Dr Helen Kingston, aged 59
British GP and co-founder of a pioneer model of social prescribing to help patients combat the isolation of illness
Interviewed in her rooms at Frome Medical Practice on May 22, 2024, Somerset.
Have you always doctored with an eye on social wellbeing?
I think general practice is about the person and the story. Even when someone turns up with a headache, that’s often just the entry point to the rest of their story. They’ll sit down and if you listen quietly, out will pour something that is very obviously the cause of their headache. It’s that bigger picture, isn’t it? There is no capacity in the NHS for all the fifteen minute GP appointments that are needed – plenty of patients will need longer than that to tell me the convoluted histories of what constitutes their life.
A lot of people have never heard of the term ‘social prescribing. Can you explain how it works?’
I find that often patients go to their GP when they’re at a turning point in their health, or in crisis in their lives, and there is a temptation — as doctors— to intervene with medication, rather than look at the root causes of a patient’s problem. I think the world has become over-medicalised. These days, every problem has a medical label and sometimes the priority is not a medical intervention — what’s needed is support. In the social prescribing model, a ‘health connections team’ - that’s what we call them in our practice— work alongside the clinical team looking at ways to support a patient with lifestyle measures. They’re non-medical staff inside our practice and I can go and knock on their door if I have a patient with a crisis who might need a more integrated approach to their health problem. That team can also deal with the most complicated cases when a patient requires complex care or needs home visits.
Is the Frome Model a blueprint for future doctoring?
I think so. What’s remarkable about the Frome Model is that apart from our paid team of Health Connectors, this town of just under 30,000 people has also trained 1200 voluntary ‘community’ connectors— from cafe owners to taxi drivers, shop assistants to librarians. Residents here have been trained how to advise their friends and neighbours about the 400 community groups and services on offer in town that often go underused for the simple reason that many people don’t know they exist. These community connectors aren’t formal volunteers, they’re just people who know how to signpost. The tribe is a very powerful mode of connection.
And word of mouth travels quickly?
Well, we now have 2200 community connectors who know how to tell people in town what services are out there. We estimate each of our community connectors has on average about 20 conversations per year. That’s 44,000 conversations that might just help someone access the help they need, people you’ve caught up upstream well before they might end up in crisis.
How can you measure the success of a doctoring model like this?
In the beginning, we just set out to deliver better patient care. We didn’t set out to save money. We didn’t set out to reduce the number of admissions to hospital. But that’s what happened. We have seen a 28-percent reduction in emergency admissions. We are getting constant feedback that we are delivering better health care to our patients, who are not coming to see us as often as they used to. In a way, we can measure our success not by measuring the number of people who need our service, it’s almost measuring the number of people who don’t need us anymore. And I can measure our success in terms of community wellbeing. I can even see it in our staff resilience and how much they’re enjoying their jobs.
What are you seeing in the community at the moment – how are people coping?
I think loneliness is on the rise and I think our technologies and the disconnection they cause is a major issue. Our reliance on information technology is helping create that isolation. Yes, it’s also making life wonderfully more efficient— look at how Zoom is making business interactions more convenient, how internet shopping is quicker and easier than going off to the high street. The thing is, if we want to collaborate and trust each other and build relationships, online is not the place to do it. And I think the way social media is dynamising perfection means young people are growing up with an increasing sense that they’re inadequate. So somebody in California has managed 5000 push-ups against your 100 – you’ll feel bad. We used to be small fish in small ponds. Now we’re tiny fish in massive oceans and I’m seeing young peoples’ mental health suffering because they’re comparing themselves against impossible ideals. Anxiety is ballooning. A person makes headlines after falling out of a tree in Arkansas and suddenly everyone in England thinks they’re going to fall out of a tree. Social media makes the world feel a lot more dangerous.
Do you think social media and our dependence on our phones has made us much less forgiving of human frailty?
I think the stakes are much, much higher for young people. I’m not sure the standards technology is setting are fair but you don’t change those things overnight. I’m seeing a forking in the road in terms of young people seeking ways to regain control over their lives. I’m seeing a lot of low mood, anxiety, depression, more eating disorders amongst young women definitely. But I think some of this need for control – the explosion in radical eating and compulsive dieting regimes, for example, are a normal response, an adaptive reflex to an environment that’s hostile. Social media, with its obsession with perfection, creates a hostile environment for people. It refuses to acknowledge that we’re all dysfunctional in some way. And loneliness is just a label in that vast collection of human dysfunctions. Really, loneliness just a point on the spectrum of normal, so I say let’s focus on framing social anxiety a different way. Let’s create a more friendly, relaxed and interactive community. The knock-on effect is that it becomes easier for those on the lonely end of the spectrum to feel more included.
And yet we’re still not talking publicly or openly about the consequences of loneliness and isolation when we’re happy to talk openly about mental health. Why do you think talking about loneliness is the last taboo?
