A Connected Scotland: our strategy for tackling social isolation and loneliness and building stronger social connections

Definitions

Social Isolation and Loneliness – our definitions^[6]

Social isolation refers to when an individual has an objective lack of social relationships (in terms of quality and/or quantity) at individual group, community and societal levels.

Loneliness is particularly difficult as a young parent when you don't necessarily have the support network that older parents do… I struggle to fit in with both my peers (because I have a baby) and older mums at toddler groups (because I am a lot younger than most of them).^[7]
– young parent

Loneliness is a subjective feeling experienced when there is a difference between the social relationships we would like to have and those we have.

When I started caring, I had lots of friends and a busy social life. I was active in my community, had great work colleagues; I felt part of the world…Over the years of caring, most of my friends gave up on me always pulling out at the last minute…After my caring role ended a year ago, I realised just how isolated I've become and how little social confidence I have now.
– carer

Social isolation and loneliness can be experienced independently from one another. It is possible for people who appear well connected socially to feel lonely – and for people who live in solitude or with few connections to be content. Temporary loneliness is something that many people feel from time to time, for different reasons. Chronic loneliness is more serious and, again, can come about for different reasons. Our Strategy looks to tackle social isolation among those for whom it is not a choice, and it also seeks to address the broader systemic, structural and cultural issues that create the conditions for social isolation and loneliness to occur in the first place.

What we know – the evidence base

Social isolation and loneliness is an issue that can affect anyone at any point in their life – in youth or in adulthood. Different factors can place individuals at greater risk, including major life transitions, personal characteristics and health conditions. The broad nature of social isolation and loneliness makes them challenging problems to tackle, as they cut across many different issues and effect people differently.

The reality is that social isolation and loneliness permeates all ages, stages and groups in our society. Children and young people increasingly report feelings of loneliness, and far from it being the 'best days of their lives', students entering further or higher education can often find building and maintaining their first social networks as adults challenging. We know that significant life events such as becoming a parent for the first time, retirement from employment or loss of family and friends can leave many in a place where they feel alone and isolated. Moreover, traumatic events – for example abuse, a period of imprisonment, homelessness or addiction – can lead to a situation where isolation compounds the challenges of recovery and/or reintegration into society.

Globally, we are more connected than ever before – with greater access to information and technological resources that enable us to keep in touch across time zones and continents. Yet, despite the prospects it holds for social progress, technology has also presented significant challenges. Those who do not utilise technology or feel less comfortable doing so can be left feeling excluded in a world where online communication and digital services are quickly becoming the norm. However, many people increasingly feel that digital convenience has overtaken face-to-face contact, and technology can actually become a factor in increasing isolation^[8]. For those who are fully engaged with digital forms of communications, the concern that social media can undermine wellbeing and lead to increased mental health issues in vulnerable people has been widely publicised in recent years^[9]. In order to embrace the transformative potential of technology, and to realise Scotland's full potential in a digital world, we need to develop the online resilience of our citizens to lessen the impact technology can have on social exclusion and feelings of loneliness.

Social isolation and loneliness can affect people in a number of ways. There are well documented mental health impacts, including becoming more susceptible to depression, and a greater likelihood of developing clinical dementia for older people who are lonely. There are also significant physical health impacts that are comparable to obesity or smoking^[10].

We also recognise that there are a series of complex needs that human beings have. We know if we focus our Strategy on any single group or need, then we will be limiting the effectiveness of our interventions. In order to make a tangible difference to people who are socially isolated or lonely, our approach has to take the full spectrum of needs into consideration. One of the starting points for developing this draft strategy was therefore gaining a comprehensive understanding of the prevalence of social isolation and loneliness in Scotland.

