- Loneliness is a public health priority, in a similar way to smoking and obesity
- Loneliness is a problem for people of all ages throughout the life course – it does not just affect older people
- The pandemic has made problems worse, with social networks disrupted and people, including children and young people, left isolated from family and friends during lockdowns
- Tackling loneliness is a preventative measure that improves quality of life for individuals and reduces long-term costs for health and social care
- Interventions are generally low-cost or cost-neutral and can provide a good return on investment
- Reducing loneliness requires all local partners to work together. Councils, the NHS and the voluntary and community sector (VCS) are central, but other partners, such as transport and housing, have an important contribution to make
- Local partners need a strategic approach which identifies patterns of loneliness, levels of need and community assets
- A range of tools are available solutions - these include a Framework for interventions developed by the Campaign to End Loneliness, Age UK’s Loneliness heat map, Open referral data project and Reaching Out, a guide produced by the LGA and National Association of Local Councils
- Loneliness is best tackled by a system- wide approach involving all partners, particularly the VCS, under the strategic leadership of a Health and Wellbeing Board (HWB)
- The public’s understanding about the problems of loneliness is sometimes limited, so public health messages can help people realise the importance of building and maintaining social relationships
- Individuals and communities have a role in ensuring that people who are lonely and isolated are identified and included.
Why you need to know
Society is changing rapidly. The ways we live and work are shifting towards a more digital society. Jobs are becoming more solitary, families becoming dispersed across the country and globe and people are living longer.
There is much to celebrate, but there are consequences too. One of those, it seems, is that loneliness and social isolation are becoming a growing problem. According to the Campaign to End Loneliness, 45 per cent of people experienced bouts of loneliness before the pandemic with 5 per cent describing themselves as “often or always” lonely. The pandemic, unsurprisingly, has only made the situation worse.
There is a growing body of research showing that loneliness is a serious condition which can have a harmful effect on individuals’ physical and mental health, as well as bringing costs to public finance, particularly health and social care, and to the economy.
Loneliness is associated with higher rates of depression, high blood pressure and dementia. It is said to lead 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.
Lonely individuals are more likely to visit their GP and hospital emergency departments; three-quarter of GPs say that up to five of their patients each day attend mainly because they are lonely. People who are lonely also have a higher incidence of falls, and are at increased risk of needing long-term care, including residential and nursing home care. This results in significant and potentially avoidable costs to public services.
The role of councils
Councils have a key role in tackling loneliness, using their knowledge of the local community to bring together partners and lead projects. What is more, they own many of the assets where community action can take place, such as parks, libraries and schools. Councils are also responsible for public health, adult social care and children and young people’s services.
There are good examples of the different ways councils are having an impact. For example, in Worcestershire a dedicated loneliness services has been created, while Norfolk is using its libraries team to tackle the problem. Other councils are supporting their local communities – both financially and practically – to develop locally-led solutions.
Interventions to tackle loneliness can be both successful in terms of outcomes for individuals and cost effectiveness. For example, the London borough of Waltham Forest’s work to tackle loneliness through its social prescribing services has been found to have a return on investment of £1.92 for every £1 spent.
A growing national priority
Loneliness is increasingly recognised as a national priority. Much of the initial pressure to combat loneliness stemmed from national VCS organisations, particularly Age UK and the Campaign to End Loneliness, which provides useful online guidance for councils and commissioners.
The profile of loneliness at national levels was raised through the work of the Jo Cox Commission, which published a report on the issue in December 2017. It led to the government developing a cross-government strategy to combat loneliness. A Connected Society, was published in 2018 and set out some of the key steps that were to be taken. This included the creation of the Building Connections Fund to support community groups, a greater commitment to social prescribing and creating greater awareness about the issue. The Office for National Statistics now publishes statistics to measure loneliness and the What Works Centre for Wellbeing has published evidence on how to tackle loneliness.
Both the commission’s report and the government’s strategy also make recommendations for local action, stressing that local leaders in councils, the wider public sector and business all have a critical role in tackling loneliness
The impact of COVID-19
Unsurprisingly, after more than a year of lockdowns, social distancing and restrictions on travel and gatherings, levels of loneliness have increased. Prior to the pandemic 5 per cent of people were reporting they felt lonely “often or always”, but by the early 2021 that had increased to 7.2 per cent or 3.7 million adults, according to the Office for National Statistics.
Areas with higher concentrations of young people (especially students) or with more unemployment tended to have the highest rates of loneliness. Living in a single-person household, difficulties with relationships caused by the pandemic and not having anyone to talk to have also contributed to experiences of loneliness.
The Campaign to End Loneliness has highlighted that while many people who were lonely during the pandemic will recover as they return to work or participate in leisure activities and reconnect with friends and family, people who face barriers to reconnection, such as mental or physical health issues, or unemployment, may need additional support.
The pandemic demonstrated the effectiveness of remote and online support for people of all ages who were isolated or lonely. Remote delivery has also widened access to support. It allowed services to reach people unable to leave their homes. It also offered a way to participate for those who find face-to-face socialising more challenging. However, issues of digital exclusion and access still exist so this may not be a solution suitable for all.