There’s still a stigma. Definitely. But what we’ve tried to do here is shift everybody a couple of notches up the scale of what we broadly consider ‘mentally healthy.’ Yes, of course some people at the lower end of that spectrum, those in the risk zone for loneliness will need a bit of additional support to feel included in the community, but if the whole of society were to shift slightly, it would make life much easier to manage for those who are struggling to feel accepted. Basically we’re trying to widen the bounds of what constitutes ‘normal.’ You need a cultural shift. I think if we focus on improving how we are interacting with each other you end up with a society that’s more inclusive of more types of people.
You’re not a big fan of the word ‘volunteer’ I notice, and yet your social prescribing model depends quite heavily on the concept of volunteering?
In the formal sense, volunteering suggests someone who’s working without being paid. I think volunteering has its place but we prefer the term ‘befriending’ because it better promotes the idea of being a good neighbour. When you befriend someone, sometimes it’s the giver, not the receiver, who feels even better afterwards. The word volunteer suggests you are doing something to someone or for someone. We want people in the community to feel equal. You help someone, they help you. You’ll feel just as good as the ‘giver of help’, as you might when you’re ‘receiving the help.’ We’re trying to build two-way communities: the sense that if something in your life goes wrong, there’s always going to be someone who has got your back. So often what is stressing people out is not that they can’t manage their day-to-day lives. Their anxiety is caused by worrying about who’ll be there for them if a real disaster strikes.
What’s the first step then? What can people do? Do we need to start weaning ourselves off social media?
You can’t change a culture overnight. I think we need to move away from transactional discussions and start having more meaningful conversations. Sure we like what technology has done to drive efficiency, but technology is also dismantling the notion that people feel better when they have a sense of belonging. And that drive for efficiency in our lives is not satisfying our need for belonging. That means taking time out for our important relationships – not being relentlessly busy. And it also means having a casual conversation with a shopkeeper rather than ignoring them because you’re on your phone. It’s slowing down long enough to have a brief chat with your neighbour up the street rather than just marching past them. Even a 20-second ‘hello’ and ‘how are you?’ and ‘what’s been happening?’ is enough to build a sense of belonging to a community. I certainly think we need to create opportunities for more quality face-to-face conversations, the ones where we have to read peoples’ expressions and interpret their gestures, where we feel seen and heard and understood. I see society becoming much more risk averse. There’s much less forgiveness for past transgressions. Cancel culture means no-one is allowed to have a history. The stakes are suddenly very high and that creates social anxiety, which in turns feeds peoples’ growing sense that they’re inadequate. And when we feel disconnected, or inferior, we lose our resilience. We need to learn how to trust each other again.
Jenny Hartnoll, aged 57
Development lead and co-founder of Health Connections Mendip and the Frome Model of Enhanced Primary Care
Interviewed at her favourite café in Frome on 30 May 2024
At what point did you realise the Frome model was having a real effect in the community?
I had been implanting the idea of the community having the power to improve itself when I first started working for Frome Medical Centre. Having one foot in the GP practice and one foot in the community, I saw from both sides how well it was working. I realised the power of what I was doing. How far we’d come in just two years. You have to have belief in the beginning.
Was there an element of blind faith involved?
(Laughs) Probably. I knew I could work alongside individuals in Frome to help them find the power to look after themselves. The blind faith was hoping that the GP practice would open its doors to this. I had patients saying, ‘how do we tell our doctors what we want in the community?’ The community groups were already out there. The active citizens were already out there. It was the knitting and weaving that was needed. And that was my challenge: to create the narrative of what the model would look like.
What do you consider is the most successful measurement of what you’ve achieved?
I think it’s the fact that GP practices are now working in a different way. They’re seeing the patient as a whole person. I think we have shone a light on how the concept of community can improve the health of its citizens. Even now, when I’m roaming around town for two hours sticking up posters and saying hello to people, I love the magic that happens when someone says, ‘Hey, I have an idea — let’s have library connectors!’ Everyone’s thinking about everybody else — what’s still needed and how to fill the gaps. And of course, you have to respect that not everyone’s feeling great out there. Plenty of people in Frome are feeling lonely or dejected. Alienated. We don’t say we’re the perfect town, but we do say we’ve got all kinds of support to help anyone who’s feeling vulnerable. Now, more and more people are moving to Frome because we have a reputation for being a town with high social capital. Not everyone loves that of course, because it's driving up house prices and making rent more expensive. But we know we’re a nice place to live.
How important is word of mouth and do you think that’s a key driver for this?
We looked at the optimal referral routes and every time word of mouth came out on top. Word of mouth has a power that’s very potent. That’s why I set up the ‘community connectors’ project because that’s the fastest way for local news to travel. I think people in Frome like to talk to each other. It’s the way to activate the neural pathways across town, mostly by simple conversations. I needed to find those key players who had the energy and the passion to publicise what we were doing. They could be anyone and everyone — from a homeless person to a school teacher. A rubbish bin man to a hairdresser. They’re the people who would get word around town that there’s a new support group for stroke patients. Or that there’s a community fridge behind the town hall where anyone could go and get nice vegetables or a loaf of bread and milk if they were short that week. That there was a new yoga class or a dog-walking service or someone who could come and see if your house was heating properly. This model works on common sense. It can be replicated in any town or any city anywhere. It relies on communities learning how to nurture themselves. My job is to maintain the ripple effect, to shine the light on what’s missing and keep innovating.
