects like my colleague's Iftikar that work with refugees.

[10:40] in Assam or my colleague Priscilla who works with, it came to us as a school-based mental health programme in Daujilin which is again a low resource setting within what funders in India fund also.

[11:00] We got proposals to work on mental health of fishermen communities that are in the coastal areas that are experiencing increase in sea levels and what we also observed was our year on year funding to disaster release was increasing.

[11:20] But none of it came as climate change and mental health projects. And I think that is really because a lot was said over the last few days on funders and need for funders to step in, is that the conversations on climate are happening in a different sector.

[11:40] Conversations on mental health are happening in a different sector. Mental health and climate change is again not happening with communities as part of it or marginalized communities specifically as part of it and as Brian has been talking for the last two days, LGBTQI communities are missing.

[12:00] persons with disabilities are missing, persons doing daily wage earnings are missing from conversations, and the language on climate and mental health unfortunately is being led by mental health professionals, researchers with an

[12:20] And research requests coming without community involvement beyond data collection points. So I think I will use this opportunity to also talk about challenges funders who want to fund climate and mental health with a marginalization lens may experience. Thank you, Preeti.

[12:40] Now we move on to Beli.

[13:00] joining you and as Priti mentioned to be joining this all women panel today. Just to build on what everyone has shared, my initial thoughts on the theme of this discussion is that if we truly want scalable, sustainable change, then we also need to be dismantling the frameworks that perpetuate.

[13:20] the separation of climate action and mental health. I think now more than ever, we see that we're up against very powerful systems that profit from keeping these issues disconnected. And as a young indigenous climate justice activist and planetary health practitioner fighting against these systems,

[13:40] our work every day. And in light of recent shifts in governance, I think we can no longer ignore how deeply policy impacts our lives and how the wrong policies and practices perpetuate harm and injustice. We are seeing this with the current US administration. We are experiencing this in my country, Indonesia as well right now.

[14:00] The reality is we need to fight for the right people to sit at those tables or we must be prepared to challenge the systems. And zooming into the climate and mental health space, I believe that long-term sustainable action in this nexus needs to come from first, recognizing that the systems that drive climate

[14:20] climate change and mental health crises, capitalism, I'm talking about consumerism and profit-driven exploitation. These are the same systems that are keeping us from seeing these issues as interconnected. So it's a question of how do we prioritize dismantling these systems. Second is that policy and practice only work when they

[14:40] are grounded in the realities they aim to address. So the question is how are we currently understanding those realities and how do we ensure that we stay connected to them. Me personally as someone who's working both with indigenous and local communities in Borneo and with health systems and health professionals across the Southeast Asia region,

[15:00] I can see that there's clearly a gap in approaching this climate and mental health nexus. I think the status quo right now relies on narrow, more one-dimensional views that fail to capture the complexity of people's lived experiences. And on the other hand, we tend to overmedicalize and disregard how a large part of

[15:20] creating mental health and wellbeing also comes from our relationship with the environment around us. So my call is also to expand our understanding here, which also means we expand what counts as knowledge and who counts as experts. And thirdly, I think effective advocacy has to come from multiple.

[15:40] multiple sites. So it's about how do we bring people together? And an example with healthcare without harm, Southeast Asia is we manage a regional network of health professionals who are championing climate justice and health equity. And while we are just starting to incorporate mental health advocacy into this work, we have seen

[16:00] how key narrative changes can happen when health professionals, environmental organizations, mobility advocates, clean air advocates, just transition movements, when they are all brought together. And I think that there are many existing groups fighting for the same end goal. In many ways, our advocacy is all also

[16:20] deeply interconnected. We all want a healthier, a more just, a more nature-aligned world that leaves no one behind. So right now the call is how do we bring these groups together strategically so that pressure, urgency, and solutions can come from all sides to address this climate and mental health nexus.

