Behavioral Health Brief: Eradicating Social Isolation — Grand Challenge Focus
By Sue Coyle, MSW
Social Work Today
Vol. 20 No. 3 P. 8

Social isolation is increasingly a topic of conversation in today’s society and was accentuated amid the recent emphasis on social distancing. People often complain about the increasing use of technology, the younger generations, and the disappearance of real conversation, but they may fail to take the next step toward true understanding. That’s a mistake.

Social isolation and its subsequent loneliness are far more complex than a population glued to its phones. It is something that affects a significant portion of individuals throughout the country. In fact, according to a 2020 Consensus Study Report of the National Academies of Science, Engineering and Medicine, “Approximately one-quarter (24%) of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely.” That proportion comprises more than one-third of adults older than 45 and has been the same since at least 2010 when the AARP conducted a national survey.

The impact of such prevalent isolation and loneliness is seen both physically and mentally. As such, it is the responsibility of all health professionals—including social workers—to help address and reduce social isolation.

Isolation and Loneliness
To best treat social isolation and loneliness, one must first understand the difference between the two.

“There’s definitely an overlap,” says Sandra Edmonds Crewe, PhD, MSW, ACSW, dean and a professor of social work at Howard University and director of the Howard University Multidisciplinary Gerontology Center. “[However], one is subjective and the other is objective. Social isolation, you can in a sense measure it. It’s about the number of networks and individuals you are associated with.” She continues that isolation can lead to loneliness, which is more about perception.

There are certain groups of people, such as older adults and veterans, most likely to experience isolation. However, isolation spans all populations, regardless of age or experience.

While social isolation may encompass one’s whole life, it is possible, Crewe says, to experience isolation in one sector of one’s life and not in others. Offering a personal example, she recounts being a part of desegregation and, as such, being one of very few black students in her high school. “I was socially isolated in high school, but I did not feel the isolation in my home and faith-based network,” she says. “A protective factor is to have a strong social network outside of the exclusionary environment, but it doesn’t necessarily lessen the pain within the environment.”

One can also experience social isolation without experiencing loneliness. The latter is a possible effect of the former, not a certain one. In fact, “Social isolation and loneliness do not always go together. About 28% of older adults in the United States, or 13.8 million people, live alone, according to a report by the Administration for Community Living’s Administration on Aging of the U.S. Department of Health and Human Services, but many of them are not lonely or socially isolated. At the same time, some people feel lonely despite being surrounded by family and friends” (National Institute on Aging, 2019).

Loneliness is a perception, as Crewe noted above. It is a negative feeling of being alone and disconnected. According to the American Psychiatric Academy (2017), “Loneliness usually refers to the distress people feel when their actual social involvement and relationships are not what they want them to be.”

It is that perception that connects to poor mental and physical health (though Crewe notes that some happily socially isolated individuals may also experience poor health effects).

Impact and Treatment
The impact of isolation-related loneliness is wide reaching. Crewe notes that it can contribute to anxiety and depression, as well as suicidal ideations. The internalization of loneliness and the mental health issues that arise as a result can then lead to self-medication and substance use, she says by way of example.

“Mental health is inextricably related to our networks,” Crewe says. “When there’s a disruption of those networks, whether through death or through the inability to go to faith-based communities [for instance], it can lead to deterioration in terms of their cognitive functioning. We sometimes take for granted the value in keeping you connected.” She notes that even being able to have a conversation about opposing views—something difficult in today’s political environment—can be a positive experience.

Physically, isolation and loneliness have been deemed as harmful as smoking 15 cigarettes per day. They are risk factors for obesity, lack of physical activity, cardiovascular concerns, high blood pressure, and more. Researchers have found that isolation can lead to a higher mortality rate as well.

To treat an individual struggling with social isolation, then, is complicated. The first goal is to address the isolation. “We try to understand what is causing the disconnect in the networks. If you know that they disconnected because of a loss of a partner, we go into grief and loss intervention,” Crewe says. “It allows them to process the way that they’re feeling. It doesn’t necessarily connect the person with someone else, but at least it gets them in touch with what’s going on.”

