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By LISA EISENHAUER

Dr. Venkata Dalai sees the evidence among patients of what the U.S. surgeon general spotlights in a recent advisory called "Our Epidemic of Loneliness and Isolation."

A psychiatrist on staff at Mercy Hospital Fort Smith in Northwest Arkansas, part of Chesterfield, Missouri-based Mercy, Dalai says that for some patients the biggest need is for a social support structure.

"I feel helpless sometimes because the problem is not depression, the problem is not anxiety," he says. "The problem is feeling isolated or living alone, and lack of people to talk to or share something."

Other mental health care providers as well as social service coordinators across the Catholic health ministry say they, too, see many patients who are lonely or socially isolated as well as indications that the prevalence of those experiences is increasing. They voice support for Surgeon General Dr. Vivek Murthy's appeal for a national response.

Harm to individuals, society
Murthy issued his call-to-action May 3in an 82-page advisory. He says studies have found that half of the nation's adults reported experiencing loneliness even before the COVID-19 pandemic cut many people off from family, friends and support systems.

"Loneliness is far more than just a bad feeling — it harms both individual and societal health," Murthy writes.

He says being socially disconnected increases the risk of cardiovascular disease, dementia, stroke, depression, anxiety and premature death. He adds that the harmful effects of a society that lacks social connection "can be felt in our schools, workplaces, and civic organizations, where performance, productivity, and engagement are diminished."

Murthy's advisory says countering the epidemic of loneliness and isolation will require "reimagining the structures, policies, and programs that shape a community to best support the development of healthy relationships." Some of the responses he calls for are public, such as investing in libraries and green spaces, and others are personal, such as reaching out to neighbors and setting phones aside when dining with others.

The advisory has a page of ideas for health workers, health systems and insurers. Those ideas include:

• Explicitly acknowledge social connection as a priority for health.
• Provide health professionals with formal training and continuing education on the health and medical relevance of social connection and risks associated with social disconnection.
• Provide adequate reimbursement for time spent assessing and addressing concerns about social disconnection and incorporate these measurements into value-based payment models.

Bold action needed
Mekhala Merchant, a licensed clinical psychologist with Loyola Medicine and an associate professor in the Department of Psychiatry and Behavioral Neurosciences at Stritch School of Medicine at Loyola University Chicago, calls the advisory a good start to draw attention to the worsening trends of loneliness and isolation.

Merchant says some of the findings cited in the advisory that stood out to her were that the rate of loneliness among young adults ticked up every year from 1976 through 2019, that only 16% of Americans feel connected to their local communities and that 30% live alone.

The findings make a compelling argument, she says, that loneliness should be addressed across society, including by health care providers. "I do think that for an advisory to have impact we have to make bold claims about the changes we expect from the health system," Merchant says.

She points out that Loyola Medicine already has processes in place, such as screenings, to identify mental or spiritual distress in patients. Loyola Medicine, part of Trinity Health, also has social workers, psychologists and chaplains on staff to provide care and connections to community services.

"Our mission statement is 'Treating the human spirit,'" she notes. "I believe we are very focused and committed to understanding the psychosocial needs of any of the patients that we're treating in any of our medical specialties."

Suffering alone
Dr. Katherine Johnson, interim chair of psychiatry at Loyola Medicine, says she and her colleagues have seen spikes in cases of depression and anxiety in recent years that are in large part consequences of social disconnection.

In fact, she says, many people suffering mental illness believe they are alone in their misery. "I have so many patients tell me, 'Everybody else seems to be doing OK,'" she says. "And I'm like, 'No, I'm here to tell you they're not.'"

Johnson agrees that the surgeon general presents what could be a good start to a conversation about Americans' disconnection and to addressing isolation and loneliness — which she calls "modifiable risk factors" for mental and physical ailments.

The next step, she says, is to follow through with funding. "The government, in particular, is going to have to put their money where their advisory is," she adds.

She cites, for example, the advisory's call for training and continuing education for health care professionals on the health impacts of isolation and loneliness as an action that comes with costs. Another is its call for insurance coverage of the time that care providers spend assessing and addressing social disconnection.

Offering connections
Joshua Primeaux is director of social services for the mental and behavioral health department at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana. He helps make social connections for patients who show signs of isolation, such as linking elderly people to community programs that offer group activities.

Primeaux says that the system Our Lady of the Lake is part of, Franciscan Missionaries of Our Lady Health System, has prioritized assessing and addressing the social determinants of health among patients. Care providers and social workers have access to a platform called Pathways to refer patients to community agencies that can help meet underlying needs that fuel mental distress, such as hunger or homelessness.

Even so, Primeaux says he's not sure that all patients follow up on those referrals or that the agencies can meet the demand for assistance. "We can provide the information, but are they actually going to get the resources?" he wonders. "I'm not very confident of that."

Primeaux says many patients, especially the elderly, are in need of family support to see that their social needs are met.

Stressing social structure
Dalai, the Mercy psychiatrist, agrees that family is often the missing link for disconnected patients and for those suffering mental health crises.

Dalai recalls recently nudging a patient with treatment-resistant depression to contact his estranged parents. The patient did and later told Dalai that he hugged his parents, dined with them and enjoyed his best time ever.

"I think the touching, the feeling and the hugging and the physical presence definitely makes a huge difference," Dalai says. "So whenever I interview my patients the first time, I always stress the social structure because that plays a very big role in treating the mental health disorders."

Dr. Jay Weatherill is a psychiatrist who practices at Avera Behavioral Health Hospital in Sioux Falls, South Dakota, and primarily treats adult inpatients. He says social isolation is often a precipitating factor identified among patients with depression or anxiety. He calls it is as big of a contributing factor to those conditions as substance use disorders and loss, such as from a failed marriage or through diminished health.

Weatherill says the various behavioral therapies he and his colleagues employ all have a socialization component. In addition, the care providers educate their patients on the importance of being around other people.

"It is emphasized every day on our unit," he says. "Even if a person has some social anxiety and doesn't feel comfortable yet attending a group, it's talking to staff or talking to other patients one on one."

However, staying connected to other people once they are on their own is a challenge for many patients, Weatherill admits. "I wish I could write a prescription for social support and it would be that easy," he says. "Many people just don't have it."

'Why didn't this happen before?'
Susan LaMonica is a nurse practitioner with Hospital Sisters Health System Medical Group in Effingham, Illinois, who specializes in mental health. She's seeing an upsurge in requests for care amid a shortage of providers. Right now, new patients have to wait 2½ months for an appointment with her. Some of her patients drive almost two hours to get to her office.

LaMonica says the pandemic undoubtedly created conditions that left more people feeling alone and isolated. Among her recent patients, many said their biggest complaint was being lonely. "Patients didn't get to see their family during the pandemic. Many took the precautions pretty seriously," LaMonica says. "They would FaceTime and stuff, but they really missed that in-person connection with them."

Amid the stress and grief the pandemic created, LaMonica says the crisis has brought some beneficial changes. It has reduced the stigma around mental health care and focused national attention on the need for social connection. That attention, she suspects, is what prompted the surgeon general's advisory.

"I think honestly the biggest thing that struck me is why didn't this happen before?" she says "You know, why are we in 2023 just talking about loneliness? But I guess it took the pandemic to really bring it to the forefront."