[16:40] Thank you so much, Belay, and thank you, all of you, for these incredible opening statements. I was taking notes and I realized that there are a couple of themes that have emerged in these conversations, especially around the importance of community-driven solutions, the role of youth advocacy, and also the need to integrate mental health into

[17:00] broader health systems. And I think it's important to dive deeper into these key themes. So we can start with first the question of scalability. Let's mix it up a little. Alana, I think I want to direct this question to you. Since you work on creating self-sustaining wellness equisystem,

[17:20] So what mechanisms do you think are the most effective in scaling these programs and ecosystems across different cultural and geographic contexts?

[17:40] to upskill young people or the demographic that you're working in. I think a lot of the times it's providing them with knowledge, providing them with leadership skills so that they can be at their best to do their best for an environment or whatever they're advocating for. I think that young people have a lot to offer.

[18:00] And sometimes it's just about providing them with that toolbox, whether it's the research skills or having the background to learn more about environmental science or even public skills training as well. All of those skills I think are so important. But especially when you're thinking about scalability, it's really important to think about how

[18:20] you can do that within community settings. So a lot of things that I do is I work with schools and one of the reasons why I think it's important to do these trainings and these upskill sessions within community settings is because a lot of the times if you provide a young person with a tool or you provide anyone with a tool really, what

[18:40] happens if you don't practice. A lot of the times that knowledge, those tools, you forget them, you lose them, and then the scalability or the long-term implementation or the impact of what you're doing becomes diminished. So a lot of the times, if you do this work in communities, a lot of the times there's more accountability.

[19:00] might have a peer, you might have a buddy who said, oh, did you practice that tool? Did you do this activity? And that way, the impact of what you're doing continues to spread and continues to grow. So I think that's my piece, but wondering what other people think. Do you want to add anything?

[19:20] Okay, that's a really interesting perspective, Alana, and I do agree with it. I think just to build onto that question, I also would like to understand the role of technology when it comes to scaling up these mechanisms.

[19:40] mental health interventions. And I know Dr. Rachna that you have worked on using technology to scale up mental health interventions in India. So we would like to hear from you on how we can use these technological innovations for mental health, especially in areas that are climate-prone, climate-affected.

[20:00] Yeah, thank you for that question. I think, and I'd like to really agree with Lana here on involvement of communities and keeping the momentum going. Once you have started off an intervention and as much as that's required for any peer-to-peer or community-based intervention, it's equally true for technology as well.

[20:20] because it's easy to get it first on your phone or first somewhere to start using it, but then continuation of its use is going to be really dependent on many things. And so, especially in climate-prone areas, the challenges are going to be just multifold. We know that in many of our countries, there is already an existing digital divide. One is that people may not have access to phone

[20:40] and internets is what we understand. But the second divide is who really creates these technology? And so if you look at, and we reviewed about 100 mental health interventions that were available on, let's say, Google Play Store a couple years ago, and we figured that 60% to 70% were actually coming in from.

[21:00] the Western countries that were developed by them and hugely used. And these were probably the more popular technological mental health interventions than the Indian or indigenous, the ones that are produced by India for Indian settings. So I think that digital divide on who produces it, for whom it is it produces also another factor.

[21:20] to look at. But for climate-prone areas, there are many applications of technologies that one could really focus on and a lot of them are intuitive, especially if you keep the vulnerabilities of both the providers and the users in mind. Some of the ways in which technology can really help is to first create awareness and knowledge.

[21:40] and empower people with knowledge about how climate impacts their health. Often we don't understand that, like for example heat stress, how to protect yourself. If warnings are sent out on time, if people are equipped with information on how to deal with increasing temperatures at that time, it helps them adapt better.

[22:00] at the same time it also has health system prepare better. So those kind of applications where you're sending information and signals to both the providers and the community about the impending changes because of climate, additional vulnerabilities created, how the spike in mental health problems will be visible.

[22:20] how the spike in other vulnerabilities or community related problems like, you might see more aggression, more violence, might be visible, that would be helpful, that's one. The second application of technology is to simply improve access of care within climate prone areas. What would happen is a challenge not just for a person to seek care, but also for the health.

[22:40] an urgency to get care and more difficulties on the part of the provider or the system to provide care. And at that point in time, technology can really be a game changer in terms of not just sending accurate information, but also providing immediate psychosocial support. Sometimes it's just about clarification of doubts, finding your loved ones.