It is not always possible—or desired—to completely end the physical social isolation, and so those working one on one look for unique ways to connect individuals. Not all socially isolated individuals can end that isolation with in-person contact. Mobility and transportation can be barriers. Additionally, they don’t always want to have more face-to-face connections. And now, as society battles COVID-19, coming together in person is not possible in many parts of the country.

When that is the case, clinicians/case managers working with these individuals need to look for unique methods of connection, such as social media. This, Crewe says, is where technology can be a boon rather than a bane. Telephone and virtual support groups, as well as e-mail and social media, can help create new networks and connections, or reestablish old ones. “You can’t change the fact that your grandchild moved away, but you can still stay connected,” Crewe says. She also references a situation in which an older adult could no longer attend church due to mobility and transportation concerns. Enabling that adult to watch their service on the internet allowed them to maintain a social connection.

When it is not possible to create new connections, the clinicians look to identify other means of fulfillment, Crewe says. “If you can’t grow the network and the person is comfortable with where they are, you move it to a different level. What really brings [the client] joy?” Crewe recalls one woman who loved to knit and so began knitting caps for newborns. Though she did not go out and physically interact with new supports, she connected with them through this craft.

By addressing the isolation in one of these ways, the clinician opens the door to better treat the mental and physical health effects of loneliness.

This creativity is even more needed now during social distancing. Crewe notes that social distance does not mean social isolation, but it can lead to it. “If social distancing results in individuals not being socially connected with others, there is the risk of social isolation. Thus, as social workers, we must be on the frontline encouraging ways for families to connect at a distance,” she says.

“The important thing is to stay connected during the pandemic. We want to be mindful that social distancing can damage social networks if they are not attended to. Maybe a lesson learned during the pandemic is the human value and health benefits of staying connected.”

Community Role
However, it is not just the individual clinicians who are responsible for addressing social isolation; communities and community members are a part of the solution as well. When, for example, a parishioner stops coming to services, the other congregants and religious leadership should look to find out why that is and what they can do to stay connected to the individual.

One thing that Crewe does is note down the birthdays of those in her networks who have passed. On those birthdays, she reaches out to the loved ones to remind them that they have support. “Those are the days that the family members think about,” she says.

On a broader level, communities should be designed with social inclusion in mind. “One of the reasons we’re seeing such a build-up of social isolation is because we pride [ourselves on] our privacy,” Crewe says. “We build communities where there are not as many communal spaces. [They] are not as much in vogue as they were before.” When Crewe worked in public housing, she says that she always made sure the laundry room was a great place to be, because that was a communal place where everyone went and could connect.

Crewe also touts cultural events, which bring together neighbors who may not have otherwise bonded, as well as a community focus on mobility—creating an environment in which everyone can access transportation, needed resources, and communal spaces. “That’s the community’s responsibility,” she says.

As for the social work community, responsibility extends well beyond individual clinical work. That is why Eradicate Social Isolation is one of the Grand Challenges for Social Work. Research, advocacy, and community building are all steps that social workers can take to help achieve this goal. For example, there is a push among the leaders of this Grand Challenge to develop and promote strategies for eradicating social isolation. They hope to have a number of activities this coming September, bridging Grandparents Day and Good Neighbor Day, that will draw attention to the prevalence and dangers of social isolation.

But most importantly, Crewe adds, the social work community—and community at large—must not forget that “Social isolation is a micro-level consequence of macro-level social forces: racism, homophobia, xenophobia, sexism, classism. When we exclude people, we are making fertile territory for social isolation.”

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.

References
American Psychiatric Association. (2017, January 5). Loneliness: A growing health concern. Retrieved from https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2017/01/loneliness-a-growing-health-concern

National Academies of Science, Engineering and Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. Retrieved from https://www.nap.edu/read/25663/chapter/2

National Institute on Aging. (2019, April 23). Social isolation, loneliness in older people pose health risks. Retrieved from https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks