Our lands, our minds: research and action agenda on Indigenous mental health in a changing climate

Introduction

Indigenous communities often define wellness according to a remarkably resilient, time-tested and intimate interconnectedness with their territorial homelands, watersheds and associated ecosystems (Redvers et al., 2023a). Despite histories of colonial subjugation, land-dispossession and well-documented health inequities associated with disproportionate impacts of social and ecological determinants of health, Indigenous communities remain adherent to ancestral Indigenous Traditional Ecological Knowledge Systems (TEK) that guide these critical relationships to Land and place (Redvers et al., 2023a,b). In the context of climate change, irreversible loss/damage and environmental shifts to terrestrial, freshwater and coastal ecosystems have challenged these lifeways, and contributed to food and water insecurity, foregrounding as key determinants of health and wellbeing, and determinants of mental health, in particular (Cunsolo and Ellis, 2018; Middleton et al., 2020).

Climate change and mental health represent two of the most significant global challenges of our time (Lawrance et al., 2022). Awareness of their interconnectedness has grown substantially in recent years, as climate change demonstrably exacerbates mental health challenges. Importantly, climate change has been recognized as a risk amplifier, disrupting usual conditions known to support mental health, particularly for communities burdened by social and health inequities, within and between countries (Intergovernmental Panel On Climate Change, 2023). This occurs through increased exposure to extreme heat and the trauma of severe weather events, as well as the destabilization of essential conditions for wellbeing, such as food and water security, stable housing, and clean air (Lawrance et al., 2022). The resulting psychological distress is further compounded by the awareness of ongoing climate threats and insufficient policy action. Individuals with pre-existing mental health conditions are particularly vulnerable to these stressors, facing heightened risks of physical heat stress and mortality during heatwaves.

In response to the escalating mental health burden of the climate crisis, research in this field has expanded rapidly (Romanello et al., 2024). However, significant evidence gaps persist between and within numerous regions. These include a lack of data on the precise mental health burden attributable to climate change, the specific pathways and mechanisms of these impacts, the mental health co-benefits of climate action, and the most effective interventions (Lawrance E. L. et al., 2024; Charlson et al., 2021; Xue et al., 2024). Moreover, considerable differences in the climate-sensitive risk profiles between Indigenous and non-Indigenous communities are often under-recognized within Industrialized nations, e.g., the United States, Australia and Canada (Middleton et al., 2020). Despite these differences, the research landscape remains fragmented across disciplines, sectors, and geographies, with an uneven focus on certain topics and global regions. This siloed approach impedes the translation of evidence into coordinated policy and practice. Consequently, a more integrated and inclusive research agenda is urgently needed to generate the evidence required to effectively understand, monitor, and respond to the complex interconnections between climate change and mental health within Indigenous communities (Middleton et al., 2020; Lawrance E. L. et al., 2024).

Connecting climate minds (CCM): a new approach to climate and mental health

Launched in 2023 with funding from the global charitable organization, Welcome, the Connecting Climate Minds (CCM) project set out to create an inclusive agenda for research and action on climate change and mental health:

• (1) The project had two main, interconnected goals. First, it sought to develop a unified research and action plan that is guided by the needs of people who have personal and lived experience with mental health challenges in the context of climate change. Second, the project aimed to facilitate connected communities of practice for climate change and mental health in seven global regions. These communities, based on the Sustainable Development Goals, were developed to create and put the new agenda into action (Faciolince et al., 2024). By combining a global perspective with a regional focus, CCM brought together diverse viewpoints to create a shared vision. This aim allows the generated research priorities to effectively address key evidence gaps, and inform policy and practice at the intersection of climate change and mental health.

Prioritizing indigenous knowledge and lived experience

A central focus of the CCM project was an opportunity to support Indigenous communities, due to the critical need for place-based and culturally-relevant Indigenous knowledges to protect mental health in a changing climate, and to highlight the challenges faced by frontline communities. Historically and contemporarily these forms of knowledges have been marginalized and excluded from environmental health academic discourse and spaces. This is despite concrete calls for the amplification of Indigenous TEK in regards to climate change and biodiversity loss—that of which does not separate spirit from knowledge, or spirit from action—they are intertwined (Redvers et al., 2023a; Yellow Cloud and Redvers, 2023).

The CCM project's Lived Experience Working Group (LEWG) prioritized engaging with and centering the leadership of Indigenous communities. The goal was to understand how climate change is affecting the mental health of Indigenous Peoples and what solutions already exist. This process helped to develop a lived experience-informed research and action agenda specifically for this diverse group.

Objectives of the indigenous people's research and action agenda for climate change and mental health

The new research and action agenda is designed to guide future efforts for those facing and responding to the growing mental health challenges of climate change. It aims to support communities, researchers, and policymakers who are already addressing these issues by creating a more connected and collaborative field. This agenda also empowers experts from various disciplines and sectors to join in and make progress by identifying clear priorities and promoting a more inclusive and interdisciplinary approach.

The agenda addresses these aims through three core objectives:

• Identify a set research priorities that can inform action to meet the needs of Indigenous Peoples experiencing and responding to the mental health impacts of climate change.
• Offer recommendations for researchers and practitioners on framing culturally sensitive, place-based understandings of climate and mental health for diverse Indigenous populations, needed to appropriately conduct research and translate evidence to action in policy and practice.
• Foster cross-disciplinary collaboration among researchers, funders, and policy experts to advance Indigenous-led climate change and mental health research. Provide actionable priorities for effective collective impact (Faciolince et al., 2024).

Methodology

The development of the agenda

This research and action agenda was developed using a thorough and inclusive methodology to capture, combine, and refine a wide range of perspectives while fostering connections within a growing community of practice. Viewing the research process as part of the project's outcome and impact was made possible by an environment of institutional flexibility and iterative, collective alignment. A total of 11 research and action agendas were developed in CCM (available on the Connecting Climate Minds Global Online Hub). In parallel to the Indigenous-focused agenda, seven regional research and action agendas (in every Sustainable Development Goal region), a global youth agenda, and a global smallholder farmers and fisher peoples agenda were developed. A global research and action agenda was developed to synthesize insights from all other agendas.

Project governance

The formulation of this agenda was a result of a collaborative effort that engaged multiple diverse groups, including the Connecting Climate Minds global project team, which consisted of: global coordinators (Climate Cares Center at Imperial College London and the Red Cross Red Crescent Climate Center), a Lived Experience Working Group (led by the Climate Mental Health Network, SustyVibes and Force of Nature), an Indigenous Advisory Group, and Inter-community Dialogue Partners. In addition, the project partnered with the UNITAR Global Indigenous Youth Summit on Climate Change (GIYSCC) to hold a session on the Indigenous Dialogues. The formats and methods employed in the Indigenous dialogues were a result of collaboration with partners and the Indigenous Advisory Group, who played a crucial role in the iterative development of the methodology, fostering the exchange of processes, learnings, and challenges across different regions.

Indigenous advisory group

A group of six advisors was brought on in a compensated capacity to help guide the Indigenous dialogue workstream. Recruitment for the Advisory Group consisted of outreach across existing CCM networks, contacts from Regional dialogue leads, and the UNITAR GIYSCC network. The selection was based on availability as well as active engagement with the intersections between climate change and Indigenous health. The Indigenous Advisors' backgrounds included Indigenous researchers, health workers, and young activists from the United States, Singapore, Japan, Cameroon, and Australia. The Indigenous Advisors provided feedback on internal processes and framings, guided ethical considerations, brokered connections for the dialogues, and offered insights on the analysis of the data.