[23:00] finding more resources, but so that. But these systems can't be set in place after you have a disaster. And so like we heard in a panel in the morning, preparing for it, identifying which geographical areas, which populations are more vulnerable and preparing for it will be very important. We are seeing a lot of interest in applying

[23:20] We have to see if it applies equally to languages that are not English and to cultures that are not Western. Having said that, it's still an area that emerges, especially if you can merge it with weather-related information to provide good access to information. Let's stop here.

[23:40] I think those are very important points, especially around making technology more inclusive and accessible, especially for communities that are most affected by climate change. Now we have spoken about how to scale these interventions, and I would like to shift gears and turn towards understanding the challenges of advocacy.

[24:00] So even when we have good models in place, good technology in place, pushing for policy change can really be an uphill battle. And on that note, Preeti, I have a question for you. Since you work with governments and also funders, what have been some of the biggest challenges when it comes to

[24:20] comes to advocacy, especially to different groups and when it comes to embedding mental health policy into like the systems. Yeah. So if I could just add to it and I'll talk more in terms of what has helped us do that.

[24:40] of advocacy because challenges are many in everyone's work areas. I think for us it has always helped to write things down as to what would a particular issue mean in the context of India.

[25:00] So we did, we have a yearly journal called Reframe and every year we have a theme when it was coming out to, like I said, we were not seeing grant notes to fund on climate and mental health. We said let's write a particular issue on.

[25:20] on climate and mental health justice. And that just gives a language to some people around to say, oh this work can also be called in this way. They are already seeing it. It's just the language I think that comes through it because then that becomes an advocacy tool that they are also using.

[25:40] I think the other thing that we started doing is started getting involved with more marginalized committees to understand what are they looking at as languages. And who are the, I think, developmental organizations that are working with these marginalized communities? Who are the organizations that are working with home-

[26:00] people that are working with migrant workers, how are they articulating mental health? What is the language that these committees or groups are using to indicate impact of like heat waves or more rainfall or flood.

[26:20] to better our own understanding of the subject. The third thing we started doing is being part of disability forums, which were already engaging with climate forums. So we, in fact, took out a statement

[26:40] with disability-inclusive climate action. It's a group, I don't know how many of you are aware, to say that the COP was not disabled-friendly and accessible. And there's need to use, of course, privileges of being a funder to make these call-outs in an open manner.

[27:00] The third thing that we started doing is because we were not getting research on, say, impact of heat or increasing heat temperatures on marginalized communities, we ourselves commissioned the research to be done on daily wage earners in a state.

[27:20] called Rajasthan, which is where more, where part of it is in a desert area to understand what's the impact. But to do that research, we took people who are from the community with the same lived realities and we created an advisory.

[27:40] that was also community-based and community-led. And while that research may not get the academic clearance, for us it is important to commission this kind of research or to even fund research where organisations are working with them.

[28:00] say on the issue of homelessness to say what are you hearing about mental health and if they don't fully understand mental health then to build capacity of these organizations to do that research because like everyone was saying there is a need for data.

[28:20] But you can have data in many forms and it need not be published research articles and that's been our experience that when you go to the government, one, you definitely need somebody who is buying into the idea and and you will have to draw their personal

[28:40] But after that, they are not asking you for academic papers. Right? They know their stuff better. These government officials are the brightest mind in the country. You just need to change their perspective to, say,

[29:00] How can your existing work be enhanced by incorporating a mental health lens or a climate justice lens? And we have found that written document for them to read. Introduction to organizations that work with marginalized groups.

[29:20] introduction to research that's been done by the community can work. I think you made a very interesting point around the strategic framing right and how that helps to embed mental health.

[29:40] into policy. And now I would like to ask Belay to sort of build on this since you have already been involved in international advocacy at local and national level. What do you think have been the most effective strategies for pushing for stronger commitments to mental health within global climate?

