What counties can learn from the Surgeon General’s mental health board

From the COVID-19 pandemic to the opioid epidemic, Americans are struggling with mental health and local governments are working on ways to help. The new US Surgeon General report, “Our Epidemic of Loneliness and Isolation,” is a valuable resource for municipalities to strengthen mental health in their communities.

The report highlights how loneliness and isolation lead to negative health outcomes. Loneliness is an internal state of feeling that one’s social needs are not being met. Social isolation is an external state of few relationships, roles, and interactions with other people. Both harm our mental and physical health. According to the report, social isolation increases the risk of premature death as much as smoking up to 15 cigarettes a day.

Social isolation makes it difficult to access help, from personal support to health professionals. Economic and racial disparities exacerbate the problem when black, Hispanic, low-income, homeless, or elderly Americans no longer have access to social infrastructure. Awareness and change are sorely needed because, while self-reports of social isolation increase each year, less than 20% of American adults recognize it as a major problem.

So what can municipalities do? An important part of the solution is improving our social connections. Municipalities, in particular, can focus on the following policy areas.

Investing in social infrastructure and the built environment

Municipalities can invest in community infrastructure, partnerships and the built environment to bring people together. This encourages “strong” connections, where people build relationships with each other, and “weak” connections, where people have casual interactions. Municipalities can therefore support a wide range of social infrastructure to meet a wide range of needs.

The social infrastructure might look like:

  • Libraries and playgrounds for young people to form strong connections with their peers.
  • More peaceful green spaces and religious centers preferred by the elderly.
  • Benches and walkable streets that encourage more organic connections between people who are new to each other.
  • Extracurricular programs and community events that connect generations.

Another report, “Tackling Loneliness through the Built Environment” highlights more specific ways to encourage social connections through design.

Beyond the built environment, community organizations, from arts groups to restaurants, often host events that bring people together. Municipalities can support them as they convene nonprofit partners to help address community mental health.

Social infrastructure must be equitably accessible, especially for groups most at risk of social isolation. For example, strict loitering laws and unfair enforcement can discourage young people from connecting with friends if they don’t have enough public spaces. “Hostile architecture” that makes sitting and resting uncomfortable, often with the aim of dislodging displaced residents, can prevent residents from enjoying their time in public.

Incorporate social connectedness and health into all policies

The report highlights how public health is inseparable from other policy choices. Every department can impact public health, so every department must consider its ability to promote social connection.

Municipalities can incorporate social connectedness into policy and assess how existing policies can contribute to social isolation. For example:

  • A zoning practice can isolate a community from green spaces.
  • Health partnerships can increase access to much-needed therapy.
  • Funding arts and culture can provide more opportunities to connect and uplift diverse community groups.

Paid leave can give city employees more time to connect with their communities, while improved public transportation can make the city more accessible to youth and low-income residents. Through communication campaigns, municipalities can raise awareness of the importance of social connection and combat stigma around mental health.

Public health insights can help here, such as trauma-informed social policies that describe how municipalities can reduce the risk of retraumatizing and stigmatizing residents. For example, a homeless drug user may benefit from a “housing first” approach that provides the stability he needs to recover. Some police calls may be diverted to mental health and community response teams who are trained to create safer outcomes in mental health emergencies. When community health workers and community members advocate for what they need, their local knowledge can drive public health strategies.

Next steps

The Surgeon General’s report highlights important measures municipalities can take to address social isolation. Some steps include:

  1. Exploring the actions recommended by the report for municipalities
  1. Reviewing policies and partnerships through the lens of social connection
  1. Connect with the National League of Cities for resources, support and possible initiatives

The urgent “Loneliness and Isolation Epidemic” comes from a mix of underinvestment in health, stigma around mental health, existing inequalities, and historical uncertainty for many Americans. Good policies can minimize the damage caused by disconnection and create more chances for a sense of trust and community to grow.

After all, every patient is also a resident, embedded in a community and built environment that can help them thrive.


About the author

About the author

An Pham is an intern at City of Opportunities

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