by Judy Laing, University of Bristol Law School
‘A sad soul can kill you quicker, far quicker, than a germ’.
John Steinbeck, Travels with Charley: In Search of America.
Mental Health Awareness week this year is focusing on loneliness. As the Chair of the Mental Health Foundation explains, loneliness is a ‘significant public health issue’ and ‘remains one of the key indicators of poor mental health’.
Loneliness and social isolation were already causing concern to GPs across the country before the Covid-19 pandemic. Speaking in 2017, Professor Helen Stokes-Lampard, former Chair of the Royal College of General Practitioners, described the impact of social isolation on individual patients and its toll on the NHS. Lonely people contact their GP more often and lonely people have a 50% increased risk of early death compared to people with strong social links. The Royal College developed a loneliness manifesto and action plans to increase awareness and promote community action to combat loneliness in society.
The restrictions on social movement and personal contact over the last couple of years as a result of the pandemic have exacerbated the social isolation faced by millions of people in the UK today. A Campaign to End Loneliness survey in July 2021 found that 71% of UK adults in the survey think that loneliness is going to be a serious issue beyond Covid-19, and a new report, ‘Loneliness beyond Covid-19’ highlighted that around a million more people became chronically lonely during lockdown.
Loneliness and social isolation can be as bad for patients as chronic physical health conditions. Studies have demonstrated that social isolation triggers cellular changes that result in chronic inflammation, predisposing lonely people to serious physical conditions such as heart disease, stroke and cancer. The 2010 Marmot Review into reducing health inequalities, ‘Fair Society, Healthy Lives’ found that:
‘Individuals who are socially isolated are between two and five times more likely than those who have strong social ties to die prematurely.’ (p. 138)
Loneliness is not a diagnosable mental illness, but there is evidence that it can lead to significant deterioration in mental health and serious mental illness, for example depression, and cognitive decline, including dementia. These physical and mental health risks arising from loneliness highlight how important it is to implement laws and policies that take a preventive approach to combat mental ill-health and inequalities.
My colleague, John Coggon and I wrote in an article in 2019 ‘Exploring new paradigms in mental health and capacity law: persons, population and parity of esteem’, that current mental health laws are crisis driven and far too reactive. We suggested that laws should be designed to support and promote good mental health, with a renewed focus on prevention and proactive intervention. The government has made proposals to reform the Mental Health Act in a White Paper in January 2021, and a draft Mental Health Bill will be announced in the Queen’s Speech on 10th May 2022. The proposals are designed to tighten the criteria for using the Mental Health Act’s compulsory treatment powers. Limiting the use of the Act, however, will only be effective if there is well resourced and comprehensive sources of health and community support and early intervention available for patients in need. But the proposals do very little to address this need for proactive and preventive care and support. The Care Act 2014 places statutory obligations on local authorities in England to take action to promote wellbeing and prevent the development of needs for care and support. Wellbeing is a broad concept in the legislation, defined as relating to a range of factors, including social and economic wellbeing, contribution to society and personal/family domains and relationships. Accordingly, the Campaign to End Loneliness suggests that ‘action to end loneliness should form an important part of this work’ and local councils are encouraged to take a range of practical steps to address the issue, as part of their Care Act duties. However, evidence suggests that local councils have been failing to discharge their duties under the Act, which has led to reforms in the new Health and Social Care Act 2012. New measures include strengthening oversight of local council Care Act functions by the independent regulator for health and social care in England, the Care Quality Commission.
At a policy level, central government published the first ever loneliness strategy in 2018. ‘A connected society: a strategy for tackling loneliness’ laid the foundations for change and looked at what can be done to design in care and support for social relationships. Subsequent annual reports on the strategy have highlighted that progress has been made with some initiatives, such as trying to address the stigma around loneliness and developing an evidence base on loneliness research. The strategy has been recently supplemented by Emerging Together: the Tackling Loneliness Network Action Plan which forms part of the government’s plan to tackle loneliness arising from the Covid-19 pandemic. The plan includes a range of measures and resources to support organisations and individuals to respond to the growing epidemic of loneliness and social isolation in society. The government has also recently published a discussion paper and call for evidence on mental health and wellbeing as part of its commitment to ‘levelling up’ and addressing unequal health outcomes across the country. The consultation is open until 7th July 2022 and is asking for views on what we can do to improve everyone’s mental health and wellbeing.
This renewed focus on mental health and wellbeing is welcome and long overdue. These laws and policies form an important part of central and local government’s response to loneliness, but we should not underestimate the scale of the challenge to combat this growing epidemic in the wake of Covid. One of the most pressing issues to address is the chronic underfunding and neglect of the care sector, huge cuts to local authority budgets, and urgent need to remedy the gap between real needs and resources. As the Parliamentary Public Accounts Committee noted in a report in June 2021:
‘COVID-19 has had a devastating impact on the care sector. Those receiving care, care workers and millions of unpaid carers deserve our upmost gratitude and respect. The pandemic has shone a light on the sector and underlined how vital it is to so many, while emphasising that care is not properly funded, lacks transparency and urgently needs reform’.
Professor Judy Laing is currently undertaking a parliamentary academic fellowship in the House of Commons Library related to mental health law reform. Judy has written this Blog in her capacity as a Professor and member of the Centre for Health, Law, and Society at the University of Bristol Law School and any views expressed are her own. Professor Laing delivers a number of modules relating to mental health and human rights law on the LLM Health, Law, and Society.