“The barrier of loneliness: the palpable, desperate need of the human animal to be with his fellow man. Up there … is an enemy known as isolation.”
The Washington Post recently shared the quote above from a 1959 Twilight Zone episode that explored the impacts of a man being all alone. We were well into multiple states having issued stay in place orders when experts began suggesting “physical distancing” would be a better description than “social distancing.” Whatever we call it… the reality is that many of us are getting a far lower dosage of the nourishing human connection we normally experience. And, for individuals with serious mental illness and older Americans, the baselines are often already far too low.
Physical Health Impacts of Isolation
In Part 1, we explored the need to coordinate together to survive the early surge on hospitals. But, longer-lasting impacts to our communities must be anticipated after the tsunami washes through. Disasters create many different types of reactions, even within the same person. SAMHSA’s Disaster Preparedness, Response, and Recovery site describes the range of responses to the stress associated with an emergency as ranging from ordinary resilience and leveraging supports, resources, connections and hope to coping with serious mental and/or emotional distress.
With COVID-19, we have an additional challenge of extended isolation as one of the main tools of stopping the spread of contagion. FEMA states, “We are halfway through 15 Days to Slow the Spread. Do your part to flatten the curve: Stay home as much as much as possible. If you need to go out, practice physical distancing.”
In 2010, Psychologist Julianne Holt-Lunstad’s meta-analysis of 148 mortality studies demonstrated the immense power of social support and connectedness and the negative impact of isolation, going well beyond emotional well-being and showing the effects on health and life-span. She has extended this work continuously since, demonstrating that social integration and close relationships are more potent to extending your life than a smoker quitting cigarettes (the next most powerful action we can take to live longer and healthier). Simply put, loneliness increases the likelihood of early death by 30%.
Physical distancing helped many US cities dramatically lower their death rates during the 1918 H1N1 flu, and we’re likely to see it continue at various levels. We must think creatively about how our disaster mental health crisis response adapts to fill the gap.
The Baseline for Individuals With Serious Mental Illness
We should pay extra attention to older Americans and those with serious mental illness (SMI). The latter already have documented challenges with friends and social supports, and they die earlier than the average American due to a host of health challenges, including diabetes and cardiovascular disease. Both groups will be more likely to worry about their personal risk, given the COVID-19 impacts upon those who are older, with immunocompromised medical conditions or multiple health problems.
Professor Thomas Joiner’s groundbreaking 2005 work “Why People Die by Suicide” suggested that the two most painful experiences in life are loneliness and feeling like a burden to others. By contrast, he suggested that people who are connected and perceive they are making a contribution to others are protected. We tend to think of suicide as simply a symptom of serious mental illness, but the outcomes generally experienced by SMI individuals (loneliness, unemployment, etc.) would suggest tremendous risk for any population. In fact, the hazard ratio for suicide for people with SMI dramatically exceeds other at-risk groups like LGBT, older white males, active duty military and veterans, and Native Americans/Alaskan Natives.
Normally, our national behavioral health resources provide many supports to mitigate these challenges, with medical, clinical and peer support staffing and services. To the extent that these supports are unavailable or limited in capacity during COVID-19, the risk for these individuals will be higher.
People with SMI are also more likely to live in poverty, experience homelessness, and still too many don’t have smartphones, or sufficient minutes, or necessary Wi-Fi, and can’t stay connected with Zoom-like technologies or access news or social support at the level most of us take for granted.
Our Next Steps
Mental health and substance use crisis providers came together during Hurricane Katrina with agencies from across the country sending staff to Baton Rouge to shore up the local call center that was overwhelmed with individuals in distress. Partnerships with FEMA, SAMHSA and local and state authorities were closely coordinated and fast-acting. In 2020, we have technological solutions that were unavailable 15 years ago, and we’ll need to leverage telehealth and also adapt and pioneer new supports to scale an outreach that will make a difference both now and in the months to come.
Hope and support are on the horizon. Last week, SAMHSA released applications for Emergency Grants to Address Mental and Substance Use Disorders During COVID-19, offering funding to states, territories, and tribes to develop comprehensive systems to address the escalation in depression, anxiety, trauma, and grief across the nation. Funding will be used for crisis intervention services, mental and substance use disorder treatment, crisis counseling, and other related supports for children and adults impacted by the COVID-19 pandemic. Applications are due April 10th and we expect that it will translate into the creation of COVID-19 Emotional Support Lines and community-specific websites that connect individuals impacted by the epidemic to get the support they need.
In addition, the FEMA Crisis Counseling Assistance and Training Program (CCP) funds support individual and group counseling, brief educational contacts, public education meetings, assessment, referral and resource linkage and community networking and support. They also engage in the development and distribution of educational materials and media and public service announcements. Here are some more details:
- The Immediate Services Program funds up to 60 days after a presidential major disaster declaration and is due 14 days after Individual Assistance is designated on the major declaration.
- The Regular Services Program funds up to 9 months and is due 60 days after the date above.
To learn the date the president approved your state’s major disaster declaration, visit Fema.gov/Coronavirus and select Declaration News Releases.
We cannot wait to reconnect. It’s a matter of life or death. If 9/11 and Katrina taught us anything, the mental health disaster response started after the immediate crisis was concluded. If Arizona’s Dr. Cara Christ is correct in her assessment of the timing (the peak is in April and hospitalizations spike the following month), this means our job doesn’t end in May… it’s just beginning.