Social isolation and loneliness are health risks that affect a quarter of American adults 65 and older (National Academies of Sciences, Engineering, and Medicine, 2020). Social isolation is defined as the objective state of having few social relationships or infrequent social contact with others, and loneliness is defined as a subjective feeling of being isolated (Cudjoe et al., 2020). Studies have shown that social isolation and loneliness have negative effects on a person’s physical and mental health (De Jong, van Tilburg, & Dykstra, 2016). As the behavioral health population ages, their health challenges increase and have been shown to create feelings of loneliness (Domènech-Abella et al., 2019).
Most recently, due to COVID-19, there has been a period of increased isolation across the world. The pandemic called for unprecedented seclusion to prevent transmission of the virus. The risk of infection was higher for specific populations, namely older adults over the age of 60 (US CDC, 2020). While employing these public health measures assisted in the reduction of the transmission of the virus, we experienced an increase in isolation and loneliness among older adults (Hwang, Rabheru, Peisah, Reichman, & Ikeda, 2020). Older adults with a mental health diagnosis also experienced higher levels of loneliness and isolation (Donizzetti, 2022).
As a behavioral health provider, the impact of social support on the overall health of an individual is well known. Cohen, Underwood & Gottlieb (2000) state that social support is important for retaining or improving an individual’s health and well-being when living with health challenges.
At Services for the UnderServed (S:US), we provide support to approximately 37,000 individuals with co-occurring health conditions on an annual basis; of those served, about 15% are 65 and older. S:US trains staff at all levels to provide client-centered care with a focus on providing care based on the specific needs of each individual, taking into account their environment and current resources. Our interconnected programs aim to serve the “whole person” by providing holistic care that focuses on identifying not just health needs but social needs as well. This was our goal before COVID-19 and continues to be a key focus, as providing support related to socialization and recreational activities has been shown to be beneficial for individuals who have a mental health diagnosis (Forrester-Jones et al., 2012).
S:US operates several programs on its own and collaboratively works to support each person served with health needs as well as socialization. Our Certified Community Behavioral Health Clinics (CCBHC), Clubhouse, and Street Engagement teams are a few programs that also serve as the entry point into our system of care. CCBHCs are an outpatient model which utilizes a multidisciplinary team to apply evidence-based treatment, psychiatric rehabilitation, case management, and peer support services both on-site and within the community. At our CCBHC, an individual can spend the day receiving services from different providers while joining groups that are geared towards their behavioral health and social needs. All services are available on-site, in the person’s home, and through telehealth. These different modes of services allow persons served to readily access care no matter their circumstances. As a result of the services provided, many are connected to needed support in their homes and community, such as home health care, transportation, and connections to our Clubhouse or any other programs they can attend during the day.
Clubhouses are community-based and are aimed at supporting people living with mental illness (referred to as members). Clubhouse offers a community where members have access to opportunities for socialization and skill development. An individual who joins and attends our Clubhouse as a member spends the day working in “units” specific to different skill-developing tasks. Currently, we have units that focus on the development of skills such as outreach, newsletter production, and other activities that can be used in the operation of the Clubhouse. Another unit focuses on culinary skills, allowing members to participate in the preparation and creation of meals, a skill that is transferable to their own home environment. The members also have the opportunity to socialize while they work and at mealtimes with other members, which has been found to boost their sense of community.
Our Street Engagement teams engage individuals and older adults based on specific needs such as substance use or homelessness. Individuals are able to get one-on-one services in the community from the team to assist with specific needs as well as support the individual with socialization. Currently, the teams we operate serve communities in Brooklyn, Harlem, and the Bronx. They provide support and engagement opportunities and connect individuals to our outpatient and housing programs.
Our CCBHCs, Clubhouse, and Street Engagement teams are all staffed with licensed practitioners, case management, and certified peer staff. Specifically, peer support has been shown as an intervention that can positively address social skills and support, thereby promoting recovery in mental health and related services. Peers are individuals who have lived experience with mental health and/or substance use; they are trained to use their experience to support others with similar conditions. In all of the program types mentioned, peer staff often share their lived experience when dealing with isolation and loneliness during their own recovery. In addition, a peer supports the individual by providing resources for services while also accompanying them to aid with understanding and integration.
