ISOLATION AND MENTAL HEALTH,
HOW CAN COMMUNITIES HELP?
Revd. Dr Alison J Gray, FRCPsych
Dr Olivia Bush MRCP
Dr Kit Byatt, FRCP
The Context
Revd. Dr Alison Gray FRCPsych
Consultant in Liaison Psychiatry
2gether NHS Mental Health Trust
Types of loneliness
• Emotional loneliness
• Social loneliness
Social Support
cannot
fully compensate
Why Loneliness ?
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Makes parents care for children
Homeostatic mechanism
Different set points
50% genetic
Loneliness cycle
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Lonely people are sensitive to social threat
Expect to be rejected
Respond negatively
Act difficult
More lonely
Stress, support and physical symptoms
Chronic loneliness linked to…
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Lower self control
Obesity, poor diet, lack of exercise,
Worse physical health
Stroke, heart attack, cancer
Worse mental health
Dementias, Alzheimer’s disease, vascular
dementia,
• Depression, anxiety, suicide
Biological effects
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Increased blood pressure
Stress hormones
Low immunity
Inflammation
Poor sleep
Loneliness cycle
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Lonely people are sensitive to social threat
Expect to be rejected
Respond negatively
Act difficult
More lonely
Mental illness
• Difficult to be with
• People expect
Challenging behaviour
BUT
Severe and enduring mental illness
Charles Darwin, Florence Nightingale, Winston
Churchill, Abraham Lincoln, Vincent Van Gogh,
Virginia Woolf, Buzz Aldrin, Charles Dickens, Isaac
Newton, Leo Tolstoy, Ernest Hemingway, Sylvia Plath,
Mark Twain, Edgar Allen Poe
Bradley Wiggins, Ricky Hatton, Carlos Tevez, Frank
Bruno, Mario Ballotelli, Stan Collymore, Serena
Williams, Andy Cole, Neil Lennon, Paul Gascoigne,
Clark Carlisle, Dean Windass, Andrew Flintoff, Tasha
Danvers, Kelly Holmes, John Kirwan, Paul McGrath
Kirsten Dunst, Carrie Fisher, Robin Williams, Steven
Fry, Bill Oddie, Elton John, Janet Jackson, Kurt Cobain,
MP’s John Prescott, David Blunkett, Charles Walker,
Kevan Jones, Sarah Woolaston
• Mental illnesses are common
• One in Four
• Every family in the Land
• No health without mental
health
Loneliness kills: 9 years follow up
The Evidence
Dr Olivia Bush MRCP
Specialist Registrar in Palliative Care
St Richard’s Hospice, Worcester
Action to reduce loneliness
• Immense number and variety of projects
• Recent study drawing evidence together
Focus of projects
Groups
or
1-2-1
Focus of projects
Groups or 1-2-1 work:
a) Social skills
b) Social support
c) Social contact
a) ‘Loneliness cycle’
Focus of projects
Groups or 1-2-1 work:
a) Social skills
b) Social support
c) Social contact
a) ‘Loneliness cycle’
Focus of projects
Groups or 1-2-1 work:
a) Social skills
b) Social support
c) Social contact
d) ‘Loneliness cycle’
Focus of projects
Groups or 1-2-1 work:
a) Social skills
b) Social support
c) Social contact
a) ‘Loneliness cycle’
For whom?
For whom?
• different Age groups
For whom?
• different Age groups
• Displaced
For whom?
• different Age groups
• Displaced
• Marginalised
For whom?
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different Age groups
Displaced
Marginalised
specific Role
For whom?
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different Age groups
Displaced
Marginalised
specific Role
Gender specific
For whom?
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different Age groups
Displaced
Marginalised
specific Role
Gender specific
Mental health
For whom?
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different Age groups
Displaced
Marginalised
specific Role
Gender specific
Mental health
Other diagnoses
What works best?
What works best?
• Targeting the ‘loneliness cycle’ most effective
What works best?
• Targeting the ‘loneliness cycle’ most effective
• Men benefit more than women
What works best?
• Targeting the ‘loneliness cycle’ most effective
• Men benefit more than women
• Is social support/interaction effective?
What works best?
What works best?
