How providers grapple with ongoing issue of loneliness that is exacerbating mental health crisis

Filled with anxiety, one of Mount Laurel-based Samaritan‘s elderly patients had a visiting daughter call the hospice and palliative care company’s staff to inform them that her pet cat was acting strangely.

Erika Thomas, one of the nonprofit’s leaders, recalls how the look of relief and contentment spread over her face when the patient later saw her pet cat up and moving again … complete with a fresh set of batteries.

At a time when loneliness has been declared a “pressing global threat” by the World Health Organization and an epidemic-level issue by U.S. Surgeon General Vivek Murthy, organizations involved in mental health are keen on cementing whatever interactions and bonds they can in patients’ lives.

Erika Thomas. (Samaritan)

“And I know, for some people, it might not seem like a robotic pet could provide that companionship, but, when you have dementia or other serious illnesses and can’t interact the same way with friends and family around you, it’s a way of making an impact,” Thomas said.

More needs to be done for the more than 2.3 million Jerseyans reportedly lonely or socially isolated, according to Thomas, who holds the apt job title of director of social connections at Samaritan.

She said individuals experiencing loneliness are at higher risk for premature mortality and various diseases. Murthy also reported that the health distress of loneliness could be equivalent to smoking 15 cigarettes a day.

On top of what Samaritan is doing with its robotic pets for the elderly and a “friendly caller program” that facilitates connections between patients and pen pal-like volunteers, Thomas wants to partner with what she views as potential changemakers across many different segments of the industry to start coming up with more solutions.

“I see many ideas and programs we could develop in our future to continue to address the problem of limited socialization and loneliness,” she said. “We want to take the lead.”

Mental health experts in New Jersey convey that loneliness is upping demand for their services. But differentiating loneliness from the other drivers of demand can be difficult.

Dr. Hillary Cohen. (Englewood Health)

Englewood Health‘s Dr. Hillary Cohen said there are often a number of reasons patients end up in crisis outside of just social isolation; and there are just as many reasons they’ve ended up isolated in the first place.

“Yet, it’s clearly a major factor for many patients,” she said. “And there’s even patients maybe surrounded by people, friends and family, who you wouldn’t traditionally think of as lonely. But, still, they feel isolated in part by the stigma they may feel toward a mental health issue.”

Cohen, chief medical officer at Englewood Hospital, said the demand is such that the organization has felt the need to make significant investments into behavioral health services to serve its patient population over the past few years.

Dr. Darian Eletto, chief clinical officer for behavioral health services at Bergen New Bridge Medical Center, said that institution also has started expanding its behavioral health capacity.

There’s an increased need for mental health services today, she said. Loneliness, she expects, plays a part in that.

Dr. Darian Eletto. (Bergen New Bridge Medical Center)

“I think we really started to notice it during the pandemic, when people were on lockdown and maybe didn’t have the same connections with family, friends or community agencies,” she said. “We heard so often at that time people saying, ‘I used to go to church,’ and that helped them feel like they were a part of something.”

Those in the industry saw support groups for mental health conditions and substance abuse go from meeting regularly to adjourning either on a temporary or permanent basis. That partly accounts for the step-up in loneliness during pandemic months bleeding into a post-pandemic environment, Eletto said.

“We see an increased anxiety around sickness and infection in a lot of patients and an uptick in obsessive-compulsive behaviors coming out of the pandemic,” Eletto said. “And, if a patient was seriously ill from COVID, they’ve sometimes had a hard time reacclimating to society because they worry about what’s going to happen if they go out again.”

If there’s a sign that mental health organizations have risen to the challenge, it’s in the overall picture of the state’s mental health landscape presented by Debra Wentz, CEO of the New Jersey Association of Mental Health and Addiction Agencies. New Jersey’s suicide rate has been on a slight downward trend over recent years, Wentz said, but the work is far from over.

“Between that and the number of opioid overdoses, there’s a small percentage of a decline (in New Jersey) compared to other states,” she said. “But, we’re still dealing with staggering numbers. There’s still too much suicidal ideation and too many overdoses.”

From her post as head of the state’s leading mental health trade association, Wentz would like to see a continued investment from state leaders in coming years. While acknowledging that the industry has benefited from budgetary wins in the past few years, Wentz said staffing shortages at underfunded organizations still constitute access challenges.

The demand is high enough that it’s hard for the resources to keep from lagging behind, she said, especially given the way loneliness has escalated to a widespread crisis.

“That’s a real trend that’s leading to greater anxiety and increased suicidal ideation … particularly in an elderly population, who have sometimes experienced a diminution of capacity, loss of partners and health or mobility,” she said. “One thing we’ve seen that lead to is a huge increase in alcoholism in older men.”

Wentz appreciates any redoubling of attention to mental health topics, which she certainly believes the surgeon general’s declaration of loneliness as an epidemic accomplished.

She saw it as validating for mental health providers. She’s also hoping it resonates with everyone outside her space, and perhaps serves as a call to action for them.

“If you know someone — whether it’s a friend, family member or colleague — and they’re not getting out to connect with people, or if they’re not able to, it’s important to see what you can do to help them socialize,” she said.

Anti-social media?

Debra Wentz can’t begin to imagine what mental health service providers needing to keep in touch with clients would’ve done without the online video conferencing platforms that proved indispensable during the pandemic.

But the New Jersey mental health leader can imagine how people might feel without the constant presence of digital communication tools such as social media in their lives: Happier, perhaps.

Dr. Frank Ghinassi.

“While you might think having people communicate with you in these new settings would help with the alienation and isolation people are experiencing, sometimes, it’s the opposite effect,” she said. “Social media has created a lot of feelings of inferiority that lead to a lot more anxiety.”

Dr. Frank Ghinassi, CEO and president at Rutgers University Behavioral Health Care and senior vice president of behavioral health services at RWJBarnabas Health, said the impacts of social media are particularly acute in youth, whose sense of self is still being shaped.

“Younger individuals are accessing social media earlier and earlier,” he said. “And, in doing so, they’re not only subjected to the judgment and feedback of kids around them and impacted by that, but exposing them to potentially hurtful, negative comments from people who have never met them.

“They’re learning their social place and identity often on these platforms where judgments can be fleeting, highly subjective and based on little more than whatever images have been shared. That can impact a young person’s self-worth and self-esteem, and, if not positively impacted, create a pathway through stress to behavioral and mental health disorders.”

Ghinassi said that can manifest as generalized anxiety, body dysmorphic disorder or other mental health problems.

“And, true to almost everything in life, there’s no single cure for (social media’s effects on youth),” he said. “We’d like to keep parents alert to the upsides and downsides of these platforms. … But, if you just tell them you can’t do this, you set up a power dynamic, which, for probably hundreds of generations, kids have rebelled against when forbidden to do something.”