We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. Hi, everyone. We are a group of researchers from Queen Mary University of London and King's College London. We are all interested in studying loneliness in children and young people. My name is Jennifer Lau. And I'm a professor of youth resilience. Hi. I'm Lauren. And I'm a research assistant. Hi. I'm Ahmed. And I'm also a student research assistant. Hi. I'm Tom. And I'm a clinical psychologist and NIHI research fellow. So today, we are going to be talking about strategies that young people use to manage loneliness and also what interventions and programmes are available to young people. We've conducted now a number of different research studies looking at how young people cope. So what they say they find helpful and also what they would recommend to young people. And actually, one of these studies was conducted during the lockdown phases of the COVID-19 pandemic. So the first thing to say is that there seemed to be a number of different strategies. Young people find different strategies helpful. So no one size fits all. And in fact, the literature on coping now suggests that having a range of different coping strategies is the most useful. And it's about flexibility in how you use those strategies that might be most beneficial. Having said that, some of the things that they said were helpful included things like doing distracting but enjoyable activities, particularly ones where you get to connect with other people. So joining a club, doing an activity like sports or arts is a common way that young people use to connect with other young people. Other young people have said that they found actually being on their own in solitude sometimes really helps in terms of reflecting. And sometimes that reflection could involve ways to connect with other people. And they find that actually having that plan of how they can meet other people quite reassuring and reduces the intensity of their loneliness. And then still other young people have said self-compassion, so being kind to oneself, or having regular routines, healthier lifestyles like good sleep patterns, good diets, those kinds of things are helpful more generally to mental health as well as to loneliness. And then finally, some young people say that they have-- they experience anxiety about approaching new social situations. So for them, having-- or going into a social situation, reappraising it in a more positive way, and not going in fearing the negative or fearing the worst is actually quite helpful to them. So something that I've noticed and that other young people have mentioned to me and I've just recognised, is that loneliness isn't always something that you easily recognise. It's not a conscious thought of I'm feeling lonely right now, especially when it comes with so many other overwhelming emotions. And it's hard to realise that loneliness is what you're experiencing. If someone isn't aware of it, they might cope with loneliness in a more unhealthy ways, since they're not aware of the loneliness being something that's affecting them. And this could be things, for example, like spending too much time on their phones, sometimes using substances, or even forming unhealthy new relationships, and just being online a lot, which is all in an effort to feel connected. From what I've seen with people around me, loneliness can also stem from deeper issues, not just being physically alone. Things like social isolation due to race, or gender identity, or sexuality makes it harder to feel like you belong with other people, and emphasises that loneliness. I found that finding safe spaces around people who understand you and can relate to you, where you can truly be yourself, really does help those feelings of loneliness and makes a big difference to someone's overall well-being. So recent reviews from the research literature looking at how well different interventions reduce loneliness in children and adolescents show some promising results. Overall, programmes designed specifically for young people do seem to help reduce feelings of loneliness. Broadly speaking, these interventions tend to fall into a couple of categories. Psychological interventions target internal processes, processes like negative thinking patterns, often through cognitive behavioural therapy. And in doing so, they may build social and emotional skills. Then there are social interventions that aim to create more opportunities for connection and interaction. So perhaps we can explore each of these in more detail. So I think one of the challenges is that the population of young people who experience elevated levels of loneliness is really heterogeneous. So it's not one group, but we know it can be very, very variable. So it includes, for example, maybe young people who are neurodiverse, those with mental health problems, those with social skills difficulties, those who have experienced bullying, and those with physical health needs as well. And of course, then those different groups are going to need different types of interventions. And a one-size-fits-all approach is never going to be particularly effective. And I think that's one of the reasons why either modular designs, where you could have an intervention with lots of different types of intervention within it that could target each of these processes, could be really helpful. Or alternatively, us moving to a system where there's a variety of different interventions available, and then we can match that to the individual young person, depending on the drivers of their loneliness. However, one of the challenges at the moment is we haven't really got that evidence on exactly what works for whom. And that feels a really important area of future research. And that will be really, really key. Another thing is differentiating between when loneliness becomes harmful and when loneliness is more of a typical adaptive experience because, again, I think that's something that we'll need to approach very differently. And that's something that we have recently done a study on that should hopefully be published soon as well. And I think there are lots of issues then about how we can actually implement these interventions within services in the NHS. So firstly, loneliness is a transdiagnostic problem, as we've spoken about. And therefore, it's not going to be something that we only see in one clinical pathway within a CAMHS service, for example, and is likely to be seen across all the different pathways. And therefore, we need different types of intervention available for different groups of young people. Another real challenge is that there's a real lack of awareness within mental health services at the moment around loneliness from clinicians, so it's not something that you are trained to either assess, or to recognise, or to intervene with as part of your training. And that also feels like a really, really important area that we need to think about. I suppose coming back to what Lauren was saying, that there seemed to be different types of intervention that are available. So there might be ways of addressing some of these negative thinking styles through CBT, for example. And there are also lots of community organisations that offer activities and opportunities for young people to meet other young people through more structured settings. So, for example, sports and arts, like we talked about earlier. And I suppose, more formally, some of this is present in what the government or the NHS are rolling out called social prescribing, where young people might be, based on their needs and preferences, be referred or allocated to an organisation in the community where they can engage in some of those opportunities. We are also at the moment evaluating a community-based programme. It's mainly for young adults, but there's no reason why it couldn't be extended