Pre-dialogue scoping

The project team identified an international outreach list and engaged in snowball networking to reach new networks of Indigenous communities across the world. Over 10 informational calls and learning sessions were hosted with practitioners working in this area to socialize the project and gauge interest for participation. Some of the groups networked with include: Land Body Ecologies, Amazon Frontlines, Waman Wasi, Center for Cosmovision and Indigenous Knowledge, Conscious Food Systems Alliance, Fondo Agroecológico para la Península de Yucatán (FAPY), Minority Rights International, Child Trends, The Planetary Health Alliance, and others. The team also received outreach support from the CCM Regional Teams who helped connect with relevant participants from their regional communities of practice. The CCM Lived Experience Working Group was also involved in outreach to key Indigenous lived experience networks across regions, particularly in Sub-Saharan Africa. Insights gathered through the pre-dialogue scoping stage informed dialogue design and recruitment.

The priorities identified in the Indigenous-focused agenda were combined with those identified in seven regional research and action agendas, a youth agenda, and a smallholder farmers and fisher peoples agenda to inform a global research and action agenda for climate change and mental health (Lawrance E. L. et al., 2024; Lawrance E. et al., 2024).

Dialogue methodology

The LEWG of the CCM project prioritized the engagement and leadership of Indigenous communities in dialogues that sought to understand the ways mental health is being affected by climate change, particularly for Indigenous communities, and what solutions exist. The overall goal was to generate a mutually beneficial space of exchange within and across territories that could surface the needs, priorities, and approaches of Indigenous worldviews at this intersection.

Formats

Recognizing the vast diversity within and across Indigenous communities, various spaces and modalities for participation were offered between October-November 2023. The Indigenous sub-thematic dialogues took place in (1) two in-person inter-community dialogues; and (2) a global online dialogue. Inter-community dialogues took place with communities where the CCM global project team had pre-existing, established relationships. The project team discerned that multiple formats for engagement were necessary for creating access for collaborators (participants) to contribute who face barriers to online dialogue formats, and in order to establish spaces of mutual benefit to the collaborators involved. This hybrid model, encompassing both physical and virtual dialogues, supported accessibility, place-based ownership and steer of dialogues, and the possibility for transnational exchange around the subject matter. Although an in-depth discussion of the methodology is beyond the scope of this manuscript, more information can be found in the full report (Faciolince et al., 2024). (Please see Table 1 for more information on inter-community dialogues).

Table 1. Global Inter-community dialogues.

Collaborators and recruitment

The process of recruitment was done relationally with significant time committed to sharing the research process with potential collaborators, providing additional information when required and creating space for feedback on the ways the dialogue would be delivered. We relied on personal and professional networks of our research team and Indigenous Advisors, and we reached out to several networks and organizations working on either Indigenous rights, Indigenous health, cultural heritage or advocacy around traditional ecological knowledge.

Consent process

Cultural awareness and accessibility were key considerations when seeking consent from Indigenous communities and individuals. These processes considered local language and cultural protocols determined by the Indigenous communities involved in the research “nothing about us, without us” (Marsden et al., 2020; Brockie et al., 2022). After consultation with the Indigenous Advisors, a two-step process was adopted for obtaining informed consent for the in-person dialogues, involving collective consent from traditional authorities as well as individual consent from dialogue participants. Individual consent was sought for the virtual dialogue.

Collective consent

Collective consent processes are an ethical standard in Indigenous research that helps balance Indigenous sovereignty and collective ownership of knowledge vs. individual intellectual property rights (Brockie et al., 2022; Healey, 2019). Research, which can be used as a political process to produce knowledge which state actors may rely upon to support their decisions, or dismiss when it does not support their aims, has been problematic for Indigenous Peoples globally (Marsden et al., 2020; Brockie et al., 2022). This approach was validated by the Indigenous Advisory Group and Indigenous partners. Importantly, collective consent does not take away from individuals providing informed consent and protecting individual identifying information. Rather, collective consent marks approval from local overseeing bodies to enable research to take place and outlines the collective rights and expectations involved in the research. It also includes the collective power to give or withhold consent, make decisions, and ensure collective self-determination. Furthermore, Indigenous communities continue to advocate for the integration of collective consent processes in Indigenous research across the world, such as in New Zealand with Māori (Indigenous) peoples, who have advocated for consultation-based, collective consent processes being integrated into mainstream ethics protocol processes. This is consistent with Indigenous Data Sovereignty and OCAP (Brockie et al., 2022; Carroll et al., 2020).

In the inter-community dialogue consent process, the letter of invitation and informed consent was sent to the overseeing traditional authorities (e.g., in Spanish to community leaders across Kichwa communities in San Martín, Peru; in English to the King's regent in Kom village, Cameroon). They granted permission for the participation of their communities in the dialogues before dialogue partners engaged individual community members.

Individual consent

In addition to collective consent, free, prior, and informed consent was sought from all participants. At the inter-community dialogues, all individual participants were informed of the purpose of the dialogues verbally through a reading of the participant information sheet aloud and were offered written copies of the document. The process required by the Imperial College Ethics Review Board was explained to all dialogue participants, who were informed that the ethics requirements require informed consent evidenced through individual, written, signed documents. Participants were provided an opportunity at this stage of the process to respond to the request for written confirmation. Considering the varying levels of literacy among Indigenous community members, some members provided signatures, while others gave consent via fingerprints.

Compensation

All collaborators were provided an honorarium of 40 USD for their time engaging in dialogues that supported transportation, wifi, and time costs for engagement.

Analysis methodology

The CCM global coordinating team conducted a global landscaping exercise of relevant existing climate change and mental health reviews and identified four broad research categories as areas of critical need for further work globally. This framework was used as the basis for structuring discussions within dialogues to generate research and action priorities and formed the global coding framework for analysis. High-level research categories were: (1) mental health impacts, risks and protective factors, (2) pathways and mechanisms through which climate change impacts mental health, (3) mental health benefits and risks of climate action and (4) mental health interventions in the context of climate change. Each high-level research category contained a set of sub-categories. High-level action agenda categories used to guide dialogue discussion were: (1) conducting research and (2) translating evidence into action. Each high-level category contained five sub-categories: (1) the desired state (2) challenges, (3) opportunities and enablers, (4) relevant potential partners and (5) priority next steps/recommendations to investors and actors. This global framework was adapted by the authors, with support from the Indigenous Advisory Group, to ensure relevance to the Indigenous research and action agenda setting process and in response to insights from the pre-dialogue scoping.

The qualitative data from the dialogues was analyzed by our research team, with the support of two members of the Indigenous Advisory Group. Coding followed a thematic analytic process that included deductive coding according to the CCM core research categories, with adjustments to the categories and themes made inductively based on the dialogue data. During the process of coding, emergent themes and sub-themes were coded and the prevalence was calculated for each. Analysis: dialogue data (transcripts of breakout rooms, notes and inter-community dialogue reports) was analyzed using a narrative coding approach. The analyst team populated a matrix based on the global coding framework by coding quotes and emergent themes based on prevalence.

Draft priority research and action themes: this matrix was used to draft a list of priority research themes, refined via consultation with the Indigenous Advisory Group. Selection of priority research themes adhered to a globally developed structure and selection criteria (e.g., potential to answer greatest emerging lived experience needs and evidence gaps in the literature, potential to inform decision making in policy and practice, research feasibility). Priorities for action were generated using a similar matrix, based on the global framework, and an inductive approach to generating priorities within each sub-category.

Finalization of priority research themes: a final list of priority research themes was generated based on incorporation of feedback from Indigenous experts and the CCM core team (see Table 1).

Ethics, data collection and storage

This study has been reviewed and given an ethically favorable opinion by the Imperial College Research Ethics Committee (study title: “Global Dialogues to set an actionable research agenda and build a community of practice in climate change and mental health”; study ID number: 6522690).

