Dr Ally Jaffee So, hello everybody. My  name is Dr Ally Jaffee. I’m an NHS Doctor   specialising in Psychiatry, and very  passionate about youth mental health.   I’m also a Trustee of Chimo Trust, which is all  about “promoting holistic interventions using   social prescribing for young people  with mental health challenges.” So,   I’m absolutely thrilled to be discussing “youth  mental health, adolescents, and loneliness” today   with an incredible panel of speakers. So,  I’m going to pass over to the ladies first,   because ladies first. And so, I will start with  you Dr Keri Wong, please introduce yourself. Dr Keri Wong Thanks for that, Ally. Hi everyone.  I’m Dr Keri Wong. I’m an Associate Professor   of Developmental Psychology at the University  College London. I also Co-direct UCL’s Centre for   Education and Criminal Justice. And like, Ally,  I’m also passionate about youth mental health   and particularly, focusing on the role of youth  hubs and youth clubs, community centres as spaces   that may help promote or hinder some of these  outcomes that we’re looking at in young people.   And recently, as – I’m also Co-editing an ACAMH  Special Issue focused on “the role of physical   environments on young people’s psychosocial  outcomes.” So, look out for that as well. Thanks. Dr Ally Jaffee Thanks very much, and  over to you, Dr Katherine Thompson. Dr Katherine Thompson Hi, I’m Katherine or Katie  Thompson, and I’m a Postdoc Researcher at Purdue   University in the Sociology Department,  and I did my PhD at King’s College London,   looking all about social isolation and how that  links to mental health. So, I have a real interest   in looking at longitudinal patterns in research  and how we can better understand the complex links   between social environments and our mental  health. Yeah, thank you for having me. Dr Ally Jaffee And finally, last but not  least, over to you, Dr Henry Aughterson. Dr Henry Aughterson Hi, Ally. Yes, my name’s  Henry. I’m a Junior or Resident Doctor,   but also have a research background, having done  my PhD in an area called Social Prescribing. So,   all about, kind of, connecting individuals  to community groups and activities, and some   of that research involved social prescribing  research among adolescents and yeah, I also   have a background in doing, kind of, workshop  facilitation in schools on things like masculinity   and things like that. So, yeah, interest in social  prescribing, as well as youth mental health. Dr Ally Jaffee Wow, a diverse and brilliant  panel. So, let’s kick off with a very difficult   question. So, let’s discuss “is loneliness  and mental health bidirectional in a young   people’s population?” So, does poor  mental health lead to loneliness and   does loneliness lead to poor mental health?  And what does the research show about this? Dr Keri Wong So, I’ll go – I’ll have a first stab  at that. I certainly think it is a bidirectional   relationship between loneliness and mental  health, particularly in young people. A lot   of the existing research to date has documented,  if anything, this relationship. I think there are   various nuances to that relationship as well.  There’s not so much as if – evidence looking   at tracking loneliness over time, and I think  there could be more, but possibly on our panel   we’ll – we have expertise to showcase some of  this work as well, but certainly, the answer is   “yes.” And there is good evidence establishing  this link between loneliness and mental health   in young people, but certainly, a bit more  nuanced understanding is needed in this area. Dr Ally Jaffee And over to you, Katie. Dr Katherine Thompson Yeah, I completely agree.  I think a lot of what is thought about when we   think about social isolation and loneliness is how  it – that direction links to mental health. So,   if you are lonely, then you’re at more risk for  mental health problems, and it’s not actually   considered that much in the literature about the  other way around. So, it could be that people   who are vulnerable with their mental health or  physical health are also at greater risk of being   lonely or socially isolated, but it’s incredibly  difficult to capture those associations. So, I think one of the blocks there is, how  we are measuring in large cohort studies. So,   in a lot of the work that I have done, you  take a lot of participants and you can see   changes across the lifespan, and actually, having  the measures of loneliness and social isolation is   quite rare in those large cohort studies. So, it  can be difficult to unpick those associations. And   I think one of the projects that we worked on  was around ADHD, so looking at how – “is there   this bidirectional relationship between social  isolation and ADHD symptoms?” And what we found   that – was actually when we were controlling for  any, sort of, stable characteristics across time,   it was the children that had increased ADHD  symptoms that then went on to become isolated,   rather than the other way around. So, I think it’s  a nice way to show that actually vulnerable people   are also at risk of becoming isolated, which  could then lead onto other problems. So, it’s   a very – definitely, a very complicated cyclic  relationship that needs more research, for sure. Dr Ally Jaffee I was going to mention that 2010  meta-analysis by, I think it was Dr Julianne   Holt-Lunstad and her colleagues, and it came to my  attention because I was following Dr Vivek Murthy,   the USA Surgeon General, who really used this as  his political argument as to why communities need   to be better to foster relationships so that  we can improve all-cause mortality. And that   was coming from the States, but actually  what was really interesting in the UK,   and sadly, we’ve gone slightly backwards  here, is that I believe in 2016 or so,   when Jo Cox was a MP, and obviously,  she had a very sad end to her career,   she actually was trying to implement “a Loneliness  Minister” and bring about “a loneliness reduction   strategy,” which I think was absolutely  brilliant, but sadly, that no longer exists. And this seems to be a bit of a frustration  of mine and of many of my colleagues that when   there’s a change of government, there seems to be  a lack of continuity with especially mental health   interventions that are done within that government  to carry on in the next government. And so,   that kind of brings me onto early  support hubs and over to you, Dr Keri,   because this was something that was really  discussed in the Conservative Government   about early support hubs for mental health, and  what is your take on where we’re at with these   early support hubs in our current government, and  are we still on track to bring this into reality? Dr Keri Wong Hmmm, great question, Ally, and I  ask the same questions myself actually. Maybe just   a bit of a disclaimer, too. I’m currently seconded  to the Home Office as part of a ESRC Policy   Fellowship with, kind of, sort of, an 18-month  period. And during my time I’ve seen the change   of government from Conservative to Labour at  this point and so I think a lot of the missions,   especially the new ones as well, it really does  take some more detailed look at – to see whether   some of this is continue – continuing what the  previous government has done or whether it’s   a rebranding or relabelling of things that are  similar, but needs a bit more focus on as well.   So, according to what I understand the missions  to be at the current – with the current Labour   Government, there is still a focus on early  intervention to – as such, but this is framed   under the “Safer Streets Mission” of focusing  more on “Young Futures hubs,” they call it. Dr Keri Wong So, to me, in my mind,  as a layperson, Researcher, you know,   someone from outside reading this, I think it’s  tapping into some of the early intervention hubs,   family hubs as well that we hear about  from the previous government. And,   you know, a part of me wants to hope that this  is something promising, this is something that   this government will also focus on. And I think  there is, you know, reasons to believe that,   you know, the idea that early intervention  and prevention is something that everyone,   I think, can agree with on – or on, and that this  government is potentially also resourcing as well. How that would look like? I think they are still  – you know, we’re still waiting to hear more about   the details, but certainly from the research  side, I think there’s a lot of hope perhaps   also in really pushing the agenda for early  intervention. And as I said, in community spaces,   in local hubs or youth hubs, that being a  primary, sort of, area of focus as well. Dr Ally Jaffee I think that’s great to  hear, and as far as my knowledge goes,   Best For You, which is a wonderful London-wide  charity, they’re connected to Central and North   West London NHS Trust. They, I think, are also  working on the early support hubs being brought   to the front – forefront and keeping up with the  momentum of them, but let’s see. It’s a work in   progress and really important to obviously have  that physical space because we’ve lost “third   spaces” for young people. So, as we’ve lost these  “third spaces” for young people, what can we do to   combat this and to actually improve connection  amongst young people in this digital age? Dr Keri Wong