My first job in the NHS, a decade ago, was to set up a brand-new team within Mental Health services that was for people who frequently attend emergency services.
I was given my brief by the team leader, who was seconded part-time, from the Assertive Outreach team – typically the team that deals with the most ‘hard to reach’ people in the community.
The new team (FACE team – Frequent Attenders Care Enhanced) was to go a step further, to find and work with, those who appeared at emergency services the most frequently. In some cases, this would be in excess of 150 times a year.
So, I set to it and made my connection with A&E, and the Ambulance, Fire, and Police services.
Once the team was up and running, with 2 Community Psychiatric Nurses, a Senior Social Worker, and an Occupational Therapist, I switched from set-up to frontline work.
Attendees consisted of people who presented at A&E with things like acute abdominal pain and back pain, for which there was no physical cause; alcohol, recreational, and prescription drug overdoses, both accidental and deliberate, or complications arising from misuse of such substances. Also those who either called, or had frequent dealings with, any of the other emergency services.
It had been hypothesised by senior NHS managers and directors, prior to set up, that this cohort of people would be found to be suffering from any number of weird, wonderful, and severe mental health conditions – hence why it was set up within Mental Health services.
This hypothesis couldn’t be further from the truth, and, within days, we were flooded with referrals from all directions.
I experienced some things that, in print, sound far-fetched. For example, I arrived at one home visit to find the fire, ambulance, and police services at the ajar front door of a man – I walked in and found him offering to make us all a cup of tea, having called the services claiming that he had taken an overdose of painkillers.
Another time I had to lay low waiting for the police, in the (very posh) flat of someone who had just received a call to say that a drug dealer was coming over to shoot him.
And yet another, I had to look for, and collect, a person renowned in the area as a, now homeless, ‘gangster’, heroin addict and alcoholic, to get him to a rehab interview, first driving around with him and his wheelchair in my car, trying to locate his prosthetic leg that he had mislaid the night before.
Then there was the very religious, and charming, lady who frequently became ‘overcome with the Holy Spirit’ in the middle of the town centre, attracting a lot of interest and engagement from members of the public, especially after several pints of Old Rosie. She enjoyed my visits to her home, during which we enjoyed some deep, meaningful, and highly lucid conversations.
You may have already guessed that the overwhelming outcome of this pilot, was that these people were lonely, isolated, and disconnected.
Very quickly, we came to realise that the 8 weeks we were given to work intensively with these people, to get them up and running and no longer attending emergency services, was a totally unrealistic timeframe.
It had taken years of trauma, abuse, and subsequent isolation from family, friends, and the wider community, for them to adopt unhealthy and often highly risky ‘coping strategies’ and behaviours, for them to get to that place, and it would need a complete life overhaul, including the relearning (or learning) or social skills, finding hobbies and interests, calming of trauma, abstinence from substances, and the rest, before we could simply ‘plug’ them into existing groups and services and/or hope they would find some friends and re-integrate smoothly into the community.
So, what is the point of this story?
Well, the work that I did in that team was just a very very tiny snippet of a great problem in our society. We were completely swamped with referrals for people we could have worked with, but we simply didn’t have the resources to work with more than a few people at a time. And that was just in one small area of the country.
In my view, and the views of many of the researchers, health professionals, and healers out there, our health provision is basically upside down. We deal only with the symptoms that people present with and rarely get to the root cause and, if we do, we find that it is too difficult, or costly, to deal with and it gets swept back under the carpet.
The irony was, that teams like this sprang up around the country at a similar time, because it had been flagged that people attending emergency services were costing the taxpayer a lot of money. I would argue that the way we deal, or not, with the endemic challenges of our culture and communities, is what costs the money and, most of all, 
costs lives.
There is no excuse for it, in truth, as there is ample research telling us what the issue is and how we might deal with it. Even if you don’t have access to a scientific journals database, just google ‘human connection articles’ or ‘social connection articles’ or something similar like ‘the cost of social isolation’ and you will find reams and reams of references and papers to trawl through.
What is connection?
