Trapped in a Bubble

Trapped in a bubble An investigation into triggers for loneliness in the UK

Contents Foreword 4 Executive summary 6 1. Background, aims and approach 12 2. Loneliness is an important issue for the UK 16 3. What causes loneliness, and how can it become chronic? 20 4. What is it like to be lonely in the UK? 31 5. What is the support landscape like for loneliness in the UK? 34 6. What kind of support do people want and how do they want support delivered? 38 7. Conclusions 49 December 2016 ISBN 978-0-900228-30-8 Front cover photos (clockwise from top left) © Phil Smyth / BRC, © Simon Rawles.

What does it feel like to be lonely? I can tell you exactly, it’s like being in a bubble and you want to get out but you just can't, you try and you can’t do it, you just can’t get out. (Male research participant, Wales) Photo: © Simon Rawles. 3

Foreword Mike Adamson Chief Executive, British Red Cross Earlier this year, I met Beryl who lives in a rural part of Cheshire. Suffering from circulatory problems and diabetes, she ﬁnds walking difﬁcult and struggles to get to her regular medical appointments. The cost of the taxi fare to her hospital is a huge slice of her state pension. At the British Red Cross, we have supported Beryl d. by arranging transport not only to hospital but also to do her shopping and connect her into the community. Beryl told me that this is a vital lifeline Photo: © Alex Rumsfor for her. Our partnership with Co-op is so important contribution to the available evidence on the because in her state of isolation, Beryl is far from state of loneliness in our communities, and how alone. In over 30 years of delivering independent best to tackle it. It shows clearly how loneliness living services in communities all over the UK, is an urgent public issue with serious personal Red Cross volunteers and staff have supported and societal impacts across the whole of our thousands of other vulnerable people like Beryl. communities, not conﬁned solely to older They come from all backgrounds, are of all ages generations. And it underlines how accessible, and have very different challenges and experiences tailored support can make all the difference to in their lives. people going through changes in their lives, by breaking a potentially inescapable slide from Few of these people come to us simply because vulnerability to disconnection to chronic loneliness. they are lonely. They typically have complex and chronic healthcare needs, often alongside social I would like to thank Kantar Public for their and emotional challenges. But our volunteers thorough research. I would also like to thank and staff have found that a high number of our the many people who contributed – both those service users live alone, and show high levels of who have experienced loneliness in their lives, social isolation and even higher levels of loneliness. and partners from a wide range of organisations Indeed, they have identiﬁed loneliness and working to support lonely and isolated people. social isolation as the underlying problems most A key ﬁnding in this report is the importance of frequently affecting the people we support – collaboration across organisations in delivering and these people’s situations are becoming ever sustainable solutions. Everyone at the Red Cross more complex. is looking forward to putting this into practice and It’s quite clear that loneliness and social isolation making a real difference with Co-op colleagues is a crisis we cannot ignore, causing untold misery and members, as we work together to provide vital and, ultimately, unnecessary pressure support for thousands of people to reconnect with on hard-pressed statutory services. their communities and help all those experiencing loneliness to have their voices heard. Wanting to take action, we began by ensuring we had a full understanding of the issues. We But we believe our partnership can go further reviewed existing research covering some 40 years than this. By making this research and our wider and commissioned Kantar Public to address the evidence base available, I hope other organisations signiﬁcant gaps in the evidence base. and individuals can beneﬁt from all of the insight we have brought together and ﬁnd it valuable in We believe that the insight and research we have informing and further developing their work. We brought together provides a signiﬁcant can tackle loneliness together. Foreword 4

Richard Pennycook Chief Executive, Co-op I’m very pleased to introduce this report, which brings together ﬁndings from UK-wide research capturing the ﬁrst-hand accounts of loneliness with six previously underrepresented groups of people. It also marks the next vital stage in our partnership with the British Red Cross enabling us to develop an evidence based campaign for tackling loneliness. The Co-op has a long history of campaigning, which started when the Rochdale Pioneers formed the ﬁrst customer owned co-op in 1844. They gave their community safe food at a fair price and since then we’ve continued to make a Photo: © Co-op. stand on issues of importance to our members. bereavement has caused them to start to From pioneering Fairtrade to tackling climate feel disconnected. change, the Co-op has been at the forefront of responding to societal issues. What’s clear is that that our partnership with the British Red Cross will be vital in reconnecting Our decision to turn our attention to the issue of thousands of those who’ve become critically loneliness and social isolation was in response isolated and lonely. to our members and colleagues. We know that it is an issue that affects one in seven of our But, as with so many social health issues, this members, and more than one in ten Co-op report sets out how all aspects of society - colleagues, and some 80,000 of our members individuals, businesses, community groups or and colleagues took part in a vote for us to NGOs - can play a role in terms of prevention partner with the British Red Cross. Since then and early response. Having identiﬁed some of they have been fundraising and have raised the triggers to loneliness beyond aging we millions of pounds to help fund British Red Cross can look at how we engage and mobilise our services that tackle loneliness. business, our colleagues and members and help build more resilient communities wherein more This report is both humbling and inspiring to people have more ways to stay connected. read. I’m very grateful to those who were willing to share with us their personal experience As with previous campaigns, our commitment of loneliness, and those who shared their to tackling loneliness has to be a long-term one. knowledge as experts in the ﬁeld, which has It’s a complicated societal issue that can’t be helped us to understand with far greater clarity solved in one or two years by one organisation the factors that cause it and the interventions that alone but we’re committed to long-term, could prevent or lesson its impacts. sustainable solutions. One insight that really stands out is that no With the understanding we now have we are one is immune to loneliness, and certainly it ready to start the challenging but exciting job does not just impact the elderly. Many people of addressing one of the major social issues of who experience it, have at one point been our age. ‘connected’ but a life change such as becoming a mother, going through a divorce or separation, deteriorating health or mobility, retirement, or Foreword 5

Executive summary Background The Co-op and British Red Cross have The research also involved capturing the views of established a partnership to tackle loneliness in experts in the ﬁeld and carrying out a survey with the UK. The partnership commissioned specialist a representative sample of the UK public. For social research agency Kantar Public to carry further details on our approach, see Chapter 1. out rigorous research into loneliness in UK communities. The research focused on potential triggers for loneliness across life stages and Loneliness is an important issue built upon each organisation’s existing insights. for the UK Speciﬁcally, the research sought to understand:Loneliness was viewed as an issue of public 1. What the general public thinks about interest and the research found loneliness was a loneliness, including views on how serious a surprisingly common issue experienced by adults problem loneliness is, who experiences it, in the public. Yet, the public perceptions of who and the public’s role in reducing lonelinessexperiences loneliness is out of sync with the reality, with more people mistakenly perceiving it 2. The causes, experiences and impacts of as an issue faced either solely or predominately loneliness for six selected groups, each by older people. representing personal characteristics or life experiences that have the potential to trigger loneliness What causes loneliness, and how 3. How loneliness transitions from a temporary can it become chronic? situation to a chronic issue, and how to This research found that the causes of loneliness prevent this are often complex, multi-layered, and mutually 4. The support available for people experiencing reinforcing. Loneliness stems from a combination loneliness in the UK; including both formal of personal, community, and UK-wide factors services and informal community driven rather than being the product of one event or support, and any perceived gaps in provisionchange in circumstances. 5. What kind of support is needed to tackle The importance of role and identity was a loneliness, and what potential services recurring theme across our research; the lack users want. of identity or lack of clarity over assigned roles in society, for example caused by a life transition, was a key trigger for loneliness. When a person’s Who did we target for the research?identity or role was disrupted by an expected An initial literature review undertaken by the or sudden life event, this could cause an old partnership identiﬁed that loneliness is a identity to fall away and a new one with added widespread issue. There is much literature on responsibilities and burdens to appear. This loneliness in later life, but triggers for loneliness sometimes negatively affected the social across life stages is less well documented. connections of an individual – their friendships, Therefore, the research concentrated on acquaintances, family and colleagues. Our survey six target groups: young new mums (aged shows that 73% of those who stated they 18-24); individuals with mobility limitations; were always/often lonely fall within one of individuals with health issues; individuals who are the research target groups, which supports recently divorced or separated (within the last two the decision to include these groupings within the years); individuals living without children at home scope of the project. (‘empty nesters’) and retirees; and the recently bereaved (within the last six months to two years). Executive summary 6

Drivers of loneliness and barriers to connection c Social and cultural norms, work/life o ie S ty balance, stigma, digital age, insular communities, political landscape, mmun o ity C ﬁnancial hardships nec t on ion Social activities, funding cuts, C s Indi- statutory services, transport, vidual neighbourhood safety Friends and acquaintances, family, colleagues Sense of self, health, income, energy, conﬁdence, emotions, perceptions Outside of these moments where life events What is it like to be lonely in the UK? affected the way people saw themselves, participants also talked about factors related to As with other complicated and entrenched who they were as individuals that diminished social problems, loneliness impacted on people their ability to connect with others – their sense experiencing it in a number of ways that spanned of self, health, income, energy, conﬁdence, across people’s biological, psychological and emotions and changed habits. social spheres. These impacts made connecting with others even more difﬁcult. The context of one’s community also contributed to feelings of disconnection – fewer Loneliness physically impacts on the person social activities available, the disappearance experiencing it (the biological impacts); making of social spaces (community centres, city daily routines and engaging socially with people squares where people tend to congregate), more difﬁcult. Feeling more tired and experiencing difﬁculty accessing statutory services and a lowered sense of well-being was described support, inadequate transport infrastructure, and by participants experiencing loneliness. These neighbourhood safety. physical impacts were closely linked to severe psychological consequences; lower energy, Features of UK society also contributed to the feeling stressed and anxious more often, and experience of loneliness for our participants mental health problems developing or worsening. – social and cultural norms (i.e. the perceived inappropriateness of talking with strangers), the Participants experiencing loneliness also impact of modern lives on work/life balance (i.e. described how they felt and what they thought ﬂexible working hours/shift work), the perceived while experiencing loneliness (the psychological stigma of loneliness, communities becoming impacts), including lower conﬁdence and more ‘closed off’, the rise of digital and online negative emotions and beliefs. Participants engagement, ‘beneﬁts culture’ narratives and described feeling ‘alone’, ‘trapped’, ‘without whether someone was ‘deserving of support’, purpose’, ‘angry’ and ‘frustrated’. In the more and austerity measures contributing to fewer and serious cases, loneliness elicited thoughts of self- lower quality services and support available. For harm and suicide. further details on the causes of loneliness, see People also acted differently when they were Chapter 3. lonely (the social impacts). The social impacts included participants shutting themselves off from others, engaging or talking less, taking less care of their appearance/hygiene, and changing their sleeping and eating habits. Executive summary 7

Summary of biological, psychological and behavioural impacts of loneliness Biological Increased illness Worsening symptoms Low energy Stress, Anxiety Insomnia Mood disorders Hypervigilance Over/under eating IDENTITY CRISIS Low conﬁdence Disengagement Negative emotions Self-isolation thoughts and beliefs Stop Poor work/ Weak ‘coping’ skills planning hobby performance Suicidality Social Poor hygiene skills Reduced exercise Psychological Behavioural Amidst the complex and interlinked impacts What is the support landscape like of loneliness is, for many, an identity crisis. for loneliness in the UK? The combination of biological, psychological and social impacts exacerbates existing While the research suggests that there are some disconnection: how can you connect when areas of good practice, like using digital forums to you feel lost, unwell and when you’ve isolated complement other forms of support, participants yourself? Getting to the point of identity crisis was and experts were generally critical of the current particularly characteristic of the chronically lonely support landscape. and seen by these participants as a negative and For participants and experts alike, lack of challenging reality to be living. For more details on awareness about available services and support what is it like to be lonely in the UK, see Chapter 4.for people experiencing loneliness was a key barrier to tackling loneliness. Existing support was viewed as prioritising older groups and sometimes overlooking others, at times urgent, support needs. Participants also felt well-meaning, but potentially damaging, one-off interventions stemmed from some providers’ difﬁculties sustaining a service. Individuals experiencing loneliness perceived a lack of informal support, where they could access less-intensive and more casual opportunities for establishing connections within their communities. For more details on the current support landscape, see Chapter 5. Executive summary 8