So, I guess my quick response to  that would be that there should still be a focus   on, kind of, youth hubs and community centres and  spaces, keeping these well-resourced and actually   open to young people. Between 2010 and 2019,  we’ve seen a, sort of, 30% closure of important   youth hubs in this country. And we know that they  are actually key spaces that young people find   to be safe, to be spaces where they learn,  to be spaces where they socialise and make   new friends. And in this – you know, on this  topic of loneliness, this is really pertinent   in thinking about young people’s social health,  as much as it is their mental health as well,   and physical health, because loneliness is,  you know, related to all of those things. And so, one aspect is, you know, keeping  these youth hubs and resources actually   available for young people in this country, I  think is going to be super important. And this   necessarily means, not necessarily creating  new spaces because brand new spaces may not   gain the same trust for the young people that  go there, but also, I think it’s more about   thinking about what existing provisions are in  place already. You know, what do local charities   that are providing youth provision,  what do they need to actually survive   and make sure that they’re providing that  high-quality provision for young people   from the prevention of mental health and problems  later on as well? So, that’ll be my answer. Dr Katherine Thompson Yeah. Well, that was a  fantastic answer, and I’m not sure if I have   much to add beyond that, but I really liked what  you said about having really safe spaces for young   people, and I think socially, that is incredibly  important to feel safe with your peers. And,   for example, especially things around the arts  and the music, that’s a really nice way for young   people to come together and also to enjoy their  time and feel safe and connect with each other.   And I also really liked what you said about really  thinking about what the charities need. Also,   as a Researcher, I guess what research needs to  be done and what questions don’t we know, what do   we know works and doesn’t work, and how we can ask  these questions in, like a – yeah, how we can ask   these as research questions to better support  the charities and the policymakers as well. Dr Ally Jaffee Absolutely. Dr Henry Aughterson Yeah, brilliant answers.  I think maybe I’ll just, sort of, briefly touch   upon social prescribing. I’m sure we’ll talk about  this a bit later as well, but one of the things   with social prescribing in general as a movement,  you know, social prescribing has always existed,   but within the NHS anyway. Maybe five, ten years  ago, the word “social prescribing” started getting   used almost as though the NHS was, kind of, waking  up to the power of community. But one thing with   the rollout in social prescribing largely is  that it’s been focused on adults. And from the   start you’ve had the Youth Social Prescribing  Network who’ve been, kind of, leading on this,   but on the whole, social prescribing has been  largely focused to adults. The Link Workers, who   are those employed to sit in between GP land and  the community, have been geared towards adults. Dr Henry Aughterson That’s changing a bit.  There’s been a new report by the National Academy   for Social Prescribing showing some great work  that’s happening, but just touching on what Keri   was saying in terms of, you know, a lot of these  community hubs being diminished in recent years,   and the same has occurred among the adult  population as well, but it’s also about how you,   kind of, identify the children that would most  benefit for these things. And at the moment within   social prescribing, at least within healthcare,  adults can access a Link Worker, whereas most   children’s don’t – you know, do – most children  don’t really get that opportunity via their   schools. So, it’s about thinking, you know, how  do we invest in those, kind of, linking roles in   between schools and the community, more primary  care and the community for young people. Yeah. Dr Ally Jaffee And do you know of any  initiatives that are looking at using youth   social prescription to, for instance, get rid of  the waiting lists when trying to get into CAMHS   or trying to assist them whilst they are on the  waiting list as a replacement or complimentary? Dr Henry Aughterson Hmmm. So, I know Barnardo’s  are doing a lot of work in this area. They’re   probably the largest, kind of, provider of  voluntary sector social prescribing in the UK. And   they’ve worked with local primary care systems,  integrative care systems in different areas,   and yeah, have found that there have been  reductions in the use of primary care services,   which obviously has knock-on effects for,  you know, saving money locally and, kind of,   wider societal benefits. But they’ve  also shown, yeah, that some of these,   kind of, services had a really positive  impact on children’s mental health as well. Dr Ally Jaffee And touching upon what  Keri said about using what we’ve already   got and repurposing it to actually enhance  social connection and meet mental health   challenges of young people, I know that you  were involved in a football group, Henry,   could you tell us a little bit about that  and whether you worked with young people,   you know, ten to 25, who you saw  benefit from this intervention? Dr Henry Aughterson Yeah. So, most of my,  kind of, PhD research was centred on adults,   but the – I spent some time with a  football group, as well as a number   of other groups. The football group  served people from 16 upwards. So,   there are a lot of people who are  18, 19, 20. It was a group in London   set up to support people with – so all the service  users of the football group had some, kind of,   mental health challenge or addiction problem and  they would play football with this football group,   you know, several times a week. The football group  also had a Sports Physiotherapist, as well as a   Mental Health Nurse from the local mental health  hospital that would often, kind of, scout patients   within their mental health hospital and then  actually play football with them themselves. They were actually healthcare professionals  playing football alongside the service users and,   you know, really, kind of, enabled this continuity  of care that you don’t really see much, you know,   in the NHS and also, kind of, breaking down  of that professional and patient boundary.   And, yeah, we found that these – you know, the  football group supported people through, kind of,   different mechanisms, so biological mechanisms,  behavioural mechanisms, psychological, and social   and – yeah, especially among the, you know,  younger population, 18 to 25, many of whom had   addiction problems, and they were finding football  was actually replacing some of those addictions.   So, they were – not they were becoming addicted  to football, but it was replacing an unhealthy   habit with a healthy habit and being surrounded  by people who were, kind of, very supportive of   that as opposed to being surrounded by people  who were maybe, kind of, reinforcing their,   kind of, negative habits. So, yeah, I saw  a lot of beneficial effects of that group. Dr Ally Jaffee That’s incredible to hear. And  do you guys, Keri or Katherine, do you know of   any other initiatives that are similar to that  or that you’ve come across for young people? Dr Keri Wong I would just add maybe  to Henry’s point, as I was listening   to him talk about physical activity as  encouraging young people to engage with,   you know, different lifestyle almost and also an  – a place or chance for them to meet new friends   and see role models. I think I just wanted  to highlight a few points here, which is,   you know, some of the work that I’ve done with  youth clubs and small charities in that space,   is that a lot of the young people I work with  are oftentimes not in education, employment and   training as well. So, you know, outside of the  traditional spaces we work with young people in,   you know, in healthcare, in school settings, there  are also, actually in this country, about 12.3% of   16 to 25 year olds who are not in education  and employment and training at this point. You know, that’s a massive group that currently  we don’t really have much support for. And these   youth clubs that they often engage with provision  and meet other people is really crucial in,   I think, thinking or promoting their sense  of connectedness with others in a sense   of community. And so, you know, there in that  space, is not just, I suppose, physical activity,   you know, it’s all sorts of things, from the arts,  creative arts, from them learning about teamwork,   from them discovering their own, sort of, passions  and things to do in life even beyond, you know,   if they don’t succeed in school. I think that  sense of building confidence is also very crucial   in these spaces, but I thought I’d just mention,  you know, that as, not exactly programmes that   have been shown already to be good interventions,  but certainly, things that are happening in the   local space, in the community that I think deserve  attention as well, for us to, as Researchers,   to further explore what works and how does it  work and how do we measure these things as well. Dr Ally Jaffee Thank you. Do you have anything  to add, Katie, or do you want to move on? Dr Katherine Thompson No, not really. I think,  yeah, you both – yeah, it’s fantastic work what   you’re doing and I think I – I’m now in the US.  