America’s Loneliness Epidemic is Fueling a Mental Health Crisis

A recent Deloitte report uncovered the staggering economic costs of mental health inequities in America, and it should serve as a wake-up call for us all. The findings are alarming: $477.5 billion in unnecessary expenses annually, projected to reach $1.3 trillion by 2040 if left unaddressed. But beyond the eye-popping numbers lies a deeper truth – America is in the midst of a loneliness epidemic that was only exacerbated by the Covid-19 pandemic. And it’s taking a devastating toll on our mental and physical well-being.

Several key insights from the report underscore this reality. The cost of treating chronic physical health conditions related to mental health inequities is expected to skyrocket 3x by 2040. Mental health challenges are often an invisible accelerant, making it harder for individuals to manage comorbid chronic diseases. Productivity losses due to mental health inequities are projected to more than double to $252 billion in that same timeframe as people struggle with absenteeism and presenteeism at work. And premature deaths from suicide, substance abuse, and untreated mental illness could cost society nearly $1 trillion. annually by 2040.

While it’s true that these burdens fall disproportionately on disadvantaged populations who face greater barriers to accessing care, it would be a mistake to assume mental health struggles are limited to the poorest among us. The loneliness epidemic cuts across all segments of society. Over the past few years, pandemic-created isolation has weakened personal and community bonds, which are strong predictors of mental and physical well-being. Preventive mental health services certainly have a role to play for severe illnesses, but may be less impactful at scale for those whose issues stem primarily from a lack of human connection.

As a society, we must recognize that so much of the mental health crisis is downstream of fraying social fabric. Certainly, integrating behavioral health into primary care and incentivizing regular screenings, as the report suggests, are important steps. But the most effective way to reduce the presence and costs of these inequities is to help people rebuild relationships and community, especially for those most at risk.

As the president of a health services platform, I recognize that health care providers have a role to play in this approach, but they are only a small part of identifying and solving this problem. To start, there are three elements I would emphasize:

Invest in public “third places”

The concept of “third places” — shared spaces other than home or work where individuals congregate — is well understood. For some, that means bars and restaurants, and for others that means public goods like parks and libraries. That latter category is increasingly underfunded. Here in New York, we’ve seen library hours consistently reduced, leaving many New York libraries as a 9-5 respite for the unhoused and providing limited hours for families to bring children, or seniors to create gathering opportunities. That is short-sighted. Third-places are invaluable parts of every community in that they provide the physical infrastructure for socialization. As those environments were shut down during the pandemic, they’ve become deprioritized within modern American life. We need to reverse that trend.

Structure social policy to increase private presence of shared spaces

If you’ve spent time in New York, you’ve likely seen public spaces within private buildings — most of the most recognizable private buildings in New York have some form of reserved public space for gathering. For years, New York has provided zoning benefits to developers that agree to include such public spaces within their private developments. More generally, that model is one we can and should extend beyond skyscraper construction. Tax breaks or zoning benefits for creating multi-purpose spaces can sit alongside funding to subsidize community gatherings (like Robert Putnam’s well-studied bowling leagues) and neighborhood activities (e.g., community festivals, block parties, etc.).

Involve health care providers 

Finally, much like we’ve added an annual wellness assessment and various screenings to the list of reimbursable preventive care services under Medicare, we should both train primary care and mental health clinicians to ask about social isolation, and include assessments using validated tools (such as the 3-item scale regarding loneliness in the HRS Psychosocial & Lifestyle Questionnaire) in regular screenings to help identify at-risk individuals. Critically, though, the answer to identifying at-risk individuals isn’t simply the consumption of more clinical services — it’s building and rebuilding social bonds within their communities to keep them out of health care settings and within networks of trusted individuals. For too many older Americans, a large share of their social engagement comes from sitting in physician office waiting rooms and in brief conversations with their doctors. A 2014 study in the European Journal of Ageing makes this explicit — when asked what they valued about their relationship with a general practitioner, interviewees were twice as likely to reference them being “demonstrably friendly, kind, able to joke, and have enough time for the consultation” than to reference their skill at delivering medical care. Increasing that form of interconnectedness is an incredibly inefficient way to generate stronger community bonds, and I don’t propose we emphasize that approach as the most effective way to treat loneliness. 

This is easier said than done in an era of continued social fragmentation, but it starts with acknowledging the real drivers of deteriorating population mental health. We need more culturally relevant and accessible care that appreciates the societal and situational factors affecting patients’ well-being. Care models should facilitate human connection, not just clinical services, and we must make concerted efforts to bring people together again within their own communities. Some of the tools that have allowed us to live separately can also bring more mental health support and connection, including video calling, telehealth visits, asynchronous communications (like chat with a doctor or a therapist), and online support groups via forums. These are all tools that perhaps have hurt attendance at in-person gatherings, but they do establish more modern forms of community ties and, hopefully, durable social support. 

The economic costs outlined in the Deloitte report are staggering, but the human costs are even higher. As we emerge from the acute phase of the pandemic, we have an opportunity and obligation to address the loneliness and disconnection plaguing our society. Only by making this a priority can we hope to reverse the mental health crisis and build a healthier, more resilient America for all.

Picture: Getty Images, CasarsaGuru

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