1. ISOLATION AND MENTAL HEALTH, HOW CAN COMMUNITIES HELP? Revd. Dr Alison J Gray, FRCPsych Dr Olivia Bush MRCP Dr Kit Byatt, FRCP

2. The Context Revd. Dr Alison Gray FRCPsych Consultant in Liaison Psychiatry 2gether NHS Mental Health Trust

3. Types of loneliness Emotional loneliness Social loneliness Social Support cannot fully compensate

4. Why Loneliness ? Makes parents care for children Homeostatic mechanism Different set points 50% genetic

5. Loneliness cycle Lonely people are sensitive to social threat Expect to be rejected Respond negatively Act difficult More lonely

6. Stress, support and physical symptoms

7. Chronic loneliness linked to… 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

8. Biological effects Increased blood pressure Stress hormones Low immunity Inflammation Poor sleep

9. Loneliness cycle Lonely people are sensitive to social threat Expect to be rejected Respond negatively Act difficult More lonely

10. Difficult to be with People expect Challenging behaviour BUT Mental illness

11. Severe and enduring mental illness

13. 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

14. Mental illnesses are common One in Four Every family in the Land No health without mental health

15. Loneliness kills: 9 years follow up

17. The Evidence Dr Olivia Bush MRCP Specialist Registrar in Palliative Care St Richard’s Hospice, Worcester

18. Action to reduce loneliness Immense number and variety of projects Recent study drawing evidence together

20. Focus of projects Groups or 1-2-1

21. Focus of projects Groups or 1-2-1 work: a)Social skills b)Social support c)Social contact a)‘Loneliness cycle’

22. Focus of projects Groups or 1-2-1 work: a)Social skills b)Social support c)Social contact a)‘Loneliness cycle’

23. Focus of projects Groups or 1-2-1 work: a)Social skills b)Social support c)Social contact d) ‘Loneliness cycle’

24. Focus of projects Groups or 1-2-1 work: a)Social skills b)Social support c)Social contact a)‘Loneliness cycle’

25. For whom?

26. different Age groups

27. For whom? different Age groups Displaced

28. For whom? different Age groups Displaced Marginalised

29. For whom? different Age groups Displaced Marginalised specific Role

30. For whom? different Age groups Displaced Marginalised specific Role Gender specific

31. For whom? different Age groups Displaced Marginalised specific Role Gender specific Mental health

32. For whom? different Age groups Displaced Marginalised specific Role Gender specific Mental health Other diagnoses

33. What works best?

34. Targeting the ‘loneliness cycle’ most effective

35. What works best? Targeting the ‘loneliness cycle’ most effective Men benefit more than women

36. What works best? Targeting the ‘loneliness cycle’ most effective Men benefit more than women Is social support/interaction effective?

37. What works best?

38. Group education/ activity Target specific groups More than one approach Participant’s voice Cattan et al 1998 & 2005

39. What works best? Group education/ activity Target specific groups More than one approach Participant’s voice Cattan et al 1998 & 2005

40. What works best? Group education/ activity Target specific groups More than one approach Participant’s voice Cattan et al 1998 & 2005

41. What works best? Group education/ activity Target specific groups More than one approach Participant’s voice Cattan et al 1998 & 2005

42. Care interpreting research! Bias Applicable to real-life situation?

43. Key Messages Good practice to start with research evidence Don’t accept research findings at face value

45. Where next? Dr Kit Byatt FRCP Consultant in General and Geriatric Medicine Wye Valley NHS Trust

46. 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

47. ‘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

48. ‘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

49. 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

50. Identifying target Asking what people want Evaluating impact Governance structure Masi et al. Personality and Social Psychology Review 15(3) 219–266

51. ‘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

52. NHS Five Year Forward View http://www.england.nhs.uk/ourwork/futurenhs/

53. ‘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/http://www.england.nhs.uk/ourwork/futurenhs/ p16

54. 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/http://www.england.nhs.uk/ourwork/futurenhs/ p3

55. 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/http://www.england.nhs.uk/ourwork/futurenhs/ p18

56. 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/http://www.england.nhs.uk/ourwork/futurenhs/ p19

57. 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/http://www.england.nhs.uk/ourwork/futurenhs/ p25

58. ‘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/http://www.england.nhs.uk/ourwork/futurenhs/ p25 How will we support these new care models?

59. ‘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/http://www.england.nhs.uk/ourwork/futurenhs/ p25 How will we support these new care models?

60. Whatever we do… …must be: Planned – with users Integrated with current systems Properly implemented Evaluated re outcomes Within a governance framework