Smile Speak ShareA positive initiative to address loneliness

What are we going to do about loneliness?

Purpose

Smile Speak Share is proposed by the Friendship Project as an initiative which will address loneliness by encouraging positive social habits which assist local communities improve social connection and help individuals navigate periods of loneliness.

This paper outlines the proposed initiative following a meeting held on Friday 4 November 2016 in Canberra, ACT to see if there is interest from individuals, businesses, service providers, agencies, government and funders would get behind an initiative like Smile Speak Share to address loneliness in Australia.

Contents

Executive Summary1 Loneliness – its costs and causes2 What is being done about loneliness?3 What is Smile Speak Share?4 Element 1 – The Message5 Element 2 – Local community ownership, engagement and action6 Element 3 – Social impact funding7 How will Smile Speak Share operate?

Version Control

Date issued Details11.10.16 LB Initial draft 28.10.16 Draft issued for discussion purposes only – Canberra meeting 4 Nov 20163.12.16 Final version following Canberra meeting and feedback period

Comments on the initiative are welcome. Please forward them to lesley.brookes@friendshipproject.com.au

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Executive SummaryBackground

Loneliness is commonly defined as the feeling that social connections are inadequate. It is a naturally occurring physiological sensation, like pain or hunger, which prompts us to seek social connection. If not dealt with, loneliness can be dangerous to our individual health and well-being.

Loneliness, and the related state of poor social connectedness, is increasingly being shown by Australian and international research to be a significant contributor to poor physical and mental health, with the concomitant social and economic costs - not to mention unnecessary human misery.

In Australia, the current focus in research and media is primarily on the impact of loneliness on mental health and suicide. As well, there are many well-established and effective services targeted at dealing with the loneliness experienced by specific groups, such as older people, young people, carers, men, migrants, minority groups and young mothers.

Increasingly, there are positive community initiatives, such as R U Ok? and Neighbour Day, which seek to encourage individuals to extend friendly care and to build a sense of connection and community. New and innovative approaches to reducing loneliness, such as +Connect, are also in development.

Smile Speak Share – a positive and preventative proposal

The Smile Speak Share initiative is a proposal to complement and support these programs, products and services. It encourages individuals and communities to create and practise habits which help us individually to navigate periods of loneliness and collectively to reach out to those at risk of loneliness.

The concept of the Smile Speak Share initiative is based on the success of the ‘Slip! Slop! Slap!’ campaign which transformed Australians’ attitudes and behaviours by creating life-long preventative habits that significantly reduced the occurrence of skin cancer.

Key elements of the proposal for a Smile Speak Share initiative

There are three key elements of the proposal:

1 The creation of simple, evidence-based, habit-forming messages and practices, such as Smile Speak Share which can be easily communicated, promoted and used by individuals of all ages, and by communities, to create closer social connection

2 Local community ownership, engagement and action driven through local community leadership. They will work with existing community services, businesses, government agencies, schools, service groups, clubs and groups. They will initiate conversations about loneliness, use the message of Smile Speak Share to encourage appropriate local responses to loneliness. Each community implements an action research project similar to the Joseph Rowntree Foundation’s ‘Let’s Talk About Loneliness’ process. This process identifies gaps in services, and supports the development of local responses to specifically address loneliness and create greater social connection

3 Securing social impact funding from philanthropic sources, based on similar overseas models, to fund: the staged development and roll-out of the messaging; provide limited seed funding for local community action research; and pay for initiatives which measurably reduce loneliness and/or increase social connection

Principles underlying the Smile Speak Share proposal

Smile Speak Share will be developed with the intent that the initiative will be:

based on physiological, psychological, sociological and economic research about the causes and effects of loneliness and the means of alleviating it

outcome focussed and use valid and reliable measures of effective changeP a g e

created by the collaborative effort of interested persons, services and organisations, with a view to developing a communications, resources and processes strategy which can be used by a range of organisations and groups to enhance, complement and supplement their existing work, rather than cut across their own corporate imperatives and messaging

capable of being trialled and replicated in Australian metropolitan, regional and rural locations, commencing in those localities in which potential funders have already expressed in-principle interest in seed funding the initiative

linked with similar international initiatives through strategic partnerships once developed, the initiative will be gifted to suitable organisation(s) to host and operate in

perpetuity The Friendship Project, led by Lesley Brookes, will harness the collaboration of suitable

professionals to progress the development of the Smile Speak Share initiative, with in-principle support from a group of stakeholders, who will create a Consultative Body for the initiative.