The Our Voice Citizens' Panel indicated that 1 in 10 people in Scotland often feel lonely^[11]. However, there are other sources of information that help us understand the scale of this problem. Acting on the recommendations of the Equal Opportunities Committee report, the Scottish Government commissioned an evidence review which was completed by NHS Health Scotland^[12] and provided some of the following key statistics^[13]:

• 6% of adults have contact with family, friends or neighbours less than once or twice a week (Scottish Health Survey, 2017).
• 18% of people have limited regular social contact in their neighbourhoods (Scottish Social Attitudes survey, 2013).
• 21% feel that they don't have a strong sense of belonging to their local community (Scottish Household Survey, 2017).
• 48% of people exhibit a degree of social mistrust, which is connected to their level of social contact and feelings of belonging to the local community (Scottish Social Attitudes survey, 2015).
• 28% of people volunteer (Scottish Household Survey 2017), and 46% have been involved in some kind of community action to help improve their local area (Scottish Social Attitudes survey, 2015).
• A significant minority of children are vulnerable to social isolation because of poor peer support or bullying (Health Behaviours in School Age Children, 2014).

There is a range of other evidence sources:

Particular groups of people may be at increased risk of social isolation and loneliness – including those with socio-economic disadvantage, those with poor physical and mental health, disabled people, children with few friends or who are LGBTI, those living alone, those who have been bereaved, men over 50, minority ethnic groups, and those from LGBTI communities^[14].

• 11% of adults in Scotland often feel lonely, and 34% feel lonely sometimes (Mental Health Foundation 2010)^[15].
• Over a third of people in Scotland live alone, and 40% of adults who live alone were of pensionable age in 2017 (Scottish Household Survey 2017)^[16].
• Research suggesting that "8 out of 10 carers have felt lonely or socially isolated as a result of looking after a loved one"^[17].
• Figures from Childline revealed that last year there were 295,202 counselling sessions (2016-17), of which 4,063 were about loneliness. The majority of the sessions concerning loneliness (73%) were with girls.
• In the first half of 2016, 31% of the 16,000 calls received to Silver Line Scotland included loneliness as a key theme.
• In the second half of 2016, 33% of calls to the National LGBT Helpline were from people experiencing loneliness and social isolation.
• In 2010, Samaritans commissioned a UK-wide evaluation of its emotional support services (telephone and email)^[18]. It found that 6% of respondents cited loneliness and/or isolation as their main reason for contacting Samaritans. Some callers describe themselves as either having no access to informal support networks or considering the other people in their life to be unsupportive. Poor social relationships and/or relationship breakdown were often cited as the start of their problems, for example, in not feeling like they had someone to talk to and feeling lonely.
• GoWell carried out a study of loneliness in deprived areas of Glasgow which found that 31.5% of working-age adults who were disabled or off work for long periods due to illness were "frequently lonely"; people who reported high levels of anti-social behaviour in their community and those who did not feel safe walking alone at night "were more likely to report loneliness by between 30 and 50%"; and 17% of men and 15% of women living in deprived areas reported "frequent loneliness"^[19].

Stakeholders have published a number of reports which reflect upon the impact of social isolation and loneliness on communities, along with what matters in seeking to address these issues. These include:

• Voluntary Health Scotland's paper on the lived experience of loneliness and social isolation in Scotland, which reflects on a wide range of issues^[20];
• Research by the Royal Blind and Scottish War Blinded into links between vision impairment and loneliness^[21];
• Volunteer Scotland's report on volunteering, health and wellbeing and how volunteering helps reduce social isolation and loneliness^[22].
• Scottish Public Health Network's report on loneliness and the role of public health^[23]; and
• Sensscot's briefing on the role of social enterprises in tackling social isolation and loneliness^[24].

The refreshed National Performance Framework^[25] published earlier this year included for the first time a new national indicator on loneliness, which sits under a new national outcome that "We live in communities that are inclusive, empowered, resilient and safe". To help measure this, a new question on loneliness has been included in the Scottish Household Survey from 2018, with the first results available in September 2019.