In response to the growing problems and to build on its loneliness strategy, the government has set up the Tackling Loneliness Network. It brings together more than 70 organisations to share expertise and develop innovation. The network has published an action plan setting out what steps it is taking. Four task and finish groups have been set up to address loneliness in young people, loneliness in older people, local and placed-based approaches and digital inclusion. A new digital platform, the Tackling Loneliness Hub, has been launched that allows members to share evidence, insights and ideas.
Identifying who is at risk
It is important that local areas identify who is at risk of loneliness in their area, and where there are loneliness hot spots. Sources of information can include Joint Strategic Needs Assessment (JSNA), and local intelligence and national information such as that provided by the ONS and Age UK.
One of the highest risk factors for experiencing loneliness is age. Around half of people aged 75 or over live alone; 17 per cent are in contact with family, friends and neighbours less than once a week, and for 11 per cent it is less than once a month. Associated risk factors in old age are low income, poor physical or mental health, and living alone in isolated rural areas or in deprived urban communities.
In terms of loneliness, the pandemic has had a direct impact on the groups listed above. The pandemic is also likely to have exacerbated the problems faced by those who were previously most at risk and be more prevalent amongst groups facing exclusion, including because of ethnicity, sexuality, disability or other factors.
Loneliness is also prevalent in other age groups. Risk factors for adults of working age are similar to those for older people – unemployment, being female, never being married, being bereaved , poor support network, long term physical or mental health, disability, and cognitive impairment. Risk factors often overlap and reflect many of the social determinants that lead to health inequalities.
A significant number of young parents have also reported being always or often lonely. Recent research shows that a 82 per cent per cent of mothers under 30 feel lonely some of the time while more than four in 10 are lonely often or always. Single parents have also been identified as experiencing loneliness, with studies showing between 8% and 21% of single parents reporting feeling lonely.
By using personal characteristics and circumstances that increase or reduce the likelihood of experiencing loneliness, the ONS identified three distinct profiles of people at particular risk from loneliness:
- widowed homeowners living alone with long-term health conditions
- unmarried, middle-age people with long-term health conditions
- young renters with little trust and sense of belonging to their area.
It has also been clear for some time that children and young people struggle with the issue. They are often surrounded by people—other children, teachers, and family – and so the concept of children and young people feeling lonely is not always recognised.
But data published by the ONS showed 11.3% of children said that they were “often” lonely; this was more common among younger children aged 10 to 12 years (14.0%) than among those aged 13 to 15 years (8.6%). Key reasons for loneliness for children that have been identified involved transitions in life, such as moving from primary to secondary school, bullying, disability and bereavement. Children who were not satisfied with the relationships with their family and friends report experiencing loneliness more often.
Looking at age, 16-24 and 25–34-year-olds were more likely to report feeling often/always lonely (both 8%) than 50-64 year olds (5%), and over 65 year olds (both 3%). In addition, 16-24 and 25–34 year-olds were also less likely to say they never feel lonely than all other age groups.
It is not clear exactly what impact the pandemic has had on rates of loneliness among children and young people. But the ONS found that those aged 16-24 were four times more likely to report ‘lockdown loneliness’ than those aged 65 plus. Disruptions to schooling, college, university and social activities is likely to have made the situation worse – and certainly there is evidence rates of mental health problems have increased.
Strategy and partnership
Many areas have made loneliness an explicit public health priority – a health and wellbeing issue which is ‘everyone’s business’. As such it has been covered by some councils in the local Joint Health and Wellbeing Strategy, as well as specific strategies and measurable delivery plans for groups, such as older people and mental health.
There is a strong case for considering loneliness as a key preventative measure in shifting from acute and long-term care to self-help and support in communities, so that tackling loneliness is also addressed within the preventative strands of integrated care systems.
Self-help, peer support and co-production are themes that run throughout all measures to combat loneliness. People at risk of loneliness can be well placed to help others and themselves by helping to design and provide support, through mechanisms such as volunteering.
The following section considers a framework of interventions for tackling loneliness, which could be used to shape local delivery plans. It is important to note that most interventions are low-cost, either because they involve better targeting of existing resources or working with organisations and communities to refocus existing capacity.
However, at this time of severe financial pressure on councils, the NHS and other partners, preventative services can be first in line for cuts. Finding suitable ways of highlighting the importance and measuring the impact of such approaches, including personal stories and evaluations, will help highlight their importance.
Similarly, the social value of assets such as libraries and green spaces, when they are used as multi-functional hubs for health and wellbeing activity, is increasingly recognised, and needs to be taken into account when considering savings
What can be done
There are a variety of publications that provide practical guidance to help develop initiatives to tackle loneliness. The Local Government Association and National Association of Local Councils have published a document called Reaching out, which contains checklists of steps that can be taken. Meanwhile, the Campaign to End Loneliness have developed a framework setting out categories for interventions to provide a comprehensive system to tackle loneliness. The sort of measures that are recommended fall under five broad categories.