Each element of the project will be progressed, commencing with:

the production of sample communications materials for trialling the formation and seed funding for three local community leadership groups to trial a process to

reduce loneliness in diverse Australian contexts, prior to its replication in other localities the preparation of a social impact investment business case and/or funding application to

targeted philanthropic bodies to be submitted by a suitable organisation with charitable status

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1 Loneliness – its costs and causes

Loneliness defined

Loneliness is commonly defined as the feeling that social connections are inadequate. Lim and Gleeson (2014) describe it as follows:

Loneliness, sometimes referred to as ‘perceived social isolation’, is defined as a subjective experience of social isolation. Loneliness has been shown more to be related to the quality of social relationships than the quantity, and is typically characterized by feelings of social disconnection ... It occurs when there is a discrepancy between desired and actual amounts of social interaction. Humans are a social species and have a fundamental need to belong. Feelings of loneliness have been perceived to be early warning signals of potential threats to psychological health ... Loneliness is also associated with an increased risk of various health conditions (e.g., increased inflammation, decreased immunity) and can occur in transient and chronic forms across the lifespan.1

Masi, Chen, Hawkley and Cacioppo (2010) in writing about loneliness say:

Like hunger, thirst, and pain, loneliness is typically mild and transient because it contributes to the maintenance or repair of meaningful social connections – as occurs when a child is reunited with his or her parent following a separation or when a spouse returns home following a trip. When meaningful social connections are perceived as severed or unavailable, however, loneliness can produce deleterious effects on cognition and behavior2 that, in turn, increases the likelihood that loneliness becomes chronic3.

Social isolation, which reflects an objective measure of social interactions and relationships, is a related, but distinct concept, as pointed out by Masi, Chen, Hawkley and Cacioppo (2010). They undertook a meta-analysis of interventions to reduce loneliness4 in which they also noted not only the deleterious effects of loneliness on cognition and behavior, but also: the prevalence of loneliness across the life-span, from kindergarten to old age; the damaging health effects of loneliness; and the impairment of executive functioning, in part, because loneliness triggers hypervigilance for social threats. They conclude, ‘the impact of loneliness on such diverse aspects of physical and mental health provides justification for interventions to mitigate this experience.’5

Costs of loneliness – physical, psychological, sociological, economic

The UK Campaign To End Loneliness reviewed the literature and created the stark warning, ‘Loneliness is as bad for you as smoking fifteen cigarettes a day’.

Dr Michelle Lim from Swinburne University provides an equally stark warning in relation to mental health, ‘If loneliness is not addressed, a person is more likely to experience depression, social anxiety and paranoia in the next six months’. 6

Australian social researcher and author Hugh Mackay reminds us of the social costs which result from loneliness when he writes of our interdependence as a species and ‘our deepest quandary: we are individuals with an independent sense of personal identity and we are members of groups, with a strong sense of social identity fed by our desire to connect and to belong’.7 He writes of the increasing trend in our society which contributes to growing loneliness.

The growth in the number of single-person households is the big story of modern Western societies. Solo houses are like the ‘global warming’ of population statistics: a phenomenon we knew was coming but failed to appreciate the rate of its acceleration; a radical change of consequences, some yet unknown …

In Australia, [solo households] is the single biggest category, accounting for more than 25 percent of all households, … predicted to exceed 30 percent of all households by 2030…

Two-person households are also more common than ever: the combination of one- and two-person households now accounts for well over 50 percent of households in most Western societies.8

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Hugh Mackay goes on to point out that with the ageing of the population, bereaved, elderly people generate a constant supply of new people being thrust into solo households, often struggling to cope, particularly if they have never lived alone previously. Others, including many younger people, will live alone from time to time throughout their lives. He continues,

Even some younger people who have chosen to live alone and seem generally happy with their lot can be surprised by loneliness, like a virus lying dormant that sometimes strikes unexpectedly…

