In the small town of Singtam, nestled beside the Teesta River in Sikkim, India, Neelam Nandi* struggles with anxiety every time she hears heavy rainfalls or warning sirens. For her, these sounds are haunting reminders of the night the banks of the Teesta River burst, submerging her home in deluge and darkness.

The Nandi family is among the few survivors of a glacial lake outburst flood (GLOF) that hit the Himalayan state of Sikkim when heavy rainfall caused the overflow of South Lhonak Lake in the early hours of October 4, 2023. The flood caused widespread destruction, government reports indicating that it claimed 55 lives and affected an estimated 80,000 people across 100 villages. Now, more than a year later, Sikkim's residents continue to suffer unseen damage from the disaster—its mental health impact.

India's growing vulnerability to GLOFs, driven by climate-induced changes in the Hindu Kush Himalayas, underscores an urgent crisis. As government initiatives seek to assess and reduce climate risks, the mental health consequences of such disasters, as seen after the Sikkim floods, demand attention. An integrated approach addressing climate resilience, disaster preparedness, and psychological well-being is crucial to protecting affected communities.

Experts in psychological health have drawn links between climate change-induced extreme weather events and the impact they have on mental health

"It's been over a year, and my daughter still can't attend school or lead a normal life. She's on medication and has suffered multiple panic attacks where she's lost consciousness," explains Neelam's mother, Preeti Nandi*. "My husband rescued her and two other children when water started entering our rented house," she recalls. Preeti also suffers from anxiety following the flood, and now needs medication and counseling from doctors at Singtam District Hospital to cope.

The lake's overflow had surged toward the nearby Teesta III Dam, breaching its banks and collapsing the dam. The fast-moving flood triggered landslides and carried debris, and soon reached Singtam, where the family lived.

"The flood not only reshaped the region's physical landscape but also left a lasting impact on the mental health of its survivors," says Dr. Seema*, a psychiatrist from Singtam District Hospital.

Both Neelam and her mother have been under Seema's care for the past year. The doctor recounted the details:

I met the Nandi family at a relief camp set up for flood victims who had lost their homes. Many of the men and women there reported experiencing fear, panic, and restlessness after the disaster. However, most of the patients from the camp did not return for follow-up care after being resettled. Neelam and Preeti, on the other hand, continue to receive counseling and medication.

According to Seema, climate disruption and resettlement has hindered the collection of definitive data on the number of flood victims who suffered from psychological issues—such as anxiety, posttraumatic stress disorder (PTSD), or other mental health disorders—because most people never returned for follow-up visits at the district hospital.

Despite the lack of concrete data, mental health professionals indicate that the burden continues. "The number of patients seeking treatment for mental health have increased in Singtam Hospital post-pandemic, and after the GLOF it has increased too. Old patients who were stable have relapsed. Ten to 15 new patients and a few follow-up cases come every week [to] the Psychiatry Department for treatment," says Devendra Singh, a neuroscience researcher and psychotherapist who has been working in the state for close to a decade.

Psychological Impact

"Shock, denial, and adjustment issues are just the beginning. Acute stress disorder, anxiety, panic attacks, and restlessness often follow. When these responses become a pattern, hyperarousal sets in—feeling constantly on edge, overly alert, and fearing even the smallest sounds, as if another calamity is looming," explains Singh.

Neelam and Preeti look outside their kitchen window. Photo courtesy of Diwash Gahatraj Photo courtesy of Diwash Gahatraj

"There's a constant fear of another flood like last year, which haunts me in [my] nightmares. I feel restless and anxious every time it rains heavily," explains Neelam, who has attempted suicide twice.

Experts in psychological health have drawn links between climate change-induced extreme weather events and the impact they have on mental health. Researchers assessed the psychological well-being of primary survivors of India's deadly Uttarakhand floods in 2013. The report highlights that around 70% of survivors experienced significant psychological stress, with symptoms including depression, anxiety, and PTSD. Factors such as the loss of loved ones, property damage, and disruptions in livelihood were identified as significant stressors.

Untreated mental health conditions can severely hinder both individual and community recovery following a disaster. Indian psychiatrist Suvarna Jyothi Kantipudi explains:

For individuals, these conditions often lead to debilitating challenges like sleep disturbances, social withdrawal, and even suicidal thoughts or attempts. These issues not only intensify personal suffering but also impair an individual's ability to contribute to recovery efforts, such as rebuilding homes, restoring livelihoods, or maintaining social connections. . . . On a larger scale, untreated mental health conditions can undermine entire communities. They weaken social networks, strain health-care systems, and impede economic recovery by reducing workforce participation. Chronic stress and trauma can also have intergenerational effects, with epigenetic changes that perpetuate cycles of poor mental health, diminishing resilience in future generations.

Climate Vulnerability

GLOFs are a growing concern in the Himalayas. They pose a growing danger to communities because many of the 54,000 glaciers in the Hindu Kush Himalaya region are shrinking due to climate change. A 2023 report revealed that the Himalayas, glaciers, and the permafrost of Hindu Kush are undergoing irreversible changes, creating greater threats to people living in the plains.

The Sikkim tragedy is the second major climate change-induced glacial lake outburst flood in India. Ten years ago, in 2013, the Uttarakhand floods, one of India's worst natural disasters, were primarily triggered by a combination of extreme weather events and environmental mismanagement. Chorabari Tal, a glacial lake near Kedarnath, breached its moraine dam due to heavy rainfall and additional water from glacier melt, claiming thousands of lives and causing widespread damage to infrastructure.

The Sikkim tragedy is the second major climate change-induced glacial lake outburst flood in India

After the Sikkim floods, the Indian government set up the National GLOF Risk Mitigation Program, including expeditions to monitor Himalayan glacial lakes. The program consists of sixteen teams in the National Disaster Management Authority, which aim to monitor glacial lakes and warn of potential floods before they occur. The government has sanctioned 1.5 billion rupees ($18 million) for the risk assessment and mitigation of GLOFs.

Although the government has taken critical steps toward disaster prevention, the program does not currently focus on addressing the mental health impacts on survivors of such disasters. In a 2023 review for Health Psychology Research, psychiatrists and mental health counselors urged culturally sensitive approaches and tailored therapies to address the unique needs of disaster survivors—citing India's floods in their research. Despite progress, the review calls for more research into long-term outcomes and efficacy of mental health treatments across diverse populations and disaster types.

Programs like the National Mental Health Program and the National Tele Mental Health Program in India are steps forward, but their impact is hindered by uneven implementation, stigma against seeking mental health care, and lack of disaster-specific training. India should increase funding for preventive mental health initiatives, integrate mental health into broader health-care delivery, and adopt task-sharing models to decentralize care.

Suvarna explains that India's health system is ill equipped to address disaster-related mental health challenges given a severe shortage of mental health professionals. With a psychiatrist-to-population ratio of 0.75 per 100,000—far below the World Health Organization recommendation of three per 100,000—similar gaps exist for psychologists, psychiatric nurses, and social workers. Infrastructure inadequacies and limited mental health funding—just 1% to 2% of the health-care budget—compound the issue.

At a policy level, India needs to focus on allocating greater resources to promotive and preventive mental health initiatives, integrating mental health services into the broader health-care system, and adopting a task-sharing approach to decentralize and expand access to care.

A view of Singtam, in the state of Sikkim, India, on December 31, 2024. Photo courtesy of Diwash Gahatraj Photo courtesy of Diwash Gahatraj

*EDITOR'S NOTE: Names have been changed to protect the identities of those mentioned.

In the United States, if you or someone you know is in an emotional crisis, reach out to the National Suicide & Crisis Lifeline by dialing or texting 988.

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