Taking guidance from the Indigenous Data Sovereignty (IDS) movement (Brockie et al., 2022; Carroll et al., 2020), we committed to ethical conduct of research involving Indigenous persons with a framework for the dialogues that emanated from four core principles: Respect for Persons, Concern for Welfare, Mutual Benefit and Transparency. The Indigenous dialogues were based on a process-oriented approach to research, wherein the process itself is just as important as the final output. In this iterative process, centered around relationship-building and active listening, we put into practice several additional mechanisms to respect the autonomy and safeguard Indigenous community members, considering the potential impacts on their physical, mental and spiritual health, and physical, economic and social circumstances, following the principles of Ownership, Control, Access and Protection (OCAP) (Brockie et al., 2022). These included: granting control to Indigenous collaborators over the design and stewardship of the dialogues, liaising with the Imperial College Ethics Review Board to ensure co-ownership of data with the Indigenous collaborators, providing stipends and compensations for all collaborators, providing feedback mechanisms as well as regular check-ins to ensure accountability and transparency during the process.

Data collection and storage followed the process designed by the CCM global team at Imperial College London with certain adaptations mentioned above related to Indigenous data ownership and sovereignty. Research agreements between the collaborators and participant communities were established as part of the consent process.

Results and discussion

Current state and emerging needs for climate change and mental health within indigenous populations

Climate change and mental health concerns represent two intersecting concepts recognized as indistinct within many Indigenous epistemic and ontological orientations (Redvers et al., 2023a; Cunsolo and Ellis, 2018). In many respects kinship with land and other-than human beings dictate health and welfare of Indigenous communities, whom rely on the freedom of movement, cultivation and subsistence, community and spiritual recognition of Land and place, and shelter, rooted in sovereign concepts of place that are ecocentric and cosmocentric (Redvers et al., 2023a). This agenda does not purport to represent all Indigenous communities, this agenda does represent a seminal effort to understand, both the diversity of Indigenous interests related to the intersection of climate change and mental health, while also highlighting the similarities among Indigenous communities, globally.

This section sets out the context of the research and action agenda, exploring the current state of evidence on mental health and climate change for Indigenous Peoples, alongside key insights and emerging needs for this population. While terms like “Climate change,” “mental health” and their intersections and related terms, along with other relevant key concepts, are understood and defined in diverse ways across Indigenous populations. Identifying, acknowledging and honoring the ways these terms are understood and used in different settings is critical to help foster connections, awareness and recognition across disciplines, cultures and communities. This section highlights relevant understandings among Indigenous Peoples, designed to reveal the diversity of perspectives around key concepts, as heard throughout the project.

We engaged in conversations around the framing of the Indigenous Peoples dialogues from the beginning of our work, including discussions with Indigenous Advisors and inter-community dialogue partners. The need to interrogate and adjust the framing of mental health for this particular dialogue series was evident from the outset, as Indigenous perspectives diverge from dominant biomedical approaches that often compartmentalize mental health from the interconnected realms of social, cultural, territorial and spiritual health and wellbeing (Gone, 2022).

Without such interrogation, the project ran the risk of further erasure and harm of Indigenous worldviews. Based on these preliminary conversations, the dialogues were intentionally framed in ways—and using vocabularies—that validate Indigenous worldviews and understandings of climate change and mental health (touched upon in the Introduction, and in section below). The invitation for the virtual dialogue converged around the following question:

“Healing our bodies and territories: How are the drastic changes to the health of our lands affecting our collective, spiritual and mental health?.”

The inclusion of spiritual and collective health in the framing of the global virtual dialogue was an intentional effort to reflect multidimensional understandings of the health of bodies and territories and as advised by our advisors and partners. Inter-community dialogue partners steered all conversations and framings in their dialogues to ensure relevance and respect for contextualized worldviews.

Understanding and expressions of mental health

The term mental health was used throughout the dialogues by facilitators and appeared in several of the questions asked. Despite this, other terminology and/or framings were nearly always used by our collaborators to answer the questions posed and when sharing their lived experiences.

Notably, in the intercommunity dialogue among Kichwa communities in the Peruvian Amazon, there was no mention whatsoever of “mental health” in the community responses. Rather, local and culturally/linguistically-appropriate conceptualizations of mental health were supported, and grounded the dialogues. By recognizing and valuing these interconnected dimensions held by some Indigenous communities for what Western paradigms call mental health and/or mental wellbeing, this allowed our research community to beyond the limitations of such dominant frameworks, fostering culturally responsive approaches that align with the rich tapestry of Indigenous wisdom and knowledges.

Below is a selection of insights that shed light on the language and understandings underpinning these concepts. These insights can be summarized by the following statement made by one of our collaborators: “When our life spaces are healthy, we are well.”

Relevant terminology

Vocabulary surrounding mental health impacts favored mentions of “stress,” “disillusionment,” “uncertainty,” “grief,” “anger” and “worry.” For example, “We are disappointed. We are all disappointed in this time.” Emma Lee, a collaborator from Tebrakunna country who consented to be named, spoke on the incongruity of some dominant mental health terminology with Indigenous lived experience:

“Uncertainty is helpful as it allows us to fall into our elders, into our community. But anxiety is a western construct. The language of management, the language of crisis is not our language. That terminology of anxiety needs to go in a box somewhere. Important distinction.”

Other collaborators noted that

“new diseases arise in the communities, such as stress, worry,” and “some have passed away because of the stress.” (Faciolince et al., 2024).

Furthermore, collaborators commented on the dangers of not integrating Indigenous paradigms in framings of interventions and research:

“Giving energy to mental health in isolation to wellbeing is a biomedical introduced reductionist approach that inadvertently disempowers Indigenous solutions.”

Spiritual, collective, and cultural health -

Indigenous concepts of health often include a physical, mental, emotional and spiritual connection with the land (Redvers et al., 2023a). These perspectives, although diverse in their cultural expressions, were all anchored in a profound interweaving with nature and all beings, fostering a holistic understanding of the interconnectedness between humans, their health and wellbeing, the environment and the spiritual realm. Explicit linkages across cultural, spiritual, emotional and mental health were consistently made in responses, such as:

“There's clear connectivity to spiritual and cultural health and, as we place negative impact on these important practices, it also clearly has an impact on mental health [...] There's also spiritual health, emotional health, and cultural health.”

Relationship between land health and human health

Many Indigenous epistemologies and ontologies are organized and rooted in cultures and communities that both recognize and honor their relationship with Land and place: from governance systems, ethics, creation stories, developmental theories, medicine and wellbeing to ceremonial customs (Redvers et al., 2023a). The inextricable link between land health (understood as the health of all beings in the ecosystem comprising of land, water, skies) and human health forms the foundational essence of most conceptualizations of Indigenous wellbeing:

“I think about how physical health is related to mental health and is intrinsically tied to planetary health and how we as Indigenous people care for over 80% of the biodiversity on this planet.” “We need advocacy not only for the health of people but the health for all that exists.”

In line with these quotes, one collaborator proposed the following understanding of a “triangular approach” to environmental, spiritual and physical healing, held together by cultural practices:

“We have our triangular approach based on our ancient wisdom. The first approach, at the top of the triangle, is healing our nature, Mother Earth, the rainforest. Protect the nature. The next one is to continue to retain our spiritual connection to Mother Earth as well as part of our survival. The third, the last one, is our physical healing. So once we see that this triangular approach will be implemented, then we can continue to survive here. [...] Culture is what connects all of these.” (From and Indigenous Chief in the Phillipines).

Land as healer

According to many Indigenous lifeways, the land is not merely a physical space but a profound healer, intricately linked to health and medicine, and the center of existence for many communities (Redvers et al., 2023a; Yellow Cloud and Redvers, 2023). Recognizing the land as having a profound role in shaping community lifeways and spirituality, Indigenous understandings of healing and wellness embraces a holistic perspective that interweaves physical, mental, and spiritual wellbeing, again emphasizing the interconnectedness of human health being interdependent with our Earth and place (Redvers et al., 2023a). In the words of one collaborator:

“What would our communities look like if healing was based on land as a healer?”

Given the deep interdependence with the other beings, the human-emotional world is far from being encapsulated in what is deemed as the “mind,” or what is “mental”; that is, human experiences are never separate from the wider webs of life which they are part of. Incorporating Indigenous understandings of mental health and its inextricable connection to the environment are embedded throughout the overview of the priority research themes below.

