Tackling social isolation and loneliness: consultation analysis

3. Perceptions of the value of the draft strategy

The relatively high number of responses to the consultation suggests that social isolation and loneliness is viewed as an important issue of public interest. Social isolation and loneliness are wide-ranging and cross-cutting issues that are intertwined with many other social issues, and the range of perspectives featured in responses underlines the wide scope of the topic. Overall, responses to the consultation were hopeful and constructive, rather than negative. Respondents welcomed the strategy, and viewed it as a useful starting point, but they felt more must be done to ensure it meets the needs of the Scottish people.

Perceptions of the draft strategy

The draft strategy was described as 'a good starting point', and seen as 'well researched,' 'balanced' and 'covering a wide range of social issues'.

"The proposed strategy covers a comprehensive overview of areas that can alleviate social isolation and loneliness." (Organisation)

The draft performance framework^[10] featured in many of the consultation responses, as respondents recognised the importance of the framework to hold stakeholders accountable on progress made in addressing social isolation and loneliness. However, nearly a quarter of respondents felt the draft could be strengthened to overcome what was seen as its limitations: too general and generic overall, and lacking specificity in success measures.

"Too wishy-washy, need to consider real metrics e.g. broadband by when and to whom?" (Organisation)

"We are concerned that the outcomes, measures for success, and indicators do not clearly link up with one another, appear vague, and together may not result in achieving the overall vision. The limited detail of measures such as 'improved population health' will lead to difficulties quantifying the impact of the strategy and driving future improvements." (Organisation)

Respondents also felt the government should be taking a leadership role and that the draft performance framework lacked specificity about the government's responsibilities in addressing social isolation and loneliness. Some respondents felt that the strategy did not sufficiently address the need for funding in addressing social isolation and loneliness, which is discussed in more detail in Section 4.2. Because the performance framework is a working draft, this suggests that respondents would expect to see a more comprehensive performance framework in the final version of the strategy.

For some individual respondents, the framework felt removed from the lived experiences of individuals and needed to be rebalanced to include them at the heart of the measures. Respondents felt the draft strategy could be more comprehensive and inclusive of the specific groups at risk of social isolation and loneliness, like older people, disabled people, and children and young people (particularly those in care).

Suggested changes to the performance framework in the draft strategy

Respondents felt the draft performance framework needed more specificity to support timely and impactful change. Suggestions included providing greater detail about performance measures, anticipated interventions and the roles of key stakeholders.

Respondents felt that the wider discussion of loneliness was nuanced and wide-ranging and that this needs to be translated into a comprehensive list of performance indicators.

"Performance Framework sets out the actions and indicators to chart progress, this could be enhanced if a social isolation measure could be developed together with a timeline for monitoring progress." (Organisation)

In order to offer a more rounded approach, it was suggested that the performance framework could include additional indicators with direct links to the issue of social isolation and loneliness. The examples suggested included reduction in anti-depressants prescribed, reduction in suicides, or an all-ages measure of social isolation and loneliness. Some believed the framework should move beyond demographics and consider specific life points where support is needed, for example when students leave for university. The Scottish Government may want to consider conducting further research to establish performance measures and collect population data to understand the prevalence of social isolation and loneliness.

While respondents felt the draft performance framework needed to be strengthened, some also felt that it should include what steps could be taken to address the issues of social isolation and loneliness.

"Communities outcome has too much emphasis on the fact finding aspect of it and not enough on the actions taken to address the facts that you subsequently find." (Individual)

As well as a more detailed performance framework, respondents felt the framework should also include the roles and responsibilities of the government and other key stakeholders. These organisations already collect valuable data, which could be used to paint a fuller picture of what is happening at a local level and ensure the approach to tackling loneliness and isolation goes beyond 'top-down', to include grassroots engagement.

"You have experts working at the coal-face in the third sector. We, third sector, report at least twice a year to local government - value and utilise those reports to find out what works in any community." (Organisation)

There was also a desire for measures aimed at key groups or demographics, and what was to be done to address their unique needs. Respondents called for a more detailed analysis of the risk factors leading to social isolation and loneliness, and a fuller review of the types of individuals affected and in what circumstances. Respondents also raised the need for specific indicators, and more of them to be of more use, e.g. crime and safety and antisocial behavior measures, and measures featuring the experiences and needs of specific populations, including children and young people (e.g. care leavers, and people experiencing homelessness).

The desire for greater specificity about planned actions, timings, funding and the roles of key stakeholders suggests that respondents viewed the draft strategy as the Scottish Government's plan to tackle social isolation and loneliness, and thus wanted a more detailed roadmap of the government's plans.

Perceptions of the proposed definitions for social isolation and loneliness

Respondents felt that the current definitions of social isolation and loneliness (see below) worked, but felt they could be refined to improve understanding and to make them more relatable.