What kind of support do people Building on these three models of support want and how do they want identiﬁed, and following testing and validation of a support delivered? number of support options, the following principles for effective support emerged. These principles Feelings and experiences of loneliness are highly highlight the key ‘building blocks’ from which to individualistic and often unpredictable. Experts construct successful future services and support. recommend a combination of the following three Services and support should: models of support to tackle loneliness, depending give a sense of purpose to the individual on individual circumstances:¤ be peer-led and co-designed to include Preventative support – Support that ¤ ¤ can identify those at risk, such as those people in similar circumstances experiencing a life transition, and tries to be local to individuals and easy to access ¤ prevent future loneliness was seen as being more effective in helping individuals who are ¤ be free or affordable on the ‘cusp’ or ‘cliff edge’ of loneliness (when instil a sense of identity for participants who ¤ they are nearing a life event or substantial shift are going through a period of transition in their daily routine). For participants, small provide sustained support, and clear and easy gestures (for example, saying hello, ¤ asking how their day is going) from others goals and pathways out of support such as friends, colleagues, and peers were when appropriate beneﬁt others and ‘give back’ to society, crucial for preventing loneliness.¤ which can make individuals feel ‘useful’ Responsive support – Support which ¤ be built around shared interests. responds to and is shaped by the needs of ¤ those already experiencing loneliness was Participants held a range of views as to who necessary and valuable when dealing with a could deliver support founded on these life event or disruption to routine. Responsive principles, and play a part in tackling loneliness: support needs to involve positively framed Charity and voluntary sector organisations and user-centred activities. Effective types ¤ of responsive support were seen as those – Viewed by both experts and participants that give individuals a clear purpose, help as being the most closely linked to providing them forge new relationships, develop new services to tackle loneliness historically. These interests, or rediscover old skills through organisations were seen as being able to volunteering or taking a night class. Meeting help community organisations to grow public others going through similar experiences was support and provide momentum around a also key for some participants. ‘call to action’, using their brand credibility from working at grass roots level to build Restorative support – Support which can ¤ support for campaigning. help those who are at risk of slipping into Individuals in communities – Experts chronic loneliness (i.e. loneliness which is ¤ experienced over a longer period) to re-believe that building resilience in communities engage was most successfully implemented so individuals can reduce the likelihood when an individual is trying to reconnect of loneliness hinges on the inclusion of with their community but may need some community members in the design of future added support to achieve this. It is therefore services, ensuring services are tailored, important that people are supported to rebuild relevant and ﬁt for local need. Peer-led their conﬁdence and use this newfound support was identiﬁed as necessary, self-assurance to forge new connections.encouraging individuals to connect with others who had been in similar circumstances but had managed to overcome them. Executive summary 9

Community groups have a part to play in Conclusions providing sought-after informal support, e.g. providing community facilities where The following conclusions emerged from like-minded individuals can meet and the research: promoting small public gestures within local The public viewed loneliness as an important ¤ communities, for example stopping for a short issue, and the research found loneliness is a chat with neighbours or asking family/friends common experience in the UK. Yet, the public how they are doing. perceptions of who experiences loneliness Trusted community advisors – Experts was out of sync with the reality, with more ¤ people mistakenly perceiving it as an issue and participants saw trusted people in communities, such as GPs, housing faced either solely or predominately by associations and local authorities, as being older people. well-placed to signpost to social support and As well as age which is well documented in ¤ activities, helping individuals to make the ﬁrst the literature as a risk factor for loneliness, the step to accessing services and support.research conﬁrmed that people experiencing Businesses – Neither participants nor life events which can disrupt existing ¤ connections were at risk. This will enable experts saw local businesses as traditionally providing community services and support preventative and early reactive support to be to tackle loneliness, but did identify them developed to tackle loneliness around these as being well-placed to host and deliver life events. activities in the community, supporting people People experiencing loneliness can view ¤ to connect. The impact of funding cuts to connection as a daunting experience, and local services led experts to view businesses can begin to question their own self-worth. as having a role to play in funding initiatives Chronic loneliness seems to be most likely in partnership with service providers. Local within this complex context of new emerging businesses were also viewed by participants self-identity, which can lead to barriers to as ideal community ‘hot spots’ for promoting re-connection and potentially even reduced community events and support activities.self-worth. At worst, some people even Employers – Experts viewed employers, became convinced they had nothing to offer ¤ and described having suicidal thoughts. though not automatically associated with supporting loneliness, as well-placed Loneliness can have serious consequences ¤ to connect their employees with social for individuals (for example, physical, networks either within the business or in psychological and social impacts). Our their communities. Experts recognised that research showed that some of these employers have the unique potential to deliver consequences can negatively impact on targeted programmes such as mentoring communities (for example, people withdraw (i.e. for those going into retirement) and one-from communities, contributing and to-one counselling (i.e. following giving birth engaging less) and society (for example, or experiencing loss). reduced productivity at work, increased sick days). Loneliness can also have serious consequences for isolated individuals in terms of increased morbidity, lower life satisfaction and a predisposition towards low mental and physical health. Executive summary 10

There is low awareness of the support People experiencing loneliness prefer face- ¤ ¤ available to help people connect and to to-face services and support, including a tackle loneliness. The current landscape mix of more intense ‘one-on-one services’ was not seen as ﬁt for purpose, with support and less formal ‘interest-led peer-to-peer viewed as piecemeal and fragmented; interaction.’ While digital services and support existing support was viewed as prioritising were seen as important, participants viewed older populations, a lack of local support these services as supplementing face-to-face created challenges for accessibility, one-support or helping an individual organise face- off/short-term interventions were seen as to-face connection. problematic, and there was a need for Our survey showed that the public believed informal support services.¤ that sometimes it was ‘small gestures’ which Those who already ﬁnd engaging in social can make the most difference, and this was ¤ relationships difﬁcult or challenging due to echoed by our experts and the people we other factors are more likely to be at risk of spoke to experiencing loneliness. There is experiencing loneliness. Other life stresses a need to seize the momentum expressed such as physical isolation or mental health by the general public currently towards issues can create increased barriers for small acts which can be undertaken on an people who in turn become more at risk individual level within local communities to of transitioning to chronic loneliness.improve social cohesion and connectedness The causes of loneliness are often complex, in communities. ¤ multi-layered and reinforcing. Loneliness Experts, the public, and individuals ¤ is caused by a combination of personal, experiencing loneliness are all accepting of community and broader society issues. the multiple roles the different players can People experiencing loneliness need different take in tackling loneliness by delivering both types of support depending on their individual formal and informal support. Consolidating circumstances (using preventative, responsive, and building on experience across charities and restorative models of support). To prevent and voluntary sector organisations, individuals and tackle loneliness, different stages of in communities, Government, businesses, need require a combination of formats and and employers could achieve more with less programmes (both formal and informal) as resource in providing sustainable, tailored individuals move along the spectrum from services and support to those experiencing temporary to chronic circumstances.loneliness. Loneliness therefore requires a society-wide response where the strengths of multiple partners are utilised. Executive summary 11

1. Background, aims and approach The role connections play in the At the outset, it is key to stress that as the experience of loneliness existing body of literature in the area suggests, loneliness is not synonymous with being Our social connections are fundamental to our alone, nor does being in the presence of daily experience, to the ways that we make others automatically protect individuals from meaning in our lives and to quality of life and life experiencing feelings of loneliness. Rather, satisfaction. At best, being socially connected loneliness is best described as the distressing – and having roles to play with the friends, feeling that individuals experience when a colleagues, family members, neighbours, and person’s network of social relationships with even casual acquaintances in our lives – others is less satisfying than they desire in either provides a sense of purpose, comradery, 8 quality or quantity. belonging and identity. Conversely, lacking meaningful and satisfying social connections has surprisingly powerful The need to learn more negative consequences across the mental and The partnership began by conducting a literature physical health spectrum. When we are lonely, review on loneliness and social isolation to we are less resistant to external stressors, our highlight some of the key factors or risks of bodies ﬁnd it harder to repair themselves1, and loneliness, and identify groups of people who 2 life satisfaction is likely to be low. Cognitive might beneﬁt from interventions. The evidence 3 4 functioning declines , and the risk of dementia conﬁrmed the importance of loneliness as an 5 and depression increases. The evidence issue and the urgency for tackling it, yet, there suggests that feeling lonely or socially excluded remained gaps in the literature: loneliness and can have similar damaging consequences to isolation can have serious consequences, but 6 an individual’s health as obesity or smoking , there was a lack of rigorous, ﬁrst hand evidence with longitudinal studies indicating increased from those experiencing loneliness based on risk of high blood pressure and the potential personal characteristics and life experiences, for heart-related diseases to develop. Perhaps and insight into the existing landscape of support most worryingly, the longitudinal evidence also available. Also unclear was what the impact indicates that loneliness can predict increased looks and feels like for people living with social 7 morbidity and mortality. disconnection. There was little substantive evidence that systematically explored what was needed to make positive change from the perspective of the people most in need. And 1 Hawley, L.C and Cacioppo J.T, (2010) “Loneliness Matters: there was a lack of evidence available from A Theoretical and Empirical Review of Consequences and Mechanisms”, Annals of Behavioural Medicine, 40, 218-27 people who experienced loneliness about what 2 Thomas, M, (2015) “New Perspectives on Loneliness: Developing might help to prevent loneliness from occurring Theory, Methodology and Evidence for Practice”, Seminar Series, in the ﬁrst place, and how to prevent temporary Campaign to End Loneliness 3 Steptoe, A. et al, (2013) “Social Isolation, Loneliness and All–cause situations from transitioning into chronic states. Mortality in Older Men and Women”, Proceedings of the National Academy of Sciences of the United States of America, 110, 5797-5801To ensure that its own future activity was grounded 4 Holwerda, J. et al, (2012) “Feelings of Loneliness, but not social in rigorous, robust, and participatory evidence, the isolation predict dementia onset: results from the Amsterdam Study of the Elderly, Journal of Neurology, Neurosurgery and Psychiatry, partnership commissioned substantive research 85, 135-142 about loneliness in the UK. Conducted by Kantar 5 Hawley, L.C and Cacioppo J.T, (2010) “Loneliness Matters: A Theoretical and Empirical Review of Consequences and 9 Public , a specialist independent social research Mechanisms”, Annals of Behavioural Medicine, 40, 218-27 6 Holt-Lundstad, J, Smith T.B and Layton, J.B (2010) Social relationships and mortality risk: a meta-analytic review, PLo Med. doi 10.1371/journal.pmed.1000316 7 Perlman, D and Peplau, L.A, “Loneliness Research: A Survey 8 Bernard, S, (2013)”Loneliness and Social Isolation Among Older of Empirical Findings” (1974) in Peplau, L.A & Goldston, S (Eds), People in North Yorkshire”, WP2565,1-51 Social Policy Research “Preventing the harmful consequences of severe and persistent Unit, University of York, York loneliness”, 13-46 Washington DC: U.S. Government Printing Ofﬁce9 http://www.kantar.com/public/ Background, aims and approach 12

agency, the research reported here represents a Focusing on six target groups large-scale exploration of public experiences and needs around loneliness focusing on potential The literature review undertaken by the partnership triggers across life stages – via a multi-phased, identiﬁed that loneliness is a widespread issue. mixed method research approach (see the There is much literature on loneliness in later life, Executive summary for an overview, and the but triggers for loneliness across life stages is Annex for further details). This report presents the less well documented. Therefore, the research combined insight from qualitative research – with concentrated on six groups: 45 experts, and 115 members of the public who young new mums (aged 18 – 24) ¤ were experiencing loneliness – and a nationally individuals with mobility limitations representative quantitative survey with the general ¤ individuals with health issues public (2,523 respondents).¤ individuals recently divorced or separated ¤ Aims of the research (within the last two years) individuals living without children at home This research aimed to provide a rigorous ¤ (‘empty nesters’) and retirees evidence base for the partnership – providing individuals recently bereaved (within the last up-to-date evidence about how the UK public ¤ experience loneliness, and public and stakeholder six months to two years). priorities for action. Speciﬁcally, the research These six groups met several of the following aimed to understand: criteria for inclusion in the research: 1. What the general public thinks about 1. the literature review demonstrated a gap in loneliness, including views on how serious understanding of the needs and experiences a problem loneliness is, who experiences it, of the people in the groups; and the public’s role in reducing loneliness; 2. the groups were thought to be under-served 2. The causes, experiences and impacts of by existing services and support based on loneliness – for six selected groups that the literature review or on British Red Cross’ each represent personal characteristics or experience from the delivery of its services; and life experiences that have the potential to trigger loneliness; 3. occurred in high enough numbers in the general public to make research feasible – 3. How loneliness transitions from a temporary i.e. the group could be identiﬁed and recruited situation to a chronic issue – and how to to the research. prevent this; Full sampling details, as well as the recruitment 4. The support available for people experiencing screeners used to deﬁne each group, are loneliness in the UK, including both formal included in the Annex. services and informal community driven support, and any perceived gaps in provision; and 5. What kind of support is needed to tackle loneliness, and what potential service users want. Background, aims and approach 13