Understanding the drivers of climate change

Coloniality, power and land health emerged as woven into many understandings of the drivers of climate change, intersecting alongside profound spiritual disruptions that underpin the resulting drastic environmental loss and damage. Overall, they point to a deep recognition of violence—both historical and present—undermining the entire web of life. Incidentally, the manifestations of climate change that many Indigenous Peoples are facing, therefore, are often seen as a result of these root causes, otherwise understood and social and ecological determinants of health within Indigenous communities (i.e., violence, power imbalances, extractivism, colonialism), and are difficult to disentangle from the web of causalities.

From colonialism to climate disruptions, many collaborators named the historical thread that shows a striking continuity of violence across generations:

“In a sense, climate change is being seen much more holistically. We're looking at, what are, again, those intergenerational violences that we need to deal with? Some of it came through climate change. Some of it came through the terrible extraction practices. Others came through setting up systems of slavery. They're all mixed together.”

Such statements came hand in hand with naming “development projects,” including mass extraction on lands and industrial farming, as the culprits of climate change:

“This whole development model has gone hand in hand with the deterioration of nature and the health of the people.”; “These changes are happening because mostly the corn business has come, that is the first place why we have stopped planting, they cut down all the mountains, the forests, now when we plant, they no longer want to produce, sometimes when we plant it grows small and dries up, sometimes the same even if it rains, the land is poisonous, the land is contaminated, it grows but it no longer bears fruit as before, the land no longer receives the roots of the seeds.”

There were also other accounts offered, including those that rely on spiritual explanations for the drastic shifts in the environment and climate observed, for example:

“They think that it's the god of the seas that they haven't really satisfied the god of the seas over some many years and now the seas are actually overflowing their banks and causing mayhem.”

Another, shared that “now the souls, the mothers of those animas (guardian spirits) are gone,” pointing to spiritual disruptions as the causes of ecosystemic imbalances.

Research agenda

Background to research categories and priority research themes

This research agenda presents an aligned vision to guide the climate and mental health field for Indigenous people. The priority research themes represent areas where targeted research investment could create a full picture of impacts, their mechanisms and solutions across both mental health and climate actions. We outline why these have been identified as priorities, and how they can be addressed by combining expertise across disciplines and sectors. Research priorities have been generated through consultation with experts across disciplines, sectors and geographies in the region and iterated with experts regionally and globally.

Research priorities are presented within four overarching research categories that were identified as areas of critical need for further work globally and that map the climate and mental health research space at a high level, based on an initial review of global literature. Note that some priorities span multiple categories.

Impacts, risks and vulnerable groups: improving our understanding of the extent to which mental health is affected by climate change and for whom. For example: what mental health outcomes are impacted or at risk; the prevalence, severity, economic and societal costs of these impacts; and who is most vulnerable to these impacts.

Pathways and mechanisms: improving our understanding of how climate change affects mental health and, in particular, whether there are factors specific to climate change that increase mental health risks or create new experiences of mental health challenges. This includes considering biological, psychological, societal or environmental pathways and mechanisms.

Mental health benefits of climate action (adaptation and mitigation): understanding and quantifying when and how climate adaptation and mitigation actions, across sectors, can also have win-win benefits for mental health.

Mental health interventions/solutions in the context of climate change: identifying the most effective mental health interventions and solutions to support mental health in the context of climate change, across diverse sectors. This encompasses providing support to people already experiencing negative mental health impacts and reducing risk or severity of future negative impacts.

We hope that these identified priorities, along with the created subcategories, will serve as a catalyst, directing research efforts, guiding resource allocation by funding entities and consolidating evidence production. Ultimately, this collective effort will empower policymakers and practitioners to effectively address the evolving and anticipated mental health needs of young people in the context of climate change.

Priority research themes (see Supplementary Table 1. for a thorough review).

This document aims to encompass Indigenous Peoples' collective, relational perspectives on mental health and wellbeing, recognizing the inseparable connection between human wellbeing and the land, in order to better conceptualize the health implications of climate change.

Understanding these requires acknowledging the intricate relationships woven into Indigenous lived experiences, challenging the conventional categorical divisions of insights that fail to encapsulate the interconnected and interdependent nature of Indigenous perspectives on mental health and the environment. Embracing a holistic view is essential, as these findings underscore the deeply interwoven tapestry of types of wellbeing (e.g., emotional, spiritual, psychological, social, cultural, ecological), defying neat divisions and emphasizing the intrinsic interweaving of all aspects of Indigenous lived experience. Below are recommendations under each theme for priority research questions. The research team made an intentional effort to keep themes inclusive of Indigenous framings of these issues.

Overview of themes for impacts, risks and vulnerable groups participant quotes:

Intergenerational trauma, including colonial violence and extractivism

Historical violence has inflicted enduring wounds on the mental health of Indigenous Peoples, perpetuating cycles of trauma that reverberate through generations. The suppression of cultural practices and Indigenous knowledge has created concrete blockages to cultural vitality, amplifying the mental health impacts among diverse groups. There is also an understanding that legacies of colonial systems—still present in the form of extractive industries and how development is conceived and rolled out, for example—are at the root of a complex web of social, economic and climate-related issues. This makes it difficult to untangle issues and to infer causality explicitly between climate change and mental health issues.

On the interconnectedness of issues and violence:

“So much of our culture was disrupted by past policy, by colonization, slavery, massacres, you name it. We had it.”

“Because of colonial influence we've got a lot of intergenerational trauma, which results in a lot of issues, mental health, physical health. [...] All of that is a factor that really goes hand in hand with the trauma associated with environmental change, negative environmental change, because there's already that distrust with authority and anger and trauma related to disconnection from Country and being moved around and told that you're not allowed to perform certain practices or speak your language.”

“Even if it's happened over a lot of years-we were already endangered because of colonialism, the stripping of our lifestyle and foods that have, we still don't have a strong identity in west–figuring out the self-sufficiency and value system of the west which is different from who we are innately.”

On the challenge of extractive industries:

“As tradition-bearers in the Indigenous Peoples' communities, we have faced the challenges like mining, the multinational companies, and the exploitation, abuse, and the conversion of the ways and beliefs within the tribal communities.”; “We've got mines that are imposing on the [Tinga] community, for example, and the red tape of being able to access Country like sacred sites because of misinformation and all sorts of other things. So it's not just the physical aspects of environmental change but the colonial barrier that is stopping that connection from being established.”

“There is too much extraction–out of the lands, but of us too—the mining of the spirit, the human being, the lands. And, you can see it in the mental health of our people—we are being mined and you can see it in the mental health people, we are empty shells, and in some cases, we might have been part of that extraction of our own souls.”

Compounded grief and exacerbation of mental health-related issues from climate-related events

Both anticipation of potential climate-related events and historical loss and damage from climate change generates great uncertainty and fear regarding the safety of communities and their livelihoods. Otherwise known as ecological grief, such losses are particularly salient and impactful for frontline communities, particularly Indigenous communities practicing subsistence livelihoods in coastal communities (Redvers et al., 2023a; Cunsolo and Ellis, 2018) While ecological grief, or the grief and mourning of of local and natural ecosystems from climate change has been recognized as a disenfranchised grief from ecological losses, the scale and projection of such losses can be seen as catastrophic to the collective community (Faciolince et al., 2024; Redvers et al., 2023a).

“Because of the mental stress, the grief that they were experiencing due to flooding… Flooding was just being a stressor or a trigger, so to speak.”

“One thing we talk about in my spiritual care world is anticipatory creep. You go through the trauma of experiencing things, but then the foreknowledge of how bad things can get… You're already anticipating grieving even before things actually manifest. It's a part of the heart of people to do so, but it can also really take a wear and tear on the spirit and psyche.”

“Environmental change has led to increases in suicide rates, addiction, increased mortality—even among elders.”