Though it can strike anyone, at odd times and places, loneliness is a more obvious hazard for singletons than for people in multiple-person households. If the antidote to loneliness is the comfort of companionship, then being isolated in a single-person household creates the obvious difficulty that such companionship may not always be available.9

While various authors, such as Diener and Seligman (2004)10 have argued for a broader view of social costs than just the economic, in the UK some of the Reconnections projects being run by Age UK Hereford and Worcestershire are paid for by social impact bonds by Worchestershire County Council (and is evaluated by the London School of Economics11) on the basis that there is a lesser cost of interventions to prevent ongoing loneliness than there is in medical costs in treating the health effects of loneliness.

The Friendship Project is not aware of an Australian study which quantifies the economic cost of the physical, mental and social health risks of loneliness. It is self-evident that the cost is considerable, and a proportion of that cost is avoidable. This means that individuals, communities, service providers, government, employers and their insurers, as well as philanthropic funders, all have a vested interest in taking preventative action to alleviate and mitigate the impacts of loneliness.

Causes of loneliness

There are many reasons why loneliness strikes. While it can be induced by social anxiety or other mental health susceptibility, it is often also induced by external factors which occur at important transitions in our lives, such as:

Moving to a new school or work Leaving home A close family member or friend moving away Death – particularly of a partner or close family member or friend Divorce Moving home Redundancy or unemployment Illness or disability which limits or isolates us physically or emotionally Becoming a carer Becoming a stay-at-home parent Loss of connection with a group, such as other members of a team, club or group with shared

interests Loss of transport or access to meaningful community settings and events

The research on the impact of technology on loneliness is mixed. Certainly technology can link people and some apps are very powerful in monitoring people’s well-being and prompting them to take action to connect with others. However, technology is also distancing because the quality of interaction is often lessened through sending messages rather than speaking, and having many ‘friends’ with whom one has public conversations, rather than a small number of friends with whom one has a more intimate connection.

Once a person has become lonely, Masi, Chen, Hawkley and Cacioppo (2010) conclude that the person slips into a downward loop,

In which individuals have increased sensitivity to and surveillance for social threats, preferentially attend to negative social information…, remember more of the negative social expectations …, and

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are more likely to behave in ways that confirm their negative expectations. This loop has short-term self-protective features but over the long term heightens cognitive load, diminishes executive functioning, and adversely influences physical and mental health and well-being. 12

Research and theory about the causes of loneliness, claim Masi, Chen, Hawkley and Cacioppo (2010), indicates that fifty per cent is genetic and fifty per cent is environmental. Therefore ‘loneliness is not an immutable trait but rather can be exacerbated or ameliorated by social interactions.’ They continue, ‘These findings suggest that interventions that enhance a feeling of social connectedness can alter self – and other – perceptions along dimensions that have the potential to improve the quality of social interactions and relationships and keep loneliness at bay.’13

But, they also warn that loneliness is contagious.

Individuals who are connected with lonelier individuals also become lonelier themselves, over time, demonstrating the powerful influences of social networks. Lonely individuals embedded in an enriched social environment find it easier to break out of the loneliness cycle than those without an enriched environment.14

By contrast, positive psychological and sociological research shows that happiness spreads. In 2008 Science Daily reported on a data mining study undertaken by Christakis and Fowler15 using data from the Framingham Heart Study. The summary reads:

When an individual becomes happy, the network effect can be measured up to three degrees. One person’s happiness triggers a chain reaction that benefits not only his friends, but his friends’ friends, and his friends’ friends’ friends. That effect lasts for up to one year. Conversely, sadness does not spread through social networks as robustly as happiness.

The article goes on to say, ‘when an individual becomes happy, a friend living within a mile experience a 25 percent increased chance of becoming happy … and next door neighbours, 34 percent’.16

Baker, Cross & Wooten (2003) argue that there is evidence in the literature for the impact in social networks of ‘positive’ ties which result in outcomes such as empowerment, high performance and improved well-being. Their particular interest was in ‘energizing relationships’, which focused on the extent to which interpersonal relationships generated or depleted a feeling of energy. Their work indicates that a positive energizer uplifts and boosts others. That positive energizers are optimistic, trustworthy, unselfish and heedful people, who have learned to be positive energizers by developing positive habits. Their positive energy had the power to change a social group.

