Friendship Needed: How Healthcare Organizations Can Help

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In my work with emerging adults, it isn’t uncommon to have 18- to 22-year-olds tell me that their parent (often their mother) is their closest confidante and one of the few people they trust. It’s also not uncommon today for emerging adults to experience relationships with their parents more representative of peer relationships of the past. This reality is a significant developmental issue that could have consequences regarding these emerging adults' later need for affiliation, need for intimacy, and resistance to loneliness, once family networks and environmental contexts change.

Loneliness and Social Anxiety

Loneliness and social anxiety are serious public health crises and described as such by the U.S. Surgeon General Vivek Murthy (Murthy, 2023). So, although modern-era parents may appreciate being the bestie to their teen or 20-something children, researchers have taken an interest in how to comprehensively teach people how to establish and sustain non-kin friendships for enhanced well-being (Hong, Yeh, Sandy, Fellows, Martin, Shaeffer, Tkatch, Parker, & Kim, 2022). It's important that socially anxious and lonely people think and feel that establishing affiliation and intimacy with others can be achieved in contemporary culture.

Thus, a comprehensive approach to addressing loneliness goes beyond merely teaching behavioral skills to the lonely and friendless. It also incorporates teaching people about their thoughts and emotions and how these, too, can contribute to approach and avoidance motivation regarding establishing connections with others. Hong et al. (2022) argued that such teaching should occur within established healthcare systems; for example, the creation of programs within community health organizations that could provide friendship interventions.

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The Healthcare System as a Bridge to Friendship

It is not a radical approach to suggest involving the healthcare system in efforts to assist people to establish friendships to benefit their mental health. This is despite loneliness being known as a health concern. Murthy has described loneliness as being part of the contemporary social infrastructure.

For example, people often download apps to their mobile devices that enable them to scroll through other peoples’ profiles in search of a date or love connection. Also, some people may opt to join activity-based groups via apps to meet strangers of similar interests to enjoy time-limited prearranged activities.

It is possible that in the social situations that I’ve mentioned, the focus on dating or time-limited prearranged activities could lead to a sense of connection. Connection based on common interest, though, is only one aspect of establishing friendship (Hong et al., 2022). Therefore, it is possible that a lonely person who solely uses apps such as these might not experience interaction that leads to the development of authentic friendships. The researchers described that a comprehensive approach to teaching friendship development within a healthcare system should include developing health-based programs that address building confidence, community, and connections around similar interests.

Hong et al. made the case that healthcare systems are particularly well-positioned to serve lonely people who may have limited opportunities for social engagement. They also suggested that healthcare systems might partner with other organizations to diversify their offerings. Healthcare systems have the infrastructure to offer a diversity of programs in a safe space for vulnerable persons such as lonely older adults (Hong et al., 2022). However, for vulnerable lonely people of any age, it is possible that such people could have low confidence in their ability to make friends.

Confidence

For a vulnerable person who lacks confidence, a need for reciprocity is important to address. Healthcare systems that have the resources can conduct assessments of friendship skill-building and people’s confidence that they can establish authentic reciprocal friendships. Healthcare systems would then be able to develop programs so that lonely people of any age can learn skills and learn more about where they need to improve. Researchers also suggest that interventions should teach about conflict management. The interventions might focus on developing programs to teach people how to manage conflict in their lives so that they can better initiate and maintain human connections that include bonding around shared interests.

Connection

Homophily refers to a connection based on similar interests. Homophily can extend beyond family. Bonding through similar interests can occur in programs that are created in a healthcare system of organizational partnerships; however, this may not be easy for people who are socially anxious and more comfortable in an online-only world (Haidt, 2024). Emotions and lack of confidence could prohibit people from instinctively connecting around homophily. An increased need for friendship interventions in contemporary times is a reflection of how half-connection has disrupted people’s natural experience of a sense of unity and community (Watson, 2022).

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Community

Utilizing the healthcare system in community partnership with other organizations could encompass integration with community centers such as senior centers, youth recreation centers, and LGBTQIA+ centers. Through these partnerships, lonely humans may have greater opportunities for building trust, commitment, and bonds, with a subsequent increase in the release of the tend-and-befriend hormone, oxytocin.

Because of the diversity of personality traits among lonely and friendless people, Hong et al. recommend that people be given a variety of opportunities to engage in dyads, small groups, and large community gatherings. This diversity of options for structuring people's social engagement takes into consideration their personality differences (e.g., introverts, shyness). The researchers also asserted that with larger routine community gatherings, the opportunity for human connections to be sustained is more likely, rather than dissolving when people relocate or drop out (Hong et al., 2022).

Conclusion

Phone, online, and in-person social interactions are necessary to address loneliness across age groups in a post-COVID world of increased anxiety. Researchers have concluded that there is a high prevalence of loneliness, yet there is also a stigma to being lonely. Healthcare systems are ideally situated to address these concerns because most people already have a reason to engage with the healthcare system for preventive care or for treatment. Friendship interventions could thus be marketed and incorporated within these spaces.

Researchers shared that the interventions have to be carefully marketed due to the stigma of loneliness. Thus, healthcare systems would need to avoid marketing that focuses on the word "loneliness" rather than on the word "friendship." Finally, Hong et al. asserted that healthcare workers must be allowed to bill insurance for addressing loneliness as the public health crisis that it is.