Adapting to Heatwaves: Systematic Review and Co-development of Coping Strategies for Mental Health

Background: Extreme heat has significant impacts on mental health, yet evidence-based guidance for coping strategies is lacking.Aims: This mixed-methods approach combined a systematic review and qualitative investigation to identify coping strategies for individuals struggling with their mental health during hot weather, leading to the co-development of a set of practical recommendations. Method: We searched Web of Science and PubMed for publications reporting coping strategies related to extreme heat and mental health and/or barriers to coping. We also held six focus groups with healthcare professionals (n=12) and people with lived experience of mental illness and/or extreme heat (n=21). Transcripts were analysed using thematic content analysis and informed the development of the recommendations.Results: The systematic review identified 182 articles, with 10 eligible for inclusion. None focused on mental health-specific coping. Reported strategies were mainly behavioural adaptations to reduce heat exposure, such as staying indoors and using fans. Six studies also reported barriers related to social, health, and socioeconomic conditions. Qualitative analysis identified four themes: (1) pre-planning, (2) reactive strategies, (3) psychosocial strategies, and (4) barriers. Participants expressed the need for simple, actionable guidance, leading to the co-development of nine tips, which we summarised in the acronym ‘COOL MINDS’.Conclusions: Our mixed-methods study identified coping strategies relevant to the mental health impacts of extreme heat. The lack of mental health-specific research highlights a gap in heatwave preparedness. Our ‘COOL MINDS’ recommendations offer a practical, user-informed starting point that, pending validation, could be used in mental health services and community outreach.