Core principles of practising sustainable psychiatry

Sustainable psychiatry recognises that climate change and ecological stresses are major threats to mental health. The NHS is working toward net-zero, and psychiatry has a direct role in reducing healthcare-related emissions while improving patient outcomes. Sustainable practice strengthens clinical quality, service efficiency and health equity.

Why sustainability matters

Climate impacts worsen mental illness directly (for example, trauma from extreme weather) and indirectly (through inequality, displacement and reduced access to nature). Since healthcare itself contributes significantly to emissions, psychiatric services have a responsibility to reduce their environmental footprint and protect long-term population mental health.

An overarching framework

• Effective sustainable psychiatry focuses on three aims:
• Mitigation – reducing emissions from prescribing, travel, estates and resource use.
• Adaptation – ensuring services remain resilient to climate impacts and can support affected patients.
• Prevention and promotion – prioritising upstream interventions that improve wellbeing and reduce reliance on high-resource care.

Core principles of sustainable psychiatric practice

1. Embed sustainability in clinical decision-making
Incorporate environmental impact alongside clinical benefit when discussing treatment options. Shared decision-making helps avoid low-value interventions, reduce waste and match patients to low-carbon alternatives when appropriate.

2. Prioritise prevention, social determinants and nature-based interventions
Upstream interventions reduce future service demand and often produce co-benefits, such as improved wellbeing and reduced carbon use. Social prescribing, green social activities and community support can be integrated into care plans where clinically appropriate.

3. Reduce carbon from prescribing, investigations and treatment pathways
Rational prescribing, deprescribing when safe, choosing lower-waste medication formulations, minimising unnecessary investigations and avoiding single-use items where alternatives exist all contribute significantly to reducing emissions.

4. Rethink travel and access to care
Travel—by staff and patients—is often one of the largest contributors to service-related emissions. Remote consultations, when clinically suitable, clustered outpatient appointments and active travel options reduce unnecessary journeys without compromising care.

5. Focus on sustainable service design and leadership
Include sustainability in governance structures. Use simple carbon-aware audits, develop green plans, run sustainability-focused quality improvement projects and track measurable outcomes. Leadership involvement helps ensure sustainability becomes a long-term cultural norm.

6. Build a sustainable and healthy workforce
Wellbeing and sustainability are linked. Minimising burnout, improving rostering, reducing avoidable travel and giving staff time for sustainability work strengthen both environmental and clinical resilience.

7. Enhance education, research and advocacy
Provide training on sustainable mental healthcare for trainees and multidisciplinary teams. Support research into low-carbon care pathways and advocate for investment in greener infrastructure, prevention and community resources.

8. Promote equity and justice
Climate change disproportionately affects disadvantaged groups. Sustainable practice should focus on interventions that reduce inequalities while lowering emissions, such as local outreach, housing-focused interventions and improving access to safe green spaces.

A practical checklist for teams

• Complete a simple carbon-aware baseline audit (travel, prescribing, procurement, energy use).
• Select two or three achievable improvement projects for the year.
• Add sustainability to regular team meeting agendas.
• Nominate a sustainability or “green” lead.
• Link with estates, procurement and pharmacy to identify high-impact opportunities.
• Offer brief training on sustainable prescribing and social prescribing options.
• Measure and report meaningful metrics (e.g., avoided travel miles, medication reviews completed).

Short-, medium- and long-term actions

• Short term (3–6 months): Conduct a baseline audit, start medication review sessions, examine clinic travel patterns.
• Medium term (6–18 months): Add nature-based and community support options to care pathways, redesign community visit schedules, review procurement practices.
• Long term (18+ months): Embed sustainability in organisational strategy, upgrade estates to improve energy efficiency and demonstrate reductions in emissions alongside clinical improvement.

Measuring impact

Useful measures include estimated emissions, percentages of low-carbon consultations, avoided travel mileage, prescribing changes, patient-reported outcomes and workforce wellbeing indicators. Aligning these with trust or ICS green plans ensures psychiatry’s contribution to net-zero is visible across the system.

Barriers and how to overcome them

Common challenges include limited time, competing clinical pressures and uncertainty about where to start. Address these by selecting projects with strong clinical co-benefits, using small pilot tests, and integrating sustainability into existing governance and professional objectives. Partnering with sustainability teams provides additional support.

Seven key takeaways for practising psychiatrists

1. Sustainability is part of clinical responsibility.
2. Focus on prevention and social determinants whenever evidence supports it.
3. Make prescribing and investigations as low-carbon as clinically safe.
4. Reduce travel emissions with thoughtful planning and appropriate use of remote care.
5. Integrate sustainability into governance and continuous improvement.
6. Support workforce wellbeing as a core sustainability priority.
7. Educate, research and advocate for greener mental healthcare.

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