Research approach Work was conducted iteratively across four phases, with each phase ﬂexibly adapting to emerging insight from the phase before. Figure 1 summarises the research approach. For a detailed discussion of the approach to this research please see the Annex. Figure 1. Summary of the research approach Phase 1: Phase 2: Phase 3: Phase 4: Mapping the Contexts Brainstorming Testing and landscape and needs solutions validating 27 telephone Primary research Online workshops Online forum interviews with with six target and depths - research - expert witnessesgroups - reaching reaching 21 reaching 24 people Mix of service 115 people expert witnesses experiencing providers and BRC experiencing To share ﬁndings loneliness and Co-op loneliness from the public To test and validate membership Mix of depth research and support solutions and partners interviews, small brainstorm Nat-rep survey of group sessions and support solutions 2,523 UK adults online forums What could work, aged 16+ who could Survey also made provide it? available to Co-op members 45 experts all together - 27 in Phase 1 and 18 new experts in Phase 3. Analysis Analysis of the general public survey data was conducted primarily at a total sample level, but the Our analytical approach for the qualitative research large, robust sample size allowed for analysis by was iterative and inductive – building upwards from demographic subgroups, and of target groups of the views of participants – incorporating elements interest, where relevant. of ‘grounded theory’ analysis i.e. the thematic review and continual analysis of hypotheses from For a detailed discussion of the approach to participants’ transcriptions and dialogue. Analysis the analysis of the data please see the began informally during ﬁeldwork itself; as our supporting Annex. research team worked closely together throughout the ﬁeldwork period, feeding back headline ﬁndings to each other as discussions were conducted, and continually updating our approach and thinking as we amassed data. The data was analysed to search for themes and trends. Background, aims and approach 14

How to read this report It is important to emphasise that data and ﬁndings A wide variety of participant contexts were drawn from the qualitative elements of this captured in this research – with differences in research are not intended to be representative or lifestyle, life-stages, social contexts and needs statistically generalisable to the wider population. providing vibrant and often emotional research sessions. However, we also observed points of Our aim has been to: striking similarity: participants across workshops, 1. provide an overview of the range of potential in different locations, and from different walks triggers across life stages that may be risk of life, noted many of the same key drivers of factors for experiencing loneliness loneliness; they raised similar pathways towards 2. document the range of needs and hopes for loneliness; and they identiﬁed some of the same support from those experiencing loneliness that key needs, and principles for how to meet emerge as a result those. In the spirit of representing these points of commonality and shared vision, our reporting 3. give some early indication about how needs has not taken the path of drawing the reader’s differ for some speciﬁc groups of interest.attention to every point of debate or difference Likewise, whilst we have included voices from of opinion. We ask you to take for granted that across the UK – from all four nations, and from every participant added their own nuance to the more urban and more rural areas – we have collective view that you see represented at many done so for purposes of representation only. This points in reporting. At the same time, where views research did not look to capture the views and have obviously diverged and split – for example, experiences of people who do not experience according to target group, or stage of experience loneliness and therefore we are unable to say of loneliness – we have provided indication of this. why individuals who may seem to be at risk The views of a range of people were captured in of loneliness are not. There is a potential role the research and referred to throughout this report: for future research to understand geographic Experts – refers to the experts working in differences in need and the factors that protect ¤ individuals from experiencing loneliness in the ﬁeld of loneliness, including providers, more depth. academics and policy makers Public – refers to the views of individuals ¤ captured in the general public survey Participants – refers to the people ¤ experiencing loneliness captured in the qualitative research. Background, aims and approach 15

2. Loneliness is an important issue for the UK Loneliness is an issue of the vast majority of respondents (88%) indicated public interest that they consider it a serious issue, with 32% responding the issue of loneliness is very serious When this research began it was an open question (Figure 2, below). Loneliness also seems to be an as to whether the general public considers issue that people are aware of as a topic of public loneliness to be an important issue, and whether discussion, with just over half (51%) agreeing they it was something that people are aware of and had recently ‘heard a lot about it as a problem’ thinking about. Despite the compelling evidence (16% agreed strongly). from the partnership’s literature review about the negative impacts that loneliness can have on those Very similar levels of awareness were recorded that experience it, it was uncertain whether or not for these two questions across demographics the importance of the issue was recognised by the (including by age) and across different nations and public at large. regions, but there was a signiﬁcant correlation between the two measures, with 72% of those Findings from our general public survey clearly who think loneliness is very serious agreeing they demonstrate loneliness is widely seen as an had heard a lot about it, compared to 17% of important issue. When asked how serious a those who did not think it is serious. problem they think loneliness is in the UK today, Figure 2. Views on seriousness of loneliness and awareness of loneliness as an issue How serious a problem do you think I have heard a lot about loneliness is in the UK today? loneliness as a problem recently 7 7 16 6 32 17 88 51 Agree strongly (% serious) Very serious (% agree) Agree slightly 35 Quite serious 25 Neither 56 Not serious Disagree slightly Don't know Disagree strongly Source Q2: How serious a problem do you think loneliness is in the UK today? Source Q4_1: I have heard a lot about loneliness as a problem recently Base: All UK adults aged 16+ (2,523) Loneliness is an important issue for the UK 16

Loneliness is a common issue rather that those older people surveyed reported in the UK comparatively lower rates of feeling “always or often” lonely. Whilst the research does not Findings from the general public survey also categorically evidence the reasons for this lower indicate that loneliness is something that most reported prevalence, it does suggest that older people in the public have experienced to some age groups were signiﬁcantly more likely to know degree, and that many people in the public are where to turn for support if they were experiencing dealing with loneliness at a level that may have loneliness and our expert witnesses also noted some negative impact on their life experience. that current loneliness services tended to focus on Around half of UK adults surveyed feel lonely older age groups. ‘sometimes’ or more often; it is an experience that many people can relate to. More worryingly, 18% Self-reported loneliness was higher than average feel lonely ‘always’ or ‘often’. Whilst the survey did (18% among the general population) for 5 of our 6 not capture any measure of perceived harm or target groups (it should be noted that respondents impairment – and is certainly not intended to serve could be in more than one of these groups), and as a ‘diagnosis’ of loneliness – this represents a in fact 73% of those who claimed to be ‘always’ surprising degree of loneliness in the UK public. or ‘often’ lonely belonged to one of the research target groups. Percentages of people ‘always’ Though some groups, such as 16-24 year olds, or ‘often’ lonely were highest for those who were those living on their own, and those in the DE recently divorced or separated (33%); had long- 10 social grades were more likely to express feelings term physical / mental health conditions (32%); of loneliness, this was least evident among those were people with mobility issues (30%); people aged 55 and over (and within this slightly, but not with limited access to transport (29%); people signiﬁcantly, lower levels were recorded by those experiencing bereavement in the last two years aged 70 and over – 6% compared to 11% among 112 (19%); and parents of young children (32%). those aged 55-69). This does not suggest that those aged 55 and over are less lonely but Whilst there was still evidence of self-reported loneliness among those aged 55 and over, among those in this group who are either retired, or do not 10 Social grading is a standard classiﬁcation based on the occupation of the chief income earner in a household. Those in the DE social grades are generally working in semi-skilled or unskilled 112Base sizes for this group were very small given low incidence in manual occupations, retired, or entirely dependent on the general population; further work would need to be conducted to state beneﬁts. conﬁrm prevalence of loneliness. Figure 3. Prevalence of loneliness in the UK general public Higher % always/often among: 1 4 16-24 – 32% 20 14 Children in household – 22% DE social grade* – 24% People living on own – 26% 18 Always Often Lower % always/often among: (% always/often) 55+ – 10% Sometimes 28 34 Rarely No difference in % always/often by: Never Gender, urban/rural, region Don't know Source Q1: How often do you feel lonely, if at all. Base: All UK adults aged 16+ (2,523). Loneliness is an important issue for the UK 17

have children in the home, levels of self-reported to think of ‘older people’ being lonely – with almost loneliness (9% and 10% respectively) were below a third (30%) of respondents picking this as the average compared to the general population (18%). ‘most likely group to be lonely’, and 70% thinking Furthermore, these comparatively lower levels of that older people were in the ‘top 3’ audiences likely self-reported loneliness are in contrast to experience loneliness. to the higher levels recorded among younger We of course do not know from the general public age groups (32%). survey what drives this public perception of very Interestingly, the public perception of who is most high levels of loneliness in older age, but the likely to experience loneliness is out of sync with the mismatch highlighted by the research suggests that reality. When asked who they thought was most there is a need to broaden the public’s perception likely to be experiencing loneliness, the general of who is at risk of loneliness beyond the older public survey indicates that people are most likely age groups. Figure 4. Frequency of self-reported loneliness by target group Research target groups % of general pop% always/often lonely 64 20 vs. 18% Any target group (total) vs. 18% among general among general population and Aged 55+ and retired23 9 population and Both Both 13% among 13% among = 15% = 8%those not in Aged 55+ with no children at home2210 those not in these groups these groups Long-term physical/mental health conditions/illnesses2232 Experienced bereavement in last 2 years1919 Health issues impacting ability to get around1330NOTE: Small base of 27 – Have limited access to transport 1129more work needed to confirm Aged 35+ divorced/separated in last 12 months333prevalance among Aged under 25 and parent of a young child132this group Source Q8: Which of the following, if any, apply to you? Source Q1: How often do you feel lonely, if at all? Base: All in groups of interest. Loneliness is an important issue for the UK 18

Figure 5. General public perceptions on who is most likely to experience loneliness Likelihood of experiencing loneliness % Older people 30 13 26 70 People living on their own1814 38 70 People bereaved in the last two years111438 62 People experiencing health or mobility issues9113858 People experiencing divorce or separation254048 Retired people6 6 36 48 Recently moved to a different area244046 Those who care for someone4 833 45 Those not in work/unemployed3432 39 Those whose children have left home1 23538 Young new mums24 31 37 People unable to easily access transport133236 Young people2221 25 People in mid life111718 Most likely Second most likely Those in work11 1213 Also likely Source Q3a/b/c: Which groups do you think are most likely to experience loneliness? Base: All UK adults aged 16+ (2,523) Loneliness is an important issue for the UK 19

3. What causes loneliness, and how can it become chronic? Transitional life events as triggers support and enjoyment. The social connections for loneliness embedded in this daily pattern also enabled him to enact important identity roles – for example, This research has evidenced life transitions – and as a father, an income earner, a supportive particularly role transition – as disruptive moments colleague, a good employee, and so on. that increase the risk of loneliness amongst These roles, implicitly or explicitly, formed an individuals. When existing social connections enormous part of how he saw himself, his self- are challenged or severed – for example through worth and his life satisfaction. These small, daily a break-up of a relationship, emergence of a interactions and gestures from others were serious health issue, or retirement – this can surprisingly, of great help and worth to those reduce opportunities for ‘easy’ connection and experiencing loneliness. also threaten self-identity. A range of barriers to connection – which vary from person to person Versions of this narrative were shared by and can occur across individual, community participants from other target groups as well. and social levels – can then additionally weaken When they talked about what their lives were like people’s ability to make or sustain connections. ‘pre-loneliness,’ participants shared the ways Once habits of disconnection have set in, they their social connections shaped their days: a become hard to break. Loneliness itself can wife who, before her spouse died, valued the become a barrier to connection. People who daily, predictable interaction with her partner over are experiencing loneliness can begin to view shared meals; a parent who, when her children connection as a vulnerable and anxiety-ridden were younger, felt connected with others through experience, or even begin to question their own encounters with the teachers, coaches and self-worth. Chronic loneliness seems to be most parents of the friends of her children. likely within this complex context of threatened This pattern was repeated over and over in our self-identity, barriers to connection and potentially discussions with participants. When existing even reduced self-worth. At worst, some people social ties and identities were threatened or are convinced they have nothing to offer.severed, participants needed to make do A key theme emerging from across the target without many of the predictable, and thus ‘easy,’ groups of people experiencing loneliness was the moments of interaction that they had taken for way in which loneliness was often felt at a time granted. At the same time, participants told us, a when participants were experiencing a transition vacuum in positive social connections began to in terms of their social connections and social threaten how they deﬁned themselves. As we will identities – retirement, motherhood, bereavement explore, participants even told us that at worst, etc. These transitions could either be sudden they began to question who they were, what their (e.g. the loss of a partner) or occur over time value was, and what they had to offer to those (e.g. the worsening of a health condition).they come in contact with. For example, when we asked one participant what life looked like before his retirement – for him, the advent of loneliness – he spoke about the many interactions that used to form an average day. His daily connections had a pattern: discussions and banter with colleagues and people on his route to work; a mild argument with his wife; a smile shared with a fellow commuter. This daily pattern offered opportunities for positive interaction, discussion and debate, social What causes loneliness, and how can it become chronic? 20