So, I’ve been here for the last year or so. So,   it’s very interesting. I haven’t actually had a  chance to look into what is available in terms of   community hubs here in the US. I’m sure there is  a much different system. And I think one of the   things that I want to get from the next year is  thinking how we can better translate what – the   work that we’re doing, ‘cause I think a lot of  the times I’m writing very, like, complex papers   and findings, but without having much engagement  with young people themselves. So, I think that’s,   kind of, the next stage that I need to take the  research that we’re doing at the moment. So,   I would be interested to see how that compares  in the US to the work that’s been done in the UK. Dr Ally Jaffee Yeah, I’m a big  believer in co-production. Nothing   about us without us and I think so  much of the time, even in the NHS,   we can be guilty of creating quality improvement  projects without actually asking our patients,   does this work for you? Does this actually  meet your needs? Rather than us deciding the   solution for the end user. So, I think it’s  really brilliant that that’s on your radar. And I also wanted to share the work of the  charity I’m involved in, Chimo Trust, and how   we actually have a great network of charities  who are doing this work for young people. So,   as I mentioned at the start, we invest in  charities that harness the therapeutic powers   of sport, nature, or the art to empower young  people to manage their own mental wellbeing,   especially when they’ve been set back. And  so, we have a portfolio of charities across   the UK and we support charities such as the Wave  Project, which is looking at changing young lives   through surf therapy, which is just wonderful,  and, you know, there’s a lid for every pot. We support Empire Fighting Chance, which is  non-contact boxing. We support Comics Youth   up in Liverpool, which is all about narrative  medicine and writing your own comic about   your life story. We do an equine therapy  one, Strength & Learning Through Horses,   and many more looking at music, looking at drama.  And I think it’s so wonderful that – I mean,   this is me just blowing smoke up Chimo Trust’s  bottom, but I do think it’s really wonderful   that we are actually bringing the charities  together to talk to one another so that they’re   not siloed and duplicating work and can actually  learn from each other. Because we’re seeing now,   with Green Prescribing and also with the Arts  Council and Creative Health, that there are all   these new guidelines that are being written and,  you know, wanting to bring all the stakeholders   together at the table. I know that two weeks  ago there was a APPG for Creative Health,   and so I wanted to ask all of you, how  are you working with other stakeholders   to minimise working in the silo and learn from  others and have that intersectionality as well? Dr Keri Wong That’s a great question, and  actually, I would say it’s the highlight   of my work as a Researcher, you know,  being able to go out into the field,   go knock on random people’s doors and charities  and to get to hear what they – their, you know,   lives are like and what their  challenges are in particular. I   think it’s really the highlight of my  job and why I do what I do, I think. So, some of the stakeholders I’ve currently  been working with are local charities up in   different boroughs in London, so in Islington, in  Camden, Tower Hamlets, West Acton, you know, and   so forth. I’m not originally from London, so each  of – each time I go out to a, kind of, different   neighbourhood, I find myself, sort of, in explore  – explorer mode, as it were. You know, seeing   each of these visits as an adventure because I  genuinely don’t really know the area that well.   But also, I think beyond London as well, I think  it’s also important for us to think about the   wider UK. So, I’ve currently also stakeholders  up in York, Newcastle, Manchester as well,   trying to understand how youth clubs there work  and what are the cultural or maybe situational,   sort of, differences or similarities as well to  London, you know, these youth clubs are facing. So, it’s been real pleasure, kind of, being  able to travel and go up and down the country,   as it were, to see different sites. And I think  as a Researcher, it’s so important that we are   also getting outside of our comfort zone to really  go into the spaces to understand the communities   that we are working with. Because until we do  that, until we have those conversations with them   – and also, luckily for us, they are almost  always very welcoming of us in their spaces,   which I think is a real privilege as  well. Until we, kind of, make that move,   we will continue to work in silos and we  will, as you say, continue to be coming out   with solutions that may or may not work well  for the group that we’re hoping to serve. So,   co-production all the way, and also, as  Researchers or professions just, kind of,   going out there and being willing to see new  spaces and new people, I think is part of the job. Dr Ally Jaffee Totally agree. Music to  my ears. And what about you, Katherine? Dr Katherine Thompson Hi, yeah. Well, I  haven’t worked with any stakeholders directly,   but I contributed to a project with Bridget Bryan  who conducted interviews with people talking about   loneliness and at work, and specifically how  that impacts their work and how maybe how we   think about loneliness when you are at work,  ‘cause it’s such a big part of your daily life,   right? And how that links to all other outcomes.  And it was so interesting. I went through all the   interviews with her and we looked at that and  it really changes your perspective, I think,   as an Academic. And I – my PhD was on Social  Isolation and now I work on depression research   using very big data in the US. So, it’s almost  the opposite and I think that’s a real drawback of   going into these big datasets, is that you don’t  get this contact with people that are actually   experiencing the things that you’re studying and  that you’re trying to learn about and understand,   and that’s incredibly important. And one of  the projects that is coming up and what I’m   working on is I would like to go out into these  communities and really understand how young people   think of loneliness and how they think of social  isolation and how those two things interact with   each other. Because I think young people would  probably have a lot to say about what they think   about that and what that means to them, as in, how  they experience that. Especially I think in – when   Julianne Holt-Lunstad did the document that  was talking about the – oh my God, my words. Dr Ally Jaffee Smoking. Dr Katherine Thompson Yeah, not the  meta-analysis, but the whole document   that she – the policy document she put  together with the US Government. And so   much of that was focused on adults and how we  define or look at social connections in adults,   but actually maybe young people would have really  good insights into how we measure these things   and how that they can capture them,  and especially with technology,   and how often they think or talk to their  friends. And I think that could really add some,   yeah, a lot of detail to what we study  at the moment by getting their insight. Dr Ally Jaffee There’s so much in that that  I want to unpick and I – I’m going to park the   loneliness in the workplace right now, ‘cause I  want to come back to that later when we discuss   “commercial determinants of loneliness,” which is  just fascinating. But talking about young people’s   actual view on “loneliness” as a term, have you  come up, all of you, against any barriers as to   actually getting young people to engage with the  research, as being able to research them? Do they   understand what loneliness is? Can they actually  acknowledge when they are lonely themselves?   