[30:00] negotiations and global platforms. Thank you so much. And yeah, I think strategies and also I guess challenges in a way that we've also observed and noticed and have tried to address as we do, as we push for more advocacy and policy change. I think first is in terms of

[30:20] the general landscape itself, we're seeing that there is a shift in strategy from denying that there is an interconnection to delaying action to address these connections. And one example is, it's taken so long for us to

[30:40] even recognize that climate and health in that wider sense to be recognized in a space like COP, which has gone on for almost 30 years now. We've only had the first explicit health day on COP 28. So that shows us that the challenge used to be that we're trying to push for awareness.

[31:00] of this issue, but now I think the tactic is more on delaying action to address these issues. I think one of the key strategies that our organization has tried to embed is really ensuring that the health community is part of these discussions and that the health argument continues to stay central to these discussions. And I'm going to use a

[31:20] example outside of the climate and mental health nexus for a bit here, but our recent engagements in the Global Plastic Treaty Forum. For example, this has been a space that is quite resistant to the inclusion of the health space because the current notion is that health should be excluded from our Global Plastic Treaty.

[31:40] because there is a misunderstanding that plastics is essential to healthcare. When in reality, what we're trying to advocate in this space is that we as a major consumer of plastic also have to be held accountable and that there are steps that the health sector can take rather than just having a blanket exemption for the health sector.

[32:00] to be excluded. And I think more of these cross-sectoral collaborations, coalitions need to happen between the climate and health space, and in particular, the climate and mental health space. So we identify places where there is high resistance and we create cross-sectoral knowledge and movement to push for at vopacies and strategies and

[32:20] changes in fighting those resistance. And I think the second challenge and also strategy is even when we see a policy change, there's no guarantee that the people in the systems are equipped with the right tools and knowledge to enact that policy change.

[32:40] So there has to still be a capacity-building effort for every stakeholder involved within the scope of that policy in order to implement it in a just manner, in order to implement it sustainably. And again, one of the examples that I will use is in our work with building climate-resilient healthcare systems.

[33:00] Across Southeast Asia, one of the key sources of vulnerability that we have identified is when there is a capacity building that is still needed or a gap in capacity of health professionals to address climate and health in general, but also climate and mental health issues specifically.

[33:20] really start when we look at the differences between capacity at a tertiary healthcare level versus at a primary healthcare level. And that's what we need, right? We need all of these different moving parts from tertiary, secondary to primary healthcare facilities, and health professionals working in those facilities to also be in a

[33:40] and have the tools and capacity to enact whatever policy changes is coming from the central level, the national level, or even on a global level. And so having that push for capacity-building and making sure that they know what to do when policies are enacted, I think, is one of the key strategies that needs to be done.

[34:00] be done. And also to recognize that the climate and mental health nexus is a particularly complex interplay of factors. And so there also needs to be sensitivity around vulnerabilities and urgency with the need to build trust and long-term engagement at the ground level. Yeah.

[34:20] Absolutely. I think those are very good points that you just raised, Belay. I think it's very important to understand that collaboration between different actors is extremely important when it comes to advocacy. And I think that brings me to my next question to Dr. Vasuntara. How do you think researchers

[34:40] can collaborate more effectively with advocates and policymakers to sort of bridge this gap between the research, the community-driven solutions, and action. Yeah, and Preeti, I remember we were also having this discussion during lunch, so in case you want to add something to it.

[35:00] Yeah, please go ahead.

[35:20] us as part of the solution. So similarly with the DBA when they join in, we are not necessarily known as a health man, health players and it's only been in the last 10 years. So previously health sector is only 3% of our portfolio before COVID and our main work is really on health sector development. During COVID it's gone up to about 25%.

[35:40] And that's because we're able to contribute to get a COVID vaccine. But then the thing changed again, you know, with the combination of climate change, G20, COP28, COP29. But also we wanted to make sure how to be resprampted to use the health sector to actually not only rescue.