12 Complex, interrelated drivers loneliness, an ecological model of health has of loneliness been adapted and tailored to help organise and illustrate the interplay of these drivers (See Figure Of course, not everyone that experiences a 6, below). Many people identiﬁed barriers to transitional life event becomes chronically lonely connection from individual-level characteristics – and not everyone who experiences loneliness or circumstances (e.g. health, ﬁnance, anxiety has undergone this kind of transition. Participants and other mental health difﬁculties, etc). For also raised a wide range of causes of loneliness some, it was severed connections (as discussed – causes which were typically complex, multi- above) that seemed the most pressing cause faceted, and reinforcing. of disconnection. Others raised barriers at a Each participant raised different barriers to community level, noting issues like service or connection, or causes of disconnection, and infrastructure gaps that made it harder for them what seemed to be most signiﬁcant in their to ﬁnd positive, effective, and sustained social path to loneliness varied enormously. Often, support. And some participants also identiﬁed barriers were interconnected: for example, a drivers of loneliness at a social level: in terms of participant with mobility problems might initially shared social norms about how we connect with have become disconnected from a favourite each other, the shape of modern lifestyles and social activity because it became difﬁcult to travel habits, the current funding environment, and so on. to participate; at the same time, fatigue or pain We saw a complex interplay across these drivers made engaging in new activities difﬁcult; and (individual, community, society level), and across concerns or experiences around stigma made the factors within each driver. Identifying the direction participant more wary about connection full stop. of causality was not possible, given the scope and As a way of summarising and making sense of scale of the research. these varied and often complex drivers of 12 Sallis, J. F., Cervero, R. B., Ascher, W., Henderson, K. A., Kraft, M. K., and Kerr, J. (2006) “An Ecological Approach to Creating More Physically Active Communities”, Annual Review of Public Health, 27, 297–322 Figure 6. Other drivers of loneliness and barriers to connection c Social and cultural norms, work/life o ie t S y balance, stigma, digital age, insular communities, political landscape, mmun o ity C ﬁnancial hardships nec t on ion Social activities, funding cuts, C s Indi- statutory services, transport, vidual neighbourhood safety Friends and acquaintances, family, colleagues Sense of self, health, income, energy, conﬁdence, emotions, perceptions What causes loneliness, and how can it become chronic? 21

Individual-level drivers of lonelinessHealth – Acute or chronic health concerns presented many barriers for individuals to engage Outside of the disruptive life events, participants in social connection and maintain satisfying social raised a range of challenges that started with bonds. For example, participants with health them and decreased their ability to connect with conditions noted that managing their health others – the individual-level drivers of loneliness. issues took up time and energy (e.g. getting to Figure 7 summarises these challenges.and through medical appointments, and coping with pain and discomfort). When it then came to Figure 7. Individual-level drivers of lonelinessplanning for or engaging in social activities and other enjoyment, participants found they had little time and energy left to offer. Often, links Sense with existing social connection points were also of self severed because participants found it difﬁcult or impossible to engage with hobbies they once Changed Health enjoyed – for example, retreating from sports and habits exercise groups once symptoms became too severe to participate. Indi- “[I’m] unable to use my legs in the same way vidual as healthy people…I often need to sit down Emotions Income or go home before other people do.” (Mobility, Female, London, 35-54) Income – Our research included individuals with Conﬁdence Energy a wide range of ﬁnancial circumstances, including people experiencing poverty or otherwise affected by ﬁnancial instability. Echoing the ﬁndings from the general public survey, where 24% of those surveyed noted they were often lonely as Sense of self – In the absence of positive social a result of their economic status, participants connections, confusion about who they were and experiencing loneliness said they could not afford what they had to offer could make it difﬁcult to to connect even if they had the opportunity. In engage with others. Without a sense of where particular, they told us that ongoing ﬁnancial participants were ‘starting from’ (‘I am Jim, instability makes it hard to rationalise spending and I am a postman’), connecting with others money on social or non-urgent purchases. The was more difﬁcult. For example, participants cost of typical informal activities a participant with health issues noted that as their lives, might do with someone – eating a meal out, abilities, and habits had changed, they found it going for drinks or watching a ﬁlm – were not increasingly difﬁcult to reconcile ‘who I am’ with always ﬁnancially feasible. More formal activities ‘who I used to be’. This identity transition was for establishing or strengthening connections very unsettling, making it difﬁcult to connect – exercise classes, cookery courses, further whilst participants were getting used to their education and vocational studies – were often new way of living. also out of reach due to costs. Even for those “I don’t have a place where this new character who described themselves as ‘ﬁnancially alright’, the cost of getting to and paying for activities and identity its...I’m living with and in the or services and support was sometimes seen shadow of the ghosts of my past.” as prohibitive, or, at least, as presenting a barrier (Health, Male, Aberystwyth, 55-74)to engagement. What causes loneliness, and how can it become chronic? 22

“I thought I needed to catch up [with Emotions – Some participants, particularly those with health or mobility issues, and young technology] so that I could be on the same new mums, avoided going out or engaging with page…but the cost would be £40 a week.” friends and family as regularly as they would (Retired/empty nester, Male, Oldham, 55–74) have liked due to concerns about being a burden for existing social connections. The ‘burden Energy – Sometimes, participants said that they narrative’ was a powerful one, with participants had difﬁculty prioritising social connection against repeatedly rationalising their experience of competing demands for their energy. Taking the loneliness as a result of them not wanting to time to connect in a meaningful way sometimes felt ‘bother’, ‘unduly burden’ or ‘inconvenience’ too hard once participants had met the needs of people in their lives. work, errands, childcare and care for partners and “I do not want to inconvenience others others. In an ever moving and fast paced modern because they have to push my wheelchair.” world, establishing or maintaining connections was (Mobility, Female, London, 55-74) seen to not make the priorities cut. “There’s no ‘me space’. [I] always feel tired and drained, especially with the children; Changed habits – As discussed in the previous section, transitional moments in participants’ lives juggling work and hobbies with their needs, disrupted some of their habits and hence took homework and activities.” (Young new mum, away their opportunities to connect: the divorcee London, 18-24) no longer going on regular social events with his or her partner; the parent no longer going to the Conﬁdence – Participants frequently cited lack academic, sporting or social events for their child of conﬁdence as a barrier to social connection. who has moved out of the home; the bereaved Lack of conﬁdence, either in general or that family member no longer attending family has come about from life events such as gatherings that their departed family member divorce or separation, or retirement, fuelled a used to co-ordinate. Participants also developed negative internal dialogue when they considered habits of being alone that led them away from engaging or actually engaged with others opportunities to engage. socially. Participants said that at worst, they were “When I fell out of work that was a low point. distracted when trying to talk to others by worries Not because I like working because I don’t, about self-worth; others said that once ‘out of but the fact that I miss the lads and the laughs practice’ they thought they engaged in ways that and jokes we used to play on each other... other people might feel strange, which worried It felt like a loss.” them and made connecting feel harder. Without (Mobility, Male, London, 55-74) conﬁdence to engage with others and to take up opportunities for connection, loneliness was more likely to take root. “As people started to arrive all smiling and happy to be helping with fundraising, I myself became more anxious and feeling strangely that what I was doing was just not good enough.” (Health, Female, Oldham, 55-74) What causes loneliness, and how can it become chronic? 23

There's no 'me space'. [I] always feel tired and drained, especially with the children. (Young new mum, London, 18-24) Photo: © iStock. What causes loneliness, and how can it become chronic? 24

Community-level drivers of loneliness Social spaces – Participants felt like some The local communities of participants were seen traditional spaces for people to come together, as having contributed additional challenges that such as leisure centres, were disappearing and increased risk of disconnection for participants. there were less obvious communal spaces Figure 8 summarises these challenges. for connecting with others in modern society. The loss of small and simple yet potentially powerful means of connecting regularly meant Figure 8. Community-level drivers of lonelinessthat some participants who were experiencing disconnection lost even quick and ﬂeeting regular exchanges with other people. Social “The social places in my area – clubs, halls, activities snooker, classes – have all dwindled away over the last few years which make my mmun i Co ty options to mix with people harder.” Neighbour- (Health, Male, London, 35-54) Social hood spaces safety Transport – Participants saw that infrequent, inaccessible or even non-existent transport infrastructure in communities dissuaded them from taking up opportunities to engage. Buses ran infrequently and did not allow for travel late at Statutory night, train stations were difﬁcult to get to, taxis services Transport and the cost of car parking were too expensive. Lack of transport options in general speciﬁcally the suitability and availability of transport, was particularly problematic in more rural areas. Yet Social activities – A lack of activities available even in well-connected cities, transport was a in the community, or feeling that those available barrier to engagement for some. are not relevant, was a key community-level “[It] takes up so much time and costs so contributor to loneliness. Participants felt it much and I also have to plan ahead to was difﬁcult to connect without opportunities make sure I get good deals on train price. available that are of interest, with others they can So, therefore, I don’t always visit or see relate to, and that are easy to access. For those friends as much as I would like.” individuals with the conﬁdence and willingness to reach out for support in connecting, the lack (Mobility, Female, Bristol, 55-74) of social activities in their area was seen as an obstacle difﬁcult or impossible to overcome. The Statutory services – Difﬁculty accessing kinds of social activities that were most desired services for personal needs other than loneliness, by participants to help tackle the loneliness they at the point of needing it, was seen by some were experiencing are discussed in Chapter 6.to have exacerbated their existing needs, and “I don’t use a lot of services – they do not compounded feelings of loneliness. In particular, a cater to my needs or lifestyle. A wider variety lack of holistic support for medical concerns meant should be available; this would allow people that sometimes the symptoms of issues were to meet others in the same situation or with temporarily addressed rather than the root causes. the same interests and problems.” For example, a participant experienced insomnia (Young new mum, Belfast, 18-24) after her divorce and her GP prescribed What causes loneliness, and how can it become chronic? 25

sleeping medication; she explained what she Societal drivers of loneliness had needed was signposting to counselling to rebuild her conﬁdence and get support for her Participants commonly raised concerns about anxiety about the future without a partner. As a wider societal contributors to loneliness. How we result the disconnection the participant faced was engage in public dialogue and how we structure unnecessarily prolonged. Others found that they society in the UK was felt to contribute to the did not yet meet the threshold criteria for overall causes of loneliness. Figure 9, below accessing services. summarises these challenges. “I went for the [psychodynamic] assessment Figure 9. Societal drivers of loneliness and the woman told me basically that because of the inancial [public spending] cuts, they’re Social only catering for people who are on the brink & cultural of suicide more or less…I couldn’t get it.” norms (Health, Female, London, 55-74) Financial Work/life hardships balance Neighbourhood safety – Living in a neighbourhood that was felt to be unsafe or uninviting was another barrier for some participants to go out and engage with their Political community. For some this was a sense of landscape Stigma unfriendly neighbours while others noted visible signs that raised safety concerns for them; e.g. street lamps often broken, people selling drugs, people shouting and intimidating others, Closed Digital and so on. communities age “I don’t think anything can make me feel more connected [to my neighbourhood], as I don’t like the sort of people who live here…this is Social and cultural norms – Participants a rough area.” sometimes raised that implicit social ‘rules’ about (Young new mum, London, 18-24) how people connect to each other, and with who, served as barriers to making new connections. For example, participants felt that there were social norms that ‘older people can’t spend time with young people’, and eating out on your own is ‘unacceptable’. Across groups, participants felt it had become less acceptable to chat with and start conversation with strangers; that it had become less socially acceptable to engage in social connection without a ‘reason’. Gender norms, which participants felt dictated what men and women can do and say with each other, were also seen as a powerful driver of loneliness for some participants. For example, some female divorced participants felt it would raise questions if they tried to form friendship connections with married men. Some What causes loneliness, and how can it become chronic? 26

men felt that they had the opportunity for male “The fear is that people will tell you just to pull connection, but that social norms around male yourself together. Also there are people in the emotional expression limited the depth of those world with really serious issues and isolation relationships – that they may feel lonely even doesn’t really compare!” when ‘connected’. These gender norms, for (Bereaved, Female, Glasgow, 18-34) some, were also contributors to how difﬁcult they found it to process negative emotions or Some groups also felt that stigma around situations, including loneliness.particular life experiences or issues acted as a “It used to be indoctrinated into us boys barrier to people reaching out to connect with that when we were faced with adversity others. This was particularly the case for young or hardship we should tough it out or new mums and individuals with health and ‘pull our socks up’. It was somehow a mobility issues. These participants felt society’s terrible weakness to admit things had lack of understanding about their circumstances got on top of us.” undermined their conﬁdence, raised their anxiety levels and ultimately stopped them from engaging (Mobility, Male, London, 35-54)with others in the way they would prefer. For example, young new mums noted that they Modern lives – Participants also felt that wider sometimes felt judged by other mums, or other trends in modern living were contributing to members of their community, and people with social disconnection and making loneliness health issues had experiences of being, or feeling more common. For example, they felt people that they were, negatively stereotyped as less were working harder and longer hours, living in able, or even ‘lazy’. a more antisocial way; e.g. seeing people less, “It’s still looked down upon young mums always in a hurry, and with less time for social most of the time I feel judged and made feel connection. There was a sense that people are like a less than mum just because of my age more transient, meaning that community ties can often patronised by other older mums. This be harder to establish and maintain.makes it hard to make friends as people my “Work takes a lot of my time, usually a age have diferent priorities therefore there is ten-hour day and certainly during the week, not a lot in common.” the last thing I want to do is be painting (Young new mum, Belfast, 18-24) the town red.” (Divorced/separated, Female, Glasgow, 55-74)Digital age – The rise of digital and online engagement meant that participants felt there Stigma – Participants said that they felt there were fewer opportunities to connect in person. was stigma around being lonely; they did not The rise in connections occurring over social feel that loneliness would be recognised as media and online contributed to feelings of a ‘real’ issue and something that people can isolation and loneliness as this change in legitimately ask for help. The perception that connections was seen as less ‘deep and there are other social issues more ‘important’ or meaningful’ than face-to-face encounters. that are ‘more warranting of attention’ compared “I like to meet people in a social environment, to loneliness prevented some participants from have that interaction with an actual person seeking support before a temporary feeling of and not a screen.” loneliness became more chronic. This narrative (Mobility, Female, London, 18-34) was reminiscent of the trajectory of mental health campaigning – of the need to establish mental health as a ‘legitimate’ issue, as part of Closed communities – Some participants said normalising social conversation about it and that they felt actively unwelcome in their own ensuring adequate support. communities, and that this had contributed to What causes loneliness, and how can it become chronic? 27