Is Downing Street listening to you?
Yes. They have taken note of what we’ve achieved here. Every primary care network which has a GP practice now gets funding from the NHS to employ social prescribing link workers in their area. In Frome, we now have six paid link workers. And when you team those people with community connectors signposting to information access points, you start to reach just about everybody in town. It’s not about being a volunteer. You’re just a human being who’s happy to pass on a tip or two about what’s out there for people. All we’re doing is creating a more permeable line between health and community.
What’s next for Jenny Hartnoll?
In Frome, all I need to keep doing is discovering what services are still missing. I guess I’m the glue that holds the Frome Model in place (laughs). The person who sees where things can be connected. I need to make sure the system is robust enough to grow in whatever direction we need it to. We hold a meeting once every month to attract more community connectors. We don’t care what profession you’re from. We’re interested in democratising information. It belongs to us all.
A lot of my work now is trying to keep up with international requests for information and training. So many towns and cities want to replicate what we’re doing. And what I say to them is this: there are so many low cost, practical ideas that create a sense of community.
Mark Oxborough, aged 66
Former official, House of Commons
Interviewed while volunteering at a public coffee morning in Trinity Hall, Frome, May 21, 2024
Why did you start coming here?
I wanted to do something to help other people after I retired. I wasn’t feeling lonely myself, but I didn’t want to rely completely on my wife for comfort if I ever did start to feel at a loose end. Suddenly she was getting twice as much husband for half as much money (grins). I’ve always liked to be useful. I’m sure it’s the same for most men?
Do you see much loneliness in Frome?
Oh yes, a lot of people are lost. There’s a fella about my age who lives near me and I see him all the time – roaming around, never with anyone, always alone. I started talking to him a few months ago and he told me he misses his job since he retired. He’s lost his purpose. He’s lamenting the loss of his usefulness. That’s a special kind of loneliness.
Have you worked out how much social connection you need to keep loneliness at bay? I ask you that because I just read some research findings that show men have far fewer friends than they used to.
I think that’s why we need to provide places and opportunities for strangers to meet and chat and make new connections. My wife doesn’t have a particularly good social network anymore because we moved from Kent to Somerset. I don’t think she’s doing enough to make new friends. She thinks we should each have our own space, which is fair enough, but I think you need to make more friends as you get older. The friends you thought would stick by you your whole life have a habit of dropping off the perch, and you’ve gotta fight the deficit. You’ve got to reach a critical mass of friends or you risk being alone and lonely as you get older.
Do you think many people underestimate how good it feels to volunteer?
Yes. I wonder if people are just too busy to volunteer these days? But you need to make time for selfless activities because they’re so good for wellbeing. Putting my hand up to volunteer here has given me a sense of purpose, a feeling of belonging. A lot of these people here today are friends really. They were all strangers to me four years ago but now we see each other once a week. I don’t go to their homes but I feel close to them. Even outside of this context, I think I could rely on them if I needed to. I’m pretty firm with myself about turning up. It’s difficult if you’re depressed like I am. I’ve been depressed since I was a teenager, since I was fourteen. I remember feeling completely isolated as a young lad. I felt like an outsider. I didn’t have much of a relationship with my father. He was an electronics engineer and he served in WW2 and I think he was permanently traumatised and just couldn’t relate to me.
Do you think it can be a dangerous time in a man’s life when he retires?
For me, yes. It was a massive adjustment. I’d worked in the House of Commons for 35 years. At first I enjoyed not having to commute morning and night for 40 minutes, but my wife and I retired at the same time, and it wasn’t long before we were knocking about in the house together banging heads. That’s when we decided to move west to Frome. I started volunteering as a gardener in a local hospice – I’m good at gardening or at least I think I am (winks). The thing about retirement is— you so look forward to it, but then the novelty of having nowhere to be and nothing to do wears off. For me, that’s when the depression kicked off again. I’m not really sure why — I have a lovely wife, we have a nice house, we’re all right financially.
Do you think you’re susceptible to loneliness because of your depression?
Yes, I think so. I try to manage it. I take medication and go to therapy. I’m big on routine. I do everything I can to stay on top of it but when you’re clinically depressed, you think none of the good times you had before will ever come again.
Do you think you’ve found a sense of optimism through your volunteering?
Absolutely. Couldn’t agree more, because when you volunteer, you learn pretty fast that everyone is struggling with something. It makes you realise there’s no normal and we all need to help each other. We’re at our best when we do that.
Do you think this get-together each week is really making a difference to the way the lonely see themselves?
Oh yes. Tuesdays are always a good day. I feel good. They feel good. Everyone goes home feeling like they’ve had a dose of human kindness, of conversation, of someone caring about how you feel, even if it’s just offering to make you a cup of tea. Someone told me today that they left their husband of 30 years because not once in that 30 years did he ever offer to make her a cup of tea. Well, that’s significant! We’re meant to be kind to one another.