[36:00] response to pandemics, but also prepared for pandemics. And so we use the same terminology with the climate change. So we have to build hospital, that's what we support, the governments. So what we do is we make that hospital green. So green hospitals have to make the climate resilience hospitals. So I think that's just a big

[36:20] bigger picture about reframing and that's the same thing with mental health. Instead of saying climate change impacting mental health, how about the other way around? How about saying that having strong mental health, same as physical health, get you stronger, resilience? So I think that's just a change of overarching message. The second one I just want to really separate literally about

[36:40] pitching to a different audience. From me myself as well, it was for a long time writing to academic journals, writing to grant funders, and this is a very different audience. When I get the chance to really sit across with government, you don't have a lot of time. You have to understand also who you're talking to. So with the same research that you do,

[37:00] You have to have different packages depending on who you are talking to. If you sit across beat international agencies as a collaborator, you need to be able to say what it is exactly what you need in a three minutes, five minutes, or only 15 minutes because you have a series almost like a dating, a quick dating, you have to like go around. So I think you have to be quite clear of how, what it is.

[37:20] finding that it can be actionable. The third one which is actually found very recent is that think outside the box even with the same research that is you're doing, a colleague of me was saying that his research was about getting the participants to think about in the next 50 years if your kids

[37:40] going to be writing a letter to you complaining about the issue that they haven't had now, would that change your mindset now? And it's just like before and after pre-pulse survey easily like that and then they do analysis of what change. Why is it thing is matter is it because psychosocial connection, intergenerational connection, what is it?

[38:00] like that I mean like oh okay it still bears on the foundation of work but giving the different lens and just the last thing really is to to be similar to just be persevere I know the funding is fairly hard now it's a very tricky time in public health but I think it's really how passion

[38:20] research, I think it's really important to just, you know, tweak it a little bit and be able to stand on. I remember last year we had a forum on air pollution, Korean air forum, and he said, I've been talking about air pollution for 20 years and now I'm getting popular because now I'm packing it as a climate change. So, so be just, you know, consider the evidence but also also look

[38:40] broadly as well. Q.P.D., do you want to add to that? A.K.I. I think I agree with Vasantharath that you have two to three minutes and depending on who is sitting in front of you and what is their passionate subject, you have to link your issue to them. But you also then need to

[39:00] to understand what is there, what is it in it for them. And I think it's important to do that. And because of the two to three minute, I think for me what has worked is what's the clear ask that I have from them.

[39:20] what are two sentences that I will say, I want you to do X, I want you to do Y. It needs to be very, very clear. Because if they agree, I shouldn't be waiting for another opportunity to tell them how to do it. So yeah, it has to be.

[39:40] very, very strategic communication there. Absolutely. This has been such an enriching discussion. And I would like to now hear from you all. In case you have questions for the panelists, we have mics set up. So you can go ahead and ask the questions.

[40:00] Thank you.

[40:20] again. We have around 10 minutes. So we would just like to club these questions and then we can let the panelists answer them. Thank you. Thank you for the really powerful discussion. I think part of what they want to ask is really given that in a lot of areas, the discussions about climate change and mental health is still, but mostly

[40:40] with mental health and its next to its lifetime change. It's a kind of growing and what we're noticing in the locus spaces is that some people have their own personal beliefs of mental health that might not necessarily either align with evidence or might not even be factual. I mean, used to be honest about it. So how do you, I guess,

[41:00] In your experience, how do we how do we try to approach stakeholders who have power but might have beliefs that might not align with the change we want to pursue because I think that's it. We still have to work with these people. We still have to engage with these people, but at the same time, we can't, you know, we can't fight them. Just again, they're the

[41:20] for we need that to do something for us as well. Thank you. Well that's a question to Belay. It's the first time I heard a speaker talk about the footprint of the health system.

[41:40] And I very often say health is a victim of climate change, particularly mental health, but we are also perpetrators. 6.7% in Germany. In Australia it's even more and 4% in the world average. That's three times the aviation footprint.

[42:00] I know that Health Care Without Harm is working on this and could you please describe what you're doing and how this can be spread in the room and beyond, that we should also look at our perpetration and not only being a victim as a health individual.

[42:20] Okay, yeah. Belay, do you want to go ahead first? Sure. Hello. Thank you so much for recognizing that. I sometimes forget that this is also messages that might be new and unfamiliar.

