Last reviewed 9 May 2022
For Mental Health Awareness Week this year, hosted by the Mental Health Foundation, the key theme involves raising awareness about the impact of loneliness on mental wellbeing. What exactly is loneliness, how does it impact mental health, and what can be done to address it in adult social care?
What is loneliness?
Loneliness is difficult to define as it means different things to different people.
For most people loneliness simply means being isolated or cut off from others. However, some people can feel lonely even though they have others around them. And some people can be alone for long periods but feel quite content.
Perhaps loneliness can therefore best be described as the feeling of being disconnected or isolated from others, usually when physically alone but even when with others. Usually there is a feeling of missing companionship or lost social contact which can lead to intensely negative thoughts and emotions.
Everybody feels lonely some time in their lives. It is quite normal. However, for some loneliness can become a more serious issue. It may become part of how a person views themselves. Here loneliness can become linked to feelings of low self-esteem, loss of confidence and low mood. A person can typically begin to feel worthless and inadequate. They often feel friendless and unlovable. This can lead them to withdraw still further, cutting off contact with others and becoming even more isolated. The stigma that often surrounds loneliness makes it hard to ask for help and this can make matters worse.
If prolonged, the vicious cycle of chronic or long-term loneliness can be a contributing factor in the development of more serious mental ill health, such as severe depression or anxiety states.
In the UK a number of charities are involved in raising awareness about the growing problem of loneliness and in providing support for people affected by it.
the Marmalade Trust
the Campaign to End Loneliness.
The Marmalade Trust states that it has a twofold approach to loneliness:
through its projects the Trust identifies people at risk from experiencing loneliness and points them towards the right support
through its campaigns the Trust raises awareness about loneliness across all sections of society.
The Campaign to End Loneliness is designed to raise public awareness and encourage action to address loneliness as a serious modern social problem. Supported by National Lottery funding and charitable donations, it believes that nobody who wants company should be without it.
How common is loneliness?
The Campaign to End Loneliness report that there are rising levels of loneliness across society. In England they quote statistics that up to 45% of adults (or 25 million people) occasionally, sometimes or often feel lonely. Over half a million older people are reported to go five or six days a week without speaking to anyone at all.
There is also some evidence that loneliness has increased during the Covid-19 pandemic where many people found themselves isolated at home.
Who is most likely to be affected by loneliness?
Loneliness is often seen as predominantly an issue affecting older people.
In our ageing society there is a growing trend for older people to be more isolated. For instance, the Marmalade Trust state that nearly 60% of people over the age of 85 live alone and it is estimated that the number of over-50s experiencing loneliness is set to reach two million by 2025/6.
In an eye-catching statistic the Campaign to End Loneliness state that two-fifths of older people (about 3.9 million) say that television is their main form of company.
Social exclusion is a major contributory cause. As people age they can be at greater risk of feeling excluded from society and isolated from others, especially if they are retired or bereaved and have lost life partners or family. In addition, many may suffer from mental health problems such as depression or long-term physical health problems.
However, while the problem of social isolation amongst older people is rightly identified as a key social issue, it is also clear that loneliness can affect anyone.
In fact some claim that young people, aged 16–24, are now the most likely group to experience loneliness. In addition, loneliness and isolation is thought to be more common in those with disabilities and in people of black, Asian and minority ethnic backgrounds, especially if they experience prejudice or harassment in their communities.
What can be done about loneliness?
There is no single way in which loneliness can be addressed. What works for one person may not work for another. Interventions therefore need to be varied. In addition, many people who suffer from chronic loneliness are reluctant to admit they need help.
For individuals identified as being lonely, help is often directed at trying to encourage social contact and bringing people together to provide opportunities for companionship. This can be achieved in various ways, for instance, by setting up clubs and gatherings and encouraging or enabling people to attend. By linking such opportunities with emotional and practical help and assistance, people who are experiencing loneliness can be supported to make the most of such contacts and develop friendships.
For older people in particular, most areas have local groups available which offer social gatherings and a chance to get out of the house and meet others. Volunteers are often the mainstay of such groups and visiting schemes are also valuable sources of support.
A key concept in working with loneliness is identifying and reaching out to individuals. This is because people at risk of loneliness are often withdrawn and socially isolated and do not tend to come forward of their own accord. This may be partly due to the stigma around loneliness which makes it hard for people to admit that it is a problem.
Town planners and those responsible for housing design have a part to play. They are urged to take on board the problems of loneliness and develop estates, towns and cities which have opportunities for social mixing at their heart. Community-based housing schemes encourage social inclusion and involve older people in their planning, as well as others who may suffer from loneliness. This includes housing projects such as residential care homes, retirement schemes and sheltered housing.
It is also important that local and national politicians, as well as public health commissioners and planners, recognise loneliness as a key public health challenge and work to address poverty, loneliness and isolation on a strategic level.
The Campaign to End Loneliness publish Guidance for Local Authorities and Commissioners which includes a framework to support older people experiencing, or at risk of experiencing, loneliness. The framework has been adapted from Promising Approaches to Reducing Loneliness and Isolation, produced in collaboration with Age UK.
What about loneliness in adult social care?
As in all walks of life, service users in adult social care may experience loneliness or isolation, both in residential care and in home care.
Service users in all care settings should have their social needs assessed and kept under review. Those at risk of loneliness and isolation should be identified and issues discussed with tact and care. Appropriate interventions should be agreed with the service user as part of their personalised care plan. These might include supporting individuals to maintain contacts with old friends and family members. They might also include encouraging interests and pastimes, and providing help and support to attend functions and groups where people can develop new friendships and enjoy the company of others.
Taking a holistic, person-centred approach is important. Those with underlying mental health issues should have suitable support plans in place. Those with issues of loss may benefit from bereavement counselling or support.
Loneliness or isolation is often thought to be more common when planning care for service users living in the community. For instance, it may be particularly prevalent where people live alone and are bereaved, or where they have disabilities or are living in poverty or in poor housing. Loneliness may also be more common in areas which have few social resources around (such as day centres or clubs) or where transport is not available.
The communal nature of residential care homes often leads to the assumption that loneliness is not an important consideration in such settings. However, levels of social isolation can be just as high within residential care as it is in the community.
There are many examples of excellent work carried out in care home settings designed to identify and support residents at risk of loneliness and isolation.
All residents should have their social care needs assessed on admission. Care interventions should be designed to help them stay active in their wider communities if they wish to, as well as socially active within the home. Creating care environments which are conducive to normal social interaction is a particularly important factor. Thus, informal meeting areas can be set up which include small groups of chairs, both inside and outside, and even spaces that look like pubs and cafes.
Further information and support
A great number of excellent charities and local groups work to combat loneliness and help people to connect with each other throughout the UK.
Further details about the Marmalade Trust can be found on their website at www.marmaladetrust.org.
The website includes news about the Trusts activities, more information about loneliness and details of how to volunteer and how to get help. The Trust also host an annual Loneliness Awareness Week.
The Campaign to End Loneliness publish a wide range of information and also produce a newsletter. Their website can be found at www.campaigntoendloneliness.org.
The Mental Health Foundation have made loneliness the theme of Mental Health Awareness Week 2022 and have drawn together a wealth of content on their website at www.mentalhealth.org.uk/blog/why-loneliness-theme-mental-health-awareness-week-2022.
See the topic on Understanding Mental Health and Wellbeing for more detailed information on supporting service users.