High risk population sub-groups

The following population sub-groups were mentioned in the dialogues as having increased vulnerability to life-threatening risks, as well as a corresponding risk of mental-health related difficulties: Children, Communities living on coastal areas and rivers, Community members with pre-existing health conditions, displaced people and people living in temporary settlements, elders, environmental and land defenders, pastoralist communities, people living in Indigenous reservations, people with limited mobility, widows.

“You heard about some that have passed away because of the stress, especially the elderly that can't really cope with this kind of problem.”

“When climate change affects productive processes, this leads to migration. The territories become more vulnerable, and this affects, mainly emotionally, children and women.”

“Even the Tribal leaders have been killed as they are protecting their own ancestral landscape and the sacred land. So they are killed just to get the minerals in the ancestral lands.”

“Youth there, specifically boys, migrate illegally which affects a lot of them. They need to know the value they have in the community.”

Contextualized research practices and interventions

Research methods and interventions framed by Western worldviews can disempower Indigenous engagement by overlooking or dismissing the rich depth of Indigenous knowledge (Redvers et al., 2023a; Carroll et al., 2020; Jennings et al., 2023).

Such approaches may inadvertently perpetuate a sense of cultural marginalization, undermining the effectiveness of interventions and hindering the self-determination of Indigenous communities. Actively integrating Indigenous perspectives from the outset, in the design of research and action, is essential to ensure that outcomes are culturally sensitive and aligned with the needs and worldviews of Indigenous populations. Additionally, crafting sustained, caring partnerships with collaborators is essential to avoid the pitfalls of extractive research processes that feel disrespectful.

“I think the harms I've seen so much is the demanding of a biomedical and a colonial model before creating space for a different view. That can create so much damage and lose a lot.”

“How do I put this? They're still colonizing it in a sense by bringing in experts from outside.”

“If there's no sustainable relationship, people will be reluctant to show you what they're doing.”

Overview of themes for pathways and mechanisms

Cultural disruptions, such as disconnection from land and disruptions to ceremonies and healing practices

Climate-induced shifts in ecosystems threaten traditional practices deeply intertwined with the land, diminishing the capacity of Indigenous communities to live out their cultural identity. This includes the desecration or loss of sacred sites, disruptions to cultural practices, the clash between worldviews and a lack of sense of belonging. Environmental changes not only erode the physical landscape but also inflict a profound psychological toll, a loss of identity and sever the spiritual bonds that connect Indigenous Peoples to their ancestral territories and cultural heritage.

“The challenge is that with climate change, we have added the loss of good practices of our ancestors, the culture of barter, respect for ecosystems. Today the fight is to start from rescuing native species that have been replaced by transgenics, added to what I call the loss of values in government and other competent authorities.”

Disruptions to rituals and ceremonies:

“As the Earth gets warmer, it actually becomes more dangerous and has an impact on the health of our people participating in these sacred ceremonies.”

Disruption to the balance of life and ability to sustain life:

“With the disruption of climate systems, we have the breakdown of that balance of course and an opportunity to fill the gaps together. [...] In Alaska we have an amplification of climate change that threatens our sky, water, and earth clans and, therein, all of our life and our ability to belong here on this planet and to sustain ourselves.”

Acculturation and clash of worldviews:

“We live in a world so fast paced that we don't have a chance to try and catch up with who we really are. In trying to find identity in the mainstream or cultural world, they just collide and don't fit together and all of that causes a series of medical conditions—cancer, diabetes, but also mental conditions as we are not good enough for the mainstream cultural world.”

Disruptions to traditional medicinal approaches:

“I remember that my grandmother, less than 500 meters from home, used to get mosses to cure the energy imbalance that children or adults suffered, she cured them with those mosses. Nowadays these mosses are no longer easily found in the forests, you have to go deep into the forest to get them, but it is very little anymore. This healing is linked to a whole spiritual ceremony which is also no longer given in many communities because there are no longer enough elements to do it or they are seen as retrograde practices.” and “The diversity of these [medicinal] plants is dwindling because of climate change and it is impacting the mental health of traditional healers because they are really worried. Traditional healing and attachment to nature is inseparable.”

Lack of sense of belonging:

“A lot of people don't have the privilege of our feeling a sense of belonging or learning from our land; which has profound impacts to our sense of self, sense of belonging, and mental and spiritual health.”

Loss of identity:

“We forget about our identity as an ecowarrior, as, what do you call it, a tribal leader, and Indigenous wisdom keeper because of these changes that we have now. So what are the results of these changes? So we have disappointment, abuse.”

Cultural continuity as protective factor

Cultural continuity stands as a formidable protective factor for Indigenous populations grappling with the mental health repercussions of climate degradation. The preservation of traditional practices, rituals, sacred sites and spiritual connections to the land fosters a sense of identity and belonging, acting as a resilient force against the disorienting impacts of environmental change. As climate degradation threatens the very landscapes intertwined with Indigenous cultures, the maintenance of cultural continuity becomes not only a source of strength but a vital strategy for mitigating the psychological toll of ecological disruptions.

“When we are allowed to be Māori, we are allowed to be well.”

“If you're not strong in your Culture, you're living a superficial life. You're just like a butterfly that is just flying with nowhere to perch. Culture is very necessary [...] The knowledge that people have gathered and continue to practice for centuries is culture. Culture is dynamic. We need to study our Culture and live in our Culture.”

“We are now starting to look to our Culture for sustenance rather than other world cultures. We can still practice rituals for death and need to stop seeing ourselves as victims but leaders who can connect the world spiritually.”

“So a lot of our cultural practices are starting to re-emerge post-that [colonialism] and it just so happens that climate change has formed this nexus of that and then the changing environment. Our ceremonies are coming back, but that's not due to climate change. That's due to us reawakening that.”

Spiritual connection and kinship with nature

Spiritual connection with the web of life and a sense of kinship with the natural world are crucial pathways to understanding the mental health outcomes of Indigenous populations, particularly in the context of climate change. These connections provide a framework that encompasses the interdependence of human wellbeing with the natural world, shedding light on the profound impact of environmental shifts on the spiritual and mental dimensions of Indigenous lives.

Recognizing the intricate relationship between spiritual connections and mental health is essential for developing culturally sensitive approaches that address the unique challenges faced by Indigenous communities in the face of climate-induced changes.

“One of our most, I want to say, coveted relatives and kind of like a spiritual relative is manoomin or wild rice [...] So I think if I were to make that parallel that's vital for us and that I don't think a lot of governments, federal or state agencies understand, it's that that spiritual relationship really guides our mental health and our physical health and is so important for that as we maintain those relationships with our non-human relationships.”

“The only thing that would bring intervention is to do some spiritual sacrifices to the god of the sea in order to avert that climate change.”

“I am a woman of sea Country and we have lost over 95% of our kelp species in the past few years. without our kelp, I feel that we are losing the veins and arteries of the sea country body. our inshore body is collapsing and that has material effect on our bodies as women who are custodians.”

Responsibility of governments and institutional responsiveness

This theme highlights the critical role and responsibility of the state in safeguarding the lands and health of Indigenous Peoples, including institutional responsiveness that upholds international standards and legal frameworks. Many Indigenous communities have experienced a lack of due process, with states and institutions often omitting proper consultation processes before initiating projects that drastically alter environments, emphasizing the urgent need for accountable and transparent governance to protect Indigenous rights and wellbeing.

“In Guatemala-there is no prior consultation with the communities, which we have here nearby.”

“We understand that it is not us mob who have created this catastrophe. It is the responsibility of those who have colonized us.”

Health of territory as determinant of Indigenous mental health

This theme reflects a deep understanding of the inseparable connection between the health of the land and the wellbeing of their communities. Diverse Indigenous worldviews recognize that the vitality of the land and water directly influences the physical and spiritual health of their people. This intrinsic link underscores a holistic worldview where the flourishing of individuals is intricately tied to the flourishing of the ecosystems they inhabit, emphasizing the symbiotic relationship between human health and the health of the Earth.

