The Silent Minority
An unprecedented crisis is going to impact New Jersey’s healthcare infrastructure in unforeseen ways, which concerns health experts such as Dr. Rebecca Jefferson, psychiatrist-turned-librarian. As temperatures soar through climate change and it becomes hotter and drier each year, the risk of heat-related hospitalizations for those with serious mental illness and developmental disorders increases. These groups are more vulnerable to overheating and hospitalizations during warmer seasons due to their prescription medications causing heat insensitivity, sweating, and thirst. “Climate change is coming to a point where this is becoming an immediate need to address,” argues Dr. Jefferson.
New Jersey in particular has had a dramatic shift in seasonal temperatures within recent years, with Patch reporting a trend where New Jersey summers are becoming warmer and longer. A chart published by NJ.Com tracks the average temperatures for Newark and Atlantic City from 1970 to 2015.
This data emphasizes that there is indeed a trend of rising temperatures on a local level, and indicates that Atlantic City has been drastically affected by climate change.
The New Jersey State Assessment Database has collected hospitalization rates for heat-related illnesses from 2016 through 2020. This information was gathered through entering the State Health Assessment Database through the New Jersey Department of Health Wesbite. The NJSHAD has a variety of statistics, research and data on statewide health topics and issues, including a data set for Hospitalization and Emergency Department Visits for Heat-related Illnesses. It collected this data through collaborating with the Department of Health. In July 2019 alone, there were 81 hospitalizations in comparison to the 30 reported in July 2016. In both 2016 and 2018, heat strokes were reported in the spring and fall seasons, with 2018 having 20 cases in September. This matches with what other reports indicate: the summers are becoming longer and more intense.
In this same report, the New Jersey State Assessment Database additionally reports that severe heat waves will become more common. “Extreme heat events are predicted to increase in both intensity and duration in future years. Currently, New Jersey generally experiences two heat waves per year with temperatures exceeding 90 F, and the heat waves last about four days. By the 2020s, it is projected that New Jersey will annually experience three to four heat waves lasting four to five days each. Annual number of days over 90 degrees F are projected to rise from an average of 14 days in 2000 to 23-29 days by the 2020s.”
Map provided by Dr. Nathan Magee, Physics Professor at The College of New Jersey
Rising temperatures and hotter summers will increase health emergencies and hospitalization rates in vulnerable populations with heat intolerance. These groups may include children and the elderly, but they also include people with disabilities and/or severe mental illness who take medications that cause sensitivity to heat.
Popular medications that create heat intolerance include Adderall, Microzide, Inderal, and Thorazine.
In a 2019 article titled “The Impacts of Extreme Heat on Mental Health” published in the “Psychiatric Times” Newsletter, Dr. Robin Cooper writes: “Psychiatric medications (eg, antipsychotics, anticholinergic antidepressants) have the potential to impair the body’s heat regulatory functioning; sweating and dehydration can increase lithium levels, putting patients at greater risk for dangerous toxicity during heat waves.”
The American Psychiatric Association also correlates extreme heat with increased health emergencies and the worsening of pre-existing mental and physical conditions according to a 2021 News Release.. “Several factors contribute to people with mental illness being especially vulnerable. People with schizophrenia can experience difficulties with body temperature regulation and temperature changes can change symptoms of mood disorders. Some psychiatric medications, including some antidepressants and antipsychotics, can affect the way the body regulates temperature.”
“People on Atypical antipsychotics are really predisposed to heatstroke and Malignant hypothermia – which is a reaction that is related to heat and increased temperature,” states Dr. Rebeca Jefferson. “Known side effects are Muscle spasms, kidney failure, and death.”
Dr. Rebeca Jefferson has a Ph.D in Psychiatry and years of experience in clinical psychiatry. Dr. Jefferson currently practices as the Health and Life Sciences Librarian at The College of New Jersey, specializing in biology, health sciences, and nursing to name a few.
In addition to the general dangers that increased heat imposes on these groups, Dr. Jefferson stressed that these individuals are dealing with unstable housing, which leads to unstable air conditioning.
Dr. Jefferson believes that people with SMI, or diagnosed with Serious Mental Illness, are often living in urban areas, such as Trenton, due to the proximity to treatment centers. Many come from lower-income backgrounds and their conditions or financial situations may prevent people from driving and having cars with air conditioning. Thus, they have to walk in hot, urban environments to receive treatment, which may put them at risk depending on their heat tolerance.
If they are living in shelters or low-income housing, homeless people with SMI and disabilities may not have adequate air conditioning or cooling. “The likelihood of exposure to a high heat condition is more likely and danger of medication is more likely if they’re unhoused, in the shelter system or in precarious housing,” states Dr. Jefferson.
As summers are becoming longer and hotter, the risk of more hospitalizations of vulnerable groups only increases. Dr. Jefferson argues, “before you deal with someone with severe mental illness you need to deal with multiple systemic factors first.” In order to properly prepare for this crisis and better serve these populations, disparities within the housing and healthcare systems need to be addressed.