their loneliness. For example, some participants terms of reduced support for urgent issues in noted that they did not know their neighbours, their own lives (e.g. mental and physical health and did know how to or feel encouraged to make issues, or mobility problems.) Not having support connections locally. This differed from stigma, for these made life, and connecting with others, discussed above, because it was located at the that much more difﬁcult. community level, not wider society. For people “But there again, it’s all down to money. with health and mobility issues, facing physical The way the country is at the moment access difﬁculties as well as societal ignorance things get cut. And I just think this [support to their circumstances prevented them from for people experiencing loneliness] will be connecting with their communities more regularly. one thing to get cuts.” Young new mums struggled to connect with (Mobility, Male, Oldham, 55-74) older mums, worrying that they had nothing in common or that they would be judged for their circumstances. Transitioning to chronic loneliness “I took him to a play group once and all the Over time, some participants developed habits mums were a lot older than me and quite that kept them disconnected, and what could cliquey so I have never been back.” have been a transient phase of loneliness (Young new mum, London, 18-24) transitioned to a chronic state. It was very difﬁcult for people to pinpoint when what they were experiencing became engrained in the way Political landscape – There was some evidence they spoke, acted and thought – how loneliness in our discussions with people experiencing transitioned to deﬁning who they were. mental and physical health issues that they were very worried about being categorised as Two things characterised chronically lonely ‘beneﬁt scroungers’. They noted that people participants: receiving beneﬁts seem to be stigmatised in 1. Loneliness became a habit, their default way modern political discourse and the media; it of behaving. So, not only were participants may be that longstanding political discourse trying to overcome what underpinned their 13 around ‘deservingness’ has contributed to this . loneliness experience, they were now also People experiencing health issues who were, trying to overcome their default outlook on for example, not working thus worried that they life and ways of acting. would be judged by others – which made trying to make connections more intimidating. 2. Self-worth was impacted. In addition to tackling the life events that may have “I believe that because programmes on TV triggered loneliness and the daily challenges have not truly portrayed the real disabled and of connecting, chronically lonely participants because the government have taken such were also faced with deep seated questions drastic action on those on beneits it leads about their value to others. people to believe we are all lazy not disabled.” (Health, Female, Wales, 35-54) I feel very isolated and alone. Financial hardships – Closely linked to the I would rather stay in my house political landscape but raised as a separate and important driver of loneliness was ﬁnancial than to go out at all. Miserable, hardships. Our participants noted that they felt sad and very depressed. the pressure of public spending decisions in (Mobility, Male, Oldham, 75+) 13 See http://www.bbc.co.uk/news/magazine-20431729 What causes loneliness, and how can it become chronic? 28

Differences across our six groupsDivorced/separated – Lack of trust brought Although most causes of loneliness were on by feeling ‘betrayed’ by a partner prompted common across groups, unique drivers of participants in this group to approach new loneliness also emerged. Below we outline encounters with apprehension and anxiety. some of the key drivers of loneliness raised by Losing a partner also meant for many the loss of participants in each of the six groups.certain knowledge and skills. For example, some said that their partner had handled the ﬁnances Young new mums – Participants noted that and home care, and after the relationship broke even where their initial social connections were down the participant had to learn how to take strong, either before or shortly after the birth of on these responsibilities. Or, the partner played their baby, they had experienced diminishing a leading role in establishing and maintaining support from friends and family as the months social connections with others and without them went on. For those with a strong existing support the participant not only lost those relationships network, the inﬂux of attention and support was but had to learn social skills. This was often an followed by increasingly fewer encounters, as the intimidating task for people. ‘novelty’ of the new baby wore off. The high cost “I found it really hard being on my own again; of childcare reinforced the identity of the young you think going to a party and other occasions mum as a mum because they could not afford a by yourself is a big thing’.” childminder while they went out. And, as noted (Divorced/separated, Female, Scotland, 35-54) above, some perceived judgement from older mums and others in their community about the choices they had made to have children ‘early’.Empty nesters/retirees – The blank canvas of each day was particularly jarring for this group; “A label given to me as a young mum created a divide between me and other older mums there was now a lot of free time that needed to be ﬁlled. For some, this time began to be ﬁlled as I always felt they looked down on me and this lead to conversations being very brief.” with ruminations and worries about all the things they had been too distracted by work or childcare (Young new mum, Belfast, 18-24) to give much thought to. The massive disruption Recently bereaved – bereavement brings a for retirees, of no longer having a job to take up very particular type of disruption; not only have most of their time, meant a lack of structure and you lost a very important relationship but also all purpose for each day. of the connections that came with that individual “There’s only so much decorating you can who has passed away are gone. Experiencing do – I’m just scratching around for things grief (being in a more vulnerable and anxious to do now.” state after the loss of a loved one) resulted in (Retired/empty nester, Male, Oldham, 55-74) participants isolating themselves, then realising that relationships had fallen away during their mourning period. Time-limited support, much the Mobility and health issues – Strong concerns same as for young new mums, was raised as an about being dependent on others and not issue, with participants noting that their support wanting to be a burden was a key barrier to networks ‘lost interest’ or thinking that ‘enough engagement for those with mobility and health time has passed, you need to move on.’issues. The physical toll of connecting with other “The time when I actually needed distraction people like getting to or engaging with activities and support, however, came much later dissuaded participants from connecting. The when everything had calmed down. But at weighing up of the physical, emotional and this point, when I could feel more up to mental costs of connecting were described as talking or going out, most people had resulting in the belief that the costs outweigh moved on with their own lives.” the beneﬁts of connecting. (Bereaved, Male, Belfast, 18-34) What causes loneliness, and how can it become chronic? 29

The rurality factor and services available in rural communities, There were minimal differences in the overall particularly transportation services. Participants causes of loneliness due to rurality; this described difﬁculties getting to the support that research would suggest it is as possible to be was available due to a lack of or unaffordable lonely in the city as it is in a more rural setting. transport links. However, rural communities However, rurality did present its own barriers were felt to be less closed off than their urban to connection and contributed to isolation, counterparts; responses from the general public which, for some, lead to their experience of survey indicate that rural participants are more loneliness. For example, participants noted that likely to claim they ask people how they are, and there were fewer and more expensive support stop for chats. Most of my activities revolve around the availability of others to either drive me or push my wheelchair… I no longer have the freedom of jumping on and off buses or driving my own car. (Mobility, Female, London, 55-74) Photo: © Simon Rawles. What causes loneliness, and how can it become chronic? 30

4. What is it like to be lonely in the UK? Introduction The biopsychosocial model Overall, this research reveals clear and often of the impacts of loneliness severe impacts of loneliness across the biological, The experience of loneliness was in many ways psychological and behavioural space of one’s a cycle of struggle for participants, with a range life. Loneliness affects the physical health and of impacts reinforcing and perpetuating one well-being of an individual experiencing it, it another. Like many complex social problems, impacts on how an individual thinks and feels and loneliness also clearly involved negative impacts it inﬂuences how an individual acts. Loneliness across a range of biological, psychological and either caused or exacerbated serious symptoms social domains. Figure 10, below, summarises such as physical and mental illness, anxiety and these impacts and helps to illustrate the way negative emotion, self-isolation, stress, and so particular impacts overlap using the 14 on. At worst, loneliness was linked to suicidality biopsychosocial model. This model is a for some participants. framework often used in the mental and social Amidst this wide spectrum of impacts, health disciplines and we have adapted it to help participants experiencing loneliness often said represent the impacts faced by our participants. they ceased to ‘feel like themselves’; they looked, acted and felt different. This sense of feeling ‘different’ became a contributor to loneliness, as many participants began to question their 14 Adapted from: Engel, G.L. (1980) The clinical application of the own identity and self-worth. biopsychosocial model. American Journal of Psychiatry. Volume 137, Issue 5. Pg. 535-544 Figure 10. Summary of biological, psychological and behavioural impacts Biological of loneliness Increased illness Worsening symptoms Low energy Stress, Anxiety Insomnia Mood disorders Hypervigilance Over/under eating IDENTITY CRISIS Low conﬁdence Disengagement Negative emotions Self-isolation thoughts and beliefs Stop Poor work/ Weak ‘coping’ skills planning hobby performance Suicidality Social Poor hygiene skills Reduced exercise Psychological Behavioural What is it like to be lonely in the UK? 31

Biological impacts of lonelinessPsychological impacts of loneliness Loneliness physically affects people, often Loneliness resulted in low conﬁdence and in ways that make it harder to fulﬁl everyday negative emotions, thoughts, and beliefs – and routines, and harder to engage with others. at worst, triggered thoughts of self-harm and Participants described feeling tired and generally suicide. Participants described feeling ‘alone’, more poorly, with some people feeling new health ‘trapped’, ‘without purpose’, ‘angry’, and problems they had never experienced before, ‘frustrated’, demonstrating the powerful negative and existing health symptoms often worsening. effect loneliness has on an individual’s mental Physical impacts were closely linked to the well-being. The experience of acute or sustained serious psychological impacts of loneliness: low loneliness was so terrible for them that self-harm energy; feeling stressed and anxious more often; and suicidal thoughts were reported by seven and mental health problems developing or getting participants through the research. worse. At times participants found it difﬁcult to “You feel like you’re in a black pit and there’s assign causation – were they more tired because no light and you’re struggling. You want to they felt lonely, or were they ﬁnding it hard to get out but you can’t get out.” connect because of how tired they were? Others (Health, Female, London, 18-34) noted that they saw clear causal patterns to their energy levels – when they stopped engaging and Depression develops or worsens, and felt lonelier, they began to feel less energised and participants began to self-criticise. Sustained well overall. loneliness weakens the ability of people to cope “My energy levels are low, I feel tired and with their circumstances. a loss in conidence to go out and meet “Isolation is depressing, so you go into new people.” depression. I’ve had mornings where I’m so depressed I’ve gone back to bed and (Mobility, Female, Bristol, 55-74)I’ve said when I wake up it will be diferent.” Some participants, particularly the chronically (Mobility, Female, London, 35-54) lonely, described their experience of loneliness as resulting in what is known as hypervigilance Feeling like this encourages disconnection in social situations in the mental health space. from others, encouraging those experiencing They felt ‘especially anxious’ and ‘out of practice’ loneliness to shut themselves away from in social situations, which led to them feeling encounters with other people. Adding to the ‘over-sensitive’ to how others were viewing difﬁculty, loneliness prevents some people from them and made even simple interactions more planning for the future, instead leaving them overwhelming. Participants felt stuck in a negative unable to see the potential ahead and thinking feedback loop – it was too hard to engage with ‘what’s the point?’ and ‘what good am I?’ other people, which meant that they withdrew from social environments, which in turn made them feel even more isolated and ‘out of practice’ for the future. Every retreat meant that the stakes were raised for future interactions. What does it feel like to be lonely? I can tell you exactly, it’s like being in a bubble and you want to get out but you just can't, you try and you can’t do it, you just can’t get out. (Health issues, Male, Wales, 55-74) What is it like to be lonely in the UK? 32

