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Address Social Support Needs of Those With Behavioral Health Conditions Who Live Solo
In this era that places such high value on personal engagement, interpersonal support, and community involvement, it is quite surprising to learn that a large and growing number of Americans are living alone. Recent information from the Census Bureau shows that almost one-third of US households only have a single member. From 8% in 1940, the number of households with “solitaries” has more than tripled to an estimated 29% in 2022. This represents more than 36 million households at present.
The percentage of people also varies considerably by age. It ranges from a low of 5% for those below age 25 years to a high of 33% for those who are 75 years and older.
This trend is unprecedented historically, not only in the US, but also in other countries. Several distinct factors are frequently cited. These include the aging of the US population, later age of marriage (from early to mid and later 20s) or not marrying at all, movement of females into the labor force (now almost 50% of those employed), and the general migration from rural to urban communities. It also is likely that the trend has been further enabled by the recent rise of social media.
Although this trend has an upside, e.g., more independence and less responsibility, it also is clear that the downside likely outweighs these potential advantages. From a behavioral health perspective, we have learned in the last quarter century that most mental health and substance use conditions are caused by trauma due to problems in social and physical life determinants. One of these key determinants is appropriate social connection and support.
A lack of needed social support and social isolation usually occur together. Just a few weeks ago, the US Surgeon General, Vivek Murthy, MD, issued an advisory on the growing problem of social isolation in our country and its consequences, such as loneliness and reduced personal wellbeing. He finds that more than half of the adult US population experiences loneliness today. Social isolation and loneliness are often associated with other conditions, such as depression and anxiety.
We are unlikely to have much success in changing the growing trend of solitary households. It is both long-term and worldwide. Thus, we will need to consider remedial steps to promote appropriate social support and reduce social isolation for those living alone who are at risk of or who already have a mental health condition or substance use disorder.
Measures taken during the COVID-19 pandemic have already taught us much about the importance of outreach to those at risk of social isolation. Steps such as telephone calls and video chats were undertaken by many families, sets of friends, and community groups. We can adapt these strategies to support those at risk of or who already are experiencing a behavioral health condition.
Similarly, we can develop a network of buddies for those who already have a behavioral health condition. These buddies would be other people from the same local community who would be available to talk, to meet, and to provide needed social support. Every client would have at least one buddy.
Finally, we also can take steps to help improve the day-to-day functioning of local communities. Most of our communities need to become empowered by informal leaders to undertake community development tasks such as social gatherings, informal community projects, and even more formal chat groups and daily gatherings.
None of the steps described here will require the use of professional behavioral healthcare staff during this period of workforce crisis. Rather, all tasks can be undertaken by peers, other paraprofessionals, and community members who want to support their own localities.
The growing trend of solitary households can exacerbate behavioral health conditions by reducing necessary social support. We can counter the effects of this trend through a broad range of social support endeavors ranging from frequent outreach and buddy systems to community building activities.
Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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