Preparation for hot weather and guidance for mental health consumers in preventative strategies for heatwave conditions can avert serious physical health sequelae from extreme heat conditions.

A heatwave is an extended period of very high temperatures which impact on individual's health. People with mental illness, particularly those who are socially isolated, disadvantaged and on certain psychotropic medications are a vulnerable group, especially during periods of extreme temperatures.

Signs and symptoms of heat stroke [i.e. core body temp above 40^oC] in very hot weather is a medical emergency which requires rapid cooling and medical assistance.

Recognition of heat related illness needs to be accompanied by management and referral as required.

Following some Clozapine related client deaths from natural causes, with possible relationship for some of these in very hot summer months, Mental Health Drug & Alcohol service (MHDA) formed a Heat Wave working party. The aim was to explore and develop some MHDA specific resources for staff and clients prior to the 2011-12 summer.

• Heat Wave working party formed to meet regularly. This is a multi disciplinary group with consumer input
• Clozapine client deaths reviewed locally as well as a further independent review of the physical care of these clients by the CRIS team at Royal North Shore Hospital. Temperatures charts also accessed from the BOM site around the summer of 2010-11. Action Plan for issues arising from the CRIS file audit
• Literature search undertaken plus review of current general resources via NSW Health site and public Health resources, as well as resource material from Prof Beverly Raphael's slides on Heat and Summer, from a Disaster Control perspective
• Promotional material designed and resources, which include drink bottles, hats, and fridge magnets with the Heat wave message, sourced and distributed
• Flyer developed, printed and distributed
  Heatwave Flyer ( pdf - 233 KB) or Heatwave Flyer (pub - 493 KB)
• Brochures developed, printed and distributed (A4, A3)
  Heatwave Brochure ( pdf - 249 KB) or Heatwave Brochure (pub - 391 KB)
• Educational resource for staff
  • a power point presentation developed
    Heatwave Overview ( pdf - 1.2 MB) or Heatwave Overview ( pptx - 1.3 MB) 
  • sessions with staff to raise awareness undertaken with each sector /service with a cascade model for team leaders to then present to teams within their jurisdiction
• A Guideline for MHDA staff to follow with suggestions to assist their clients in hot weather and heat wave conditions
• Launch of promotional materials and education undertaken in Mental Health Month, October 2011 for consumers and staff
• A system in place for ongoing ordering of promotional materials

Implementation included key educational awareness messages for clients and staff which were focussed on planning and were cost neutral.

Social behaviours in heatwave conditions contributing to poor health outcomes

• Increased alcohol and drug consumption – 'water first encouraged
• Heat and violent behaviours: an association may be due to increased irritability
• Motor vehicle accidents, more so in holiday season
• Vulnerable youth – risk behaviours including drug and alcohol use and water based activities
• Drownings increase in summer months
• Stress can increase in hot conditions
• Some attitudes eg, not being worried about heatwave conditions can cause people not to heed the associated dangers.

Advice to Mental Health consumers regarding preparation and prevention

Consumers should be encouraged to:

• Check the weather forecast on radio, TV or Internet
• Plan day to day activities according to weather conditions
• Stay in cool areas as much as possible e.g., inside home with a fan or air-conditioning / cooled premises such as shopping centres, library, friends' places or health centres
• Avoid the heat in the middle of the day, especially between 11am and 3pm and plan shopping trips and chores
• Drink water frequently and check with their doctor if they are on fluid restrictions
• Have a cool shower
• Avoid high sugar content drinks, alcohol and caffeine containing beverages, including 'energy drinks'
• Study the effects of their medications and check with health worker / Doctor any side effects that may get worse on hot days
• If they are worried about themselves or others, seek medical attention
• Dress for hot weather - cool loose light coloured clothing
• Plan for electrical power blackouts, as air conditioning and fans will not be available
• It is especially important to stay hydrated on very hot days
• If emergency assistance is required, Mental Health consumers should call, triple zero (000) or 0000 on mobile phones.

The key message communicated to our consumers and staff was: Hot weather is dangerous.

High temperatures are a threat to health, especially in summer. Heat can affect consumers if they are on medications such as anticholinergic drugs which impair sweating or neuroleptic drugs which interfere with thermo regulation. Sweating can also affect serum Lithium levels and in extreme circumstance contribute to Lithium toxicity. In addition some patients with schizophrenia and related disorders experience bodily perceptions differently including temperature, independently of medication effects.

Early recognition of heat stroke and prompt treatment reduces mortality.

To date all education sessions and distribution of promotional materials has been very positively received. The small cost of the awareness and promotion, approx $10,000, for a very large combined area of MHDA, went a long way.

The next step is to identify a relevant physical or mental health issue for a targeted campaign each year in Mental health Month, through linking with the MHDA Physical healthcare Committee across our services.

Liz Newton, Michael Paton, Paula Hanlon, Eda De Voti, Kate Jeffrey

Northern Sydney and Central Coast LHDs Mental Health Drug & Alcohol Service

• Professor Beverley Raphael, Professor of Population Mental Health & Disasters, School of Medicine, University Western Sydney, Powerpoint slides, 2010
• Australasian College for Emergency Medicine, ‘Policy on Heatwave’, 2010
• NSW Health 'Maintaining health during extreme heat’
• NSLHD, CCLHD Public health Unit brochure ‘Heatwaves can kill’, 2007
• NSW Health fact sheet 2008 ‘Heat Related Illness’

Manager Quality and Research
NS & CC LHDs, Mental Health D&A
Macquarie Hospital
Wicks Rd, North Ryde, NSW, 2113
Phone: 02 9887 5690