[42:40] for people. But I'm glad that these kinds of narratives are being pushed. That's exactly what our organization is setting out to do. We operate on the basis of first do no harm, which is a very familiar and key and integral oath to the health sector.

[43:00] The way that our organization started is actually in realizing that how our health systems operate is in a way harming the environment which in turn harms the patients and the people and the communities that we serve. So how do we really hold on to that first do no harm oath if we don't transform the way that the health sector and the health systems.

[43:20] provide care for our communities, especially now in the face of the climate crisis. A couple of things that we focus on as an organization, both globally and regionally, is first creating a path towards decarbonization. I think that's one of the key strategies, especially in light of mitigation.

[43:40] of the emissions that we create as a health sector. We did a study with Arup in 2019, and some of the numbers that you were mentioning with regards to the footprint of the healthcare sector in Germany is aligning with our findings that the healthcare sector globally emits about 5%.

[44:00] And I think that number is changing because it's been five years now, amid 5% of the total global greenhouse gases. And if we were a country, we would be the fifth largest emitter in the world. And that does not align with that first do no harm principle. So one of our key strategies is in creating a path for decarbonization for healthcare systems.

[44:20] worldwide. But at the same time, how do we also balance that with the understanding that not all countries and not all health systems have the same capacity to mitigate, nor the same priority to mitigate. And I'm speaking particularly in terms of health systems in climate-vulnerable countries. In the Philippines, for example, one of our hospital-

[44:40] members had to face a tropical cyclone at the same time as the COVID-19 pandemic and having to deal with that interconnected issue, which also has an effect on the mental health of the workers who are providing care at the same time. We're realizing that there's a lot of nuance to this work and that we have to look for it.

[45:00] at mitigation and adaptation as a mix that is needed to build climate-resilient healthcare worldwide. And the other key thing that we want to see is leadership. And this is in particular speaking on what I have shared earlier, that we need the voices of healthcare professionals. I don't know how many in the room right now are

[45:20] part of the health system or our health professionals themselves. But we see that there's a lot of trust that is being placed in the voices of health professionals and what we need now more than ever is for them to speak up, be capacitated and champion this work in climate justice, this work in advancing the climate and mental health nexus, and this

[45:40] work in fighting for equity and justice for everyone, whether that's in the context of healthcare or beyond. Thank you.

[46:00] change the mindset of stakeholders when you want to address certain things. And that's one issue that we have as well. For example, you can't just go into a country and say, oh, we want to help change your climate change and mental health impact. It doesn't work like that, especially when exposure is very much a public good. These are actually international, non-serve.

[46:20] issue, but then the impact is in-house. It's actually the-it's from a minister of public health, in particular, you know, mental health department. So it is really hard to-and I think you point out the good things about, you know, cultural susceptibility as well. So you don't want to go into the country and say, do you have problems? Can you help you solve? It also doesn't

[46:40] work like that. So what we're trying to do to go in is a week go with different narratives. You know it might not be a specific mental health issue. It could be task shifting as you know as Professor Rickram is saying like oh how about we can bring in strengthening community health workers how to actually build that capacity to do mental health. We can come in and say

[47:00] how about a medical education, we can actually help you to build more psychiatrists and psychologists in the next 10 years. So I think something like that or even going to different ministry, it doesn't always have to be Ministry of Health, it could be Ministry of Social Welfare. So we can go in and say we understand that the vulnerable population

[47:20] When it's climate change, elderly persons, you know, is it something that we can come in and kind of see if there's an impact on the mental health that day more? Is there anything else we could do? Is it telemedicine perhaps that, you know, instead of they having to come in to get healthcare? So something along those lines. So I think that probably where one of the starting point.

[47:40] Just to partly also to answer your question, this change in mindsets is a really tough game. But often what happens is in conversations, in my understanding especially, when you're working with the governments directly in order to bring about a change in certain area of work, it's not necessarily just

[48:00] the mindset. It's actually feasibility and it's actually what additional resources are you really asking for? Often as researchers or as people who are doing an advocacy we go with with one particular solution and just do this. Psychosocial interventions work we heard yesterday, we're probably going to hear, we have to give a mental health awareness app to the individuals.

