PRIME-Boston (Prevention of and Response to Incidents of Climate-Related Mental Health Emergencies in Vulnerable Communities in Boston, MA)

Project Summary/Abstract There is growing evidence demonstrating that extreme heat is adversely impacting the mental health of exposed populations. However, there is a need for further research at high spatial and temporal scales that allows for investigation of the role of potential neighborhood-level mediators (e.g., residential greenness or air

pollution) and the impacts in potentially vulnerable subgroups. In this mixed-methods study we will investigate the impact of extreme heat on mental health among uninsured and publicly insured individuals in the City of Boston, with a particular focus on understanding how both environmental factors and individual behavioral

patterns influence the effects of heat on mental health within this high-risk population. We will first leverage data (2005 – 2019) from a unique emergency services program (Boston Emergency Services Team [BEST]) that services ~18,000 publicly insured and uninsured persons each year in the greater Boston area. In Aim 1,

we will assess the relationship between temperature and psychiatric emergency services encounters in the BEST data, with particular focus to diurnal variation in exposure-response that can be leveraged to provide additional care for these high-risk patients. In Aim 2, we will supplement this quantitative data with the

collection of semi-structured qualitative interviews with clinicians who are treating BEST patients during warm periods (May 2024 – September 2024). The objective of these interviews is to assess BEST clinician perspectives on the role that extreme heat plays in mental illness, as well as the feasibility of proposed

interventions within the BEST population. We will also identify key resources needed by clinicians to support patients who may not have access to traditional protective measures (such as in-home air conditioning) in managing their mental health during periods of extreme heat. This focus on clinical perspectives is a critical

innovation of this project, as work on climate change and health is often purely epidemiological in nature and thus misses opportunities for effective intervention to support the health of climate-affected populations. Finally, in Aim 3, we will quantify the potential for heterogeneity in the temperature-mental health relationship

using the BEST data. We will focus specifically on important individual indicators of vulnerability (including age, sex, race/ethnicity, and experiencing homelessness), as well as neighborhood-level features such as air pollution, the built environment / urban greenspace, and the presence of existing interventions (e.g., cooling

centers) intending to reduce the health impacts of extreme heat in the greater Boston area. The findings from Aim 3 will complement the qualitative data produced in Aim 2 to provide a fuller understanding of the factors that contribute to mental health impacts of extreme heat, ranging from social and behavioral to environmental

determinants. Overall, this study will provide crucial information to support this high-risk population in the context of extreme heat and global climate change.