Can they admit to it? Because there’s so much  taboo and stigma with saying, “I feel lonely.” And actually, when I was driving on the motorway  just outside of North London the other week,   I saw this brilliant billboard that said,  “#TheLonelyMillion.” And then I Googled it   after being the millennial that I am and found  the social media platform. And it’s essentially   looking at how one million young adults between 20  to 34 struggle with loneliness. And they’re making   an entire campaign about that and how we can  reduce the stigma. So, it seems like, you know,   this conversation is becoming more mainstream,  but I just wanted to check in with all of you,   have you come up against any barriers  with actually the subject of loneliness,   how it’s explained, how it’s  received by your end user? Dr Keri Wong I think just two quick points for me  on that, not specific maybe to loneliness per se,   but certainly when I’m co-producing  measures or methods with young people,   oftentimes they might even point me to a – kind  of, a viral TikTok video that’s ongoing, you know,   and say, “Actually, that’s really great that this  expresses exactly what I feel and how – you know,   what my experience is at the moment.” So, that’s,  sort of, one thing. I think it’s our willingness   as Researchers to even ask the question  or provide the platform for them to share,   you know, how would we define this concept  and what are some resources that you might   want to bring into the conversation to  facilitate our understanding of this? And then the second point being, you know,  oftentimes, I think Researchers go in thinking,   “Oh, this survey is standardised. We need this to  be completed by you and this is the standardised   interview that we use in clinics, and please help  us complete this.” But, you know, the way in which   we go about executing and operationalising that in  spaces that are not the lab or the school setting,   is actually really challenging and we should  acknowledge that there could be other ways for   us to rethink how we do research in the field. And  it’s so important that we start from, you know,   make it youth-led and make sure that they are,  first, comfortable and safe and feel trusting of   you of the piece of research, and really, where  possible, including them in the conversation and   getting them to lead, you know, you to the  right definitions, to the right processes,   and really letting, you know, my research hat,  you know, kind of, at the door before I even enter   into their space. Because that’s the best way,  I think, of doing research that’s co-produced. Dr Ally Jaffee Thank you, and, Henry, do you  feel like there is any taboo with – and stigma   with the term “loneliness,” going back to when  you were at medical school, and I know you were   a student for a very long time because you did  your PhD in between. Very brainy over there. So,   do you think any of your medical student friends  or even yourself would’ve felt comfortable at the   time to say, “I’m lonely” and what that language  looked like during that time at university? Dr Henry Aughterson It’s a really interesting  question because I think we don’t always   understand what loneliness means, do we?  And we sometimes mistake it with, kind of,   social isolation, whereas loneliness  is more a, kind of, perceived feeling,   you know. Often, you know, I’m lucky to have  never experienced, kind of, chronic loneliness,   but I’ve definitely experienced loneliness and  periods of loneliness. And it hasn’t been because   I haven’t had lots of social connections  in my life. It’s because I hadn’t been   connecting to them, for whatever reason, been in  a different place or I’ve been busy or whatever,   you know – or it’s the wrong type of sex –  social connections, whatever it might be.   So, part of it is around the language, I  think, and, kind of, education, you know,   among young people about what that can mean. And  also, that we all experience it occasionally. The one million, I mean, I imagine that’ll be  a – you know, maybe that’ll be those who count   as “chronically lonely.” The actual number of  people who experience loneliness occasionally   or often is much, much higher than that in the  UK. And so, yeah, I do think there is, you know,   there is still a stigma, you know, especially  among young people where a lot of your, kind of,   identity is based around how, kind of, “cool  you think you are” or “how you appear to your   friends.” And so, it’d be a really difficult thing  to, you know, admit, I think, for a young person. And part of this ties into a passion I have  around, you know, I think there needs to be a   revolution on, kind of, emotional health,  kind of, workshop training in schools,   not just mental health, actually emotional  health. So, understanding our emotions.   We’re just expected to, kind of, learn this in  life, and that’s fine. You know, most of us do,   but a lot of us, you know, will continue to, kind  of, struggle with, kind of, emotional regulation.   And there’s not a huge amount out there in schools  in terms of, you know, our relationship with our   thoughts and, you know, what does “feeling lonely  mean” and, you know, all of these things. And I   think we need a bit of a revolution in that,  as well as, kind of, mental health as well. I used to do a bit of facilitation for a charity  called Beyond Equality and they specialise – so   they’re largely men who go into schools and do  workshops with young boys on masculinity and   mental health, but, kind of, topics specifically  around, kind of, masculinity and what it means to   be a man and, kind of, challenging certain gender  stereotypes. And I found largely, regardless of   the school, you know, we did schools of all  backgrounds all round the UK, and it was just   young boys, but in general, you know, they were  very, very engaged. And because it was a workshop,   kind of, format, it wasn’t dictatorial or, you  know, teaching someone something. It was, kind of,   you know, us wanting to hear from them and then,  kind of, you know, facilitating the conversation.   And, you know, because people had, kind of –  people were empowered in that process, pe – you   know, the young children became, you know, very  engaged and came up with new ideas and, you know,   you can see how those things can really work,  but I – you know, myself at school, I don’t know   about you guys, but I had absolutely, you know,  nothing in that regard. I didn’t even know even,   you know, mental health was even talk – you know,  was even talked about as a term at that stage, so… Dr Ally Jaffee Hear, hear, yeah, definitely. I  mean, I’m a millennial and I think you are too,   Henry. I think we might all be,  which is quite exciting, so, yeah. Dr Henry Aughterson I don’t actually know what  a millennial means, but yeah, I’ll join the club. Dr Ally Jaffee I – we are at the same  age, so I know you’re a millennial. Dr Henry Aughterson Okay, okay. Dr Ally Jaffee It’s like 1995 onwards. Yeah,  1995, 1996 back, but yeah, Gen Z seem to be   getting a lot more emotional literacy training,  which is fantastic, but then there is still that   issue around – which we’ll get onto with you,  Henry, around the digital age lending itself   to not being able to have as deep of relationships  as one would when there was no technology perhaps. But just coming to some of Keri’s work,  which I really wanted to discuss and   which I think is really important, is that  during COVID, it was this massive shared   experience where obviously everyone was an  individual throughout it, but it was that   one experience where everyone was supposed to  abide by the same rules. Obviously different   if you were a healthcare worker going in or an  essential keyworker, but everyone was, kind of,   stripped of having their usual social interaction.  So, it almost was a leveller for some people. And   some people – some patients I’ve spoken to,  actually say, “COVID was a great time for them   ‘cause it made them feel less self-conscious  about being more isolated because everyone   was more isolated.” So, Keri, I just wanted to  come to you about what the impact of COVID was   on “loneliness and social isolation,” and if you  can just share some of your work in that domain. Dr Keri Wong Yes, certainly. So, during COVID,  we launched what was the global survey online,   as most Researchers did at the  time. It was open – you know,   it was a link and it was open to anyone who had  access to the link. And it was translated to   seven to eight different languages at that  point, ‘cause we were wanting a, sort of,   international perspective on how COVID’s  impacting people’s mental health, social   and physical health as well. What we did find  in this longitudinal study, so we had, sort of,   three timepoints from April 2020, six months’  later, and then also 12 months’ later we did,   sort of, the same survey. We found that actually  loneliness did – across the different ages,   it was high for most of the population as it were.  And this wasn’t different in different countries. It was interesting to see that it was  across the board even though obviously   lockdown restrictions were quite different  in different countries. But generally,   people who did, you know, complete our  survey, identified and self-reported   that loneliness levels were pretty high.  