“Here in Aotearoa New Zealand we see that the land is not well so the people cannot be well.” “I hope as we move forward as a society, the interlinkages of restoring the health of the Earth and restoring the health of our people are more globally recognized. This is wisdom and practice of Indigenous people all over the world that is not new and we've lost a lot of it.”

“We are understanding that it's all our relations that go through these levels of violence”

“We believe that the rainforest is our market, our hospital, our pharmacy. The medicinal plants that we have are there. So it affects our survival sense in a physical way since those medicinal plants are gone. These changes will really affect our mental health since, as the Elder said, we are all refugees of our own land since these capitalists, these people, these outsiders are destroying our sacred ancestral lands.”

Loss of food security and livelihoods

Climate-related impacts often lead to the loss of harvests, heightened economic stress, and present a profound threat to food security for affected communities. These interconnected challenges not only jeopardize the traditional ways of life and food production (food sovereignty) but also contribute to a sense of uncertainty and vulnerability, intensifying the broader impacts of climate change on Indigenous wellbeing.

“The agricultural seeds that parents preserve each year are flooded. Cassava seedlings. If you don't have seeds to start the next plantation, you will have problems the following year. This has become an annual trauma that people face.”

“Of course, the soil texture also changes [after flooding], so they're unable to really practice agriculture and it's really affecting food security for most of these communities. It's a really big challenge.”

Water-related disruptions (floods, shortages, pollution)

Many Indigenous communities often grapple with a cascade of water-related disruptions and water insecurity from recurrent flooding and pollution, to water shortages, which in turn affect their access to basic services. These challenges jeopardize livelihoods and instill a pervasive sense of uncertainty as Indigenous peoples witness the deterioration of a vital resource intimately linked to their cultural, economic, spiritual and emotional wellbeing. In addition to financial and livelihood hardship, the need to turn away from traditional foods and practices, and the shift from being producers to consumers, brings added layers of distress. In some Indigenous communities, the Anishinaabeg for example, *water is considered the first medicine*.

“Where I live, there is no water. We share the streams and rivers with animals–this is causing challenges. With heavy rains, we cannot access health facilities, schools as infrastructure has been destroyed.”

“We have a clear and very hard example, which were the floods in the Peninsula due to the tropical storms of 2020, the milpas and backyards were flooded, crops, breeding animals and many seeds and plants of importance for the food of the families were lost. Of course this caused great sadness, despair and crisis for the families, for lack of quality food. They had to resort to foods that are not typical of the Mayan Culture, accompanied by the need for money to buy them.”

“Where it used to be wetlands it is now drylands and this is really affecting human beings. Now humans are sharing the little water that is available with their livestock and now diseases are spreading and it is becoming a problem to the health fraternity.”

“Industrial farming has taken so much of Indigenous land—drainage of vast lakes, connected to marshlands, the largest migratory landing for birds in US, depletion of groundwaters. Regardless of whether there is water or not, whether it is dry or not, my people will be there.”

Systemic climate-induced migration and displacement

Climate change-induced environmental disasters, as well as the slow degradation of land and water due to industrial activities, have triggered forced relocations and economic stress among different Indigenous populations. These challenges not only exacerbate the immediate loss and damage of the disasters but also perpetuate further cultural disruptions as communities grapple with the consequences of displacement and the erosion of Indigenous ways of life.

“When there's very long droughts, people have to sell their herds and the pastoral activity declines in those areas and Aboriginal People lose their jobs on the pastoral properties. The young people have to leave there and go to either the coast or to bigger centers to get work and leave the kids with grandparents and other family.”

“Women and men have greater concern to solve and meet their needs for food, medicine and are faced with resorting to western medicine or migrate to other countries or other regions to meet their needs. Abandoning their lands and therefore their practices and spiritual connection with Mother Nature.”

“You heard community members complaining about flooding. They even moved to internally displaced temporary buildings and temporary areas of settlement. They ended up having a serious crisis and they really don't have clean water to drink.”

Lack of land sovereignty and self-governance

Without control over their traditional territories and the ability to govern their own affairs, Indigenous communities experience heightened vulnerability to the ecological disruptions and cultural dislocation associated with climate change, contributing to increased stress, a sense of lack of agency in the face of destruction and debilitating wellbeing.

“It hurts the community not to be able to take care of their community and their families and also the country and to see it sitting there, just waiting for it to become an inferno again. We lost thousands upon thousands of animals in our last massive bushfire and we're just waiting for that to happen again. Yes. It's really traumatic.”

“Whitefellas are taking up rent in our cultural heads. There are two aspects to this-more white fellas are taking more from Country for their profit and greed, which affects our cultural health. the other is that the loss of Country is our physical loss through not being able to connect, care and cherish Country.”

Regional and inter-community connection and exchange as protective factor

Regional and inter-community connections create a supportive network that enables the exchange of traditional practices and adaptive measures, enhancing the ability of Indigenous communities to cope with changing environmental conditions. The collaborative approach both at a local level and at regional level provides a platform for mutual support, fostering knowledge exchange and contributing to a more comprehensive response to climate-induced health challenges.

“One thing in the Caribbean we have been starting to think more regionally. Cultures can be similar and climate change is really affecting our communities across the region and globally. There are big similarities and opportunities to share practices when you listen to our shared stories.”

Lack of services in rural areas

Many Indigenous communities frequently face a scarcity of mental health resources and availability of services due to lack of communication and support features for rural villages, exacerbating the challenges of addressing their unique mental health needs. The limited accessibility to culturally competent care further compounds the disparities.

“Because of the challenges you're facing, do you receive any mental health services? And if you do, how do you get them? Because in my country, there is only one mental health facility.”

Overview of themes for mental health benefits of climate action

Fostering and enabling a strong connection to land

Fostering a strong connection to the land among Indigenous populations featured as a co-beneficial action that harmoniously integrates both climate and mental health benefits, in line with a growing evidence base (see Introduction). This connection not only enhances ecological stewardship and resilience to climate change but also cultivates a profound sense of identity, cultural continuity and wellbeing, underscoring the interdependence of a healthy environment and mental flourishing within Indigenous communities.

“What we advocate for, is that reconnection with Country and community and healing our country, our mother, as well as healing our community and ourselves. Because of colonial influence and that sort of stuff, we've got a lot of intergenerational trauma, which results in a lot of issues, mental health, physical health [...] All of that is a factor that really goes hand in hand with the trauma associated with environmental change, negative environmental change, because there's already that distrust with authority and anger and trauma related to disconnection from country and being moved around and told that you're not allowed to perform certain practices or speak your language, that sort of thing.”

“Our answer is our need for our Indigenous People to help reconnect all people, not just our own, to our land and to the knowledge that keeps our land well so we can be well. That's the onus on us Indigenous people to not just hold on to the knowledge, but share it and connect with other people on other lands, that they now call home.”

Exchange of ecological adaptation practices

Sharing adaptation practices rooted in traditional ecological knowledge is crucial as it leverages the acute observations embedded in Indigenous Peoples' engagement with their territory. This ancestral knowledge, rooted in interdependence and honed over generations, provides routes for adapting to changing environmental conditions. Initiatives such as seed rescue and the cultivation of home gardens not only preserve biodiversity but also serve as vital repositories of resilience, fostering community-based strategies that are ecologically attuned, anchored in reciprocity with nature and culturally relevant in the face of climatic challenges.

“We began a process of selecting seeds that withstood the winds, droughts, and storms. We began to document which seeds were the most resistant; which aspects we wanted to preserve. Many localities lost their seeds-we made a practice of sharing with the commitment that if you gave a bag of seeds, next year you had to return two, so the seed bank was multiplying.”

“We've identified some plants and right now the community has built an ecological water treatment system using moringa plants, moringa sun filtration systems. That's one of the coping strategies. So with these floods, they are able to have plants within the environment and they can construct a water filter system. That has really cushioned their mental health. They are able now to address those particular problems because they have ecological solutions within that community.”

