Loneliness, social isolation and COVID-19

The Local Government Association (LGA) and Association of Directors of Public Health (ADPH) have jointly produced this practical advice for Directors of Public Health and others leading the local response to the loneliness and social isolation issues arising from the COVID-19 outbreak. It follows on from our guidance about the public mental health impacts across the life course.

Public health teams in councils are working closely with partners, especially the voluntary and community sector (VCS) to tackle loneliness and social isolation. Intervening early to tackle loneliness and social isolation during the COVID-19 outbreak and beyond will help to prevent more costly health and care needs from developing, as well as aiding community resilience and recovery.  This can only be done at the local level through partnerships between the council, voluntary and community sector, councillors, Primary Care Networks and relevant others.

Councils have a key role to play in this, because they own most of the assets where community action could or should take place, such as parks, libraries and schools, with councillors creating the localised neighbourhood partnerships to deal with a range of mental and physical health issues. Councils are also responsible for public health, adult social care and children and young people’s services. All of these services have a significant impact on tackling loneliness at a local level. The pandemic has also highlighted the importance of community volunteering in addressing loneliness.

Recent research[i] on loneliness during the pandemic has three main findings:

• People who felt most lonely prior to Covid in the UK now have even higher levels of loneliness. This increase began as physical distancing, shielding and lockdown measures were introduced in the UK, in March 2020.
• Adults most at risk of being lonely, and increasingly so over this period, have one or more of the following characteristics: they are young, living alone, on low incomes, out of work and, or with a mental health condition.
• The impact on wellbeing from people at risk of loneliness is likely to be compounded by other economic and social impacts experienced by the same people, such as those experiencing job losses and health anxieties.

Research also found that risk factors for loneliness were near identical before and during the pandemic. Young adults, women, people with lower education or income, the economically inactive, people living alone, and urban residents had a higher risk of being lonely. Some people who were already at risk for being lonely (e.g. young adults aged 18-30, people with low household income, and adults living alone) experienced a heightened risk during the COVID-19 pandemic compared to before COVID-19. Further, being a student emerged as a higher risk factor during lockdown than usual[ii]

It is likely that as the pandemic continues, we can expect more people of all ages to experience loneliness and social isolation due to the impact of local tier restrictions, national restrictions and social distancing measures. As well as the reduction in face-to-face opportunities to socialise, connect with family, neighbours and friends and to take part in physical activity and everyday cultural and faith experiences.  

There is an extensive evidence base about the impact of loneliness and social isolation on people’s lives, their relationships and their wellbeing. It is also a serious public health concern. It leads to higher rates of premature mortality comparable to those associated with smoking and alcohol consumption – around 30 per cent higher than for the general population[iii] and is a risk factor in developing depression[iv].

Whilst loneliness is often associated with social isolation, these two concepts, though linked, are distinct and will require different responses during the outbreak. For people who are already socially isolated, ie they already lack the social contacts to reach out for support, being asked to socially isolate due to COVID-19 especially if they are in a clinically high-risk group, can be particularly difficult.   

Digital exclusion is a key driver of social isolation. It is important to ensure that people without internet access or who do not use the internet still receive information in an appropriate format  and are helped to get online if they wish to do so. This will usually be part of wider plans to support people in vulnerable circumstances who do not have access to support networks during COVID-19.  

  Even if someone is not completely socially isolated in terms of having people who are important to them and who can help them to navigate their day to day lives, social distancing rules mean that many people are missing out on emotionally fulfilling social contact and may feel lonely.

Councils are working hard with the VCS and faith groups to ensure that people feel as connected as possible. Communities are self-organising and there are many imaginative responses such as virtual pubs, choirs and concerts that are helping to keep people connected.

There is also a positive opportunity to build upon the increased neighbourliness and volunteering to help strengthen community capacity and resilience in the future. An emerging challenge is sustaining community and neighbourhood responses over a longer period time and when some volunteers, such as older people, might be less likely to engage as a result of the pandemic.

The loneliness and social isolation impacts from COVID-19 will be experienced by people across the life course, but some will be more at risk than others and will need targeted approaches that are also sensitive to the stigma that can be associated with loneliness and social isolation. The table below summarises the main risk factors of loneliness and social isolation, many of which overlap, including those specific to COVID-19: 

Many councils are already using local insight and networks, including from ward councillors to identify people who may be isolated or experiencing loneliness during COVID-19 and to make them aware of potential support, building upon lessons learnt from the first wave.

The LGA’s ‘Must Know Guide’, drawing on work by the ‘Campaign to End Loneliness and Age UK’, sets out councils’ role working with partners and using community assets to address and help prevent loneliness and social isolation. The table below shows how these core responses are being adapted to reflect the COVID-19 situation, including the positive changes that are happening.  

• Resources on the LGA website including practice examples
• Guidance on ADPH website
• Summary of Government work on tackling loneliness with useful links   
• Let’s talk loneliness campaign   
• Connection Coalition – includes Jo Cox Foundation, British Red Cross, Facebook, Age UK and others.  
• Campaign to End Loneliness – new guide: ‘Promising Approaches  Revisited: Effective action on loneliness in later life’
• Every Mind Matters  
• LGA, ADPH and PHE COVID-19 Place based approach to reducing health inequalities from COVID-19
• Carers UK  
• Mind  
• Silverline  
• Alzheimer’s Society  
• Housing LIN   
• Centre for Ageing Better guide to engaging older volunteers in the wake of COVID-19
• WHO Mental Health Considerations
• Real World Public Mental Health podcast, hosted by the Behavioral Science and Public Health Network (BSPHN), looks at how evidence is being used in the real world to prevent and promote better mental health for all. It is part of a public mental health collaboration between BSPHN, PHE, ADPH, LGA, Centre for Mental Health, Mental Health Foundation and NIHR – School for Public Health Research. The podcast series follows the webinar Prevention and Promotion for Better Mental Health in Local Systems, hosted by PHE in November 2020 on behalf of the collaboration, which can be viewed on the COVID-19 public mental health community of practice