It is fair to say loneliness is a painful reality in the general UK population, but particularly among older people. Loneliness is thought to be as bad for health as obesity and smoking (Holt-Lunstad et al, 2015), and with up to one-fifth of all UK adults feeling lonely most or all of the time, effective intervention measures are required that will help improve people's quality of life quickly. However, we need to appreciate what is driving loneliness to such proportions: first the society we live in is continually changing, and the digital reality has led to people being glued to their smart gadgets, which have become the new norm of communication, shopping and interaction with each other. Then, other underlying factors to trigger loneliness may be relocation, change in or loss of jobs and, what is most relevant to this article, death of a loved one. All these situations often cause a sense of emptiness and lead people to lose their purpose in life. Periods of ill-health, contracting infectious diseases, such as COVID-19, relationship breakdown, divorce and even unplanned retirement are all worrying factors.
However, other subtle factors, such as personal thoughts and feelings, also play a crucial role in how people perceive themselves and their situations. For example, when people experience abuse, discrimination and bullying or become homeless, they can feel a sense of loneliness, especially if nothing is done to support them.
In response to increasing loneliness in the UK, the Government under Theresa May developed a loneliness strategy to help every eligible person in the UK to access support and resources to ameliorate their situation, taking lessons from the legacy of MP Jo Cox, who branded loneliness a social injustice. The guiding principles for this strategy (Department of Digital, Culture, Media and Sport, 2018) are a basis for improved integration of society, but need proper implementation. GPs are included among the agencies largely responsible for social prescribing, as three-quarters of GPs reported in a survey that they encounter between one and five people experiencing loneliness per day. Social prescribing (a commitment also made in the NHS Long Term Plan (NHS England, 2019)) is a new way of referring people experiencing loneliness to non-clinical local services (for example, sports activities, arts, group learning, community-based activities, cookery and gardening), with the sole aim of ensuring human contact, followed by support and care. There is emerging evidence from pilot experiments (Dayson and Bashir, 2014) that shows improved social outcomes for 83% of patients after 3–4 months of engagement in socially prescribed activities. Economically, this evidence translates to a reduction in usage of NHS resources after the introduction of social prescribing. However, more robust and systematic evidence on the effectiveness of social prescribing is needed, which links social prescribing schemes to reduction in GP attendance and visits to emergency departments.
Everyone can play a role in and collaborate for tackling loneliness—employers, public health services, voluntary and charity organisations, but most importantly, friends, relatives, families and communities. Indeed, social media can play a critical role in this process, depending on how it is used; like any tool, it can be of great value or a nuisance if used inappropriately. Social media users should take a moment to reflect on what they are about to post: rather than being personal and insensitive, comments should offer support, as it could mean the difference between saving or destroying someone's life and wellbeing.
Given that personal thoughts and feelings play a considerable role in how loneliness is triggered, it is equally important that social prescribing schemes focus on the best available psychological interventions to combat loneliness. Additionally, it is important to remind ourselves of the distinction between being alone and being lonely, the latter being more subtle and difficult to prescribe for, as it involves perception and is more subjective. Social prescribing needs robust intervention to counter psychological loneliness, as people can still be lonely while in the company of others. Referral to psychological, one-to-one support is fundamental, as the intervention often requires more time and expenses to achieve the desired outcomes of improving mental wellbeing.
While social prescribing is a government initiative, tackling loneliness is everyone's business. We should start with talking to our neighbours, (dare I say it) taking a break from our smart gadgets and finding real time for each other in our workplaces and communities.