Intergenerational knowledge transmission

Intergenerational knowledge transmission is a co-beneficial action that integrates climate and mental health benefits. Amidst the destruction of the land and cultural heritage, there is a growing movement to reclaim, renew, and revitalize Indigenous practices, including traditional ecological knowledge, which offers opportunities for healing people and land. As Elders pass down traditional ecological wisdom, it not only enhances the community's resilience to climate change but also fosters a sense of cultural continuity and strength, promoting mental health through a shared connection to ancestral practices and to what it means to live harmoniously with the Earth.

“What they have done in the face of the loss and disappearance of seeds is to go and collect with their grandmothers, not only the knowledge to leave it in writing (we are very influenced by Western Culture). They have gone to collect the seeds, and they have thought about how to raise these plants in another context.”

“Something that we have been recovering is not only the seeds, but the whole process of intergenerational exchange. That wisdom, that each seed has its own Culture; the Culture of corn, beans, bananas. That is to say-we have a very rich cultural baggage, which these new generations can take. Of course, many generations are losing contact with the generations that have wisdom.”

“Much of our work is to strengthen the cultural aspects, linked to traditional knowledge. Accompanying life in the community, strengthening it from its own cultural vision... The children receive an education with cultural survival, and the children do not lose their cultural identity.”

Supporting community-led action for climate adaptation

Allowing Indigenous communities to manage both resources and expertise empowers them to develop adaptive strategies to their unique cultural and environmental contexts, fostering self-sufficiency in the face of climate challenges.

“These actions that the people themselves do-these crises lead us to recovery practices, to walk the flooded cornfields.”

“We have some experiences of adaptation-of early warning systems. The use of renewable energy as an important component-here I send a photo of a beautiful ecological park. The project promotes unity, leadership, and governance. The community manages the resources. We work with a community hydro-where the energy is generated for a community, and belongs to the community. Projects are made sustainable by the participation of the communities. The community brings sustainability. We inform our producers with our frost alert system.”

Overview for themes of mental health interventions/solutions in the context of climate change

Self-determination and territorial sovereignty, including land stewardship

Strengthening connections to the land through self-determination and territorial sovereignty not only enables being in “right” relationship with the Earth, but actively supports community members' mental health amidst climate change. Granting communities the stewardship of their lands, integrates co-benefits listed in the research category above (III) by preserving cultural continuity and traditional ecological knowledge, fostering a sense of identity and belonging crucial for mental wellbeing. The inclusion and protection of Indigenous land rights in climate action not only addresses ecological concerns but also contributes to the mental wellbeing of Indigenous communities by reinforcing their role as custodians of the land.

“We need to heal this by restoring this ancestral landscape, planting the native trees, and restoring all the vegetation in it. The spiritual one… We need to continue our sacred rituals. We need to continue our connection to the Mother Earth by recognizing, identifying the early warnings that we have, the behavioral changes that we have, and the emergency response.”

“In terms of practical implementation…this project is built on the traditional legislative council. That means it's not built on colonial state governments. It's built on the traditional government structure. Right now, our community there in Cameroon is planting these plants right now as a community of practice which has been decreed by the king of the Kom kingdom, but not necessarily the state government because the state government is political.”

Health sovereignty, including access to traditional healing approaches

Health sovereignty refers to the right and ability of communities or individuals to control and govern their own traditional healing practices, including the cultivation and use of medicinal plants, rituals and other cultural approaches to health and wellbeing. Traditional healing approaches not only address mental health challenges, but also paint a more expansive canvas of wellbeing where spirituality and nature entwine, creating a sanctuary for cultural identity to flourish amid the compounding crises.

“The Mayan Tojolabal women also have planted a forest and medicinal nurseries, which in addition to supporting community health have a function within the ecological balance.”

“You find that when people are getting worried, they have to visit a soothsayer here for mental healing.”

Indigenous leadership in climate action and mental health interventions

Supporting Indigenous leadership in climate action and mental health interventions is imperative to ensure culturally sensitive approaches rooted in spiritual and cultural wisdom, ensuring each step is a dance in sacred right relations. Ensuring equal inclusion in decision-making of those belonging to Indigenous groups in the frontlines of climate change, is crucial to address their mental and wellbeing needs while incorporating their unique knowledge of ecosystem handling and protection.

“We have been able to do Indigenous, spiritual, cultural diagnosis and interpretation about climate change and mental health. We actually built interventions, not just public health interventions but also cultural, spiritual, and ancestral interventions to healing.”

“We must continue to support Indigenous and community communities not only to rescue species and landscapes, but also the culture for a Buen Vivir [Good Living].”

“In this work, follow Indigenous leadership. Much of what we're already doing-standing strong in your identity. Our work, your viewpoint are very much needed now.”

Intercultural approaches to mental health

The need for intercultural approaches to mental health arises from the imperative to bridge the gap between dominant biomedical frameworks and Indigenous worldviews. By integrating diverse perspectives and understanding the nuances of cultural contexts, intercultural approaches facilitate more effective and respectful mental health interventions that acknowledge the richness of Indigenous traditions alongside contemporary biomedical practices.

“There's mostly colonized mental health practices; not a lot of access to indigenized mental health practices such as cultural and spiritual healing practices.”.

“No matter the scientific studies, we really need to anchor on Indigenous perceptions and how people really think through this process in order to build interventions. We cannot build interventions that are scientific without cultural or spiritual interventions. People wouldn't be satisfied or mentally healed, it is important there is a wholesome response.”

“No matter how much you do this explanation, you still have to get an ancestral explanation for their mental health to really be stable.”

Additional findings from the intercommunity dialogues (see Supplementary Table 4. for more information).

In addition to the findings listed above, we have included some additional context surfaced in the intercommunity dialogues to help contextualize the priority research themes.

Peru

Adverse changes in climate and territory are urgent problems in the region, where deforestation rates are high, pollution is widespread and agrochemicals are used for monoculture agriculture. These issues are often overlooked in projects that seek economic growth. Climate change is a significant concern for the indigenous communities in the region, and they are experiencing its effects first hand. Some community members highlighted the fact that the weather is no longer as it used to be, with summers and winters arriving at different times and the climate becoming disorderly. They attribute these changes to deforestation, the cutting of trees near the streams and the use of agrochemicals.

Kinship with seeds and harmony with the Mother (Earth) are two key conceptualisations that stand out from the inter-community dialogue among Kichwa communities in San Martín, Peru. These issues are key to understanding both climate change and wellbeing, as well as their intersection, for this population. Below are excerpts from Waman Wasi's report that illustrate these themes [translated from Spanish, with some words in Kichwa]. These serve as concrete examples of cultural elements needed to foster wellbeing and mental health in this particular climate-affected context.

Seed kinship

Testimonies from the dialogue denote a Kichwa worldview that intimately links humans and seeds in kinship, where growing plants/crops is talked about as an act of criar (raising, as in raising a child).

Harmony with the mother

Rituals and Earth-honoring practices are at the root of wellbeing. The practice of “asking permission from the Mother” [Earth] implies a complex sense of direct participation not only in the world but also in the spiritual relationships and ritual. One of the rituals consisted of ikarar (cleansing and protection through the smoke of the mapacho [tobacco]) and served to resume the intimate bonds of trust with the Mother of the mountain.

Reflective lessons from the Indigenous dialogues on research approach and methodology

We uncovered several tensions while undertaking this project. An important tension, felt across the LEWG, stemmed from the difference in pace and scale between research carried out within Western “scientific” paradigms and genuine engagement with lived experiences that must be carried out at the “pace of trust”. Another, specific to this sub-thematic dialogue, regarded the confrontation between different worldviews which implied a constant mediation and consultation around fundamental framings of the research with the different teams and communities involved in shaping the project (for instance, University ethics boards with set processes and language, and the Indigenous contributors for whom we needed to seek consent appropriately, considering cultural needs and access that accounted for different languages and levels of literacy).

