Heat vulnerabilities and adaptation in mental health care work: a qualitative study
AE Schmidt, S Kainz, S Spagl, K Dinhof, K Brugger, D Rubatscher, H Voglstätter, F Sahling, M Söllner, I GrabmaierAbstract
Background
In Europe, rising temperatures and more frequent heatwaves increase health risks and strain health systems. In mental health and psychosocial care, heat has a double impact: working conditions deteriorate for staff, while clients with mental health conditions experience heat-related health and functional decline, increasing the need for support and supervision. These dynamics amplify workload and threaten service continuity in a sector already affected by workforce shortages.
Methods
We conducted 25 semi-structured interviews with staff from a hospital, a mobile care service provider, and advocacy groups representing people with mental health conditions. Data were analysed using qualitative content analysis (Kuckartz), guided by a vulnerability framework (exposure, sensitivity, adaptive capacity).
Results
High heat exposure was driven by poorly insulated, non-cooled clinical rooms and clients’ apartments, affecting both staff and clients. Staff described reduced cognitive and physical capacity during heatwaves. Client vulnerability was heightened among people with multiple disabilities, limited communication, and those taking psychotropic medication; heat further reduced self-care capacity. This increased the need for observation and assistance, potentially escalating workload during heat events. Adaptation strategies were predominantly individual (e.g., brief cooling breaks, adjusted hydration), while organisational measures were inconsistently available.
Conclusions
Heat is a workforce and patient-safety issue across European mental health services. Beyond ad-hoc coping, transformative adaptation is needed: embed heat risk into occupational health and quality standards, retrofit facilities/housing to reduce exposure, implement protocols for high-risk clients, and plan staffing and work during heat events. These system measures can prevent avoidable deterioration, protect staff wellbeing and strengthen service resilience.