Particularly those with stricter, you know,   lockdown situations, but across the board  not significantly different across countries. What we also found was that loneliness was a very  key variable when we were also looking or mapping   out different mental health measures as well. So,  we had things like levels of anxiety, depression,   self-esteem, levels of aggression, you know,  anything – most of the things you can think   of about mental health and also physical  health measures as well. But ultimately,   loneliness levels or self-perceived levels  of loneliness were really strongly connected   to mental health outcomes, as it were,  and also the physical health outcomes. An interesting other variable we included was  levels of trust in self-perceived trust. So,   I study social trust and also mistrust. When  people don’t trust others, how does this impact   their mental health? And again, during COVID, you  would imagine many people would feel the sense of   mistrust in others as well. And at the same time,  because of lockdown restrictions due to, you know,   that fuelled loneliness, we saw this, kind of,  stronger connection between mistrust and also   levels of loneliness. It led us to think that,  you know, maybe when lockdown restrictions were   to ease, you know, maybe people then would  feel less lonely as they start to connect or   reconnect with others, that some of these mental  health issues or outcomes would decrease as well. We did see that for, I would say, the majority of  the population or the sample that completed the   survey, but still there were specific groups  that maintained this high level of distrust   and this high level of loneliness as well, even  post-lockdown easing at least six months after   that. So, I think there are something to be said  there when we’re thinking about, you know, yes,   a lot of these surveys during COVID are looking  at averages across groups. But importantly,   I think within those group averages, they’re  also going to be, you know, minority or   subgroups that are disproportionately  impacted by COVID and its impacts. And still today, there are – you know, I go and  talk to young people as well, they still cite   those two years, you know, of their lives as being  very significant and impacting their current ways   of learning, their current ways of motivation,  their current even ways of thinking about their   own lifestyle and friendship groups and hobbies  and things like that. So, I think we shouldn’t,   sort of, just disregard or not even talk about  those important years, especially for young   people, ‘cause those are real defining moments  in which, you know, as we all know, when we were   younger, we were probably doing very different  things to the generation that has gone – that   had gone through COVID. And so, some of those  challenge or – challenges or lessons that we   might have learned, this generation may not have.  And so, it’s important to recognise that as well. Dr Ally Jaffee Yes, I couldn’t agree more  with that. So, coming back to you, Katherine,   because you touched on so beautifully  about this incredible work you did with   your colleague around “loneliness in the  workplace.” So, I wanted to discuss “the   commercial determinants of loneliness,” which I  think is such a fascinating umbrella, kind of,   outlook to really examine what the issues  are in society that can drive loneliness   so it’s not even really an individual  issue, but a socially constructed issue.   And COVID’s wonderful outcome was this working  from home business that started to become very   mainstream. So, I wanted to ask you about  what the data that you collected ended up,   kind of, leaning towards when it came to  working from home and feeling lonely and   how that contributed to either productivity  and/or mental health? And what is, you know,   the current state of play with working from  home versus having relationships in the office? Dr Katherine Thompson Oh, interesting question.  I am not an expert in “workplace loneliness” at   all. And Bridget is definitely the person who  can answer that question. I – we did a study in   a sample of young people where we looked at how  loneliness was related to subjective social status   and how that influences economic outcomes.  And we were looking at – I’m just trying to   remember what the stud – what we found in the  study, but I think we were looking at if that   relationship was bidirectional. So, between  loneliness and subjective social status. And   I think what we found was that loneliness  led to subjective societal – social status,   but not the other way around. So, it’s interesting  that loneliness is having these socioeconomic   outcomes, rather than the socioeconomic  outcome being the driver of loneliness. But that was in a sample of twins that was  conducted, I think they were around age 12 to 18,   and that would – data would’ve been collected  I think in the 2000s. So, it would be really   interesting to see how working from home and the  way that we work now has completely different   implications for loneliness. And I’m pretty sure  Bridget has an ongoing study looking at this. Dr Ally Jaffee Okay, brilliant. For  another webinar. That sounds great. Dr Katherine Thompson Yeah. Dr Ally Jaffee Keri, do you know much around,  kind of, workplaces, especially for young people   going into their first job and how they can  improve social connection in their workplace? Dr Keri Wong It’s interesting you ask this  because, I suppose, during COVID, we did do   a short piece of work, just cross-sectionally,  though, looking at cohort differences between,   you know, university students  who had started prior, you know,   had one year before COVID and then the cohort that  had actually started during COVID and then still,   you know, afterwards when COVID has, sort of,  you know – people are returning back to the   classroom and stuff. And even in – within  that study we found differences in levels   of loneliness across those cohort,  but not so much, other than that. Dr Ally Jaffee Great, thank you. And,  Henry, were you a student at the time of   COVID? Do you have any lived experience  to share about what it was like for you?   I was actually a medical student that  went online for my penultimate year,   which was interesting ‘cause  it’s a very practical degree. Dr Henry Aughterson No, I mean, my – so I – had  I stayed in med school, I would’ve been – my,   kind of, first year as a Junior Doctor, I  would’ve been working in COVID, but actually,   I’d taken that time out to do my PhD. So, in terms  of my work, I wasn’t, kind of, hugely affected   by it. We were – for some of that, we had to work  from home. Other times, we were kind of, sort of,   keyworkers. So, we were able to be in the office,  kind of, spaced out. I did a bit of work as a   Healthcare Assistant, some pa – kind of, which you  were able to do as a, kind of, medical student at   the time. So, again, you know, experience, kind  of, working on the frontline a bit, you know,   in the pandemic, which was obviously quite an  intense experience, but, you know, I wasn’t   doing that full-time. So, I actually felt quite  fortunate doing my PhD at the time because... Dr Ally Jaffee I’m so sure. Dr Henry Aughterson ...I was able to,  kind of, have a hybrid way of working   and still have a lot of, kind of, social  connections through work and yeah. So,   it wasn’t, kind of, hugely  affected by that, really, so… Dr Ally Jaffee Well, that’s good to hear. And  I guess we’ve touched a lot about environmental   events. So, like, COVID having an impact on  loneliness and young people’s mental health,   as well as social structures. So, I  wanted to put it out to all of you,   and I know Katherine, you’ve done some work  on this, but is there research showing that   there is some genetic basis for people  to be more predisposed to loneliness? Dr Katherine Thompson Yeah, it’s a really  interesting topic I think because – so I   haven’t looked at loneliness, but my amazing  colleague, Tim Matthews, has a lot of papers   around loneliness. And one of them was on  understanding the heritability of loneliness,   but recently we looked at the me – the  overlap between mental health problems   and social isolation. And we looked at  this longitudinally at ages 12 to 18,   and we saw that around 80% of that overlap  was due to this shared genetic influence,   which I think is really interesting in how  we think about that. Because maybe perhaps   instead of isolation or social connections or  loneliness being a risk factor or an outcome of   mental health problems, maybe it’s something that  is more intertwined or embedded in the experience   of poor mental health. So, I think what a nice  example of that is if you think about sleep. So, sleep problems often go hand-in-hand with  symptoms of depression and other mental health   problems, and they’re often a key indicator of  when someone is not feeling very well. So – and   they also go genetically hand-in-hand with mental  health, sleep problems. So, maybe social isolation   or loneliness could be a nice way – it could be a  nice way to conceptualise this of actually maybe   someone’s social connections is a key indicator  that maybe they’re having other problems. And that   could be something that is picked up in schools  and things like that. So, I just think it’s really   interesting because I think a lot of the way that  we, like, take the findings from these papers is   dependent on how we are assessing these things.  And the relationship between loneliness and   mental health is going to be incredibly complex  in terms of the bidirectionality, which I think   we did touch on, but also, yeah, the aetiology of  these things are some people are more vulnerable   than others, and how can we use that information  going forward. So, I think just as a general note   on that, that we shouldn’t be underestimating the  complexity of these things rather than saying one   thing leads to another, but involving young people  in how we design our measures, using longitudinal   data and using a very interdisciplinary approach  in research, I think is really beneficial. Dr Ally Jaffee That’s so fascinating, just  to really grasp that loneliness and obviously,   mental health issues, as we know, can be  heritable. And I guess it comes back to   what we say always in psychiatry, it’s always the  biopsychosocial model is always multifaceted and   it’s, yeah, really interesting to hear that work. And in terms of “are we actually doing enough to  combat loneliness?” Because we’ve touched upon   some of the initiatives in the early support hubs  and obviously, the football example from Henry,   which was wonderful, but as one of you  pointed out, I think it was you, Henry,   that this study from 2010 showed that  loneliness actually is a greater risk   factor than smoking to all-cause mortality.  