Studies on Indigenous populations led by non-Indigenous scholars have frequently justified the exploitation of personal narratives for research purposes and have often tokenized individuals and communities in favor of reducing diverse cultures and perspectives, thereby undermining the heterogeneity and depth of the world's Indigenous knowledges. Our research team recognized the importance of prioritizing a set of value principles to ensure the safety of and respect toward Indigenous collaborators and their contributions. These included, primarily: cultural sensitivity, relationality (prioritizing relationships) and attention to process. (See Supplementary Table 2. For a more thorough review of Practices to create an enabling research environment).

Creating an enabling environment with research practices rooted in care (See supplementary Table 3. for a more thorough review).

Engaging Indigenous populations in a research process involves respecting and valuing Indigenous knowledge, fostering meaningful collaboration and acknowledging the historical context of colonization (and how it affects the research process). Our approach to these dialogues was process-oriented, wherein the process itself was deemed just as important as the research outputs. In this iterative process, centered around relationship-building and active listening, we put into practice several additional mechanisms to respect the autonomy and safeguard Indigenous community members.

Action agenda

As the climate change and mental health field for Indigenous Peoples builds and the evidence base grows, it is crucial to avoid perpetuating existing challenges, including: (1) disconnections across disciplines and between researchers and policymakers; (2) unequal focus on topics and geographies; and (3) and siloed decision making for climate and for mental health. This includes guidance on how to best support the growing community of practice, how to translate evidence to action, and the principles that should guide this approach. Enacting this agenda will require transdisciplinary effort and coordinated action across research, funding environments, policy, and practice. This action agenda sets out priority actions to work toward a thriving climate and mental health field.

Priority next steps/recommendations to actors/investors

Below is a summary of key actions and priority next steps to implement the research agenda and to translate evidence generated through research into policy and practice.

Work toward the protection of traditional healing practices and TEK as cultural heritage

• Advocate for legal recognition and protection of traditional healing practices and TEK as part of the cultural heritage of Indigenous communities, and; Work toward incorporating these aspects into national and international legal frameworks.
• Establish partnerships between Indigenous communities and cultural institutions to support communities in establishing community-led archives or repositories for traditional healing practices and TEK. Repositories should prioritize community control, accessibility and the ability to manage and share information within the community.
• Develop educational programs to raise awareness about the importance of traditional healing practices and TEK and their co-benefits to mental health.

Invest in supporting knowledge exchanges between indigenous elders and youth

• Actively support community-led spaces for Elders to pass down traditional healing knowledge to younger generations, fostering continuity and preserving cultural practices that can strengthen climate resilience and mental health and wellbeing.
• Work with Indigenous cultural practitioners, artists and storytellers to create living repositories of their cultural heritage (also digital).

Implement straightforward procedures to access grants and financial resources and set up long-term funding partnerships

• Resources are needed to support any community-led action, and often they are tied to funders' agendas. It is necessary to provide easy-to-access grant schemes for Indigenous communities, without unnecessary bureaucracy or funders' decision-making over the use of those funds. Adopt a community-driven approach that allows Indigenous communities to prioritize their funding needs.
• Appoint dedicated Indigenous liaisons within funding agencies or organizations. These individuals can serve as points of contact for Indigenous communities, offering personalized guidance and assistance throughout the application and reporting phases.
• Establish long-term funding partnerships with Indigenous communities to build trust and continuity. Multi-year funding commitments can reduce the burden of frequent application processes and provide stability for community initiatives.

Focus research efforts to strengthen intercultural public mental health services

• Develop culturally-informed assessment tools that consider diverse expressions of mental health and wellbeing. Acknowledge and be guided by Indigenous understandings of wellbeing, which differ from Western diagnostic frameworks.
• Strengthen ethnographic approaches in mental health research. Additionally, foster more connections between the fields of medical anthropology, psychiatric anthropology and intercultural psychiatry, and put these in conversation with local climate scientists in each context.
• Hire researchers who are members of, or fluent in the languages spoken within, Indigenous communities.
• Generate more research collaborations between the fields of land health and mental health.
• Generate more research collaborations across language barriers (i.e., Spanish-speaking, French speaking, English-speaking Indigenous mental health and climate researchers) to avoid siloes across colonial language groups.

Advocate for and implement policies that support culturally-responsive mental health services

• Ensure that policies reflect the unique needs and rights of Indigenous individuals and communities.
• Implement trauma-informed care approaches that recognize and address the historical and intergenerational traumas experienced by Indigenous individuals and communities.
• Incorporate protective factors that contribute to mental health and wellbeing (e.g., access to cultural resources that enable cultural continuity) into mental health promotion efforts.
• Inadequate representation of Indigenous Peoples in healthcare governance, policymaking and service delivery can hinder the development of culturally sensitive health systems. Work with and hire Indigenous health workers, psychologists and traditional healers.
• Connection to, and kinship with, the non-human world and web of life can open many paths into different ways of relating to the living world and of responding to its drastic imbalances. Focus on the link between planetary health and human wellbeing.
• Collaborate with Indigenous communities to co-create and implement climate campaigns. Incorporate traditional ecological knowledge in campaign strategies and solutions.
• Prioritize building long-term relationships based on mutual respect and trust. Be committed to ongoing collaboration beyond the duration of specific campaigns.

Advocate for and actively support Indigenous land sovereignty and the protection of sacred sites

• Collaborate with Indigenous communities to identify and safeguard culturally significant areas. Conduct educational campaigns, workshops and events to highlight the importance of Indigenous land sovereignty and the protection of sacred sites. Foster a broader understanding of the historical context and ongoing struggles. Encourage divestment from projects that infringe on Indigenous land sovereignty.
• Give resources to help Indigenous communities buy back their ancestral lands.
• Develop policies and practices that explicitly protect sacred sites and ensure these are implemented by local and international actors (e.g., mining sector, farming trade unions).

Challenges and limitations of the research process

We experienced a number of challenges during the research process and have included suggestions to address them in future research (see Supplementary Table 3).

Conclusion

“It is our hope to continue to amplify Indigenous Peoples, and their knowledges and scholarship for the integral need of the Mother Earth spirit—for all that has been, is, and will be on Mother Earth” (Yellow Cloud and Redvers, 2023).

This paper represents a seminal research and action agenda to understand and respond to the climate impacts on Indigenous mental health and opportunities for simultaneous healing and protection of the wellbeing of people and lands. This research and action agenda does not claim to speak for all Indigenous groups or to offer a complete overview of their experiences with climate change and mental health, it serves as a starting point for future engagement and thoughtful action. The research themes are limited by the project team's ability to reach diverse communities and experiences, as well as by the vast variety of Indigenous cultures worldwide. The agenda is also shaped by the team's position, funder priorities, and the resources and time available for its development.

While this project operates within a biomedical framework of mental health, it also prompts a crucial question: What is lost if we only use these terms? Western frameworks that limit mental health to biomedical models may reflect the separation between people and their land, which is a core issue of the climate crisis itself. If these colonial separations are at the root of both climate change and our understanding of mental health, it's essential to center diverse, collective bodies of knowledge to guide how we understand and foster wellbeing in the context of climate change.

Finally, the pathways for research, pedagogy and action outlined in this agenda must be adapted to local, regional, and global contexts. The research and action steps, herein, serve as a starting point for various stakeholders. Key lessons from this process—such as building trust, working in a relational manner, and honoring Indigenous sovereignty—are applicable to many other research and action settings. We encourage others to engage in sensitive, respectful, and community-based research that is rooted in both self- and collective determination. Prioritizing and elevating Indigenous knowledge about mental health and climate change must remain central to all collective efforts to address the climate crisis.

Correction note

This article has been corrected with minor changes. These changes do not impact the scientific content of the article.

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Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fclim.2026.1724441/full#supplementary-material

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Footnotes

Edited by: Hannah Neufeld, University of Waterloo, Canada

Reviewed by: Adi Fahrudin, Universitas Esa Unggul, Indonesia

Leonel Lumogdang, Southern Philippines Agri-Business and Marine and Aquatic School of Technology (SPAMAST), Philippines