Ruth Suter, aged 59
Book keeper and volunteer.
Interviewed at the Talking Café, Frome, Somerset, UK on May 21, 2024
Why are you here today, Ruth?
I’m here because I know what loneliness feels like. People come here for different reasons but the common denominator is loneliness. (Laughs) I’m not even comfortable using that word still, because there’s such a stigma about admitting you’re lonely— that word makes you feel like a real failure, like you have no friends or that nobody likes you. People would rather say, ‘Oh I’m a bit sad’ or, ‘I’m a bit depressed.’ It’s easier to say you’re depressed than say you’re lonely. The word ‘lonely’ has these terrible connotations.
How did you cure your own loneliness and do you know why it happened?
I didn’t know loneliness until I hit menopause. My husband had always worked long hours and mostly he was too tired to sit and talk after work so I was just on my own more and more. And then he was made redundant and in the space of a few weeks, I stopped sleeping. I mean completely stopped sleeping. I got the shakes and couldn’t drive and then I lost my appetite and began to lose weight. My husband knew he couldn’t get another job because I wasn’t functioning and so I started feeling guilty on top of everything else. Inside a few weeks I just couldn’t get out of bed.
You must have been petrified?
I couldn’t figure out what was wrong with me. I’d tried HRT a few months earlier but I don’t think I gave it long enough to work. I was so scared my husband was going to leave me because I was a total wreck. But he was so good to me. I asked him to take me to a psychiatrist. And I asked the psychiatrist, ‘Have you seen anybody like me before?’ and he said ‘Yes,’ and I said, ‘I want you to tell me what level of crazy I am compared to your other patients,’ and he was so lovely— he said, ‘I think you’re a bit lonely and your hormonal fluctuations have given you a bout of depression. And he gave me anti-depressants.
Did they work?
I had the script for an entire week before I’d dare take one. I was so ashamed. I’d taken plenty of medication in my lifetime but this was mental illness and the stigma of having a mental illness terrified me. I felt so alone. Everyone expected me to be superwoman and there was no way I was going to admit to anyone I wasn’t coping. And I was more isolated than I’d ever been in my life. I’d never knew loneliness could be so paralysing.
How long did it take to recover?
I started to improve within a month and I just gradually got better after that. A lot of husbands and families wouldn’t have been so sympathetic but I was lucky. All I wanted to hear was that I was normal.
So here you are and I should call you a ‘befriender’?
Yes! The people who come here have all been feeling the kind of alienation and loneliness I went through. I’ve been coming here now for ten years. I do for myself: I enjoy the company, but I also know that when someone in the group is feeling low, I hope I might have a few techniques to help them feel they’re not alone. I just say, ‘Well done for getting out of bed.’ ‘Well done for coming.’ I remember how hard it was to get up and get going against the odds. I just want them to know everyone here has been in that dark place and come out the other side. No doctor can give you a prescription for friendship and love.
Jennifer Brook, aged 65
Volunteer church warden, Village of Nunney, Somerset, UK
Interviewed at home on May 30, 2024
The interesting thing about this village of 850 is that you’ve pretty much found the formula for beating loneliness all by yourselves.
I guess we have, haven’t we? In Nunney we all look out for each other. It’s a deeply cultural thing to be polite in Somerset. Here, they’ll call you ‘my lovely’. Drivers will always give pedestrians the right of way in the High Street. Everyone says ‘good morning’ to each other and ‘how are you?’. I find it so sad that talking to a stranger these days is made to feel like something predatory. But I’ve seen a real increase in the number of people I’d identify as isolated. And the biggest problem is that you can’t find the people who are profoundly lonely, because they’re managing on their own without help. I met a woman at the shop the other day and I’d never seen her before, and she said, ‘Well that’s because I don’t go out. I don’t want to see other people.’ The lonely people you know about are the ones who are housebound by illness or frailty and have carers and neighbours who look out for them.
How important is it in small communities for everyone to do their bit for the collective benefit of all?
(laughs) It’s just common sense really isn’t it? And a bit of selflessness. We’re not asking for hours of someone’s time. Just some ‘can-do’ attitude. I mean, the village didn’t have a playgroup so we fixed that pretty quickly. There was nothing here for young children and mothers, or carers of small children and grandparents. We figured it was really important they meet and talk and they needed a place to come together and have a decent cup of coffee and something nice to eat. And now we have a thriving playgroup. We thought winter was a pretty tough time for people who couldn’t afford to keep their homes as heated as they’d have liked, so now there’s a ‘warm spaces’ group with a group of volunteers doing coffee and soup and simple lunches one day a fortnight and we all love that.
Church congregations have been in steep decline for decades now. What’s taking the place of church in peoples’ lives do you think?