downwards for other people just to meet other young people doing things like chess or quiz nights or things like this. However, there are some important limitations in the evidence base for both of these types of intervention and in how effective they actually are. Many of the research studies have been of relatively poor quality, and most haven't included young people who actually report feeling lonely. Instead, they often focus on groups considered at high risk, such as children living with life-threatening illnesses. Additionally, the majority of evidence-based interventions that address loneliness treat it as a secondary issue. So a consequence of another primary mental or physical health problem. While there are some resources that target loneliness as the primary problem, these are mostly aimed at older adults rather than young people. I do feel as though with loneliness, unlike maybe other more defined mental health challenges, like anxiety and depression, we are still quite some way to gathering evidence for these interventions. And I suppose the field, our task now is to work together with young people, with stakeholders, to find out what interventions are acceptable to young people, which ones are feasible, and which ones are sustainable. So we are at a time in research where it's very exciting, where there's a lot of spotlight in this area. People are beginning to recognise that it's important. And we must keep the research drive to look at some of these pathways and interventions and programmes in a more systematic way. Yeah, so I think that's a really important thing for us to think about because I think at the moment, there are some really significant barriers across different levels of services that prevent these young people from accessing support. So if we think about clinical services, so, for example, CAMHS, or community paediatrics, or other health services for young people who have really quite significant needs. I think it's a well-known fact that there's currently really long waiting lists and very limited staff across most services in the country. And that means it's going to be very difficult for young people to access timely support. I think, as I said earlier, there's a real lack of knowledge at the moment around loneliness in terms of assessing it, recognising it, and what interventions can therefore be offered within these services because people haven't had the training. And there's a lack of awareness still within clinical teams around how to offer support for these young people. And I think that's a real shame because I think many young people actually come to CAMHS services and other clinical services where they're saying that loneliness is the primary problem for them. And I think this is a really good opportunity for us to be able to meet these young people where they're at. And I've had lots of experience offering these interventions to these young people with really quite complex needs, where we've had really positive results in that way. I think another increasing challenge at the moment is I think traditionally there were lots of interventions that weren't necessarily explicitly for loneliness that were being offered either in social care or in the third sector. So, for example, different social groups or different opportunities for young people to engage with others with adult scaffolding, which we know can be really important for some groups of young people experiencing loneliness. However, due to the current financial situation, many of these things have been rolled back or cut entirely, which has made it increasingly difficult for young people to access this support. And some groups may have a particularly tough time. Another important issue that young people have highlighted is the inequality and access to support for marginalised groups, often caused by discrimination and stigma. For example, disabled communities might face ableist language and stereotypes, which can make services less accessible and reduce trust between providers and service users. Racism also creates systemic barriers to support for loneliness and to general mental health support. This can include stereotyping and limited representation in mental health education as well as financial inequalities that make it harder for some families to access help. Similarly, for young people in the LGBTQIA+ community, experiences of microaggressions or discrimination from professionals can make it even more difficult to reach out for support. So to address these inequalities, young people have called for dedicated support workers who are trained to provide intersectional care. This is to ensure that support for youth loneliness is inclusive, accessible, and tailored to the diverse needs of marginalised groups. So government research from 2023 showed that while almost all university students reported feeling lonely at least once over the previous academic year, around 43%, so nearly half, worried about being judged if they admitted to it. Interestingly, nearly 90% of students also said they wouldn't judge someone else for feeling lonely. So this mismatch between fear of talking about feeling lonely and how accepting students think that they would be to others, highlights the stigma that surrounds loneliness. In response, the government partnered with charities and businesses to launch a campaign designed to help students feel more comfortable talking about loneliness. The campaign encouraged students to share meals together and promoted the Better Health Every Mind Matters website. This provides resources and support for loneliness. And it aims to normalise conversations and reduce stigma. As a current university student, I think one of the most helpful things has been the range of societies where you can meet people who share your interests. And you can literally pick any hobby or interest that you have, no matter how niche it is sometimes, and find people who regularly meet just because of that one interest. And government research also supports this. Around 40% of young people who joined a club or society reported that it was the thing that helped them the most. That said, not everybody finds those spaces easily or finds it as comfortable to approach these spaces. Also, with the move towards online lectures and more independent learning, it can be harder to make connections with course mates. I know that's happened for me. While online learning has its benefits, it can also feel quite isolating at times. So I think universities could do more to bridge the gap by creating more opportunities for students to connect, like mentoring schemes or peer support groups, or more social events that bring people together from different courses. Because most of the times, it's focused on academics rather than just connecting with others. So in summary, then, I think that's been really helpful for us all to think about the different types of interventions that young people who experience loneliness will need because actually, it will be really variable. So whilst for some young people, it might be something like greater accessibility to societies at universities, for other young people who, for example, have anxiety or low mood, actually, just giving them a society isn't going to solve their loneliness. And potentially, it could actually make it worse. And therefore, for those groups of young people, they might require more intensive input, for example, a cognitive behavioural-based psychological intervention. But given that loneliness is very common amongst young people, in a way, one thing that we do need in order to address it is to think about how we as a society, we as a community, can help to reduce stigma associated with loneliness and also create a community or a society that's more cohesive where we can all feel this belongingness. Thanks so much for watching.