Definitions

• Social isolation refers to the quality and quantity of the social relationships a person has at individual, group, community and societal levels
• Loneliness is a subjective feeling experienced when there is a difference between an individual's felt and ideal levels of social relationships

Respondents appreciated that the two definitions distinguish between social isolation and loneliness, as they are two different issues. They also saw the 'subjective' aspect of the loneliness definition as key to include. However, respondents felt the definitions could be clarified to ensure they accurately reflect the experience of social isolation and loneliness and are understood by a range of audiences.

The current definitions were seen to:

• Conflate the quality and quantity of social relationships. There were mixed views on which is more important, which points to the subjectivity of loneliness. For example, a person might have lots of social connections but may not be happy with them.

"By conflating quantity and quality, inaccurate assumptions about the latter from the former. e.g. it could be assumed that someone living within a family household, or surrounded by peers enjoys quality relationships, but this may not be the case." (Organisation)

• Minimise the emotional impact of those experiencing loneliness. Respondents expected the emotional impact of these issues to be acknowledged.

"Definition doesn't adequately describe the emotion - feelings of despair, hopelessness and emptiness that loneliness can bring. Is a detached description of an emotion, therefore people won't identify with this definition in strategy." (Individual)

• Imply attribution of blame and suggest that an individual is lacking something and thus needs to change. This was felt to reinforce the existing stigma around loneliness.

"Whether intentional or not, when someone is viewed as lonely or isolated there is an underlying attitude that they are someone lacking in something, when in fact it could be the very community that they live it that reinforces that loneliness." (Individual)

• Exclude those people that may choose solitude over the company of others, and the definitions run the risk of pathologising them.

"Anyone can feel isolated or lonely one day but not the next - definitions imply that some people are isolated and lonely and others are not, danger of this is that might lead to attempts to identify who needs help rather than ensuring what is put in place is accessible by anybody at any time." (Individual)

These points relate to the broader point that social isolation and loneliness is subjective. People experience it differently and for a range of reasons, and the definitions could be improved by taking this into account.

Suggested changes to definitions of social isolation and loneliness

Simplifying and humanising the language would improve the clarity and relevance of the definitions of social isolation and loneliness. Specifically, responses to the consultation suggested:

• Simplify terms like 'subjective' and 'societal' that may be less well understood
• Clarify the meaning of 'quality'
• Incorporate emotional isolation, to indicate that being isolated may not be a physical situation
• Reframe to include the role of communities or circumstances in contributing to social isolation and loneliness, so they don't blame individuals
• Add that loneliness can be short-term or long-term
• More clearly distinguish between social isolation and loneliness how they are related, for example can be linked but they are not always experienced together
• Include exposure to diversity of social networks

There were additional more specific suggestions, often referencing the groups most relevant to respondents, like disabled people, older people, or parents of disabled children. Although it would not be possible to include all of these groups in a definition, they underscore the importance of defining social isolation and loneliness in a way that is inclusive of key groups.

As discussed in Section 3.3, there were mixed views on the relative importance of the quality and quantity of social relationships, so the definition could perhaps be improved by changing to 'quality or quantity' to account for the range of ways people experience loneliness. One organisation's response gave NHS Highland's definition as a good example, particularly in the way it captures 'emotional' loneliness or the feeling of lacking closeness to others. This is closely aligned to the concept of 'quality' and is potentially a more relatable way of defining 'quality'.

NHS Highland Definition

Loneliness: An individual's subjective sense of lacking closeness, and social interaction with others. Although loneliness has a social aspect, it is also defined by an individual's subjective emotional state. Loneliness is more dependent on the quality than the number of relationships.

An example from a respondent who felt the loneliness definition should be simplified was to revise the definition so it communicated the subjectivity of loneliness without using the term 'subjective':

"Feeling you get when the number or type of social contacts you have with other people leaves you dissatisfied with this part of your life." (Individual)

Another organisation pointed to the Age UK definition of loneliness as an example that captures the subjectivity of the experience. The advantage of this definition is it captures the subjectivity of the experience by using the first person without using the term 'subjective'. The use of 'we', the first person plural, also implies a collective view of loneliness that may reduce the stigma surrounding loneliness.

Age UK Definition

We often feel lonely when we feel we don't have strong social relationships or are unhappy with the ones we have.

There was no consensus among respondents about how to define social isolation and loneliness; contradictions between responses appeared. For example, as seen in the discussion on the importance of quantity or quality in the definition of social isolation, and through acknowledging the diversity of experiences of these. There is a tension in the responses between a desire to make the definition as specific as possible and to simplify and ensure the definitions are relatable and easily understood. The challenge for the Scottish Government is to balance these competing needs when revising the definitions in the draft strategy.