Lim & Gleeson (2014) in their paper warning that loneliness increases the risk of psychosis, conclude,

Regardless of the modality, it is crucial that people with psychosis be given easy access to a naturalistic social environment that engenders hope and spontaneity, and provides a platform where positive relationships can be nurtured.17

Undoubtedly, all lonely people need a context where positive relationships can be nurtured, and clearly that can be created by behaviours which create positive energy and by positive people purposefully sharing their happiness with others in a community.

Loneliness – its costs and causes - in summary Loneliness is real, damaging and costly – to the individual, to the community and society Loneliness is contagious Loneliness is induced both by our attitudes and by external factors throughout life Social connectedness is key to combatting loneliness Creating natural social environments that model consistent healthy behavior,

spontaneity and nurture positive relationships are a powerful tool for addressing loneliness

Learning and practicing positive habits has the power to influence the well-being of lonely people in our community

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2 What is being done about loneliness?

There are many loneliness interventions used across the world, and numerous reviews of them have been undertaken since 1984, as noted by Masi, Chen, Hawkley and Cacioppo (2010). They noted that there were four major types of interventions: improving social skills through training enhancing social support increasing opportunities for social interaction addressing maladaptive social cognition through trainingTheir analysis indicated that social cognition interventions ‘yielded greater loneliness reduction compared to the interventions to enhance social support, social skills, or opportunities for social interaction’.18 This gives some direction for design of any future interventions.

UK Initiatives

In the UK, the Campaign to End Loneliness was established as a network of national, regional and local organisations and people working together. It was initiated in response to the Calouste Gulbenkian Foundation developing a strategic interest in dealing with problems of an ageing population. It drew together five partner organisations – Age UK Oxfordshire, Independent Age, Manchester City Council, Royal Voluntary Service and Sense – and secured additional funding from other trusts and foundations. In personal conversations with the directors and the Acting CEO of the Campaign to End Loneliness, they indicated that they saw the Campaign as having a limited life, with its primary focus being on raising awareness of loneliness and assisting and supporting others to respond to it by:

evidence-based campaigning to decision-makers facilitating learning to the front line building a research base.

Established five years ago to focus primarily on loneliness among older people, the Campaign is now recognising the need to broaden its focus to deal with loneliness throughout the life-span.

Other UK activities include the 2013 initiative of the Joseph Rowntree Foundation and the Joseph Rowntree Housing Trust which developed an action research program to explore and identify the causes of loneliness, at a community level, and what could be done about it. A copy of their article, How you can reduce loneliness in your neighbourhood is provided as an Attachment to this paper.

Research in Australia

Research in the field of loneliness continues across the world, and there is a small group of researchers working in the field in Australia for example at Swinburne University, Australian Catholic University, University of Tasmania and University of Western Australia.

There have also been a number of recent studies about the growing extent of loneliness in Australia, including work by the University of Tasmania (2008)19, the 2011 Relationships Indicator conducted by Relationships Australia20, the Australia Institute (2012)21 and Lifeline (2016) 22. The Australian research is not sufficiently robust to be conclusive about the extent of loneliness in the community. The Australia Institute (2012) is possibly the most authoritative, and also the most conservative in its estimate of the extent of loneliness in Australia. Nevertheless, it concludes,

Between 2001 and 2009 three out of ten Australians experienced loneliness. More tellingly, the proportion of people transitioning into, and out of, loneliness increased over this period, with 13 per cent experiencing repeat episodes of loneliness. An episode of loneliness was most likely to last for less than a year, however, for those whose experience extended beyond a year, it was far more likely to last for three or more years. The proportion of Australians experiencing loneliness in any given year was fairly consistent at around one in ten people23

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This is broadly similar to research results from overseas, which indicates that:

In the US, the number of people who feel isolated at any time is estimated to be about one in five individuals24.

