Adaptability of health and social services systems to protect the mental health and psychosocial well-being of populations exposed to extreme weather events (CASSSIOPÉE Project)

The project, “Adaptability of health and social services systems to protect the mental health and psychosocial well-being of populations exposed to extreme weather events” (CASSSIOPÉE Project), was funded by Health Canada’s HealthADAPT program until March 2022.

The CASSSIOPÉE project was carried out in Chaudière-Appalaches by the Université du Québec à Rimouski (UQAR) and the CISSS de Chaudière-Appalaches (CISSS-CA), in partnership with the CISSS du Bas-Saint-Laurent. The project aimed to strengthen the capacity of health systems to protect the mental health and psychosocial wellbeing of populations in the context of climate change. The targeted climatic hazards include extreme weather events, particularly floods and heat waves. The main project team consists of the CISSS-CA, UQAR, and the CISSS du Bas-Saint-Laurent, with extended support provided by the Institut national de santé publique du Québec (INSPQ), the Chaudière River Basin Committee (COBARIC), Ouranos, and Laval University. Team members carried out consultations on community adaptation needs and towards the adaptation of community and clinical services. They then developed a map of psychosocial vulnerabilities to climate change at the local community level and formulated a series of actions. Priority adaptive measures for the CISSS-CA and its partners are in preserving the mental health of populations in the context of climate change and increasing the ability of CISSS facilities to adapt.

The Chaudière-Appalaches region is particularly known for its recurring floods. Composed of a large city (Lévis), small urban centers, and vast rural territories, it covers an area of 15,073 km2 and includes 136 municipalities. In 2021, the total population for the region was 438,106. Chaudière-Appalaches is a manufacturing region due to the high proportion of jobs in this sector. The lack of labor and the arrival of more immigrants are new realities for the many industries and agricultural operations in the region. The population is also aging and groups such as recent immigrants, people living in remote areas, and the elderly are at-risk during climatic hazard events, particularly from a psychosocial perspective. In addition, rural and remote communities may experience difficulty accessing services and may have limited resources, which constitutes an additional risk factor during disruptive events.

Understanding and Assessing Impacts

Extreme weather events, such as floods and heat waves, are associated with multiple health issues, including mental health issues. In the short term, these events cause affected populations to experience a disorganization of daily life, states of acute stress, psychological distress, and exhaustion. When such events persist, it can lead to more chronic pathological conditions in the population. These psychosocial impacts are likely to increase due to climate change because of the expected increase in extreme weather events. It is therefore necessary to equip the health and social services systems to implement concentrated approaches to population mental health by mobilizing different sectors that have an influence on the wellbeing of communities.

The CASSSIOPÉE project team used population data, historical and projected climate and weather data, and qualitative data from individual interviews and focus groups in different territories of the Chaudière-Appalaches region to identify the impacts, vulnerabilities, and psychosocial needs of populations in relation to extreme weather events. This data was then used to create an index of psychosocial vulnerabilities related to heat waves and hydro-climatic events in the Chaudière-Appalaches and Bas-Saint-Laurent regions. This index is currently being completed and will be integrated into the pilot regional reinforcement and adaptation plan created for participating CISSS organizations.

The CISSS-CA was the leading public health authority for this project. CISSS-CA has nearly a hundred facilities, including 4 hospitals and 23 local community service centers spread across the territory of the region. Composed of 12,000 employees and 800 physicians, the CISSS-CA also works in partnership with community organizations. The CISSS du Bas-Saint-Laurent public health department also supported the project, and their support was useful for assessing the transferability of the methods and tools to other regions. In addition, support was provided from the InterS4 Consortium, a consortium for health care knowledge mobilization, as it has been beneficial for facilitating the creation of knowledge transfer products and the development of convincing arguments specifically intended for CISSS managers.

Identifying Actions

The CASSSIOPÉE project had three components:

  • Assessing the needs and issues of coordination and adaptation between health services and those present in the community in order to reduce the vulnerability of the Chaudière-Appalaches region, particularly focusing on mental health and psychosocial wellbeing in relation to extreme weather events in the context of climate change. To satisfy this component, qualitative data collection methods were used to conduct 116 interviews with stakeholders and citizen partners.
  • Creating a portrait of at-risk populations in the Chaudière-Appalaches and Bas-St-Laurent regions by documenting the risk factors and the capacity of the populations, the healthcare system, and its partners to deploy measures favoring the maintenance and/or restoration of mental health and psychosocial well-being in the event of floods or heat waves. To satisfy this component, data from OURANOS projects (particularly the Atlas of Vulnerability) and the ARICA project was pooled. This work was supplemented with the qualitative data that was collected during the first component of the project and the initial consultation of population databases, in order to identify the indicators needed to build a mapped psychosocial vulnerability index.
  • Identification of measures aimed at strengthening regional adaptation for participating CISSS organizations in order to reduce psychosocial impacts and preserve the mental health of populations in the context of climate change. These measures were established based on the data collected in the first stage of the project and the results of the ARICA project. They have been subject to a validation process by experts from different sectors and fields and are based on the WHO’s operational framework for strengthening the resilience of health systems.

