The Loneliness Epidemic: The Architect’s Role in Designing a Remedy

In the wake of COVID-19, an insidious epidemic of loneliness and isolation has emerged in the U.S. Lingering health and economic stresses from the pandemic coupled with increased calls for racial justice and unsettling threats of climate change have amplified the impacts and disparities of mental health in our country. The intersections of identity and economic inequality with mental health has gained clarity, and the AIA National YAF Advocacy Focus Group sought to highlight these intersections in the final installment of their advocacy webinar series.

Launched in December 2022, the virtual event “So You Want to Design for All? Designing for Mental Health” was moderated by Emily Emily Schickner, AIA, principal architect at Harrison Design. She was joined by panelists Ashley Cox, AICP, NOMA, EcoDistricts AP, an urban designer at evolveEA; Erin K. Peavey, AIA, WELL AP, EDAC, LSSYB, LEED AP BD+C, a vice president at HKS; and Mindy Thompson Fullilove, MD, LFAPA, Hon AIA, a Professor of Urban Policy and Health at The New School. Touching on her research with the AIA Strategic Council’s Mental Health Incubator and her own personal challenges, Schickner’s empathetic perspective led to a vulnerable, eyeopening conversation surrounding often overlooked topics due to their uncomfortable nature. As Schickner noted “People want to lend support, but don’t always know when others are struggling. By creating open environments, people can rely on each other.”

The webinar provided a much-needed platform for honest dialogue with the goal of de-stigmatizing mental health conversations. As Peavey contemplated, “If I could change one thing about the way we communicate, it would be normalization. I wish we would talk about mental health like diabetes or cancer and understand that mental health struggles are not a choice or a weakness. They are a part of the human experience.”

THE [MENTAL] STATE OF THE UNION

Mental health struggles are extremely prevalent in the United States. Approximately half of U.S. adults report experiencing measurable loneliness, while more than one in five adults and more than one in three young adults are living with a mental illness (Source 1). “Our epidemic of loneliness and isolation has been an under-appreciated public health crisis that has harmed individual and societal health,” said U.S. Surgeon General Dr. Vivek Murthy. The consequences of loneliness and isolation range from increased risk of heart disease, stroke, and dementia to severe mental health challenges including depression and anxiety. Peavey, who weaves together her experience in environmental psychology and architecture, noted how often the mind and body are separated in the ways they are approached medically, but loneliness is not just a mental or a social condition. Loneliness has physical and economic impacts for the individual and society as a whole.

Further, loneliness can be a hidden and insidious state. An individual who is physically surrounded by people and maintaining relationships may be internally struggling –unbeknownst to those around them. Vivek refers to loneliness as “the great masquerader,” as it often presents as emotions like anger and can be entangled in destructive behaviors like substance abuse (Source 2). These emotions and behaviors are exasperated by internalized shame and the self- and social stigma of addressing mental health.

Fullilove, a mental health practitioner, posed direct questions during the webinar: “What does it mean if a whole nation isn’t happy? How do we re-knit a broken nation? How did we make ourselves unhappy, and what does design have to do with it?” Fullilove has committed her career to exploring and developing solutions for these uncomfortable truths.

The Cultural Diagnosis

A theme emerged early in the discussion with Cox connecting her work as an urban planner to that of a clinician. “I think of myself as a therapist on the urban scale — diagnosing issues and offering prescriptions to remedy them through design.” Cox surmised that due to the structure of our society and economic systems, deep disparities must be addressed and unpacked. From race to gender to class, access to mental health resources and quality care has historically not been equal for all, and often those experiencing mental health challenges, homelessness, and poverty face punitive responses. As Fullilove stated, “Having an unequal society makes an unhappy society. The concentration of wealth undermines the health of all.”

Outlining data points to measure the state of our national mental health, Fullilove pointed to decreasing intergenerational social mobility, lack of companionship and strong friendships, and fear from increasing mass shootings. She described how the rate of mental illness is dependent on the state of the world and trauma. Addressing mass shootings, she questioned: “How are the school children in America being affected when they’ve had more active shooter drills than fire drills? That stays with you for a lifetime.”

THE ARCHI-CULTURE DIAGNOSIS

Peavey felt Fullilove peered into the soul of the architect as she described the conflicts that architects face on a daily basis — the conflict between the desires of clients who have the means to fund large projects and the communities without those resources, the conflict between the building industry and the ecological crisis, and the conflict between the demands of work and desire to participate in hobbies or start a family.

Sharing her struggles of early motherhood, Peavey recounted the loneliness she experienced caring for an infant after losing her own mother while also studying for her final Architect Registration Exam. During this trying time, she sought out connections with other mothers to fill the void, and it solidified her commitment to advocating for social connection for all. Peavey’s work is based on the principle that the physical environment is the foundation for health and is a determinant of social connection. From the water cooler to a city block, “people going through a difficult time need a place where they can be and feel connected.”

Cox emphasized the importance of concurrently analyzing the macro and micro scale. She often interfaces between systems and people in her work with the goal of reorganizing and redesigning to ensure that everyone is able to benefit. She described her collaboration with communities that have suffered historic trauma and residents whose present behaviors and social norms tend to hold them back. Cox observed that their traumas prevent them from working together to overcome the past and think beyond the present to envision a healthier, more prosperous future.