Behavioural impacts of lonelinessThe behavioural impacts of loneliness extended People act differently when they are lonely and beyond the individual experiencing loneliness; some of these behaviours pose their own barriers for example those experiencing loneliness may for connections. Participants described shutting off also be contributing less to the economy and to from others, engaging or talking less. Friendships their communities. and acquaintances were weakened or lost Unfortunately, many of these physical ‘signs’ altogether, removing for some what little social of loneliness are also fairly hidden, and may be support they had. Some also said that when they symptomatic of other personal issues – making it were connecting with others less, or felt more difﬁcult to identify people who are feeling affected lonely, they also took less care of their appearance and in need of support. It may be that focusing on and hygiene, describing how they ‘couldn’t be points of transition (see Chapter 3) in combination bothered’ or ‘didn’t have the energy’.with attention to these ‘warning signs’ may be a ”If you could get a camera and show yourself useful way in for those that want to identify and support people experiencing loneliness. the diference in conidence you would be surprised, but you sit for 20 minutes in a conversation with friends and you think Identity crisis faced by those you’re alright, but you have not spoken in experiencing chronic loneliness that time. You may be sat there listening but you’re not participating.” As noted in Chapter 1, when people are experiencing loneliness they are often also (Divorced/separated, Male, Oldham, 35-54) experiencing threats to their own identity and Participants also noted that when they lacked feelings of self-worth. Loneliness can itself also social routines and social connections, they contribute to making people feel ‘not themselves’ found it more difﬁcult to maintain healthy sleep or ‘like someone else.’ Participants noted and eating habits. Participants reported that that when they are lonely, they think, act and they either over or under slept and ate, making engage in ways they don’t recognise; they speak concentration more difﬁcult and sometimes differently and worry in social situations; they may impairing performance at work or in their hobbies. not engage in the kinds of activities that normally These behaviours could further reduce social excite them; and so on. They looked, sounded connections (e.g. if participants were too tired to and felt different than they were used to. engage with colleagues or friends) and loneliness was exacerbated. Amidst the complex and interlinked impacts of loneliness is, for many, an identity crisis. All of “If you stay in bed all day and lack motivation, this exacerbates existing disconnection: how you will not feel [able] to cook. You don’t can you connect when you feel lost, unwell necessarily feel hungry and you need someone and when you’ve isolated yourself? Getting to remind you to eat.” to the point of identity crisis was particularly (Mobility, Female, London, 55-74)characteristic for the chronically lonely and seen by these participants as a negative and challenging reality to be living. What is it like to be lonely in the UK? 33

5. What is the support landscape like for loneliness in the UK? Existing barriers to effective fragmented services and support – e.g. provided loneliness support and current by a mix of voluntary and community groups, gaps in understanding informal social networks, statutory services and support, employers and businesses, and so on. Overall, both the participants and experts who Experts expressed concern that their services contributed were critical of the existing landscape and support may not be reaching the ‘right of support for loneliness in the UK, raising real people’, i.e. that those in need of support may concerns about the visibility and adequacy of not be coming into contact with people and support available; gaps in provision for most organisations that could best provide guidance groups; limited accessibility and sustainability and signposting. of services and support; a dearth of informal support services and often fragmented delivery. “As much as we think we’re telling people While there was an acknowledgment of areas of about our services there are thousands and thousands of people who don’t know… good practice in the delivery of loneliness support (including some good provision for older people We do information sharing, community and the use of digital forums to complement calendars, adverts at libraries but people still other forms of support) participants and experts say ‘When I found out it was like a light-bulb.” were generally critical of the current support (Expert, Community) landscape. Views across four key challenges are The lack of awareness of what was available was summarised in the sections to follow.conﬁrmed by our survey with the public. Over half (54%) of respondents in the general public Lack of awareness of services and survey agreed that: “I wouldn’t know who or support and poor signposting where to turn to if I was experiencing loneliness”, with the same proportion agreeing among those Experts noted that a key difﬁculty in helping in the target groups of interest. Among those in people to access the support they needed the target groups who also claimed to be always was ensuring that services and support were or often lonely, who would most beneﬁt from effectively promoted and visible. This could be support, 75% agreed that they wouldn’t know particularly challenging in an environment of where to turn for help. Figure 11. Individual-level drivers of loneliness% agree Any target group (total)54 Have limited access to transport 66 Long-term physical/mental health conditions/illnesses59 Health issues impacting ability to get around59 Aged 35+ divorced/separated in last 12 months55 Source Q4: How much Experienced bereavement in last 2 years54do you agree or disagree Aged 55+ and retired 46 that: I wouldn’t know who or where to turn to if I was Aged 55+ with no children at home44 experiencing loneliness? Any target group AND always/often lonely Base: All UK adults aged 75 16+ (2,523) What is the support landscape like for loneliness in the UK? 34

Responses to this question varied by group. loneliness as an issue across life stages was Higher agreement was recorded by those with important in raising awareness and normalising limited access to transport (66%), long-term feelings, thereby helping to challenge stigma health conditions (59%) and those with health and misperceptions. issues which impact ability to get around (59%), whereas 46% of those aged 55+ and retired and 44% of those aged 55+ and with no Lack of local support created challenges children at home agreed. Although they were for accessibility not a target group for the research, 62% of As referenced in the previous chapter, those 16-34s also agreed, in line with their higher experiencing loneliness tend to have lower self-reported loneliness. levels of self-conﬁdence which often leads to increased social anxiety. Having to travel Support viewed as prioritising outside local communities and towns to access older populations support groups, pursue hobbies or take classes was viewed as a further barrier to connecting. Experts felt loneliness was seen as an Participants tended only to be willing to engage ‘older person’ issue, a message perhaps in services or support that were relatively close unintentionally transmitted by effective public to where they lived. campaigns, political initiatives such as the Groups and participants who were speciﬁcally 15 Government’s ‘Aging Well Policy’ , and media isolated in rural settings or were affected by attention to the importance of social support for health and mobility issues, expressed that lack older people216. It was therefore considered by of local services and support compounded experts that the service landscape tended to psychological and behavioural problems. focus on this group in terms of allocating funding Many also felt that local support resources and service provision. were shrinking. There was general consensus across the Having local amenities and services and support, research that this tendency towards ring-fencing and identifying the need for provision within funding for older groups had an unintentionally these groups was key for future service design detrimental effect on society’s awareness that for experts across the research. loneliness could be triggered by a number of events or circumstances across age groups, “You can get social care support if you genders, and backgrounds. Lack of funding meet quite high eligibility criteria but [what] for other services and support could lead to if you need it and don’t meet those quite participants having to pay to use services and high thresholds. With local government cuts support which was often difﬁcult for participants. to pensioner clubs that sort of support is disappearing because it’s not statutory.” “There is not a great deal to do for disabled people unless you are willing to pay but (Expert, Business) being on beneits with no spare money they are of limits to me.” Negative impact of one-off/ (Health, Male, Bristol, 35-54) short-term interventions For experts, creating physical spaces in the Some of our participants experiencing loneliness community that allowed for discussion of noted that they had encountered well-meaning yet damaging one-off interventions. In these 15 https://www.gov.uk/government/publications/2010-to-2015-experiences, they had taken part in ad hoc government-policy-older-people/2010-to-2015-government-policy-programmes but were left feeling dissatisﬁed older-people with the length of time they had access to the 16 https://www.thesun.co.uk/living/1578384/italian-police-cook- up-a-pasta-feast-for-an-elderly-couple-they-heard-crying-from-support, and the quality of support provided. loneliness-in-their-ﬂat-and-its-melting-peoples-hearts/ What is the support landscape like for loneliness in the UK? 35

These participants had acquired support services Support viewed as piecemeal but found that these programmes sometimes and fragmented stopped suddenly without any clear pathways Experts often found that services and support for for building independence or resilience when those experiencing loneliness lacked cohesion they concluded. The importance of preparing and collaborative working, speciﬁcally in terms for leaving a program or giving an option for of signposting and working together to create support to be extended was viewed as a crucial well-deﬁned, structured pathways for those component by participants across groups.experiencing loneliness. This ﬁnding highlights the importance of “For example, ire prevention oicers have identifying the needs of the participant from the shown how, by entering people’s homes to outset of support to gauge the frequency of advise on smoke alarms, they can help interventions, and of managing expectations of identify people who might be vulnerable to what programmes can provide in order to avoid loneliness and start a conversation with them disappointment. about other services available.” “It was good while it lasted, but when it (Expert, Community) ended and she stopped coming over to For experts, current service provision was missing the house, me and the baby missed her. an opportunity for joined-up working which could We really missed her support.” potentially identify those individuals at risk who (Young new mum, Belfast, 18-24)were not conﬁdent to come forward and access services or help. Need for informal support servicesChallenges to providing support The absence of informal support (i.e. somewhere Alongside the limitations to the current support to ‘have a chat’) in a landscape where formal landscape above, experts additionally identiﬁed services were seen to dominate, was also a three key challenges facing service and support barrier to tackling loneliness. Mental health providers in the current climate: sustainability organisations, GP services and support from of solutions; limited funding and resources for organisations such as The Samaritans were solutions; and identiﬁcation of individuals in seen as ‘too serious’ as gateways to seeking out need of support. support and served to make people across the research feel ‘uncomfortable’ or ‘awkward’. This was tied to concerns about feeling ‘like a burden’ Creating sustainable solutions and feeling that loneliness is a low-awareness or A key barrier to accessing support was providing even potentially a stigmatised issue.sustainable solutions which ﬁtted around the busy schedules of those experiencing loneliness, “It’s diicult to access help through your doctor and as a male I don’t always want or enticing individuals to use services frequently to go down this route.” when they needed support. Experts thought (Health, Male, Wales, 55-74) that service design would need to focus on creating services which allowed development This emphasises the potential opportunities for opportunities across longer-term programmes. more community-led, peer-centred support in This should present clear, forward-planning for future service design, outside of traditional formal participants and allow for continued, habitual services and support such as GPs and mental engagement, instead of one-off interventions. health service providers to tackle loneliness. “If good long term support can be provided, the country will have healthier happier people who can make a positive contribution to their community and wider society.” (Expert, Across groups) What is the support landscape like for loneliness in the UK? 36

Lack of funding and resources Identifying individuals in need of support In the current ﬁnancial climate, experts perceived The existence of social norms around coping that services and support to tackle loneliness with problems privately and the shame felt as – alongside other well-being and mental health an impact of stigma, presents barriers to early support services – were facing ﬁnancial hardship. identiﬁcation of those experiencing loneliness. This had a direct impact on their ability to identify Developing a framework for identifying those at and target those experiencing loneliness and risk, and therefore allowing timely intervention, to provide awareness and advertising on the was seen as crucial to mitigating this. A availability of services and support. There were framework which could be developed using concerns around the role of tackling loneliness joint expertise across service providers was as solely a charity and voluntary sector issue recommended, alongside providing targeted, and that more emphasis should be placed early, signposting so that temporary loneliness on opportunities for business, community did not become chronic. organisations and Government. There was “If you’re admitting you’re lonely – you’re recognition that this collaborative working could admitting you’ve failed in some way. It’s a help achieve more with fewer resources. diicult thing to talk about.” “Fundamental political approaches [are (Expert, Business) needed] to foster an inclusive, caring, society rather than a self-centred, divisive one. Central policies encouraging and supporting the voluntary sector would help hugely. As would less emphasis on austerity and more support for public services.” (Expert, Health) But there again, it's all down to money. The way the country is at the moment things get cut. And I just think this [support for people experiencing loneliness] will be one thing to get cuts. (Mobility, Male, Oldham, 75+) Photo: © iStock. What is the support landscape like for loneliness in the UK? 37