Implementation

As indicated, the project had three components. The first two components were planned in 2019 and implemented concurrently in the winter of 2020.

The first component was based on the results of a group consultation that brought together local stakeholders, including those from public and community networks, and citizen partners. The consultation was followed by individual, virtual interviews, in compliance with COVID-19 health restrictions.

The second component of the project consisted of mapping psychosocial vulnerabilities in the Chaudière-Appalaches and Bas-St-Laurent regions, based on pooling data from OURANOS and the ARICA project (as described above). The collection of data from the first component of the project and the consultation of population databases was also considered in the identification of indicators for the mapped psychosocial vulnerability index.

A pilot reinforcement and adaptation plan were produced during the last year of the project based on the results of the first two components. The measures of this plan were categorized according to the WHO’s operational framework for strengthening the resilience of health systems, and have been subject to a validation process from inter-sectoral experts, within CISSS and its partners, to ensure the relevance and feasibility of the measures identified. Sharing knowledge and raising awareness on the psychosocial impacts of climate change has also been an aspect of the project. A knowledge transfer plan has been developed, and it includes tools that will facilitate the mobilization of CISSS facilities to protect populations before, during, and after extreme weather events.

Outcomes and Monitoring Progress

The CASSSIOPÉE project demonstrated the need to include mental health and psychosocial services in climate change adaptation measures.

The main benefits/outputs of the project have been:

  • A profile of exposure to floods and heat waves for Chaudière-Appalaches
  • The identification of the individual, social, and environmental determinants of mental health in the context of climate change, and knowledge of the coping capacity of individuals, the community, and the health system
  • An adaptation plan to reduce the psychosocial impacts of climate change
  • Increased awareness of at-risk populations to the psychosocial impacts of climate change
  • Awareness within CISSS public health towards adopting a vision of population health that includes mental health, and the need for an integrated and inter-sectoral response
  • Increased knowledge on coping mechanisms and on best practices for affected communities

At the end of the project, CISSS-CA has been able to share the following recommendations and lessons learned:

  • Ensure clear and unifying leadership within the CISSS in adapting to climate change
  • Include climate change and the response to its psychosocial impacts in the CISSS risk management plans
  • Have upstream actions towards increasing prevention and preparedness within CISSS facilities
  • Strengthen inter-sectoral actions between the CISSS and its partners
  • Break down silos and mobilize all CISSS departments, as this challenge is complex and systemic
  • Be more proactive and reach out to the population towards offering mental health services
  • Support social support initiatives, as these have been identified as important community strengths
  • Take advantage of lessons learned in the context of floods and pandemics to identify best practices and build on local strengths and networks
  • Mobilize a diversity of actors within the CISSS and its partners

Next Steps

The post-pandemic mobilization of the CISSS-CA is essential so that the results and recommendations of the CASSSIOPÉE project can be used to reduce the vulnerability of the region to climate change and the resulting extreme weather events. To this end, a new cross-cutting unit on climate change has been established within the public health department of the CISSS-CA. Procedures for transmitting the results of the CASSSIOPÉE project to the managers of this unit are planned for the Fall of 2022. This unit will help breathe new life into the mobilization of knowledge and the tools developed within the framework of the project.

A pooling of the knowledge from the CASSSIOPÉE project and the INSPQ VRAC-PARC project (i.e. Regional Assessments: Assessing Regional Vulnerability to Climate Change and Designing Regional Public Health Climate Adaptation Plans) is being planned for dissemination and this will more generally highlight climate portraits of both health regions and their respective vulnerabilities.  The VRAC-PARC project is also funded under Health Canada’s HealthADAPT program and assesses ten different climatic hazards.

In the future, the transferability of the project’s results may be tested within the region of Bas-Saint-Laurent, as well as with other CISSS facilities in Quebec and other health establishments in the country.

Resources

Digital Case Story – CISSS de Chaudière-Appalaches

Atlas of the vulnerability of the Quebec population to climatic hazards (French only)

Toolkits to reduce the psychosocial impacts of populations affected by extreme weather events (French only)

Interview with Lily Lessard on Radio-Canada radio about the CASSSIOPÉE project (French only)

Summary sheet of the results of data collection on floods (French only)

Fact sheet – Study of needs, challenges and strengths in the Chaudière-Appalaches region during major floods (French only)

Heat waves: Studies of psychosocial impacts and adaptation measures in Chaudière-Appalaches (French only)

UQAR article: Managing the risks of climate change in mental health, from a reactive to preventive approach (French only)