So, if we have such brilliant smoking ban and   public health interventions to combat smoking,  do the three of you think we’re doing enough,   and we’ll make this UK-centric, to  combat loneliness knowing what we know? Dr Henry Aughterson I think I’ve just briefly  touched upon that, and I’m sure you could as well,   Ally, just from the perspective of a Doctor, and  I’ve done some, kind of, talks to medical students   on this kind of thing. We’re taught to be experts  in, you know, communicating to patients about   the side effects of medication that we give  them often for psychosocial, kind of, causes   of their biological problem, but we’re experts  at communicating, you know, our medications to   patients, you know, the risks of a surgery. We’re  pretty good at talking about exercise and diet,   not in too much detail, but in general terms,  you know, how good are we as med students and   as Doctors at having conversations with patients  about loneliness? We’re really, really poor at   that and we’re, in general, quite uncomfortable  as health professionals, especially Doctors. We don’t get any training in that really and yet,  as you point out, it’s pretty much the biggest   risk factor for the very thing that we’re spending  our lives, you know, treating, which is, you know,   health or physical health. And so, we should  be experts in this as much as we’re experts,   you know, in the, kind of, biomedical side, you  know, coming back to that biopsychosocial model.   So, from a, you know, a health professional point  of view, that’s an area we need to, kind of, look   at and how we’re training our, kind of, Doctors  and Nurses to have these conversations. ‘Cause   I think because of the stigma, you know, mental  health in general, but loneliness in particular,   because of that stigma that’s still there,  health professionals are uncomfortable with those   conversations as well. So, you know, that has a  big knock-on effect on public health, doesn’t it? Dr Ally Jaffee Hear, hear, Henry. I think that  is a brilliant action point from today that we   all need to work together to create a framework to  train medical students on how to assess, measure,   and signpost to interventions to combat  loneliness. And speaking of measurements   to actually combat – sorry, speaking of  measurements on how to detect loneliness,   because you’ve all mentioned it, us really  relevant to the research. What does that   actually look like? What scales do we have that  we could use maybe as frontline Clinicians to   assess loneliness? How do you assess it as  a School Teacher, for instance, and you’re   looking at your class of students and you want  it to be a robust, not too subjective analysis? Dr Keri Wong I mean, the – some of the measures  we’ve been using definitely with schoolchildren   and age-appropriate ones would be the LSDQ.  That’s, like, 20 items, pretty, you know,   eight year old – I think the reading age is  like eight years old and above, but then again,   you’re asking, “How about the younger, you know,  children in that spectrum?” I suppose with adults,   there’s the common other measure, which is I  think the UCLA Loneliness Scale, eight items.   That I think maybe is something that’s also  in the birth cohort studies and whatnot,   but Katherine could probably correct me if I’m  wrong. But I suppose a – you know, both of these   measures are about self-reporting, but, you  know, a part of me also thinks that actually,   say in schools, there are also other measures  looking at sociometric measures so you can get   peers to rate other peers to see who’s the maybe  most lonely or who’s the most popular or who’s   the most whatever? So, it’s a, kind of, peer  rated levels of understanding classroom dynamics   that is often used in the literature. And I  think there is some scope there, you know,   for us to think about can different informants  or different people in our lives also provide   information about one’s levels of loneliness  or one’s maybe positioning in the social scene,   as it were. And I think there is some  value there that could be, you know,   discovered or tapped into as well, but yeah,  that’s all I know, but[inaudible – 5248. Dr Ally Jaffee That is such useful  information. Thank you, and to you, Katherine. Dr Katherine Thompson Yeah, and just to follow  on from that, it’s – you mentioned a little bit   about how we can assess it in younger people and  I think that’s what’s really nice about maybe   thinking about social connection as maybe this  broader term of loneliness is obviously, as I   think Henry said earlier, this subjective feeling  that your relationships are not what you want them   to be. Whereas social isolation is having this  feeling of that you don’t – it’s not a feeling,   sorry, not having enough social connections  around you. And that might be a nice way to   detect these deficits in social connection  for young people. If they can say, “Oh,   I don’t have many friends, or I don’t  spend any time with my friends.” It’s   not necessarily tapping into loneliness,  but this could be quite a useful indicator. And what we used in a few of our studies was  the Child Behaviour Checklist, which I think   is quite a long checklist of general child  behaviour, but they have a peer problems   subscale which is often used and I think it’s  items suchlike, enjoy spending time alone,   doesn’t want to talk to other people, doesn’t  have many friends, that sort of thing. So,   I think the – developing the measures is a really  big thing and it’s a really – it’s a real deficit,   I think, in the research literature. So, how we  can get people together to – the young people   together to develop these measures would be super,  super useful for the big cohort studies as well. Dr Ally Jaffee Absolutely. Dr Katherine Thompson Oh, and I – also, something  that Keri said that I thought was really,   really important is different reporters.  So, the child – I think the Child Behaviour   Checklist is actually parent and Teacher report.  So, you’re asking the parents and the Teachers to,   like, you know, assess their – how their kids are  doing. And I’m sure the child themselves would   have something very different to say compared  to what the Teachers see at schools and what the   parents see at home. So, having a multi-informant  report would be most beneficial, I think. Dr Ally Jaffee That’s brilliant, and  to ask you both, Keri and Katherine,   because Henry touched upon it, do you  think we’re doing enough when it comes   to public mental health measures  to combat loneliness in the UK? Dr Keri Wong I think we can always do  more is the answer. I think, you know,   there’s always room for us to, you know, think  creatively about the way that we are currently   addressing the status quo. I often think  that, you know, we – you know, as Researchers,   we go about doing things maybe one way and then –  and I think it works here, let’s try and replicate   it. But it’s not until we work with different  populations, work with different age groups and   different space – work in different spaces that we  quickly realise, you know, not everything is going   to replicate exactly the same and we therefore  need to rethink the ways in which we’d – we do   research, the way in which we even interact with  different groups to engage with them. So, I’m,   at the moment, I think a large portion of my work  is about rethinking the way we think we do things.   So – and I’d always think that we – there’s room  for improvements for any of this kind of work. Dr Ally Jaffee And Katherine? Dr Katherine Thompson Yeah, I would completely  agree. There’s always room for improvement,   especially when it comes to young people.  And I think that also being mindful of not   putting pressure on people that are already at max  capacity, like I think, like, Teachers have a lot   to do in their schools and to not, I guess,  overburden the services that already exist,   right? And I think Henry touched a little bit and  – on about being a Doctor and how – talking about,   like, health and social connection and loneliness  is not something that comes up, but also,   maybe we need additional systems in place that  aren’t just reliant on Doctors and Teachers to   pick up this work as well. I’m not an expert in  that, but that’s just a general opinion, yeah. Dr Ally Jaffee Absolutely, and then a question  to all of you, but I’ll get Henry to ask it first.   