In southwestern Pennsylvania, Cox has worked with several communities with a steel industry legacy and described the complex relationships that come with that history. An ingrained power imbalance takes hold with powerful corporations both bringing benefit to and traumatizing the residents — providing jobs and allowing them to participate in the economy, but harming their environment by contributing to poor air and water quality; investing in select local institutions, but oftentimes creating a sub-par market for other businesses and real estate, leading to new issues like food deserts, poor infrastructure, and struggling schools.

Design complexities from economic systems built on historically inequitable practices to present-day lack of public transportation can be opportunities for building a more just future that values the health and wellbeing of all and improves social connection in our communities. “Communities where residents are more connected with one another fare better on several measures of population health, community safety, community resilience when natural disasters strike, prosperity, and civic engagement (Source 1).”

The Remedy

Consensus from our panelists and the Surgeon General of the U.S is that social connection is the remedy to the loneliness and isolation epidemic. As Peavey affirms, “Design is never neutral. It either supports health or hinders it.” She detailed how architects play an important role in one of the six primary determinants of social connection — physical spaces. From our home to our work place, the design qualities of the physical spaces where we spend our time are impacting our wellbeing. The walkability, access to daylight and greenness, sense of place, and thoughtful design choices “can increase social interaction, the integration of diverse people, social support, civic pride, social resilience, and social and political involvement.”

Melding her personal experiences and professional research, Peavey has extensively explored Third Places, or the “intersection of place, programs, policy, and technology that creates maximum impact.” These Third Places, which exist outside of the home (“first place”) and work (“second place”), offer an opportunity to employ design to “strengthen social capital, foster social connection, boost diversity and wellbeing” as they make up for a social deficit elsewhere.

Further, Peavey has distilled her research into “Six Design Guidelines for Creating Third Places that Support Social Health” including:

1. Accessibility: Creating places that are safe, inclusive, and walkable

2. Activation: Programming place from ordinary to extraordinary

3. Choice: Finding joy in variety, flexibility, and control

4. Human Scale: Weaving comfort into the DNA of a place

5. Nature: Moving from gray to green

6. Sense of Place: Crafting a place as unique as the people who use it

Zooming out, Fullilove explained that by evaluating the various scales of design around us — from the design of social systems that stratify us by race, gender, and class, the design of geography including redlining to human-made borders, to the design of social symbols of that geographic and social stratification — we can begin to unlock the remedy.

In her writings, Fullilove prioritizes investment in social connection through parks and gathering spaces and offers a guide to “restore joy” at various scales through nine elements of urban restoration. “When everyone has room to be themselves and room to contribute, we can collectively solve our problems.”

Envisioning her ideal future approach, Cox would like to see “a significant commitment to supporting mental health through deep economic policy and shifts in investment— more investment in public housing, ecological restoration, programs for people, access to quality healthcare, free public transportation. The cost to live and access to space should be more inclusive and that can only be done with capital and policy change in my opinion.” With mental health as a top priority, the current Surgeon

General of the U.S. has developed a framework to establish a National Strategy to Advance Social Connection based on six foundational pillars. Architects are critical to several of these pillars including: strengthening social infrastructure through physical design elements; enacting wellbeing-based policies like parental leave and flexible hours in our workplaces and promoting public transportation and access to greenspace in our communities; continuing to deepen our knowledge of the connection between mental health and architecture; and cultivating a culture of connection in both our work and personal realms. Calling attention to, focusing energy on, and, perhaps most importantly, allocating funds to such issues is a significant step in working towards a nationwide cure for the loneliness epidemic.

Architects have a unique role in shaping the built environment, and that comes with great opportunity to contribute to healing our nation through design. If you are eager to dive in, lead with empathy and kindness, initiate and engage in tough conversations to foster quality connections, and explore design decisions centered on mental health and wellbeing. For more resources, consider reading and listening to our recommendations (see graphic inset) and watching the “So You Want to Design for All? Designing for Mental Health” webinar on-demand on AIAU here: https://bit.ly/YAFMentalHealth.

The 2022 YAF National YAF Advocacy Focus Group webinar organizers: Kaitlyn Badlato, Trevor Boyle, Melissa Gaddis, Anastasia Markiw, Laura Morton, and Director, Monica Blasko.

Annotated Sources

1New Surgeon General Advisory Raises Alarm about the Devastating Impact of the Epidemic of Loneliness and Isolation in the United States | HHS.gov

2 https://www.npr.org/2020/04/20/838757183/a-socialprescription-why-human-connection-is-crucial-to-our-health

Monica Blasko Social Media Handles: LinkedIn: https://www.linkedin.com/in/monica-blasko-aia/ Instagram: state_of_mon

Above | Reading + Listening Recommendations to Design for Mental Health

Monica Blasko, AIA

Blasko is a Project Architect at Desmone, past AIA Young Architect Forum Advocacy Director, and AIA Pennsylvania Emerging Professional Award Recipient.