[48:20] We're going to probably do community-related processes for mobilizing them for advocacy and change. But what this really means for the entire system is the question that the officer is thinking or that the secretary is thinking. So what you mean is that when I need to empower my community health workers, who's going to do the community mobilization to get the people to the community health workers?

[48:40] in the first place. What's the kind of time commitment my community health worker requires? The community health worker is typically doing perinatal care. Will they be really able to talk to psychosocial interventions with respect to climate change? Okay, what happens? Where does the data go? Will it get monitored? How will I use for policy change? What it means for my tertiary care? What number of cases am I going to get?

[49:00] going to see do high, I have been a specialist to address it. And there are not many more factors that I don't even probably cannot even articulate in terms of whereas the training resources, the budget resources, the printing, and so on and so forth. So probably one of the ways in which I have found sometimes it's easier to convey a point is to really think about it and

[49:20] and share that this is the main thing that we want to change. What it really means is in your ecosystem, so many things are likely to have some amount of change. We have a lot of preparation already in the system and only these aspects are new. To be able to articulate that, you have to engage with the systems from ground up in your work and know what really happens.

[49:40] At every level. So that's number one second. What I really find fascinating is well this while we're looking at mental health conference here mental health is really not just cross-sectoral in terms of how it what impacts mental health, but also Where where all you see mental health, you know being more commonly

[50:00] by people problems being experienced. For example, NCDs, mental health density is 30 to 40 percent comorbidities. Perinatral mental health is high comorbidity. You're looking at probably every health area where mental health is getting impacted and when similarly you look at how climate change impacts us, it impacts probably all of our health. And so now we've

[50:20] What we are going to make is when you are looking at climate change and mental health, are we going to speak about climate change and health and then bring mental health? Is that one of the ways forward? Because the government is not thinking of mental health and for them the priority is also a lot of health. And so probably looking at mental health within all health areas as we have been propagating, promoting.

[50:40] for mental health, look at climate change and health for all areas and seeing mental health, how it can be bundled in terms of policy, but actually be what services you're going to provide is probably one of the ways we need to think of carefully. Thank you. Do we have more questions for the panel? Oh, okay, go ahead please.

[51:00] We have five more minutes left.

[51:20] energy as well and they're also like other security and ethical considerations when it comes to using AI for example or like with the rapid development of technology. So I'm just wondering how we can balance this, make sure we can utilize technology to the best of its use for mental health interventions and also for

[51:40] climate justice, but while not letting it kind of like sabotage the already bad like issues with human rights and social justice. Yeah, we can clap all the questions together. I think it reminds mostly a reflection which is also trying to see the.

[52:00] of the discourse that we're having here. As it's the last panel, I'm also reflecting on what we've been speaking about over the last three days. It is to me, and glad that Billye also brought that up, that it's, you know, the interconnectedness is not necessarily something that we look out for between capitalism and climate change. But at the same time, it's very surprising that over the last three days we are not talking about what's going on in West Asia, we're not talking

[52:20] about the genocide, we're not talking about the military industry complex and the fact that that counts as a very important part of the climate change crisis as well. What happens about the carbon emissions of genocide, what happens about war, what's going on in Congo right now or what happens because of the refugee crisis with the Rohingya population as well. So when we're looking at talking about climate change and silos, are we

[52:40] then also very conveniently whitewashing that narrative into climate change related to the West or are they then isolating the humanitarian sector and saying that that's something which is isolated from mental health or are we then also not talking about these discussions. So I would just want to know if you're open to that scope of conversation in spaces like these and whether or not Asia then gets represented in the communications.

[53:00] Thank you, Bart. One last question, please. Professor Fauzi-Rabani from Aachen University. So nice to see many of my Indian colleagues here. I think in South Asia as a whole, we are never going to get the experts both together to be able to get the experts together.