Throughout the literature, connection is often defined as social bonds, social interaction, social support, social participation, social relationships. One author summarises it as ‘feeling a part of something larger than yourself, feeling close to another person or group, feeling welcome and understood’ (Hallowell in Martino et al, 2015)
Humans are hard-wired to form social connections, we have lived in groups for as long as we know from the historical and archaeological records. It is literally imprinted in our DNA. In our ancestors’ time, isolation or ostracism from the group or tribe would have meant certain death. This is why people are inclined to conform to ‘social norms’ because the potential of being isolated is an existential threat. (I will follow this rabbit hole 
another time).
In addition, humans are unable to fend for themselves as infants, so the bond with our initial caregiver/s is hugely important and sets the pattern for our social connections later in life. Disruptions in our attachment to primary caregivers, from neglect, abuse, or rejection, for example, impacts our ability to connect as adults. There is a huge body of work in the field of attachment theories going back throughout the C20th. I will come back to this.
How important is connection, actually?
The scientific literature is clear. One article states in its abstract ‘there is significant evidence that social support and feeling connected can help people maintain a health body mass index, control blood sugars, improve cancer survival, decrease cardiovascular mortality, decrease depressive symptoms, mitigate post-traumatic stress disorder symptoms, and improve overall mental health’ (Martino et al, 2015).
That is not nothing!
More specifically, one meta-analysis of 148 studies looking at the health outcomes of people who are connected or disconnected, showed that people who have connections with friends, family, neighbours, or colleagues, had a 50% higher chance of survival than those who do not have connections. (Yang et al, 2016) FIFTY PERCENT or 1 in 2 – that is huge!
Conversely, through lack of connection ‘the odds of mortality increased by 91% among the socially isolated. The magnitude of this is comparable to that of smoking and exceeds those of many other known risk factors to mortality, such as obesity or physical inactivity’ (Yang et al, 2016).
In simple terms this means that, if you are sick and disconnected, you are most likely to die from that sickness – that is, more than 9 out of 10 people will die as a result of social isolation and that social isolation is a greater risk to health than smoking, obesity, or lack of exercise!
The same article then goes on to state ‘In humans, deficits in social relationships such as social isolation or low social support can similarly lead to chronic activation of immune, neuroendocrine, and metabolic systems that lie ion the pathways, leading to cardiovascular, neo-plastic, and other common aging-related diseases’ (Yang et al, 2016).
Again, in simple terms, immune, neuroendocrine and metabolic pretty much covers all body systems. Your immune system will be impaired, the interaction between the nervous system and hormonal system affected, making certain cancers more prevalent and/or difficult to treat, things like alzheimers, high blood pressure, diabetes, heart disease, and stroke, become more common.
In fact, another article looking specifically at coronary heart disease (CHD) and stroke said ‘Our review found that poor social relationships were associated with a 29% increase in risk of incident of CHD and a 32% increase in risk of stroke’. (Valtorta et al, 2016).
Connection is a human need
In the theory and methodology that I have been working on for many years, connection appears as a human need. In fact, it appears in a number of forms within the model as community connection (physical domain), attention and intimacy (emotional domain), healthy interdependence (social domain), and pretty much all of the needs in the spiritual domain which, broadly speaking, refer to connection with someone or something greater than oneself.
My research into connection goes back to the works of people such as Abraham Maslow, William Glasser, and Deci & Ryan (Self Determination theory), who all site connection in various forms such as ‘relatedness’ or 
‘love and belongingness’.
In addition, my frontline work and work with those struggling with trauma and addictions bears out the phenomenon of connection as being vital to human survival, not just thriving. In fact, Martino et al propose that connection should be considered a vital sign, along with the 4 main vital signs of body temperature, heart rate/pulse, respiratory rate, and blood pressure, such is its importance.
This means that, when I am working with someone, evaluating their level of connection is a central part of the process of ascertaining the cause of their discontent, anxiety, low mood, or frustrations. After an initial assessment of their essential needs, we can get down to the business of finding solutions to the challenges they face.
In fact, disconnection itself, often begs the question: why am I disconnected?