I’m not sure. Possibly nothing. And that’s sad, because even if you’re not the slightest bit religious, the church is a great prop for people who are lonely. That’s one of the reasons we keep this beautiful historic building open every day— so everyone can see the value in it. It’s a cultural thing isn’t it? The church building belongs to everyone. And what happens in a small village is you find there’s only ever a small number of people who’re prepared to volunteer for these kind of things, and by coincidence, they’re often the churchgoers. For me, it doesn’t matter who pulls the community together— some of us just love to provide a place and a space for people to talk to each other. And we always get a high turnout when we do things outdoors.
How do you communicate with 850 people in a village?
Well that’s the trickiest thing, so when I took on this job —most churches in the UK have a warden responsible for the upkeep of the physical building— I decided to do a little booklet of everything that goes on in town. There are only 400 houses in Nunney and we don’t have a lot: there’s no sports field, for example and the playground leaves a bit to be desired. But success breeds success and as you suck in more people who discover that volunteering is fun, so they encourage others and on it goes. You need critical mass for these things to work. The hard bit is deciding how much to do for people and how much to let them do it themselves.
I’m hearing of Atheist churches springing up in the place of religious churches: all the benefits of church and community minus God. How do you feel about that?
I’m all for it. It brings the church building back into use and the sense of community that church brings. And there’s been a great growth of ‘house churches’ —evangelical churches that organise gatherings, usually in a school. Maybe we need more atheist churches – I know I’ve seen research that says people now want to be spiritual but not religious. They’re looking for meaning in life. They’re looking for positivity and optimism and a sense of belonging that they’re missing in life. If atheist churches the way forward, then let’s use church buildings to build a new sense of community.
Toni Holcomb, aged 66, widower and father of four
Former British Rail train driver, now a transgender woman
Interviewed in her flat in Frome, Somerset on May 24, 2024
How was it being a train driver for 32 years?
In the beginning, brilliant. I was driving the heaviest freight trains in the country. They take a bit of stopping (winks). Then I started driving passenger trains— Westbury to Bristol, to Paddington, to Cardiff and I had everything that can happen to a driver: a runaway train with no brakes, six fires, an explosion, a crash, a jumper. He was just a young fella. Year 2000. 8am. Peak hour on the line to Brighton. I remember it clear as day. I think I’m still traumatised.
How have you come to be so isolated?
Retirement was hard. I liked the camaraderie of the railways. My wife died at 50. I’d already decided to transition when my wife was alive. I started having strong feelings about being a woman. I used to dress up in my sister’s clothes when I was a kid. I’m lucky my wife was very accepting. I think she liked having a female partner more than she ever did having a husband. We did everything two girls could go and do together – shopping for clothes and the like, but then she passed away. The kids grew up and moved out. That’s when I did the full change to becoming a lady. I’ve been on my own for the last twelve years.
What’s driving your loneliness do you think?
It’s the isolation. I’m always by myself. Romantic movies on the telly do me in. Listening to music can be awful because it makes you sad for better times. Work was my only outlet. I liked having conversations with all the passengers in the ticket office but the long hours in the engine were very lonely, especially at night. You’re driving everyone home to their families but you got no-one at home waiting for you. I find loneliness can hit you when you least expect it. You think you’re going alone fine and wham! Sometimes it’s hard work being a transgender lady in a small town.
How do people treat you now you’re a woman?
Oh they’re mostly lovely. People come up and talk to me all the time. They’re straightforward with me, mind. Curious but not rude, not unkind, they just treat me like any girl. People didn’t talk to me when I was a bloke so I feel over the moon about being a lady. There’s no way I’d go back to being a bloke again. I can sit down and have a proper conversation with people now. Men never sit down and have a proper conversation. They’re always trying to outdo one another. I can see both sides of the fence and ironically, the best side of the fence is being a woman. Someone said to me today at the shops, ‘Y’know, you only look 40. Thank you very much, I said. I only feel 66.’ And that’s after I been through the menopause. Now I’ve shocked you, haven’t I! (laughs)
Have you found ways to cure your loneliness?
If I knew a proper cure I’d be rich! But I certainly done some things that are working for me. Three months ago, I joined the Talking Club that meets twice a week in town. I so look forward to it. It’s two days I know I’m doing something nice. Often we get a really big group. We talk about all kinda things —it’s genuine conversation. Someone listening to you, you listening to someone. I feel like I belong somewhere. And everyone wants to belong don’t they? That’s the thing we all want. To feel wanted. And there, I feel wanted for my listening ear and for my conversation skills. I always feel so good afterwards.
From what you’re telling me, it sounds like we need to find more ways for isolated people to feel needed?
Exactly. My mental health worker has suggested I train to become a peer support person. I’ve been through a lot in my life, and sometimes all you need to hear when you’re alone and isolated and going through the hard stuff is that someone’s been there before you and come out the other end. I reckon I could help people find their blue sky. And I’d get just as much out of talking to them as they’d get talking to me. I’d feel needed. And that would be beautiful.
Reg (Lucky) Ling, aged 93. Former Pot Black coach (and the older player in Somerset’s West Wilts Snooker league).
Interviewed at the Player’s Club in Westbury, UK on May 27, 2024
What’s the secret to a great snooker player?
