The Impact of Social Isolation on Life Satisfaction and Treatment for Individuals Living with Serious Mental Illness (SMI)

Introduction: Individuals dealing with serious mental illness (SMI) have smaller social networks, less social support, and are more prone to disruption in their community tenure. In recent years there have been notable improvements in physical integration, most notably in the areas of supported housing, community-based care such as ACT teams, and supported employment. However, there have not been similar gains in improving social integration, which has been even further exacerbated by the COVID pandemic. While efforts have focused on improving the community and social integration of these individuals, there has been a lack of examination and standardization on just what the challenges are that prevent successful integration. To better understand these challenges we collected cross sectional data examining the level of social isolation of individuals with SMI living in their communities. We examine how this isolation impacts recovery and satisfaction with life through structural equation modeling (SEM).

Methods: As part of an experimental study design, survey data was collected from 58 participants diagnosed with a SMI receiving care at four community mental health (MH) centers located in Los Angeles. IRB approval was given and participants were recruited through flyers and presentations at the MH clinics. 58 participants were recruited and consented to be a part of the study with data collected at baseline and six months later. Demographic variables including life transitions and community disruptions were also collected. Three key variables were measured, social isolation and loneliness using the UCLA Loneliness scale (V.4), Mental Health care through the Recovery Awareness Scale, and Satisfaction with Life Scale were collected. Data was collected by the study team and entered into SPSS and then analyzed.

Results: The sample was comprised of individuals dealing primarily with schizophrenia (73%), with over 50% having been displaced in the past year due to homelessness, another 50% having been hospitalized in the past year, and roughly 40% having been arrested in the past six months. The sample was also comprised primarily of individuals of color with 54% African American and 36% Latino. Social isolation was quite high for the study population, even before COVID. Social network size was less than 7 individuals and high levels of social isolation were correlated to lower levels of recovery awareness and satisfaction with life. SEM results at baseline offer support for a model in which social isolation fully mediated the relationship between mental health care and life satisfaction. The final model explained 23% of the variance in life satisfaction.

Conclusions: Individuals with SMI have high levels of social isolation. This isolation negatively impacts these individuals ability to manage their mental illness and their satisfaction with life. Interventions are needed that can reduce the level of isolation and thus improve individuals ability satisfaction with life and ability to engage in recovery activities. This study adds to the understanding of how addressing isolation and loneliness may be key in improving mental health treatment and overall satisfaction with life.