What municipalities can learn from the Surgeon General’s Mental Health Opinion

From the experience of the COVID-19 pandemic to the opioid epidemic, Americans are struggling with mental health issues and local governments are working on ways to help. The US Surgeon General’s new 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 having 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 professional health care. Economic and racial disparities exacerbate the problem when black, Hispanic, low-income, homeless, or older Americans already lack access to social infrastructure. Awareness and change are badly needed because, while self-reports of social isolation are increasing every year, less than 20% of American adults recognize it as a major problem.

So what can municipalities do? A big part of the solution is to improve 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 both “strong” relationships, where people relate to each other, and “weak” relationships, where people have occasional passing interactions. Municipalities can therefore support a wide range of social infrastructure to meet a wide range of needs.

Social infrastructure can look like:

Libraries and playgrounds for young people to create strong bonds with their peers. Quieter green spaces and religious centers preferred by the elderly. Benches and walkways that encourage more organic connections between people who don’t know each other. After-school programs and community events that connect generations.

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

In addition to the built environment, community organizations ranging from arts groups to restaurants often host events that bring people together. Municipalities can support them while bringing in nonprofit partners to help address community mental health.

Social infrastructure should be equitably accessible, especially for groups most at risk of social isolation. For example, strict vagrancy laws and unfair enforcement could discourage young people from connecting with friends if they lack sufficient public spaces. “Hostile architecture” that makes sitting and resting uncomfortable, often in an effort to displace homeless residents, can prevent residents from enjoying their time in public.

Integrating social ties and health into all policies

The report highlights how inseparable public health is from other policy choices. Each department can have an impact on public health, so each department must consider its ability to promote social ties.

Municipalities can integrate social connection into policies and assess how existing policies can contribute to social isolation. For example:

A zoning practice could isolate a community from green space. Healthcare partnerships can increase access to much-needed therapies. Funding for arts and culture can provide more opportunities for connection and uplifting diverse community groups.

Paid time off can give city employees more time to connect with their communities, while improving public transit can make the city more accessible to young people and low-income residents. Through communication campaigns, municipalities can raise awareness of the importance of social connection and fight against stigma around mental health.

Ideas from public health can help here, such as trauma-informed social policy, which outlines how municipalities can reduce the risk of retraumatizing and stigmatizing residents. For example, a homeless addict might benefit from a ‘housing first’ approach that provides the stability they need to recover. Some police calls may be redirected to mental health and community response teams, which are trained to create safer outcomes in mental health emergencies. When community health workers and community members advocate for what they need, their knowledge on the ground can guide public health strategies.

Next steps

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

Explore the report’s recommended actions for municipalities Examine policies and partnerships through a social connection lens Connect with the National League of Cities for resources, support and potential initiatives

The urgent “epidemic of loneliness and isolation” stems from a mix of underinvestment in health care, 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 to develop a sense of trust and community.

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


About the author About the author

An Pham is a City of Opportunities intern

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