Endless hours and hours of boring practice. You’ve gotta beat your competition hard enough that it’s gotta hurt. But if you’re the one getting a thrashing, then you gotta take your punishment with dignity. You gotta appreciate the difficulty— and the mystery— of the game. The mystery is how badly you can play some days.
What has snooker taught you?
Well it taught me that the players needed a one-handed retractable cue chalker that would shield their clothes from soiling. So I invented one. I patented it too in 1978. Sold precisely one of the little bastards. That taught me how to smile when things go wrong.
You were married for 58 years, yes? And now you’ve been a widower for nine years. How do you keep the loneliness at bay?
Everyone has lonely moments and everyone has the right to a friend. But you can’t have a friend if you’re not being a friend. Am I lonely? No — but I have moments when I don’t have the company that I want and then I do something about it, like ring someone up or call in on someone. Loneliness is just a measurement. If you have all you require seven days a week, then you’re never lonely are you? If you need friends because the amount of sociability you have is less than the sociability you want, then you’ve got an issue with loneliness. That’s why I like the chinwaggers club.
You mean the Talking Club?
Call it what you like. I discovered it by accident. A neighbour of mine goes down to town and chinwags, so I decided to go along in 2017. I’ve been coming once a week ever since, even during Covid — we brought our own chairs and our drinks and sat outside six feet apart.
Do we talk to each other enough?
No. Not about the things that matter. We don’t risk having the important big conversations because we’re scared of failure, scared we won’t be liked or we’ll be made fun of. We’re frightened of communicating because we fear we might expose our own weaknesses. It’s time we were refreshingly honest again. It puts people at ease with each other to know everyone’s not perfect. It makes us loveable.
Why do you think we’re in the midst of an epidemic of loneliness?
I think it’s created by the way we live. People live in fear of their neighbours because they don’t understand the mathematics of risk. I dunno about Australia, but in England, roughly 2-percent of the population is criminal. That means we’re 98-percent honest, so play the odds. Take the risk and say hello to the fella up the street. The media wants to talk up the violence and drama because the mundane doesn’t sell newspapers but the world isn’t like the way they’re telling it. Most people are boring. And nice.
What’s your antidote to loneliness then?
Oh that’s easy. Be a friend. It’s not so difficult— knock on your neighbour’s door, introduce yourself and say ‘Can I help you in any way?’ and they’ll say ‘No’ because they’ll be frightened initially, and they won’t want to associate with you because they’ll think you’re mad, but they’ll remember that you bothered. And that’s the beginning. You’ll have a lot of beginnings. And don’t make just one friend because they do drop off the perch, y’know. People stop making friends as they get older. Make some young friends. Don’t think they’re too young for you. Try and meet younger people. Don’t worry about the age gap, just be friendly. Don’t hoist yourself upon people, there’s a delicacy to relationships you can’t control. Some people just won’t click with you – that’s okay, leave those ones alone and keep looking.
Have you got enough friends?
Well I can always do with one more. What are you doing next Tuesday? (laughs) I recently offered to take the lady up the street to a doctor’s appointment in a fortnight’s time. It’s no skin off my nose to bring her to the doctor and then treat her to a coffee afterwards. It’s not like I’m taking her up Mt Vesuvius. You can’t have a friend if you’re not a friend, remember?
James Lewis, aged 62, former paramedic and Amy Wood, aged 42, health support worker
Founders of the charity Dogs for Health in Frome, Somerset
Interviewed with Fred the Labrador, May 23, 2024
How did you get started using therapy dogs to treat loneliness?
Amy: I had a very isolated patient four years ago who told me how much he missed his dog and how much he’d love a visit from someone with a dog so my boss said, ‘Why don’t you set something up?’ I put a post on Facebook asking for local dog trainers and James put his hand up to help. We got really big really fast so four years ago we became a self-standing charity.
Why do you think this service took off?
James: It’s very simple - people just love dogs. If you’re lonely and you have no-one to talk to, especially if you used to have a dog, there’s a void you can’t fill. If someone comes to your house with a dog, you just feel better. It’s a door opener, a conversation opener and a great way to build confidence in people who’ve lost their ability to socialise.
Amy: We’ve had people who haven’t been out of their house in months, but if you go round with a therapy dog a few times and start that relationship you’ll find one day you can say ‘Shall we go for a walk?’ and they’ll say ‘Yes, I think I could do that now.’ Walking a dog makes you feel normal. It takes the focus off feeling vulnerable. The emotional and social benefits are amazing.
How big a problem is loneliness from what you see?
James: It’s massive. I think we’ve forgotten how to be a community. People get trapped inside their homes. It’s not pride. It’s fear. We’ve lost the ability to socialise with each other. We think we shouldn’t chat to strangers. We’re scrolling for hours on our phones and no longer know how to have a little friendly conversation in the park or at the shops. We come to your home and see what you need and talk to you about how we might help you rebuild your independence. And your confidence. Somehow we’ve lost the skills to do that ourselves.
Why do you think that is?
