Heat waves put Dutch psychiatric patients at greater risk, doctors warn
Psychiatric patients are especially vulnerable during heat waves, psychiatrist Phebe Kraanen of Dutch mental health provider Arkin told Het Parool. Mental health workers are reporting more crises, hospital admissions, aggression, dehydration, self-harm, and suicides as high temperatures put growing pressure on the country's mental health system.
Kraanen co-founded Hittepsyche ("Heat and Mental Health"), an initiative that raises awareness of heat stress in mental health care. She said people with psychiatric conditions face a mortality risk 3.5 times higher than the general population. With another hot week forecast, care teams are increasing home visits to ensure patients are drinking enough and staying medically stable.
"We notice it in our work, but when you look at the scientific literature, you see it there too," Kraanen told the newspaper. Colleagues across the country have reported a surge in emergencies. One reported "seven crises in one night." Others described visiting overheated, poorly ventilated homes "with people reacting aggressively."
The warning comes after the Dutch public health institute, RIVM, reported 480 excess deaths during the red-code heat wave in the week of June 22. Most were people age 80 or older. Kraanen said people with psychiatric disorders are often overlooked despite their elevated risk.
Heat stress occurs when the body can no longer maintain its normal temperature of about 37 degrees Celsius by sweating and widening blood vessels. In severe cases, body temperature can exceed 39 degrees, causing heat stroke, a life-threatening condition in which organs begin to fail.
Researchers do not fully understand why psychiatric patients have greater difficulty regulating body temperature, Kraanen said. One theory is that hormonal and neurological regulation is disrupted. Mental illness can also make people less likely to eat, drink or seek cooling. Medications including antidepressants, mood stabilizers and antipsychotics can further impair temperature regulation. Many patients cannot stop taking those drugs because doing so could destabilize their condition.
Poverty, poorly insulated housing, limited social networks and increased alcohol or drug use during hot weather further raise the risk. "Research also shows that substance use increases when it is hot," Kraanen said. "The hypothesis is that people look for ways to cope with the heat. But drugs or alcohol actually increase the risk of heat-related illness because your body cannot get rid of heat properly."
One patient, Bryan, has schizophrenia, diabetes, and obesity and takes antipsychotic medication. Despite using an air conditioner, keeping his curtains closed and taking "sometimes six cold showers a day," he said the heat worsened a foot wound caused by new sandals and left his feet swollen.
Another patient, Erwin, said he drinks more beer during heat waves, increasing from none to four half-liter beers a day, and sometimes six. "But I made a deal with myself that I can't go to the convenience store for more. Because I know alcohol dehydrates you," he said. He also stopped taking oxycodone, a powerful opioid painkiller. Kraanen said the drug can dull awareness of heat and suppress thirst.
Kraanen said she is especially concerned about one patient with rheumatism and psychiatric problems who has remained in bed since the June heat wave. "The woman said it felt as if her brain was being fried. She found it unbearable. Now she is exhausted, can no longer think and feels as though her body is giving up."
The situation also weighs on caregivers, Kraanen said. "We visit people, give them tips to stay cool, keep a closer eye on them, but it also feels fragile for us as health care providers. Are we doing enough? And will everything turn out all right?"
Another patient, Linda, said heat combined with the antipsychotic drug olanzapine leaves her unable to think clearly. "Heat," she told Het Parool. "It makes me irritable. Even desperate. During the last heat wave I could barely think. It was just a kind of brain fog. I have to shop and cook, but everything feels a hundred times harder than normal. I can't get rid of the heat."
Linda urged Amsterdam to install free public drinking water stations. "I don't like asking a café for water. But 2.50 euros for a bottle of water — who has that?" she said. She also urged people to check on anyone who appears overheated. "If you see someone who is overheating, ask what they need. Recently the mail carrier was standing at my door sweating, so I asked, 'Would you like an ice cream?' 'Yes, gladly.' That's how we help each other get through it."