[53:20] in climate change and mental health. So our basic infrastructure in terms of health systems development will remain the primary health care. So how do the community advocates, health care providers and policymakers can be brought together to integrate

[53:40] change in mental health at the primary care level and when will mental health cart drive the NCD horse, the non-communicable diseases horse because it's always the NCDs that goes first in primary health care. So a comment and a question both. Thank you so much. Thank you for those questions.

[54:00] I really identify with professors mentioning about the NCDs taking precedence. That's the experience in India as well. So mental health is one of the identified packages that a primary health provider is supposed to give. One of 12. The second of 12 is also NCDs.

[54:20] Having said that, when you run an evaluation, mental health is the least implemented package in primary health care. And yeah, I think they are probably, it's very strange why they are not talking to each other because it's really a very, very close bi-directional relationship between mental health and NCTs. Having said that,

[54:40] The experience that we have when we are supporting governments, 10 state government governments in the country, to run pilots of promoting mental health care within primary health care settings. And what our experience has been is that often it's actually about showing where the opportunities are.

[55:00] within the existing services where mental health and NCDs can be bundled together and creating clear pathways for service providers to support that. That's probably something that has helped, but I agree. We are a long journey for us to go. Go ahead.

[55:20] No, I was waiting if Billa wants to answer the question on any of the questions because she's on now. I can do after you if you'd like. So on the question, I completely agree. I think there needs to be conversations.

[55:40] in mental health setting with or without climate on what's happening in Gaza, what's happening in other states, there is no conversation happening. And unfortunately, that's reality. And, yeah, it should happen. It should have been a very difficult time.

[56:00] mental health is a human right and mental health intersects with whenever human rights are violated, there is a mental health impact on communities. It is not about individual resilience building, it is about access to human rights. So yes, it's missing in this case.

[56:20] space. Absolutely. Belay, any last comments? Yes, thank you so much for the questions and also the point of reflections I think for everyone. I, just responding to the latter question first on how do we create, how do we facilitate

[56:40] place for stakeholders to meet. I think in my opinion we also need to be redesigning spaces where stakeholders meet, the spaces and the mechanisms in which stakeholders meet, and if I can just zoom out from not only the primary healthcare facility setting, but also in general within local communities, with policymakers, within researchers.

[57:00] community. We have a lot of issues with our cultures, academicians advocates. I think it's operate right now. We're operating under the assumption that everyone is coming into these spaces on equal footing. But in reality, we know that there is an inherent power imbalance when, for example, my community meets with the local

[57:20] rights and etc. I think that's why it's important that when we redesign the spaces, we use a rights based approach. And I wish I could tell you the answer of how these redesign spaces would look like, but that's something that I think we're all also grappling with. But not to say that that's not an important thing.

[57:40] and necessary change that we need to make. And just also a comment on the earlier invitation to reflect on this interconnected crisis. I completely agree with Ms. Priti that these conversations need to happen. And for me, the way that I see

[58:00] it is there's a lot of solutions being put forward, whether that's in the climate health space or the climate and mental health space in particular. But when the solutions that we pursue perpetuate the same cycles of injustices, the same systems of oppression that we are seeing today, then it is not a just solution.

[58:20] And those just solutions can only come when we are courageous enough to have open, transparent, transdisciplinary conversations about all of the things that are happening right now that are completely and deeply interconnected to each other. Thank you so much, Belay. And before we end our discussion for today,

[58:40] Alana, one last question for you. Do you have any words for our generation or the youth and how we can do better and help drive a change? I think that's a very big question. I think one thing that I would say to young people kind of anywhere.

[59:00] anywhere in the world in terms of a piece of advice. I know for me, a lot of the times growing up, when I told my school or the people that I worked with, can I start a school club to do environmental advocacy work? Can I volunteer for ex-organization? A lot of the times I was actually told no. A lot of the times I was often dismissed.

[59:20] told that, you know, don't do this, do something more academic, do something more proper. So I would say for any young people who are looking to get started or looking to be in the field, don't be scared, don't listen to the nose, keep doing it anyways. Absolutely. Thank you so much to our panelists and I hope you all enjoy the lab.

[59:40] face of the symposium. Over to you, Renssel. And thank you to Muscan and the final.