Loneliness is increasing. In the US in 1985 when asked the question, ‘How many confidants do you have?’ the most common response was three. In 2004, when the same question was posed, one-quarter of the respondents said that they have no-one at all with whom to talk openly and honestly. 25

Loneliness is becoming more widespread, effecting all age groups, with some commentators referring to it as developing into epidemic proportions. In the UK the age cohort that was found to self-report as being loneliest was 45-54 year olds26, although representatives of the Campaign to End Loneliness indicated in conversation that there is evidence of children as young as 7-9 years of age seeking assistance for loneliness, and it is believed that loneliness in people over 65 years is under-reported.

Initiatives in Australia

In Australia there are many well established services and products to provide support and interventions for people experiencing loneliness. They are wide in range, specialisation and intent, and include, but are not limited to:

Telephone services to support isolated people Men’s Shed Migrant and refugee welcome schemes Visiting schemes Adopt a grandparent programs Friendship connections to link people with mental health problems to a friend Meet-ups Clubs for professionals from overseas Introduction agencies Online dating sites

There are a number of preventative programs, such as ‘R U Ok?’, and community building initiatives, such as Neighbour Day. There are also innovative new products, such as apps like +Connect to help young people deal with loneliness, and which will assist with assessing, monitoring and prompting connection.

In 2014 beyondblue and The Movember Foundation co-funded a study of Men’s Social Connectedness. It was undertaken by Boekel, Coulton, Einfeld and Arbes of Hall and Partners I Open Mind. The report indicates that about 1.1 million men in the total population experience low levels of social connectedness as measured by the Duke Social Support Index. Despite this, men experiencing social isolation or loneliness believe that they are unusual, and that although they would like to be able to talk a friend about their personal issues, they don’t have the skills to do so. Similarly, they don’t feel able to respond appropriately if a friend does so to them.

An extensive review of services to address social isolation in older adults was undertaken for beyondblue, co-funded by The Movember Foundation, in 2014 by Bond, Howden and Ralson of Roberts Evaluation Pty Ltd. It considered a wide range of services in both Australia and overseas and concluded that to improve the connectedness of older adults, several common success factors were identifiable:

Sustainability – ensuring programs can continue after funding periods end Community integration – tailoring to specific community needs, leveraging existing resources and

enhancing services Targeting specific populations – ensuring the target audience and desired outcome is clearly

stated during program design

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Co-production with the target population – involving older adults in the program design and ongoing delivery

Focusing on prevention/promotion of protective behaviours – seeking to sustain and build connections of older people to prevent them becoming severely isolated and/or depressed27

The beyondblue website goes on to note that beyondblue wishes to make a positive contribution to this space by:

facilitating national inter-agency collaboration and information sharing raising public awareness of the importance of social connections in mental health promoting (and advocating for) the existing good practice programs on offer

Published coverage

Loneliness is increasingly discussed in the media and other publications. Everyday a Google search highlights press articles from across the world talking about the ‘epidemic of loneliness’ in countries as diverse as England, Bangladesh, USA, Taiwan, Australia and India. In 2014 loneliness was a topic of discussion at the Festival of Dangerous Ideas in Sydney28.

It is surprising, however, how few non-fiction books there are on loneliness, even in a well-resourced public library, such as Sydney’s Shorelink collection. A search turned up five such books, one by Alice Muir. An English author, Muir’s 2012 book Overcoming Loneliness29 is a useful self-help book inspired by Cacioppo’s research and the Campaign to End Loneliness.

The international bestseller by Stephanie Dowrick Intimacy and Solitude initially published in 1991 and re-published in 2002, for example, distinguishes between loneliness, the state in which you are uncomfortable being by yourself, and solitude, the state in which you can be alone and comfortable being by yourself .30 It is a topic picked up and explored in much detail in the self-help literature.