James: Maybe it’s because we’re no longer making the effort with each other. Do you know who all your neighbours are and what they do? Do you talk to the elderly fella up the street? I know as a paramedic, I saw so many lonely people making up any excuse to get the ambulance round. We used to get 100 calls a month from the same three ladies in the one village, all in their 60s. We’d take the ambulance round and find them in a real state. Just not coping. But they didn’t need an ambulance. What they needed was company. When I asked one of them if she’d like me to bring a dog round she said ‘Oh yes!’ and when I arrived, there she was with makeup on and her hair done and off we went down the street in the wheelchair with the dog. We fixed up those three ladies with regular dog visits and soon they were only calling us 5 times a month (laughs).
Is part of the problem that traditionally, health care has focused on medical care not social care?
James: Certainly we don’t factor loneliness into the social care package. All we’re looking at is a patient’s health needs, not their emotional needs. The town of Frome has been really good at recognising that people living alone can become terribly isolated. As a town they’re trying really hard to make a difference. And we’re part of that groundswell. Dogs for Health help people to meet. It’s hard to get the courage up to start talking to other people but it easy to greet a dog. The dogs bridge that gap.
Amy: We had an elderly woman who’d ring the ambulance every Tuesday at dinner time complaining of chest pain. As soon as we started visiting her with a dog— she had a picture of a German Shepherd on her wall, so we took in a German Shepherd— she stopped calling. She was just lonely.
How many people do you think you’ve helped get out of the house?
Amy: Over 400 in four years. We have 40 dogs on our books. All different shapes and sizes. People ring us and say ‘I’d like my dog to become a therapy dog and I’ve got an hour a week to go visit someone.’ The owners and the dogs all go through a training programme to ensure they’re the right kind of volunteer with the right kind of dog. Then we match the dog to the client.
James: Occasionally we’ve had to borrow dogs because somebody will want a very specific breed. We once had a desperately lonely soldier in his 50s whose wife had just left him and he asked for a staffy bull terrier who could rough and tumble with him. We found one and took it over and that dog pinned him to the floor and kissed him all over for twenty minutes and afterwards the guy got up and said ‘That was great. I feel amazing because someone really loved me. Can he come every week?’
Amy: We even have a pug who’ll completely ignore you. We take him into the nursing homes and he just snorts and won’t talk to anybody. We love watching all the elderly residents working overtime trying to get his attention. It’s one of the things we pride ourselves on — while our dogs are very well-trained, they’re still just dogs, with all their nutty personalities and funny kinks and quirks.
Cerdic Hall, aged 55
Recovery Lead for the North London Mental Health Partnership
Interviewed after work in Hackney, May 18 2024
Why do you think there’s been an explosion in the number of people seeking help for chronic loneliness?
In England the division between the have’s and the have-not’s is stark. I think chronic loneliness really kicked off with Covid. The pandemic created a sense of helplessness. Covid established the isolation and created the anxiety. Even when the lockdowns were lifted, people were scared to move back into the community. People tried to distract themselves with their phones and their tv’s which led to them becoming much less engaged with the world around them. I see a lot of people who have become very isolated and struggle to get out of the house.
What is it that’s driving this pessimism do you think?
My sense is it’s driven by inequality. I see many more children living in poverty. More people are struggling financially, there’s increasing anxiety and depression, which leads to isolation. Loneliness follows pretty quick. Then you don’t eat well, you don’t sleep well, you don’t get out. You smoke more, drink more. And around it goes. Loneliness is a vicious cycle. And it doesn’t discriminate.
Can you see the markers of isolation and loneliness in the community, or is it hidden behind front doors?
The loneliest people are usually invisible. They’re too fragile to show themselves. They’ve lost their confidence and they’ve stopped practicing how to be seen. People can be very hard on themselves— when you’re lonely you have no confidence that you’re a good person. Your motivation to seek help drops away and you turn inwards. The challenge for health workers is how to convince the lonely to let us into their homes. They’ll turn down every opportunity to re-connect. They can’t bear the idea of more rejection. Instead they try to self-manage until it all gets too much and they end up in emergency with serious health issues.
How do you intervene?
There’s been a big push in England for what we call ‘mental health first aid.’ Lonely people already know they’re not coping. But they desperately need to hear that everyone experiences loneliness at some time or other — that mental health is different for everyone. We take a community approach. Some people call it ‘social prescribing.’ Rather than expect you to come to us, we come to you. We have mental health workers who do home visits and knock on doors to see how people are doing. Sometimes the biggest challenge is how to be allowed into someone’s house because if you’re chronically lonely you don’t trust anyone. You don’t want to share your vulnerability with anyone. But we have all kinds of ways of helping. We have a travel buddy service that provides someone who can come to your home and go with you to your appointments, or just walk with you to the shops. Or if you’re struggling to even step foot outside your front door, you might prefer to have someone just sit with you at home and have a cup of tea. Often a bit of genuine company is the first step towards recovery.
Are we any closer to removing the stigma of admitting to being lonely?
