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For one sweltering week in the summer of 2018, Tiohtià:ke, also known as Montreal, faced daytime temperatures as high as 35.5 C during the day – hotter than the summer averages seen in Mumbai. With the humidity, Quebec’s largest city felt more like 40 C, and nightly temperatures never fell below 20 C.
From June 30 to July 8, 2018, this heat wave killed 66 people across Montreal, according to a report released by Montreal’s public health authority the following year. Nearly 75 per cent of the dead had some sort of chronic health condition, and two-thirds were over the age of 65. However, one particular demographic stood out to researchers: the number of people with schizophrenia who died.
Roughly 25 per cent of the dead had the severe mental health condition, Montreal’s public health authority noted, despite schizophrenics making up just 0.6 per cent of Montreal’s population at the time. The same pattern showed up after the Pacific Northwest heat dome of 2021, which killed roughly 650 people across Canada’s western provinces.
“Just under two-thirds (64%) of decedents were identified with chronic illnesses that potentially could impact cognition,” read B.C.’s coroner’s subsequent report into the heat dome, “including mood and anxiety disorders, dementia, or schizophrenia.” (To be clear, the B.C. coroner’s report doesn’t separate out how many of the dead had just schizophrenia, as opposed to other underlying conditions.)
For years, medical researchers have noted the links between extreme temperatures and the worsening of mental health issues. During heat waves, people with bipolar disorder are more likely to experience dangerous manic episodes, while suicide rates rise by as much as 3.5 per cent for every degree of temperature increase above the norm.
Yet schizophrenia, specifically, is among the most difficult-to-treat mental health conditions, and not just because of its medical symptoms. A combination of outdated stereotypes, poor social safety nets, and the overlap between schizophrenia and other medical conditions means this population is especially vulnerable to extreme heat – and frontline non-profits and charities don’t appear to prioritize it.

Schizophrenia and heat regulation

Among one of the most serious mental health conditions, schizophrenia’s major symptoms include hallucinations or delusions, disorganized thinking, physical agitation, and a withdrawal from daily activities and tasks. People with the condition are at high risk of having other mental health conditions, especially depression, obsessive-compulsive disorder, and substance use disorders. According to the journal Schizophrenia Research, people with schizophrenia end their lives at 20 times the rate of the general population.
That said, Schizophrenia Society of Canada executive director Chris Summerville says it is no longer a “kiss of death diagnosis” – people with it can live normal lives, if treated adequately.
He says longitudinal studies conducted over decades have found that up to two-thirds of people with schizophrenia can recover, although they may still experience symptoms for the rest of their lives.
That said, there are a multitude of risk factors at play for people with schizophrenia, and one of them happens to be due to extreme heat. “People with schizophrenia can experience difficulties with body temperature regulation,” Summerville explains. Another is the antipsychotics and selective serotonin reuptake inhibitors (SSRIs) used to treat schizophrenia. These medications also make people more susceptible to overheating, even if they don’t have schizophrenia.
In fact, according to a 2008 study published in Environmental health perspectives, an academic journal, people with schizophrenia were twice as likely to die during heat waves than the general population. This was especially true for men with schizophrenia who were at or under 75 years of age, according to the study.
This is at least partially explained by the fact that many of the antipsychotics used to treat schizophrenia lower the body’s ability to regulate its internal temperature, making people taking them far more susceptible to overheating. Other commonly used mental health medications such as selective serotonin reuptake inhibitors (SSRIs), also present these problems.
“Most people with schizophrenia are on two or three different medications,” Summerville says. “That may be a combination of two antipsychotics, or an antipsychotic with an antidepressant, or also with a benzodiazepine.”
Organizations like the Schizophrenia Society of Canada understand the risks posed to people with schizophrenia, or anyone on medication to treat severe mental health issues like bipolar disorder, depression, or anxiety during heat waves. However, there doesn’t seem to be much in the way of dedicated support for people with schizophrenia specifically to navigate heat waves.