Awareness raising about the impact of loneliness and how it can be tackled should take place across all partners and sectors and with the public. The public generally understands the need to make healthy choices on issues such as smoking, exercise and diet, but is far less aware of the importance of social connections for health.
Probably few of us “check our relationship balances at least as often as we check our bank balances” as suggested by the Jo Cox Commission, but this may be a helpful thing to do. Running public information campaigns, promoting the issue on social media and starting local conversations about the issue are all important.
Understanding the prevalence and location of local loneliness is helpful in order to plan support. The LGA and DCMS have developed an ‘open data standard’ to support the publication of information about local services that are especially helpful for vulnerable and lonely people. A final report of this work and a series of user stories was published in 2020.
The Open Referral UK data standard is being used by a variety of service providers and users and is being reviewed by the Cabinet Office for accreditation as the national data standard for publishing information about the availability of local services. Next steps will be to encourage wider publication of more services from more regions of the country to match them to citizens’ support needs.
The following services and approaches provide the first steps in finding individuals who are experiencing loneliness and enabling them to gain support that meets their specific needs:
- training staff in a wide range of settings, such as libraries, youth clubs, pharmacies, or home care teams, to make a short intervention and refer to other help if needed.
- targeting people at risk of loneliness – for example, door-knocking schemes (with a trusted community representative) in areas where people are isolated.
- formal social care assessments – assessors should have a good understanding of what community support is available to tackle loneliness
- social prescribing in primary care – primary care staff trained to be alert to loneliness and identify community options or support such as counselling.
- home from hospital or admissions avoidance schemes – health staff identify people experiencing/at risk of isolation and loneliness
- Clear online information and advice service – highlighting local and national loneliness services or support for adults and children
- Children themselves have made suggestions for tackling loneliness – these include; making it more acceptable to discuss loneliness at school and in society; preparing young people better to understand and address loneliness in themselves and others; creating opportunities for social connection; and encouraging positive uses of social media.
Foundation services can make a good start to tackling loneliness but must be supported by appropriate networks and services. These direct interventions are focused on helping people maintain existing relationships and develop new ones. By their nature, group activities have an inbuilt potential to improve social connections, whether or not this is their primary purpose.
As well as social activity organised within communities, groups focused on health and wellbeing outcomes can be shaped to include an explicit aim of tackling loneliness – for example men’s groups, lunch clubs, walking groups, book groups for people with mental health problems, choirs, youth clubs and cooking groups for young parents.
Focusing on the potential of such groups can increase their positive outcomes – for example an organised walking group could become self-managed, giving people ongoing opportunities to maintain friendships.
One-to-one approaches, such as befriending schemes, have operated for many years for adults and young people who prefer individual support, often in their homes. Befriending schemes can be expanded by engaging those involved to themselves become befrienders, should they wish.
People for whom loneliness is part of a broader mental health issue should have access to psychological support, such as counselling or cognitive-behavioural therapy.
Structural enablers are people or organisations that encourage communities or individuals
to engage with and support, each other. Supporting structural enablers fits well within the work of councils, the VCS and partners to encourage community assets, capacity and resilience.
By making loneliness an explicit priority, community developments can be better targeted. For example, community navigators could have a remit to help develop social networks and support. This will apply to whatever model of community development the council is taking.
Specific community approaches that support tackling loneliness include:
- establishing age-friendly, dementia-friendly and mental health-friendly communities
- developing volunteering, including people who might not ordinarily volunteer
- mobilising peer support, and intergenerational support in neighbourhoods.
Gateway services are broad services like transport, technology, spatial planning and housing, which make it easier for communities to come together.
- identifying options for affordable and accessible transport
- age-friendly driving and parking
- considering social networks as a public health issue when considering major planning developments
- providing support to tackle digital exclusion.
Questions to consider
- What do you know about loneliness in your local area? Is it common issue raised by residents?
- Does your JSNA identify the levels of loneliness in your area, overall, in specific communities, groups, and in relation to issues such as rurality?
- Is tackling loneliness seen as a public health priority in your area?
- Is tackling loneliness a strategic objective in the overall Joint Health and Wellbeing Strategy and in specific strategies for older people and mental health?
- Have you considered how the pandemic has impacted upon loneliness in your local area, what it means for demand for support, and any changes you might need to make to that support and how it is offered?
- How are issues with loneliness in children and young people, including students, being considered?
- Are there delivery plans to reduce loneliness in specific groups according to local need? Are these comprehensive – incorporating all elements of the loneliness framework identified in this ‘must know’? What is the progress so far?
- Considering the strong connection between loneliness and GP visits, what is being done to tackle loneliness identified in primary care and is this joined up with community support?
- How are older people, people with mental health problems and other groups involved in co-producing solutions?
- How is loneliness being addressed in local approaches to community development?
- How is the Voluntary and Community Sector involved in helping to reduce loneliness? Are social prescribing schemes appropriately funded?
- Is there a map of local assets which could have a role in tackling loneliness?
- Is tackling loneliness taken into account in any proposals to close services?
- How is encouraging social connectivity taken into account in place-based initiatives such as planning, housing, and transport?