loneliness – JOSEPHINE ENSIGN

Living on my own in the kingdom of loneliness for over three months has made me more aware of the pernicious effects of loneliness on health and wellbeing. It does not surprise me that the U.K now has a Minister of Loneliness, and that Prime Minister Theresa May has recently released a loneliness policy report: “A Connected Society: A Strategy for Tackling Loneliness—Laying the Foundations for Change” (October 15, 2018). May calls loneliness a “great public health challenge” and plans to have GPs within the NHS to be able to refer patients to community programs geared to ease loneliness.

Yesterday, I visited a long-standing (36 years) community cafe in Edinburgh that has been successfully combating loneliness among the elderly and people living with mental health challenges Located near the Royal Edinburgh Hospital, a long-standing mental health facility in the Morningside area of the city, the Open Door Cafe is a most welcoming place. From the high school student volunteer, Hamish, who greeted me and served me a great cuppa’ and scone, to the friendly regular customer/patrons who shared their stories with me, this was a place that warmed my heart. It also gives me hope that we can open the community Doorway Cafe in the University District of Seattle along similar lines. They use a pay-it-forward model and also have a robust group of volunteers to keep the place sustainable. In addition, they receive some funding from the NHS.

It also warms my heart to have discovered that the Open Door cafe was founded by an Edinburgh nurse, Peggy Hunter, all the way back in 1982. She said, “I have a dream to turn loneliness into fellowship, isolation into recognition…” and she has done just that.

I love their statement on their website in which they succinctly describe their cafe championing of diversity: “Of course, many people who use our services have a variety of support needs, so you may find having a cuppa is a different experience to that of your usual coffee shop. Can you open your mind to share some space with someone who is different from you?”

As we begin a new year, my wish is that we commit to mental health and wellbeing. This should start with our own individual mental wellbeing, but we need to use that as a base for supporting the mental wellbeing of our families and our communities. In the midst of so much turmoil, anxiety, bigotry, misogyny, and xenophobia in our country and our world, nurturing mental wellbeing is not a luxury—it is a necessity.

An essential ingredient for mental (and physical) health and overall wellbeing is social inclusion and a sense of belonging to a caring community. The adverse health effects of increasing population-based levels of social isolation and loneliness are now being highlighted. Dhrav Khuller, M.D. writes in “How Social Isolation is Killing Us” ( NYT December 22, 2016) that social isolation and loneliness, is linked in recent studies to a 29% increased risk of heart disease and a 32% increase in stroke.

Objective measures of social isolation include quantity and quality of social network ties, as well as living situation (living alone, whether housed or homeless). Loneliness is a person’s perception of social isolation and is, therefore, a subjective measure. Researchers point out that loneliness and social isolation are often not significantly correlated even though we commonly think of them as such. A recent large meta-analysis (a study of research studies) that included 70 independent prospective (following people longitudinally) studies representing 3,407, 134 participants, revealed a significant effect of social isolation—whether measured objectively or subjectively— on mortality. The researchers for this study also found that the largest detrimental effects of social isolation were for middle-aged adults as opposed to older adults. They call for social isolation and loneliness to be added to lists of public health concerns. (See: “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review” by Julianne Holt-Lunstad, et al. in Perspectives on Psychological Science, Vol 10, issue 2, March 11, 2015.)

In the U.S. we are good at doing yet more research documenting the adverse health effects of social isolation and loneliness; we are not so good at finding constructive and sustainable ways to intervene. Many industrialized countries, including the U.K., Australia, New Zealand, Spain, and Canada are way ahead of us in terms of implementing cost-effective, community-based interventions. (See: “Researchers Confront an Epidemic of Loneliness” by Katie Hafner, NYT September 5, 2016.) In the U.K. there is the Campaign to End Loneliness. In New Zealand there is the public mental health campaign that I love: the All Right? campaign implemented in the aftermath of the Christchurch earthquakes. And addressing gendered issues, there is the Men’s Sheds movement that began in Australia and has since spread to the U.K., Ireland, Canada, and New Zealand. Another lovely and creative community-based solution I learned about this past year is the Art Hive (La Ruche d’Art) in Montreal, as well as in many other communities, including in Spain. My other wish for 2017 is that we learn from these sorts of programs and find ways to implement them in our own communities.

** A note on my (intentional) spelling of wellbeing as one un-hyphenated word: I find it both fascinating and telling that all English-speaking countries except the U.S. have moved to the use of “wellbeing” instead of the Americanized “well-being.”