Frontline heroes: Leveraging community health workers as first responders for climate-related digital mental health support

Climate-related disasters are increasing in frequency and severity, placing immense psychosocial strain on individuals, communities, and health systems, particularly in low- and middle-income countries (LMICs). The health impacts of climate-related events are also increasingly becoming evident, especially affecting mental health outcomes. The 2022 floods in Pakistan affected over 33 million people and disrupted access to essential healthcare. This article highlights lessons learned from the mPareshan project, a digital mental health intervention implemented in District Badin, Sindh, during the 2022 floods. Amidst a critical shortage of mental health professionals in those geographies, the project leveraged Pakistan’s Lady Health Worker (LHW) Programme to deliver a culturally adapted, app-based psychosocial support and counselling intervention for anxiety and depression. Despite widespread destruction caused by the floods, trained LHWs provided continued support using the mPareshan app, illustrating the feasibility of community-embedded, digitally enabled mental health care during crises. The project highlights the capacity of community health workers (CHWs) to sustain service delivery under climate adversity and emphasizes the importance of investing in their skills pertaining to psychosocial support and emotional resilience. Comparative experiences from other LMICs and a growing body of evidence suggest task-shifting to CHWs in resource-poor regions lacking professional health care providers as an alternative approach. However, the integration of digital health into psychosocial interventions led by CHWs remains underexplored. As climate emergencies escalate, scalable and context-sensitive digital mental health strategies, grounded in existing primary care, must be prioritized to promote and protect community well-being.