So, young people are completely infused in this  digital age and I do think it’s quite frustrating   to hear how demonised it is all the time that  smartphones lead to this term “brain rot,” which   the Gen Zs love, and it’s inevitability. I’m not  a big fan of the under-16s ban for smartphones   and all of that, but we won’t go into that on this  debate. But, Henry, how can we actually, you know,   not demonise smartphones for young people? It’s  an inevitability that they’ll be using them,   but how can we just improve their relationships  with their smartphone and other devices so that   they can be in the real world and connecting  with their friends or making new friends,   but, you know, could a smartphone  actually be a conduit to this? Dr Henry Aughterson It’s a great question,   yeah, and I think, you know, shaming and  demonising doesn’t really work, does it? Dr Ally Jaffee Hmmm. Dr Henry Aughterson And, you know, we need to,  sort of, bring people with us, and adults are as   guilty of spending too much time on their phone as  children are nowadays as well. And then I think,   you know, that social media and smartphones, we  group them together, you know, they’re tools,   aren’t they? And so, they’re not, kind of,  inherently, you know, negative, but I think it   is about, kind of, education on some of the, kind  of, negative effects of smartphones and social   media in a non-demonising, non-shaming way. And,  you know, some of that, you know, does involve,   kind of, thinking about healthy boundaries that  we can set up with our phones and smartphones. I haven’t done any research in this area,  but I know for me personally, I’ve definitely   experienced, I would say, kind of, “smartphone  addiction” or possibly “social media addiction”   in the past to the point where I’ve been, kind  of, angry that – at the – at how much control   I feel this device has over me, from a personal  point of view. And so, for me, I’ve had to set   very clear boundaries to make sure my use with my  phone is healthy. So, I like to think of, kind of,   tech time, but also tech space. So, you know, not  just how much screentime we’re using, you know,   on our phones, but what spaces are we carrying our  smartphone into and is it – you know, can it be,   can we have certain sections of our house,  for example, that we don’t have our phone in? So, I have a – we’ve recently moved out of London  and we have a small spare room and we call that   tech zone where we put our, kind of, phones in  basically, and I can use my phone in that room,   but the rest of the flat, for me personally,  is tech-free from my phone ‘cause I want to   connect with my partner, I want to read,  I want to play music, I want to, you know,   do things, I want to be, kind of, controlling  of my time, basically. So, little boundaries   like that. And it’s not to say that I’m not  using my phone for lots of incredible things   and just to, sort of, build on the point, you  know, can it be used in a positive way? Yeah,   there’s huge growth of really positive, kind  of, digital mental health apps, aren’t there? I know, for me, in the last year, kind  of, just like you, trying to, kind of,   produce mental health social media  content. That’s been an incredibly,   kind of, productive way of using technology to,  kind of, reach people and try and, you know,   support people a bit. So, it definitely can be  done, shouldn’t be demonised, but as I said,   just thinking about what those boundaries are for  you, and not telling people what those boundaries   should be. Just de – everyone developing their  conscious relationship with their phone. It might   be for them deleting certain apps, it might be  limiting their screentime, it might be creating   tech-free zones in their house, and having like  a buddy or a family member alongside you to,   kind of, hold you to account to those, sort  of, things can be really helpful as well. Dr Ally Jaffee I think that’s brilliant  and I’m so happy you take the nuanced   perspective as I do. And we wouldn’t  have met if it weren’t for Instagram,   you and I, so there we go, social media. Dr Henry Aughterson Well, that’s the  biggest point of all really, isn’t it, Ally? Dr Ally Jaffee Exactly, and Katherine and Keri,   do you have anything from the research  that you can point towards about the   relationship between social media and  loneliness in the younger population? Dr Keri Wong I think very briefly.  I mean, drawing on, sort of,   you know, two areas of research. So, one is  looking at delayed gratification, right? So,   this idea that social media or the pings that  we get from apps is really sending a signal in   our brain saying it’s a reward. You know, we  want to know, we want to connect with others,   we want to know what’s going on, but I think  it’s the speed in which information and signals   are being fed to young people today through their  phones that is a bit challenging to monitor. So,   I’m definitely not in the camp of, you know,  banning phones, you know, and all of these things,   but I think the other, kind of, helpful literature  in research is in addiction research. So,   we know that when, you know, people are trying to  cut or quit smoking, it’s not enough for them to   just say, “Don’t do that. You know, don’t smoke.”  Right? It’s by providing them with an alternative   behaviour that enables them to change or create  new links in the behaviour and the reward system. So, I think the same thing with young people  and their phones, you know, if they’re not – if   they’re – or if we’re asking them not to  maybe spend so much time on their phones,   what alternative behaviours are we providing  them that may be more promising, more positive?   You know, can this be physical activity? Can  it be an art activity? Can it be going out for   a walk? You know, can it be other alternative  behaviours? Which I think at the crux of it,   we need to co-create with the young people,  or at least get them to agree to come up with   some alternative habit that they would  engage with instead of their phones. So,   the research would probably - maybe these  two areas I think are most promising in   thinking about a solution with young people  and their phones, but generally, you know,   I think ultimately we want to, as Henry said, you  know, educate young people in terms of, you know,   how much time are you wasting on these apps or  on your phones? But also, getting them to get the   feedback, I think, from the information and using  that to shape and make better decisions. I think,   ultimately, young people know how much time  they’re spending on their phones and it is that   more, like, addiction to the devices that they are  wanting to constantly be online. So, if we can,   as maybe adults with a bit more emotional  control, regulation and control, if we can   help create those boundaries with young people,  then I think that would be a good solution. Dr Ally Jaffee Epic, and Katherine? Dr Katherine Thompson Yeah, I think that was  a brilliant response. I don’t have much to add   on top of that. I just think recognising the  nuance of that is incredibly important. And,   like, we have the smartphones now, they’re  going to exist and so I think just having   blanket bands or scary headlines that  say that these things are damaging is   actually not very helpful. And from –  and I guess from a research perspective,   all my research was conducted on these large  cohort studies that have been collected decades   ago now and so the participants are my age.  So, I’m using their data from when they were   younger and I think it will look completely  different if we were to do the same thing now   when we have technology. So, I don’t know what  that looks like and I hope one day we will. And I think from a personal perspective, my  brother’s autistic and he really struggles   with social connection and having Instagram  and an outlet where he can share his – the   pictures that he takes and he can talk to  me and to his friends and to his family,   has completely shifted his wellbeing, really. So  – and that’s just obviously an anecdotal thing,   but I think to have these, yeah, blanket  statements of saying how dangerous it is   to be on your phone, I’m sure there definitely  are dangers and addiction is definitely involved,   but I think also it can be very useful  to people and maybe to certain groups   of people that wouldn’t have access to being  connected to others in real life, I suppose. Dr Ally Jaffee That’s such a beautiful  anecdote. So, thank you for sharing that.   And it really aligns with a conversation  I had with the organisation Shout,   who are a suicide prevention tech service.  And they actually collected data that found   that their – one of their highest users – user  groups are of the old ADHD group because they   don’t want to speak to someone on the phone  if they’re struggling and texting saying,   “I’m struggling” or “I’m feeling suicidal” is  actually what’s in their means and something   that they feel able to do. So, I think it’s  about no one-size-fits-all and really just   allowing people to use what’s, you know,  low-hanging fruit and available to them   without demonising it and realising that everyone  is different. So, thank you for sharing that. And I guess, we’ll start to draw it to a close.  