In developing this Strategy, we are conscious that, whilst the Equal Opportunities Committee's Inquiry was the first of its kind in the world, there are distinctive approaches to tackling social isolation being taken both elsewhere in the UK and in other parts of the world. Examples include:

• The UK Government published their first loneliness strategy on 15 October 2018, which recognises that loneliness is a major public health issue. The strategy seeks to build a cross-governmental approach to tackling loneliness with a range of initiatives including greater social prescribing, working with business, developing a loneliness policy test, and supporting flexible and inclusive volunteering.
• In Wales, the Health, Social Care and Sports Committee conducted an inquiry into loneliness. It highlighted a number of issues, including the benefits of social prescribing, transitional support for retirement, exploring different housing models, and the potential for legislation to make a difference. The Committee's report sets out a number of recommendations for the Welsh Government to take forward^[26]. On 22 October 2018, the Welsh Government launched a national conversation on what can be done to combat loneliness and social isolation in Wales.
• In Northern Ireland, the then Executive published a framework to tackle rural poverty and social isolation in 2016. This focuses on promoting positive mental wellbeing, increasing opportunities for social engagement and supporting at risk groups (including farmers and disengaged young people).
• In the Republic of Ireland, Respond! Housing Association undertook research into how to combat social isolation and loneliness within social housing. It emphasised the importance of consultation, flexibility in devising solutions, partnership working and human contact.
• In Japan, social isolation and loneliness are recognised as an increasing issue, and strategies focus primarily on older people. Promoting 'worry free living environments', community-based activities, and access to cultural facilities like libraries are all seen as important.
• In New Zealand, research has highlighted the importance of volunteering, quality of relationships (as opposed to quantity) and contentment with life. Befriending was also recognised to be valuable following an evaluation by the Minister of Health.

Considering best practice in other jurisdictions is important, so we'll continue to engage with the UK and Welsh Governments as they develop their work, and monitor emerging work in Europe and elsewhere to ensure that we capture learning to inform our own approach as well as share lessons learned from work in Scotland.

What we've heard through consultation

The Equal Opportunities Committee of the last Parliament made an important contribution to kick-starting this work. The evidence it received during its inquiry led it to conclude that social isolation and loneliness are significant problems in Scotland and that individual citizens, public services and the Scottish Government should take collective responsibility for improving the situation. The Committee stated that social isolation and loneliness is everyone's issue; it should not be ignored or tolerated; and that a change in attitude is needed to consider it as part of the public health agenda in Scotland alongside issues such as poverty and poor housing.

In 2016, Befriending Networks held a national summit on loneliness, and Voluntary Health Scotland organised a conference Loneliness: A Threat to Health^[27], which focused on loneliness as a public health issue. On 15 December 2017, the Jo Cox Commission on Loneliness published a call to action^[28] for Governments and society to tackle loneliness.

Perspective: Voluntary Health Scotland

There is no X-Ray for loneliness and no blood test for social isolation, but it is increasingly recognised that a lack of connectedness can damage health throughout the life course and in communities, making loneliness and social isolation a public health issue as well as a social one. We have consistently put forward evidence to show how social isolation and loneliness are a distinctive feature of health inequalities, highlighting the role health charities and other voluntary, community and faith organisations play in supporting the most socially disconnected and isolated individuals and communities, by building social capital, individual resilience and community cohesion. In 2018, we investigated the loneliness and social isolation experienced by a number of "voices less heard", including black and ethnic minority women and carers, which is reflected in the recently published Zubairi Report. Creating a more connected Scotland requires us all to take a whole system approach encompassing health, education, inclusive growth, social security, digital, transport, planning, human rights, community empowerment and democracy.

Claire Stevens, Chief Executive

The Scottish Government held an event in April 2017 to ask stakeholders what they thought a National Strategy on social isolation and loneliness should contain and, in January 2018, we published our draft strategy for consultation. The consultation asked for views about how the strategy could be improved in terms of the definitions of social isolation and loneliness, and the actions required to address these, and who needs to be involved. In addition to inviting people and organisations to write to us, we also invited them to come to events in different parts of Scotland. In total, we held 17 community engagement events from across Scotland to hear from people about what matters to them.

When it closed at the end of April 2018, the consultation had received 419 responses from individuals and organisations. We commissioned an organisation to carry out independent analysis of the consultation findings and a report was published at the end of 2018 setting out the findings. The consultation analysis presented four prominent factors that were thought to contribute to social isolation and loneliness including transportation, housing, public spaces, and digital technology. It also presented five 'features of support': policies and regulation, sustainable funding, education and training, designing support, and delivering support. The report concluded that there is not going to be a 'quick-fix' solution – and that tackling social isolation and loneliness will require investment in public and social services that support community life and social connectivity.