I think we’re starting to. People who are desperately lonely need to be seen— but not with pity. That’s why peer support services work so well. You’re met by somebody who has also been in crisis at some time. Someone who knows what it’s like to feel isolated or too anxious to leave the house. We don’t practice high-end doctoring. We offer friendliness and helpfulness and genuine understanding. And when the relationship between the peer support worker and the lonely person is well established, we can point our clients to other services that might help them.
We’re hearing a lot about how young people are feeling lonelier then ever before. Do you think that’s true?
Yes. We’re seeing a rapid rise in anxiety and depression in young men and a rapid rise in eating disorders in young women. I think the current generation of teens are less optimistic about the future than we were. They don’t feel they have control over their lives. Social media pushes impossible ideals about how perfect they should look and what constitutes ‘success’ in life. Young people are genuinely worried about climate change – they’re anxious about the world they’re going to inherit and whether they have any power to reverse the damage. Social prescribing tries not to problematise feelings of isolation or loneliness. Rather than have the medical system tell you what’s wrong with you, we offer a community model— peer counselling if you like. We have people with mental health training who’ve been isolated themselves, who’ve experienced loneliness, or anxiety or depression, who can reassure someone that there’s all kinds of ‘normal’ and loneliness is an experience that’s part of the human condition.
Where do GP’s fit in here?
The idea is that a GP notices a patient is struggling and refers them to a social prescriber working inside the practice who can take a longer approach than just medication. That person might sit down with the patient and offer a home visit, or connect them to a volunteer who’s experienced loneliness and isolation themselves. The need for conversation, or the need to simply be in another’s company, are tiny dots in our existence, but each small interaction we can facilitate builds a framework of connection. Our job in simple terms is to help people to join the dots themselves to re-build their sense of belonging to a community. I think the whole medical system can support social prescribing for wellbeing. Lots of towns across England are treating loneliness this way and getting remarkable results. It’s the way of the future for healthcare.
Peter Tokoff, aged 60
Former Cobbler, now homeless in East London
Interviewed in Whitechapel Rd at 6.45am May 16 2024
You’re up early?
Yeah. Couldn’t sleep. Woke at 2. Needed a fag.
Any luck?
Nope. People are stingy about their smokes. I beg for rollies but most people have started on them vapes. In my day every fella had a cigarette hanging out the side of his mouth and was happy to share.
How long have you been homeless?
Twelve years. Ever since I got evicted by a bad landlord who bowled me outa my flat. I got by for a while sofa surfing — I had a few mates who let me crash— but they got sick ‘o me and I got sick ‘o them. I didn’t like their four walls enough to put up with their problems.
Did you ever get married?
Nah. Never had much luck there. Though compared to my Dad, I’ve never had it rough. He was a German soldier captured and brought over here after the war. Mum was one of the 20-thousand girls working in the Women’s Land Army. They met at a prisoner-of-war camp in Langdon Hills but no-one ever forgave her for marrying the enemy. No-one would talk to him. Or work with him. He was not accepted. My Dad died young so I stayed at home with my Mum until I was 39. I was happy to look after her. She’s gone now but I was never lonely when she was around.
Do you feel lonely now?
I gotta say I do get lonely for my sister in Essex. I can’t afford the train fare. She comes to see me once a year. That’s when I feel lonesome— when she starts talking about family. All the cousins. Y’know, from what I seen, I reckon there’s two types of kindnesses in the world. The first type some people are born with: they’re just kind by nature. Helped along by the right family. The second type of kindness? That’s the one born after countless heartbreaks and the darkest thoughts the brain can juggle. Add some shitty bad luck and you’ve got yourself a person who decides to be kind.
Are Londoners kind to you?
Not like they used to be. These days, everyone’s hustling. Grinding for the sake of grinding. Frankly, you can’t tell if someone loves you or hates you if they won’t even look at you. They don’t wanna know. They don’t care. And I’m not fooled by those do-gooders pretending they give two shits for two seconds. They’re not gonna hold my hand if there’s blood on it.
Would you like to be in a relationship?
Nope. That’s not to say I don’t love women an’ respect women. I like being around women. But I’m not bothered about ‘aving one. I’d rather ‘ave a cup of tea and a cigarette.
Have you always been a snappy dresser? Your shirt collar looks ironed…
(Laughs) I like to look presentable. I feel lousy, but I don’t wanna look lousy. I usually go to Liverpool St station to beg. I gotta keep my bed at the hostel. It’s all I got. I’m on the verge of getting kicked out because I owe them $100 quid so begging gives me that bit extra to pay off my debts.
What do you hope for?
To be a bit more comfortable. To be not begging for a bed or a fag or a cake. I don’t wanna be rich. I don’t wanna buy stuff. I just don’t want to burden people. The worst thing is the bloody pavement. There’s nothing nice about it. It’s always cold. And you never stop hearing the traffic. Evening’s the worst time of day. Everyone’s going home and you don’t have a home to go to.
Do you feel like an outsider then?
Nah. Takes all sorts. I’m part of the city. I belong here too.