So, I just want to end on asking each of you, and   I’ll share mine as well, three tips, if you can do  that, on how to improve social connection, and it   can be personal, so what do you do to improve  social connection on a daily or weekly basis? Dr Keri Wong Three tips is quite a lot. Dr Ally Jaffee Okay, so let’s not do three. Dr Keri Wong I got one that I’d love to try, I’ve  yet to try, but I’ve heard that it – you know,   I’ve heard it and I thought is – it’s a  great idea, which is to connect with people   or ask maybe one individual out almost for  a walk-in nature to connect once a week. So,   I heard that that was something that, you know,  someone else had done. They would go on a hike,   obviously a bit limited in London, but, you  know, if you were just, you know, and to invite   an individual that you haven’t connected with for  a long time, once a week, a different individual,   to go for a walk and I thought that that sounded  really wholesome. So, I might give that a try,   but generally, I usually find activities where  we can do together or explore new things together   to try and meet up with friends and  improve social connection, so, yeah. Dr Ally Jaffee Perfect. I love a  walk and talk. And they actually say   that shoulder-to-shoulder listening is far  less intimidating than if you’re, you know,   sat across someone having to make eye contact the  whole time at a coffee or whatever. So, really   resonate with that. And what about you, Katherine?  However many tips you want to provide us with. Dr Katherine Thompson Yeah, it’s hard. It’s  really hard when you think about your own life.   And it’s – they say that about driving as well,  that driving is much easier to talk because you   are side-to-side. I think that’s a really  good question. I think maybe my tip would   be when you are having a social interaction  or you have a chance to meet up with someone   is trying to make that as meaningful to you  as you can. So, I think it’s very easy to talk   about very trivial things and chat away about  politics and the weather and everything, but   someone said to me recently that they would ask  on a date, a friend date or a romantic date for   if they remembered their 18th birthday and what  they did on their 18th birthday? And what you   can tell from someone’s response from that I  thought was really, really interesting. So,   maybe just asking quite, yeah, in-depth  que – not invasive questions, but yeah,   interesting questions and hearing people’s  responses I think can be really connecting. Dr Ally Jaffee I’m going to take  that tip. That will be funny stories,   I’m sure. And what about you, Henry? Dr Henry Aughterson That’s great. I love that  question. I’m not actually sure if I could answer   it, which maybe points to what I was doing on  my 18th birthday, but few tips. So, I think   finding, kind of, local groups. I love, kind of,  participating in local, kind of, community groups.   We – again, we moved out of London and moved  to a town on the seaside. I’ve joined a choir,   I do a football group, so ru – I do a running  group as well, so – when I can. So, joining   groups like that, it’s – I think it’s great.  You know, you’re bonding over shared activity,   again, and it can be a lot less intent – a lot  less intense than one-on-one stuff. As Keri said,   obviously going for a walk with a friend’s great,  also phone calls. Phone calls are very underrated,   I think. I feel like the older generation is much  better at this, but – be – probably because people   just message so much, but actually, having  a phone call with someone is that, kind of,   in between of messaging and, you know, meeting up  in-person and you can really connect with someone,   especially someone who, you know, you don’t  live in the same, kind of, place as anymore. I often use my Sundays to, kind of, plan  in social things for the next week. So,   using your Sunday, if you work or go to school  Monday to Friday, can be a really helpful day.   And then just to give a total flipside answer  as well, because it massively applies to me,   is also learning to say no to the right things  as well and, you know, socialising in a smart way   for you. And if you’re someone that says yes to a  lot of things and struggles to say no to things,   it’s about training that. It’s something that  you can practice that, and it takes years, but,   you – you know, you learn to say no to the things  that, kind of, sap energy from you, basically.   And I think it’s important to ask yourself that  question, is this experience going to nourish me   or is this experience actually going to, kind of,  drain me quite a lot? And sometimes we all have   to do things that drain us occasionally and, you  know, things we have to show up for, absolutely.   But if we’re doing things repeatedly over and  over again with particular groups or particular   people or particular activities that are not  adding to our life and are not nourishing us,   it’s completely okay to say no. You have complete  control over your own time. And that will be hard   at first because you’ve, sort of, trained  your brain to say yes to everything. So,   it will take practice, you – it will be  difficult at first, but it does get easier.   And then you’re kind of, you know, you’re being  your most authentic self. So, I think, you know,   the right people in your life eventually, kind of,  understand that. And it’s a bit less exhausting   because you’re being your, kind of, honest, most  authentic self about what you do and don’t want to   do. So, I think that’s a really important skill  to, kind of, train, but it does take some time. Dr Ally Jaffee Definitely a work in progress  with that. I totally align with that last point.   And I’m trying to be as intentional as possible  with my time, but, you know, you can say yes to   too much and sometimes it’s too late to pull out  and you have to honour those commitments. But   I just wanted to share my tips. So, I’d say when  I go for a meal or for a coffee with a friend,   I try and have no phones on the table  because I find it really distracting. So,   I get quite strange about it and I don’t  even know if they’ve picked up on it,   but if their phone is facing upwards, so the  screen is facing, I’ll – in the beginning,   ‘cause I didn’t have the language to say why it  was bothering, I’d just say, “Oh, the glare in   my eyes, or the light in my eyes, could you mind  flipping it over, I’m finding it distracting?”   And now that I’m owning more that I just want  to have that in-depth connection, I’ll be like,   “Do you mind putting your phone away? Unless  it’s – can you put it on vibrate, unless it’s   an emergency ‘cause I find it really distracting?”  And yeah, they’ve warmed to that now and they’re   still sometimes like, “What’s wrong with you?” But  I find that really useful so I can just be in the   moment with someone and feel like if I’m speaking,  they are actually paying attention and vice versa. And I also agree about the phone calls. It’s  really a wonderful tool that we have and sometimes   they’re not able to fit into my schedule. So, I’m  quite big on the voice note function on WhatsApp.   So, I’m really big on catching up with people  from all over the world using voice notes. Dr Ally Jaffee And then finally, just coming back  to the commercial determinants of loneliness, I do   believe that convenience services like Deliveroo  and all these things that we have are amazing,   but actually they can reduce your chances of  smiling at a stranger or saying thank you to   the person at a checkout. So, when I can, I  do try and go to the shops myself to purchase   something and if I’m in the mood to be friendly,  then I am. And it’s a really nice interaction,   but not to put pressure on yourself if you don’t  want to speak to someone in a supermarket, but   it’s just really nice to be in your neighbourhood  and in those public spaces and not always rely on   the convenience of an app saying, “Yes, I’ll  deliver your bananas and milk in ten minutes.” So, that would be it from me and so, just wanted  to say a huge thank you to all of you for your   incredible insights day. It’s been a really  rich conversation discussing social isolation   versus loneliness, the measurements of how to  look at loneliness, loneliness across COVID,   in the workplace, we’ve really covered so much  and even, you know, got to touch upon social   media. And so, I just wanted to say thank  you and if you can go around and say where   people can keep up with your work on social  media and any things upcoming, like research   papers that are coming out that you want people  to be aware of. So, starting with you, Keri. Dr Keri Wong Great. You can follow my  work on both, this is X and Bluesky,   it’s @DrKeriWong. And the latest, sort of, paper  we’re – or series of papers that’s coming out is,   as I mentioned right at the beginning, which  is a special issue looking at the role of   physical environments on young – children  and young people’s psychosocial outcomes,   and this is out in ACAMH as well. So, next  month, what – was the – watch out for it. Dr Ally Jaffee Fantastic. Dr Katherine Thompson Yeah, you can find me  on Bluesky. I think it’s KT, as in the letters,   ktnthompson, and my paper came out on  the overlap between social isolation   and mental health relatively recently in the  last few months. So, you can check that out. Dr Henry Aughterson Great, yeah. So, my kind of  research, you can find just looking up my name and   Google Scholar and I’m quite active on  Instagram now, so doctor_mentalhealth,   and that’s just a page with, kind of, mental  health, kind of, tips, evidence-based mental   health tips, things like that. So, yeah,  give it a follow if that interests you. Dr Ally Jaffee And I’m @drallyjaffee on LinkedIn,   Instagram, TikTok, and pretty much everywhere.  And you can also follow Chimo Trust, C-h-i-m-o,   to see the wonderful work we’re doing  with charities and social prescribing for   young people. So, thank you all so much.  We’ll bring this webinar to a close now.