Loneliness: an underappreciated problem
One in five adults in Northern Ireland are always or often lonely - almost 300,000 people in total.
The effects of loneliness are staggering – similar to those of obesity or smoking 15 cigarettes a day. It can increase the risk of early death by as much as 30%.
The one-in-five figure emerged from research by the Red Cross that has since been reinforced by Department of Health surveys.
According to Trapped in a Bubble - a paper published by the Red Cross in 2015, together with the Co-op – there is widespread appreciation among the public that loneliness is a significant social problem. However, the nature of that problem appears to be misunderstood.
The general perception is that older people are the most likely to experience loneliness, followed by people who live alone. While those circumstances can be risk factors, this is not the whole story.
Per Red Cross research, people are at highest risk of loneliness when going through major life changes or transitions, such as:
- Becoming a new parent
- Becoming a carer
- After bereavement
- Following a health crisis
- Because of a decline in mobility
- After retirement
- Relationship breakdown, separation or divorce
- Empty nesters - parents whose children have all left home
Despite the prevalence of loneliness, and the fact its driving factors apply to most people at some point (and often several different points) in their lives, only 52% of adults would know where to turn if it happened to them.
British Red Cross Policy and Public Affairs Officer Mary Friel spoke with Scope about an area of public policy that is deserving of – and starting to get – greater attention.
“This is an emerging policy area, and I think that is the case because we are understanding the public health impacts more.
“The Red Cross wants to understand when people are most likely to experience loneliness, where it becomes chronic, when it becomes part of your identity and part of your behaviour - and has an impact on health and wellbeing and affects your ability to build new relationships.
“A couple of years ago, when there was public policy push around loneliness, it was through the lens of later years. However, that didn’t reflect the reality on the ground.
“A lot of good, peer-reviewed evidence has come out recently. A number of community and voluntary organisations, including ourselves, have paid attention to it because it represents the reality for a lot of service users.
“Loneliness cuts across all the services we offer in Northern Ireland: short-term wheelchair users; people relying on emergency response, such as victims of flooding; refugees and asylum seekers.”
However, Ms Friel added that loneliness can happen to anyone: “It’s now recognised that loneliness can affect anyone at all ages and all stages in life. Life circumstances can change in the blink of an eye, meaning it can happen to anyone, no matter your age or background.”
The greater understanding of loneliness, and its consequences, has led to some efforts to try and combat the problem.
Belfast City Council, through its Age Friendly Strategy, is creating some interventions that the Red Cross says are very good – and would like to see copied by other councils and, crucially, mirrored with provision aimed at all ages.
Ms Friel also says the Health and Social Care system is beginning to adapt to broader concerns about loneliness, but this needs to be expanded greatly.
“There should be an identification of touch points for individuals with HSC, where they can be asked if they are socially conscious or connected. A number of different questions could be asked: ‘Have you had many full conversations this week? Have you left the house?’
“The Royal College of GPs has been calling for this, locally as well as nationally - a full connections test at key points in the Health and Social Care system, for example at the GP or at the point when someone leaves hospital.”
Integration of a larger focus on loneliness into appropriate parts of HSC could – perhaps should – dovetail well with other ongoing reforms, be that the comprehensive Bengoa agenda, or something more specific like a greater use of social prescribing.
Identifying loneliness is obviously a crucial part of tackling the problem – but it is not the only part.
If an individual is chronically lonely, with perhaps several significant knock-on effects on their physical and mental health, it is not necessarily straightforward to reconnect them with their community, their friends and family, or with other people in general – wherever links may have broken down.
“If someone has got to the point of being chronically lonely they might have lost confidence and need one-to-one support, often at home, to build confidence.
“In Red Cross, we try to take a person-centred approach - being able to sit down with someone and identify what happened at the time or just before things began to change, and what was life like before that.
“Then you can look at re-establishing previous interests, or starting afresh, but with it very much led by the person – I think that’s very important.”
Red Cross has a range of policy asks that could help tackle loneliness.
Something that could be done almost immediately is an increase in messaging, highlighting how widespread significant loneliness is amongst the population, and also the fact that it is not just a problem for older people.
This is already happening elsewhere. Public Health England is developing clear and easily-digestible messages that will be rolled out later, as part of their public health campaign, and officials in Scotland are beginning to take similar steps.
However, other parts of the UK are already ahead of NI on policy. Prime Minister Theresa May launched the government’s first loneliness strategy in October, focusing on England. Scotland followed suit in December, and a Welsh strategy is currently being finalised.
Northern Ireland has no strategy. Without a functioning Stormont, we will not get one. Nonetheless, Red Cross believes it is of critical importance – and, as part of any strategy, baselines need to be taken to better understand NI loneliness in more detail.
“Our very top line ask is really for a loneliness strategy for Northern Ireland, which recognises loneliness at all ages.
“We need to understand and unpick issues and get people to analyse where the greatest need is. From that we will be able to target better interventions.”
In the meantime, raising awareness is critical, especially in spaces where there might be low awareness that loneliness is a risk.
Red Cross wants to build links and partnerships with other local organisations that help going through the identified transitions that increase the risk of loneliness, such as perhaps Carers NI, Marie Curie, Parents NI, as well as mental health organisations and even those representing children and young people’s interests. Given the nature of loneliness, as we now understand it, the list of potential partners is long.
“We should have good public health messages and shine a light on the specialist organisations that are able to follow that up with very specific policies that will make a big difference in the lives of people.”
Without proper governance, problems like this are all much tougher address than they should be.
A proper strategy, and a proper baseline – Ms Friel points out that there was no indicator looking at loneliness in the Programme for Government in the last Assembly mandate – are best done by government and should be done asap.
However, this does not mean good work cannot be done. The third sector can step forward to meet this problem, particularly where organisations have service users who are going through life changes and transitions.
Raising awareness is also vital. Loneliness might not be what you think it is, it can happen to anyone, and its effects are substantial and troubling.
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