• Group education/ activity
• Target specific groups
• More than one approach
• Participant’s voice
Cattan et al 1998 & 2005
What works best?
• Group education/ activity
• Target specific groups
• More than one approach
• Participant’s voice
Cattan et al 1998 & 2005
What works best?
• Group education/ activity
• Target specific groups
• More than one approach
• Participant’s voice
Cattan et al 1998 & 2005
What works best?
• Group education/ activity
• Target specific groups
• More than one approach
• Participant’s voice
Cattan et al 1998 & 2005
Care interpreting research!
• Bias
• Applicable to real-life situation?
Key Messages
• Good practice to start with research evidence
• Don’t accept research findings at face value
Where next?
Dr Kit Byatt FRCP
Consultant in General and Geriatric Medicine
Wye Valley NHS Trust
Key points
‘…an individual may be lonely in a crowd or
socially contented while alone.’
Masi et al. Personality and Social Psychology Review 15(3) 219–266
‘Because the number of friends or social
interactions is not as predictive of loneliness as
the quality of their relationships, increasing
opportunities for social interaction and
enhancing social support may address social
isolation more than loneliness.’
Masi et al. Personality and Social Psychology Review 15(3) 219–266
‘In contrast, improving social skills and
addressing maladaptive social cognition focus
on quality of social interaction and therefore
address loneliness more directly.’
Masi et al. Personality and Social Psychology Review 15(3) 219–266
• Users liked flexibility & adaptation of services
• Interventions include:
– Befriending
– Mentoring
– ‘Community Navigators’
– Social group schemes
Masi et al. Personality and Social Psychology Review 15(3) 219–266
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Identifying target
Asking what people want
Evaluating impact
Governance structure
Masi et al. Personality and Social Psychology Review 15(3) 219–266
‘If schemes to target loneliness in older people
are to be effective, they must involve older
people at every stage, including planning,
development, delivery and assessment.’
Masi et al. Personality and Social Psychology Review 15(3) 219–266
NHS Five Year Forward View
http://www.england.nhs.uk/ourwork/futurenhs/
‘New Models of Care’
We need to:
• Manage systems – care networks – not organisations
• Make out-of-hospital care much larger part of NHS’ role
• Integrate services around the patient
• Learn much faster from best examples (UK & outside)
• Evaluate new care models
http://www.england.nhs.uk/ourwork/futurenhs/ p16
Engaging communities
• Commit to giving patients more control of
their own care, including the option of
combining health and social care, and new
support for carers and volunteers.
• Action needed to develop and deliver the new
models of care, local flexibility and more
investment in our workforce, technology and
innovation.
http://www.england.nhs.uk/ourwork/futurenhs/ p3
One size fits all?
‘to identify the characteristics of similar health
communities across England, and then jointly
work with them to consider which of the new
options… constitute viable ways forward for
their local health and care services.’
http://www.england.nhs.uk/ourwork/futurenhs/ p18
Multispecialty Community Providers
‘These new models would also draw on the
‘renewable energy’ of carers, volunteers and
patients themselves, accessing hard-to-reach
groups and taking new approaches to changing
health behaviours.’
http://www.england.nhs.uk/ourwork/futurenhs/ p19
How will we support these new care models?
‘We will therefore now work with local
communities and leaders to identify what
changes are needed in how national and local
organisations best work together, and will jointly
develop:’
http://www.england.nhs.uk/ourwork/futurenhs/ p25
How will we support these new care models?
‘Detailed prototyping of each of the new care
models described above, together with any
others that may be proposed that offer the
potential to deliver the necessary
transformation - in each case identifying current
exemplars, potential benefits, risks and
transition costs.’
http://www.england.nhs.uk/ourwork/futurenhs/ p25
How will we support these new care models?
‘A shared method of assessing the
characteristics of each health economy, to help
inform local choice of preferred models,
promote peer learning with similar areas, and
allow joint intervention in health economies
that are furthest from where they need to be.’
http://www.england.nhs.uk/ourwork/futurenhs/ p25
Whatever we do…
…must be:
• Planned – with users
• Integrated with current systems
• Properly implemented
• Evaluated re outcomes
• Within a governance framework