6. What kind of support do people want and how do they want support delivered? A combination of strategies and Restorative support – services and ¤ support types are needed support that help people get out of an established habit of disconnection. For Our research suggests that there is no one ‘ideal’ some, this level of support might require service for people who are feeling lonely – just as fairly intense conﬁdence building, particularly there is no one pathway towards loneliness, or if issues of self-worth have set in. Others way of experiencing it. might simply want a ‘nudge’ in the right A mix of support for different stages of loneliness direction, something to do, and support to is needed (i.e. across preventative, responsive, sustain positive social connection. and restorative services and support); support that is participant-centred and tailored to the needs of the groups they are serving; and at least Preventative support some element of face-to-face connection, even Of course, loneliness cannot always be if users are also engaging digitally in some way. anticipated: for some, a range of complex barriers There was no strong participant preference about may mean that loneliness emerges or worsens who delivered these services and support, but in unexpected ways. However, in other cases experts stressed that partnership and resource-we can anticipate key life events or transitions sharing across deliverers (e.g. businesses and that this research has shown to be risk factors employers; community groups; charities and third for loneliness – e.g. retirement or motherhood. sector bodies) was key to ensuring that services Having an awareness of the key triggers or and support were sustainable in the long term.‘stress points’ was crucial to delivering support The format and type of service that participants before loneliness became a chronic problem. thought would have been most useful to support Participants experiencing loneliness and experts them varied widely. How ‘intense’ they needed thought more should be done to help people the service to be, and how they wanted it to be develop a ‘plan for action’ to prevent loneliness delivered (e.g. by an informal network, experts, or from setting in during stress points. Key elements peers) depended largely on where the participant of preventative support suggested by experts was on their journey of need for connection. Therefore, rather than focusing on one kind of and participants were the early recognition of service or support, there is a need for a mix of loneliness risk, signposting and more effort provision, extending across:from others to connect. This support would anticipate life stages, such as retirement or young Preventative support – support to help ¤ motherhood, to identify potential support users, anticipate potential ‘risk’ points for loneliness, and help build resilience and skills for changes develop strategies to mitigate loneliness, and to their circumstances that may make them ensure that there is support available if things susceptible to loneliness. get tough; The need for raising awareness of the potential Responsive support – support at critical ¤ to become lonely following a life event, and moments of transition: particularly if the life normalising those feelings, was also noted by event is caused by potentially traumatic experts. For participants experiencing loneliness, events in their own right such as the death of it was often the unexpected arrival of these a loved one, or a divorce. Participants noted negative emotions which caused distress, with that having support during these difﬁcult many stating that if they had felt ‘more prepared’ critical moments could have helped them or spoken to someone who had previously been cope better in general, and also tackled the ‘in their shoes’ they would have made time to loneliness that began to creep in during these prepare. This would allow timely interventions difﬁcult times; What kind of support do people want and how do they want support delivered? 38

and prevent a temporary experience of loneliness Some participants noted that in times of from becoming chronic. stress, even small gestures from friends, “I didn’t expect routine to be as hard to set family, colleagues, and peers were important in preventing loneliness from taking hold. In as it has been…I thought I’d be surrounded by more people.” hindsight, participants thought it would have helped if their social connections had found time (Retirement, Female, Aberystwyth, 55-74) to ask how they were and take the initiative to get together. 17 An example of preventative service best practice is The Shaftsbury Partnership . Focus on…The Shaftesbury Partnership (Wigan, Coventry, Southampton) “[It is]…preparing people to think holistically about their needs and Aim: The Retirement Transition Initiative supports aspirations for retirement…The transition employees to prepare for retirement by thinking strand started because so many people holistically about their needs and aspirations. had poor outcomes later in life that were Summary: A course package offered to those triggered by retirement so [we] looked to coming up to retirement; it covers topics such as how you can intervene earlier and build health, ﬁnances, social connections, aspirations resilience and well-being.” for spending time, and therapeutic-based ways (Expert, Retired/empty nesters) of engaging with people. Responsive support that people are going to judge you in living the way Responsive, tailored support was seen by that you are living.” participants and experts as necessary to deal (Divorced/separated, Female, Glasgow, 34-55) with disruption during critical moments of Importantly, participants also noted that they transition. Depending on the stage of a support would need ‘permission’ on signposting to user’s needs, different types of responsive available support if they didn’t perceive their support were needed. issue as ‘serious’, and the availability of support Responsive support should involve positively for ‘low level needs’ to tackle smaller problems framed and user-centred activities, to give a clear before they became deep seated issues was purpose for people experiencing loneliness, to valuable. Existing support was viewed as only help them forge new relationships, to develop available to those with ‘real, critical’ needs, and new interests, or to rediscover old skills. Meeting many participants felt they did not meet the high others going through similar experiences threshold criteria to access services. comforted some participants. “I know of organisations like the Samaritans “I think it would be great if people had and MIND but that’s the last step, that’s for the real serious cases.” somewhere they could drop-in. People can talk (Retired/Empty nesters, Male, Oldham, 55+) freely and openly, about whatever they want to talk about with the support of other people, so Assistance in transitioning through difﬁcult that they know they are not alone…so that you life events and from statutory to community know there is a light at the end of the tunnel support with responsive services, including with somebody to help you and then you’ll see sharing tips and approaches to adjusting to new positive changes in your life rather than feeling circumstances, was also valued by participants 17 http://www.shaftesburypartnership.org/ and experts. What kind of support do people want and how do they want support delivered? 39

An example of responsive service best practice is an Employee Assistance Programme delivered by an employer in Belfast. Focus on…Employee Assistance Programme“It was useful that it was there. I needed Aim: Employers reaching out to employees in to talk about it with someone outside of looking out for their mental and physical health. my friends. I just wanted to talk. There were all these questions in my mind, Summary: Providing eight free counselling services feelings of guilt and whether I could have as part of their overall beneﬁts package, which can done anything diferently. I needed to talk be accessed by any employee at any time and to someone.” operating a 24 hour helpline 365 days a year. (Bereaved, Male, Belfast, 18-34) Restorative support Once loneliness becomes a barrier itself, people Once disconnected, individuals are often trying need help to rebuild conﬁdence and then forge to reconnect again, but might need restorative new connections. For individuals with more support to achieve this. severe need, this kind of support might involve intensive, personalised support – for example, Many participants noted that when they realised home visits with professional support staff, loneliness had ‘set in’, they needed support in or volunteers with training in handling difﬁcult the form of opportunities to build conﬁdence and emotive conversations. Support in taking and forge new connections. In particular, the small, ‘ﬁrst steps’ towards addressing their idea of bonding over shared interests and taking circumstances was seen as well-placed for up activities that offered new, positive identities, people at this stage. widely appealed. “The fact that they would visit your home Many best practice services and support allowed would remove the hurdles of going out participants to rally around fun hobbies and and facing the world for those who aren't informal connections (making things, eating, feeling up for it.” travelling) or volunteering. These approaches (Bereaved, Male, Belfast, 18-34) helped forge new connections whilst also building Once initial conﬁdence and trust had been positive identities. Both participants and experts established, both public participants and experts also stressed the need for tailoring of support, agreed that the aim of these kinds of services and and considering the relevance of activities to the support should be to begin to foster independent individual the services are looking to support.connections and self-reliance. For example, “I think doing an activity that people will more one-on-one support could eventually turn enjoy will help them to open up with each to identifying local activities or clubs that the other and help people to bond and make individual might enjoy, supporting initial ‘entry’ new connections.” into the community and problem-solving together, (Young new mum, Female, Belfast, 18-24)and, over time, be replaced by these established Other participants, particularly those experiencing social supports. chronic loneliness thought they would need more intensive support initially to ‘break the bubble’. What kind of support do people want and how do they want support delivered? 40

18 The following best practice example of restorative support – Men’s Sheds – demonstrates the strength of shared interest groups as a positive point of community and support for people experiencing loneliness, but not needing more intensive one-on-one support to reconnect. “The underlying concept of the Men's Shed project seems one that could be Focus on…Men’s Sheds (UK-wide) replicated for a range of activities and Aim: To tackle loneliness among middle-aged to groups. One of the great aspects of the older men. concept is that it is community-led with great support provided for setting up Summary: Work with men in a speciﬁc a group. It seems to be a great way to geographical area to develop social club around empower areas/communities to provide their common interests e.g. woodwork. their own solutions to meet the speciic needs of their area.” (Expert, Retired/empty nesters) What does good loneliness Support that gives a sense of purpose ¤ support look like? – Support or services that instil a sense of Across the research process, it became apparent purpose, a tangible output, are ideal. For that there was no one ‘format’ or ‘offering’ example, volunteering one’s time, taking part that was universally appealing for participants. in a course or personal development activity. Peer-led or co-designed support that Whereas one person might love the idea of a ¤ community gardening initiative as an informal way includes people in similar circumstances – to connect with others in their local community, It is essential that support is tailored with another might reject this as ‘too formal’ or target groups in mind, and reviewed and unappealing. Whilst some participants wanted revised with their input. The best way of services and support to be peer-led, others achieving this is seen as co-designed felt that having more formal ‘hosting’ might be approaches to service development, drawing beneﬁcial. However, two key ﬁndings emerged on the lived experiences of the very people from across the research: 1) some principles of the service or support hopes to engage with. ‘best practice’ in providing services and 2) an Local to individuals and easy to access – ¤ interest in face-to-face services and support. Accessibility is seen as key for engaging with support users and encouraging people to use support on a regular rather than ad hoc basis. Overarching principles of effective Centrally located or easily accessible venues loneliness support are preferred. Drawing together insight from across the Free or affordable support – Where ¤ research, there are eight key principles that possible, providing free or subsidised support underpin participant and expert responses as is key for maximising engagement and to what good support looks like. Support that encouraging individuals to approach support embodies multiple principles is seen as more and continue to utilise it. effective in responding to the needs of its users. Support that instils a sense of identity for The principles of best practice support are: ¤ participants – This type of support looks to positively frame an individual’s identity and 18 http://menssheds.org.uk/ empower them. What kind of support do people want and how do they want support delivered? 41

Support which provides clear goals and The importance of face-to-face support ¤ exit pathways – Support that provides Regardless of the category of support and in longer-term programmes if desired, which set addition to support that incorporated principles out well-deﬁned plans and build exit strategies of best practice, face-to-face support is vastly which give people the option to return and re-preferred. People want to connect in person engage. in order to overcome their disconnection, and Support that beneﬁts others – Support are wary of the ability for digital-only support to ¤ that beneﬁts other individuals, such as fully meet their need for human engagement. volunteering, is particularly effective in However, platforms such as Skype, and supporting positive sense of identity and WhatsApp did for some ‘ﬁll the gap’ when they purpose for individuals. In this sense utilising a were unable, due to transport, illness or mobility service provided by volunteers is as beneﬁcial issues, to have interactions in person with to those experiencing loneliness as is taking friends and family. part in volunteering themselves. “Online support is only good if it leads to Shared interest support – Support that meetings in person…I ind typing things up ¤ identiﬁes and leverages the unique interests to be very like discussing my thoughts but of a particular target group and uses that in a rather cold manner. The process of me to bring together individuals is cited as best thinking about what I am going to say is very practice. This can range from small, ad hoc detached to how I would react to a person activities such as coffee mornings to more one on one.” established support such as further education (Bereaved, Male, Belfast, 18-34) courses, walking clubs, and cookery classes. The preference for face-to-face contact is shared by the public in the general public survey; when presented with a range of potential support options and asked which they felt they would do to overcome feelings of loneliness, just under half of all adults (48%) indicated they would speak to friends and family, 37% would join a shared interest group and 33% would become a volunteer (See Figure 12, overleaf). What kind of support do people want and how do they want support delivered? 42

Figure 12. Ranking of preferred support options General Always/ Target groups population often lonely & always/often (2523) (458) lonely (329) Speak to family/friends4837 42 Re-establish/more contact with family or friends392628 Join a group based on a shared interest372626 Become a volunteer33 22 23 Speak to someone who has same experience262529 Attend a course or class2520 21 Visit GP/health professional2527 31 Use website/social media to engage with people242628 Talk to people you meet in community241920 Visit a website for support2026 25 Get support from a charity1614 15 Atten a regular food based event 161212 Call a telephone helpline1211 11 Use a befriending service 99 8 Get support from your employer710 10 Source Q5: If you were experiencing loneliness which, if any, of the following do you think you personally would do to help you overcome feelings of loneliness? Base: All UK adults aged 16+ (2,523) / in each group Although these support options were also Who are the key players in popular among those in the research groups who tackling loneliness? are currently always/often lonely, three speciﬁc Understanding what effective support looks like options were more likely to be mentioned:and participants’ views of how they want support speaking to someone with the same ¤ delivered are useful for informing future support experience (29% among research groups and service design. When asked who should and always/often lonely vs. 26% overall)deliver this range of support, participants were visiting a GP/health professional (31% vs. 25% less concerned about who exactly delivered it; ¤ overall) though this is very much driven by they wanted help where help was given. those whose loneliness results from health The general public in the national survey reported issues and is not applicable for all groupsthey view communities and charities as having using websites and social media to engage the greatest role to play in reducing loneliness, ¤ with people (28% vs. 24% overall) and visiting with 52% and 41% of respondents identifying websites for support (25% vs. 20% overall), these categories, respectively (See Figure 13, but again this is something which is seen overleaf). However, the qualitative research as more beneﬁcial by those with health or results would suggest that there is no rejection mobility issues. of other organisations and informal bodies playing a role – merely that community and charity groups are more strongly associated with public support provision. What kind of support do people want and how do they want support delivered? 43