Treating everyone

At the Gerstein Crisis Centre, a mental health outreach and support non-profit in Toronto, mobile teams fan out throughout two districts in Toronto’s downtown core to help people in crisis who are outdoors. They bring first aid kits, water, and Tim Horton’s cards to ensure people can at least have something to drink and purchase a meal – along with comfortable clothing, tokens to allow clients to enter a subway and cool off, and tips on how to endure a heatwave.
The Crisis Centre does have 10 short-term crisis beds at one of its downtown locations for those in mental health crises, along with 9 mental health beds available by referral only, 5 for homeless women in mental health crises, and 7 beds for men or youth dealing with serious substance use issues. During a heat wave, these beds could keep people with schizophrenia who are homeless safe. However, the Gerstein Crisis Centre doesn’t focus its efforts on addressing the high risks to schizophrenic people specifically.
Future of Good reached out to seven other mental health organizations or mutual aid groups across Canada with questions about how they addressed the dangers people with schizophrenia face during heat waves. All of them either declined to comment, never responded, or were unavailable for an interview before publication time.
Carla Pearson, director of crisis services at the Gerstein Crisis Centre, says the organization takes a more holistic approach to its clients. It looks at their individual needs rather than a medical approach to the risks of specific mental health issues and heatwaves. “That would be more of a medical model approach,” she says. “More research is needed on that. We support clients with all mental health issues.”
But there are two very specific issues people with schizophrenia face that make them particularly vulnerable during heat waves, and may require a more focused approach by changemakers.

 Isolation and substandard housing

Summerville says one of the biggest issues faced by schizophrenic people during heatwaves isn’t necessarily their condition – it is bad housing.  “Untold numbers of people with mental illness — and schizophrenia — live in inadequate housing,” he says. Overcrowded, cramped homes or stifling units in high-rise apartment towers may be the only places where people with severe mental health issues can afford to live.
Unfortunately, when extreme heat strikes, this type of housing becomes dangerous to its inhabitants. Even well-designed private homes may not be able to withstand a heatwave if they aren’t properly air conditioned. In the 2021 heat dome, 98 per cent of all B.C. deaths happened indoors. Only 7 per cent of the dead had air conditioning at their residence when they were found, and only 15 per cent of those who did – just seven people – had it turned on at the time they died.
Of course, air conditioning is expensive, and people with schizophrenia are far more likely to live in poverty than those without mental health conditions. The employment rate of people with schizophrenia in Canada is about 15 per cent, according to the Public Policy Forum. In cities, where most mental health and support services are found, high rents can force people with schizophrenia to forgo air conditioning or other methods of cooling a home in favour of having a roof over their head at all.
“There are certain things that you can do around the house to reduce your extreme heat exposure,” says Joanna Eyquem, managing director of climate-resilient infrastructure at the Intact Centre on Climate Adaptation. “But people who have less resources or live in poor-quality housing are more vulnerable because they can’t do those things.”
On its own, substandard housing is bad enough for people with schizophrenia during heatwaves. When combined with isolation, it gets even worse. People with unmanaged schizophrenia often withdraw from their daily activities, social lives, or jobs. Unless they are in a group home or congregate care setting, many people with untreated schizophrenia might not have contact with anyone for long periods of time.
While not everyone who died during the 2021 heat dome had schizophrenia, a significant number lived alone and were therefore at risk of going into shock without anyone to call for help. Half of those who died were found during wellness checks, while only a third were found by someone during routine contact – like a family member returning home from work, or a scheduled visit from friends.

 How changemakers can help

The great risk posed to people with schizophrenia lies at the intersection of poverty, substandard housing, isolation, and a reduced ability to handle high heat. These are all complex problems that no one sector of society can tackle on their own. Nonetheless, there are clear steps community service organizations with a mental health focus can take to ensure people with schizophrenia can be taken care of during a heatwave.
The B.C. coroner’s report includes recommendations for the province’s Home and Community Care Services to prioritize clients who are listed on chronic disease registries, including those with schizophrenia during heat wave response. Organizations who serve these clients could also emphasize their protection, too.
Summerville also says education for people with schizophrenia on the risks of living with the condition during a heat wave is key – but so is thinking about the impact on a person with schizophrenia well before the mercury starts to rise. “The only way you’re going to do it is by consistently educating people,” he says.

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