Social isolation and loneliness were well-noted risk factors among older adults before the pandemic, and they have increased since then. There is evidence that social connection is a protective factor for those at risk of experiencing social isolation and loneliness. To fully address the health needs of the people served, organizations need to be intentional in the integration of social connectedness across the continuum of care (Holt-Lunstad, 2021).
Programs that support the whole person through many different service modalities, including peer support, assist us in not only addressing the health needs of the aging population but also providing them with support to reduce the likelihood of social isolation and loneliness, thus improving their overall health outcomes (Fortuna et al., 2020).
Sasha-Marie Robinson, EdD, LCSW, MA, is Senior Vice President of Recovery & Treatment Services at Services for the UnderServed (S:US). To learn more about Services for the Underserved’s approaches to care, visit sus.org, call 877-583-5336, or email services@sus.org.
References
Cudjoe, T. K. M., D. L. Roth, S. L. Szanton, J. L. Wolff, C. M. Boyd, and R. J. Thorpe, Jr. 2020. The epidemiology of social isolation: National Health and Aging Trends Study. Journals of Gerontology. Series B: Psychological Sciences and Social Sciences 75(1):107–113.
Cohen, S., Underwood, L.G., & Gottlieb, B.H. (2000). Social support measurement and intervention: A guide for health and social scientists. New York: Oxford University Press.
De Jong Gierveld, J.; van Tilburg, T.G.; Dykstra, P.A. Loneliness and social isolation. In The Cambridge Handbook of Personal Relationships, 2nd ed.; Vangelisti, A., Perlman, D., Eds.; Cambridge University Press: Cambridge, UK, 2016; pp. 1–30.
Domènech-Abella, J., J. Mundo, J. M. Haro, and M. Rubio-Valera. 2019. Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from the Irish Longitudinal Study on Ageing (TILDA). Journal of Affective Disorders 246:82–88.
Donizzetti, A.R.; Lagacé, M. COVID-19 and the Elderly’s Mental Illness: The Role of Risk Perception, Social Isolation, Loneliness and Ageism. Int. J. Environ. Res. Public Health 2022, 19, 4513. doi.org/10.3390/ijerph19084513.
Holt-Lunstad J. (2021). Loneliness and Social Isolation as Risk Factors: The Power of Social Connection in Prevention. American journal of lifestyle medicine, 15(5), 567–573. doi.org/10.1177/15598276211009454
Forrester-Jones, R., Carpenter, J., Coolen-Schrijner, P., Cambridge, P., Tate, A., Hallam, A., … Wooff, D. (2012). Good friends are hard to find? The social networks of people with mental illness 12 years after de-institutionalization. Journal of Mental Health, 21, 4–14.
Fortuna, K. L., Brusilovskiy, E., Snethen, G., Brooks, J. M., Townley, G., & Salzer, M. S. (2020). Loneliness and its association with physical health conditions and psychiatric hospitalizations in people with serious mental illness. Social work in mental health, 18(5), 571–585. doi.org/10.1080/15332985.2020.1810197.
Hwang, T.-J., Rabheru, K., Peisah, C., Reichman, W., & Ikeda, M. (2020). Loneliness and social isolation during the COVID-19 pandemic. International Psychogeriatrics, 32(10), 1217–1220. Doi.org/10.1017/S1041610220000988
National Academies of Sciences, Engineering, and Medicine. 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press. doi.org/10.17226/25663.
National Academies of Sciences, Engineering, and Medicine. 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press. doi.org/10.17226/25663.
Promoting recovery in mental health and related services – WHO QualityRights Guidance and Training. Available at www.who.int/publications-detail/who-qualityrights-guidance-and-training-tools.
US CDC (2020). Severe Outcomes Among Patients with Coronavirus Disease 2019. March 27, 2020. Available at www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.