This question, in its broadest sense, leads to a philosophical debate about the entire nature of western living in the C21st, which I will not debate here.
What I will say is that, as Yang et al state ‘early life social experiences may be biologically embedded at that time, shown by an increasing body of research linking childhood disadvantage and maltreatment to increased likelihood of exaggerated biological stress response and, in turn, higher risks of inflammation and cardiovascular disease throughout adulthood’ (2016)
That is, childhood trauma and stress lead to disconnection, which also causes high levels of physiological dysregulation in adulthood. This bears up what authors such as Dr Gabor Mate discusses in his book ‘When the body says no: The costs of hidden stress’ and Dr Bessel Van Der Kolk in his book ‘The Body Keeps the Score’, as well as the large ACE study (Adverse Childhood experiences) that showed the link between childhood trauma and household dysfunction and adult emotional, psychological, and physical health outcomes.
There is a stark warning in this data though, we must cease, as a society, imposing restrictions on communities that increase social isolation. In this ‘covid era’, we must rally against isolation and lockdown policies that are counter-productive to public health as a whole.
There is nothing more nonsensical, according to the data, than isolating both sick and healthy people away from their friends and families. That is, if the health of the public is really paramount. It is an understatement to say that the long-term health impacts of lockdown on people of all ages will be severe.
The sick will take longer to recover, or not recover at all. The healthy will be vulnerable to poor emotional, physical, and psychological health challenges and, hence, lifespan will be decreased. Children will be exposed to biological stressors caused by their inability to function, socially, as they are meant to, as well as the poor adult health outcomes warned of in the ACE studies.
Frankly, we are in an age where optimal immune system functioning is of high importance and we are simply not ‘following the science’, in this respect.
Once we are aware of the relationship between connection and health, we are able to mitigate its effects.
Even where childhood may have set up the patterns for later dysfunctional social connections, attachment studies have shown that it is possible to build secure attachments and literally rewire the brain to enable us to form healthy connections in adulthood.
We need to take this message seriously, as individuals, as families, friendship groups, and communities, in order to take it out to the wider world before further damage is meted upon our society.
For me, I will continue to educate and bring people together to form physical communities that provide support, interaction, and comfort to each other, not just in times of need or crisis, but as an essential component of a balanced and healthy society that puts personal and public health at the forefront, for this and future generations.
PS I have just got back from a short walk into my little town in Cornwall. It has been a rainy, cold, dark and foggy January so far. I was feeling a bit flat and lethargic having been cooped up in front of my laptop and feeling a bit unwell for a few days. I went into the post office to renew my driving licence and the lady in there came to help me with the photo booth, we laughed hysterically as my first picture came out looking a bit startled and dazed. I came out and smiled to myself, a warm glow flowed through me (the rise of the calming bonding hormone, oxytocin, no doubt) and breathed a deep contented sigh relief at the feeling of the interaction. I walked a bit further down the road and a man stopped and commented about ‘them there traffic lights on that hill again’ (he’s Cornish), we shared a knowing nod and tut and a giggle at the prospect of the diversion we’d have to take around the town if we lived on the other side. I walked up to the castle gardens to admire the view across the valley. A couple were taking photos, they chatted with me about the beauty of the view and the castle remains and asked me to take a photo of them both together. I walked home a little lighter in my step, feeling grateful, optimistic, and a sense of belonging to a warm, friendly, and supportive community. This feeling is priceless.
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References
Martino, J., Pegg, J., Frates, EP, The Connection Prescription: Using the Power of Social interaction and the Deep Desire for Connectedness to Empower Health and Wellness, American Journal of Lifestyle Medicine, pp466-475, NovDec 2017
Valtora, NK., Kanaan, M., Gilbody, S., Ronzi, S., Hanratty, B, Loneliness and social isolation as risk factors for coronoray heart disease and stroke: systematic review and meta-analysis of longitudinal studies, BMJ Heart, pp1009-1016, April 2016
Yang,CY., Boen, C., Gerken, K., Li, T., Schorpp, K., Harris, KM, Social relationships and physiological determinants of longevity across the human life span, PNAS pp578-583, Jan 2016