Figure 13. Role of different groups and organisations in tackling loneliness % Communities/community groups52 40 92 Charities 41 48 90 Higher mentions of 'a lot' among those GPs/the NHS 34 51 85 always/often lonely (32%) and target groups Technology e.g. social media (e.g. Facebook)245174 always/often lonely (34%) Local councils19 46 65 Central government1338 52 Those always/often lonely more likely to think all groups have 'a Employers12 44 56 lot' of a role to play than overall, with the exception of Businesses in local communities104454 communities (48%) A lot A little Source Q6: How much of a role do you think each of the following have to play in helping to reduce loneliness in the UK? Base: All UK adults aged 16+ (2,523) With prompting, participants and experts Experts stressed that the future of designing shared their views on who they see as the successful services and support for these key players in tackling loneliness in addition to organisations lay in their capability to adapt and delivering support: charities and voluntary sector expand on existing services and support which organisations; community members; ‘trusted are deemed to be working well, and build on advisors’ such as GPs and housing associations; past successes. Using brand and credibility businesses; and employers. Views of the role of from working at grass roots level to build each of these key players are discussed next, support for campaigning should enable alongside more detail on participants’ thoughts community organisations to grow public support on each group in tackling loneliness. and provide momentum around a ‘call to action’. For successful services and support to build on solid foundations, it was recommended by Role of charity and voluntary experts that forging collaborative partnerships sector organisations to ﬁll gaps in local provision with other service Seen as the most historically linked with providers was vital. providing services and support in tackling loneliness, there was recognition from Role of community participants around prospects for growth by using best practice identiﬁed as building blocks The importance of building resilience in for future success. When presented with a list communities to tackle loneliness hinges on the of organisations and asked how much of a role successful integration of community members they had to play in tackling loneliness in the UK, into future service design. Participants highlighted communities/community groups and charities the need for support to be peer-led so that they were top of mind among the general public were able to connect with others who had been (52% and 41% saying the respective through the same difﬁcult challenges but had organisations had a lot of a role to play).overcome them. What kind of support do people want and how do they want support delivered? 44

“As the weeks progress maybe some of housing associations/councils too? They the community could join in the activities could circulate newsletters to tenants/owners alongside the volunteers and end up inviting people to take part in an open day becoming volunteers themselves, gaining in their close area.” even more conidence as they develop new (Mobility, Female, Wales, 24-35) skills of communication.” One third (34%) of respondents to the general (Mobility, Female, Wales, 24-35)public survey indicated that GPs and the NHS Community members were viewed as possessing had a lot of a role to play, suggesting that the the ability to educate themselves at a grass-roots public does make a link between the level. They therefore had a better understanding seriousness of loneliness and the impact it can of the root causes of loneliness within their have on health. community and were able to feed this knowledge into collaborative working. Community groups were also viewed an important player in providing Role of businesses much sought-after informal support where like-Neither participants nor experts saw businesses minded individuals could meet together and as traditionally providing community services and pursue common interests. support to tackle loneliness. Experts recommended that the capacity for “I can't speak for businesses /workplaces, community members to empathise with others how would they know they are lonely/isolated in a similar community setting was a potential unless it was brought to their attention?” route to helping to address the need for informal (Empty Nester, Female, London, 55-74) support which participants had highlighted was absent from the current support landscape. The general public survey indicates that the Another suggestion for ways in which community general public agrees: 10% state they see members could tackle loneliness at a community business in local communities as least likely to level, was their ability to initiate and mobilise the play a role in loneliness prevention. However, community around shared interests and common participants and experts did think that business grounds (i.e. shared meals, neighbourhood could have a role. For example, local businesses gardening programmes, etc.).are well-placed to host and deliver activities in “I think doing an activity that people will enjoy the community, creating opportunities for members in their community to connect with with people like them will help them to open others. Funding cuts to local services led experts up with each other and help people to bond to see businesses as having a role to play in and make new connections.” funding initiatives in partnership with local (Young new mum, Female, Belfast, 18-24)service providers. As participants stressed that accessing services Role of ‘trusted advisors’ and support located near home or where they run errands would increase the likelihood of them Participants and experts noted the importance taking up support, local businesses were seen of ‘trusted advisors’, such GPs, local authorities as important community hubs and as having and housing associations, in identifying those locations in communities with high trafﬁc from experiencing loneliness and connecting them individuals and thus could advertise and to support. These advisors have existing signpost their customers to available local relationships with individuals and as part of services and support. their advisory function, could signpost to social support and activities. The potential impact business owners and “As well as employers and businesses workers have on those experiencing loneliness also cannot be dismissed; chronically lonely supporting in the workplace, why not the What kind of support do people want and how do they want support delivered? 45

participants explained that friendly exchanges “The manager goes to me, you've done with cashiers and shop owners where often their really well and gave me a pat on the back only connection in a given week, and this contact and I actually felt connected then. It made brought them great comfort. me feel good; it didn't make me feel lonely “[Businesses delivering local activities] at that point.” (Mobility, Female, London, 35-44) would be good as it is local people helping others instead of just one big corporation. Also means the activities would be on What is the public appetite for your doorstep.” change to loneliness support? (Young new mum, Female, London, 18-24) There appears to be a great deal of willingness to help among the general public, which can Role of employers potentially be harnessed for those seeking to Like businesses, employers were not viewed combat loneliness. 81% agreed that: “There are by participants as long-established players lots of actions that everyone can take in their daily in providing support (only 12% of survey lives to help those feeling lonely” and 69% agreed respondents believed they played a large role) that: “Everybody has a duty to help people in their on the issue of loneliness. Yet many highlighted local communities who might be experiencing the need for employer-led services and support loneliness” (see Figure 14, overleaf). and the ability of employers to provide accessible Speciﬁcally, women were more likely to hold such pathways into loneliness support.views and young people – 16-24s in particular Employers were viewed as having the capacity to – were signiﬁcantly more likely to agree strongly mobilise and connect social networks speciﬁcally that there are actions that everyone can take. For when groups have moved into retirement stages both statements those who believe loneliness is to facilitate peer-led support and ‘role-modelling’ a serious problem were more likely to agree. This for those experiencing loneliness. Their ability suggests that a campaign which helps increase to provide direct and timely interventions, to perceptions of the seriousness of the issue will offer preventative signposting and to identify generate a greater feeling among the general individuals on the ‘cusp' of a major life event public of the need to play a role in helping to was seen as key for connecting people address it. with necessary support. Delivering targeted To better understand the extent to which programmes for employees such as counselling individuals could get involved, respondents were and mentoring were also suggested pathways presented with a list of actions and asked which for employers to strengthen their employees’ they currently do, and which they would be willing resilience to loneliness. to do (or do more of) in the future. “[I] would have beneitted from an impartial ear such as a counsellor…my employer was not useful; I had hoped they would direct me, you know, signpost me to support. I relied on my GP and family.” (Mobility, Female, London, 35-44) Delivering formal support to employees was not the only opportunity for employers to help in tackling loneliness amongst staff: small gestures of support and encouragement by managers and colleagues were also a powerful driver of connection. What kind of support do people want and how do they want support delivered? 46

Figure 14. Levels of participation and willingness in actions which could help tackle loneliness % Ask people other than my friends and family how they are 513485 Stop for short chat in street with neighbours/members of comunity612889 Regularly call/drop in on family/neighbours for a chat464086 Help family/neighbours with transport to social events315177 Help family/neighbours with transport to appointments324678 Volunteer for a small amount of time a week, e.g. half an hour175369 Volunteer for a longer period of time e.g. half a day a week 124658 Run a regular shared interest group in my community83644 Run a regular food based event in my community53438Currently do Run regular community group based on sharing skills53438Don't currently but would be willing Source Q7: For each of the following, please say whether it is something you currently do, whether you would be willing to do it in the future, or if it is something you would not be willing to do. Base: All UK adults aged 16+ (2,523) Most people either already do, or would be willing As the commitment asked of an individual to do the relatively easy actions – ask people becomes more challenging, however, the how they are (51% currently, 34% willing), stop proportion currently undertaking the tasks for a short chat in the street with neighbours/declines, though there is still a degree of community members (61% currently, 28% willingness. The greatest current participation willing), and regularly call in on family/neighbours is for regular volunteering for a small amount of for a chat (46% currently, 40% willing). Three time a week, e.g. half an hour (17%), and it is this in ten currently help family/neighbours with which records the highest degree of willingness transport to social events/appointments, and a out of all tasks with which respondents were further 45% would be willing to do so. presented – 53% would be willing to do so. Involving the public in support to which they only need to commit a small amount of time may generate greater involvement, which could be built on in time if participation is seen as beneﬁcial to all parties. What kind of support do people want and how do they want support delivered? 47

I don’t think anything can make me feel more connected [to my neighbourhood], as I don’t like the sort of people who live here… this is a rough area. (Young new mum, London, 18-24) Photo: © Simon Rawles. What kind of support do people want and how do they want support delivered? 48

7. Conclusions This research has demonstrated the seriousness Loneliness can have serious consequences ¤ of loneliness, not only to individuals experiencing and negative impacts at both a personal and the issue but also its potential impact on community level. Loneliness can cause and, communities, our economy, and wider society. at times, worsen existing personal problems We are now at a critical juncture where (psychological, social, and behavioural) supporting those who are at risk of experiencing and community level issues (fewer social loneliness to become reconnected with society connections, lack of conﬁdence to leave can help those individuals as well as strengthen the home). Loneliness also has serious their communities. consequences for isolated individuals The following conclusions provide useful insights including increased morbidity, lower life into what support and services are needed satisfaction, and a predisposition towards low to help people before loneliness becomes mental and physical health. It can affect all embedded, and importantly engage those who aspects of their life, including an impact on are already feeling disconnected:other social relationships and behaviours. There is low awareness of the support Loneliness is viewed as a serious and urgent ¤ ¤ available to help people reconnect and the public issue, which is a common experience current landscape is viewed as not ﬁt for in the UK. Yet the public perception of purpose outside of supporting older people. those who experience loneliness was out of Services were viewed as piecemeal and sync with the reality and there are existing fragmented. The key reason for participants challenges to framing this outside of an ‘older not accessing support was the lack of life’ problem. More attention could be given to awareness of the availability of services promote the idea that loneliness can happen and support relevant to them. One off/short across life stages, genders, and backgrounds term interventions were also viewed as and is not solely connected with later life.problematic. When services or support were Although age is well-documented in current ¤ accessed it was often too formal, did not literature as a risk factor to experiencing provide tailored support or was difﬁcult loneliness, this research conﬁrmed that to attend habitually due to location and people experiencing life events which can transport issues. Services and support disrupt existing connections are also at were signposted as needing to be tailored, risk. This ‘break of routine’ or disruption to sustainable, accessible, and targeted to identity which sees a new identity take hold is distinct stages of need. sometimes caused by a sudden or expected People who already ﬁnd maintaining social life transition and therefore identiﬁable or ¤ preventable. Recognising this risk should relationships challenging due to other factors enable preventative and early reactive support (such as health issues or physical isolation) to be developed with people undergoing are more likely to be at risk of experiencing signiﬁcant life changes. loneliness. People who face barriers in terms of other life stresses such as mental health Those experiencing loneliness can view ¤ or physical isolation are more at risk of connection with others as a daunting transitioning to chronic loneliness than others. experience, and this can result in questions The causes of loneliness are often multi- around self-worth. Chronic loneliness can ¤ therefore develop within the context of a layered and reinforcing. As loneliness is a newly emerging identity which can in turn lead complex issue which is often caused by a to difﬁculties re-connecting and the potential combination of personal, community and for reduced self-worth. At worst, people broader society issues, people experiencing experiencing loneliness felt they had little to loneliness need different types of support offer society and described suicidal thoughts.depending on their individual circumstances (preventative, responsive, restorative). To Conclusions 49

prevent and tackle loneliness, different stages believe that sometimes it is ‘small gestures’ of loneliness require a combination of formats which can make the most difference such as and programmes (both formal and informal) saying hello to neighbours or asking family as individuals move along the spectrum from and friends how they are doing. There is a temporary to chronic circumstances.need to seize the momentum expressed Face-to-face services and support are by the general public currently towards ¤ small acts which can be undertaken on an preferred with those experiencing loneliness, including a mix of more intense ‘one-on-individual level within local communities to one services’ and ‘interest-led, peer-to-improve social cohesion and build peer interaction’. While digital services and community unity. support are important for certain groups Experts, the public and individuals are ¤ who may be restricted by mobility or health, accepting of the multiple roles taken on they are seen more as supplementing or as by multiple players in tackling loneliness a facilitator of face-to-face connection rather through both formal and informal support. than a substitute. Overwhelmingly, people in Consolidating and building on experience this research have shown that face-to-face across businesses, employers, Government interaction is preferred. and other health service providers should The general public who took part in our achieve more with less resource in providing ¤ sustainable, tailored services and support to survey are interested in small, personal steps to combat a serious social problem – easy those experiencing loneliness. Partnership ‘calls to action’ such as making the time to working with clearly deﬁned roles is therefore speak to others in their community will help critical to future service design. Loneliness action feel more achievable. This was also therefore requires a society-wide response echoed by our experts and the people we where the strengths of multiple partners spoke to experiencing loneliness. The public are utilised. Conclusions 50

I think it would be great if people had somewhere they could drop-in. People can talk freely and openly, about whatever they want to talk about with the support of other people, so that they know they are not alone…so that you know there is a light at the end of the tunnel. (Divorced/separated, Female, Glasgow, 34-55) Photo: © Simon Rawles.

redcross.org.uk/lonely coop.co.uk/loneliness