John T Cacioppo and William Patrick published their very accessible review of the scientific literature on loneliness in 2009, Loneliness. The central theme of this book is that the need for social connection is a fundamental human need.31

Canadian lawyer and author, Emily White in her 2010 book, Lonely, provides a very personal account of her own life-long loneliness and her exploration of the research on loneliness and the results of a blog that she established to hear from lonely people across the world. She describes her loneliness as ‘emotional anorexia’, and a taboo ‘state you are not supposed to name’, and says, ‘What I wanted when lonely was for someone to notice how little I had. My loneliness was a way of voicing – both to myself and to those around me – how badly I need intimacy and companionship’32. Her poignant last two sentences point to the importance of the role of others in our lives,

I’m not, despite my adequate skills or powerful desire, able to write about an end to my own loneliness story. This ending has to come from outside, from someone else, from someone who takes me by the hand and leads me away from the state, away from the word, away from the feeling that’s been mine for so long.33

English psychotherapist, Phillippa Perry, in her 2012 book How to Stay Sane, in discussion of ‘relating to others’ as one of her four elements for achieving sanity, makes the point,

Without another soul or souls to check in with, pass the time with, be affected by and affect, a part of us does diminish. We do feel less human… Solitary confinement is one of the most brutal, most stressful punishments we inflict on our fellow humans. If we are to stay sane, we must not inflict it upon ourselves.34

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What is being done about loneliness? - in summary There are many examples of loneliness interventions across the world, some of which

are more effective than others. Many are not measured so their effectiveness is not known

The epidemic of loneliness is a growing topic of discussion in the media and other forums and publications

In Australia there is a fledgling research base about loneliness and a range of services, but there is still great need among many lonely people in the community

There are calls for future initiatives and interventions to use best practice by being: sustainable, integrated, targeted, co-designed with the target group, and focused on prevention and the promotion of protective behaviours. Such initiatives also must be collaborative, raise social awareness and promote good practice.

3 What is Smile Speak Share?

This proposal is for a focused, collaborative effort to address the growing problem of loneliness in a unified and concerted manner. Smile Speak Share is a positive, preventative initiative to transform existing attitudes and behaviours to reverse the current trajectory of increasing loneliness and social disconnection. The initiative will capitalise, complement and supplement the work already undertaken by many organisations throughout Australia and overseas.

Smile Speak Share was inspired by the Cancer Council’s highly successful ‘Slip! Slop! Slap!’ campaign which radically changed the attitudes and behaviours of Australians. It is an initiative which:

is a collaborative endeavor drawing on the disparate work done by numerous organisations and groups to date, to drive a more comprehensive outcome

is a positive approach to raise awareness of loneliness and promote socially connecting behaviours

has the power to change community attitudes and behaviours encourages the development of life-long, preventative habits promotes normal, preventative attitudes and behaviours that supplement interventions and

services to reduce serious and chronic loneliness and associated mental health conditions can be applied in all forms of loneliness and related programs once practiced at an individual level, has the power to impact those with whom the individual

comes into contact, lifting levels of positive social interaction once adopted at a community level, has the power to provide a positive social environment to

support and encourage lonely individuals can be funded through social impact funding or investment, to provide essential resources and

systems to support demonstrably effective interventions to reduce loneliness relies on community leadership and volunteer inputs for grass root ownership and delivery will meet the criteria for good program design: collaboration, raising social awareness and

promoting good practice

There are three elements of the proposal.

Messaging

The first element is the creation of simple, positive messaging which encourages action by individuals, which is both preventative and will create socially positive environments. This element is fundamental to the entire initiative, establishing a platform for the strategic overlay of awareness, education, choice and action.

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Community

The second element is community ownership, engagement and action through the identification of local community leadership groups who will promote the messaging and support and guide an established process in their locality to identify and resolve the issue of loneliness.

Finance

The third element is the development of a social investment business case and/or funding proposal which could be made by a suitable charity to philanthropic or other funders for resources to address the proposal’s progressive stages.

Each of these elements is now discussed in more detail.

What is Smile Speak Share? - in summary Smile Speak Share is an initiative to create and promote simple habit-forming messages

that encourage greater social connectedness While it will be a national initiative, Smile Speak Share proposes implementation at a

local level, under local leadership, guided by local research about specific local needs and tailoring action plans to respond specifically to those needs

Social impact investment will be used for: message development and implementation; seed funding grants to local communities; and to pay for interventions which demonstrably reduce loneliness and/or increase social connectedness

4 Element 1: The Message

Vision: Australians respond to a simple message by recognising the risks of loneliness and adopting attitudes and habitual behaviours which connect them more closely to others and thereby help to prevent and alleviate loneliness

This messaging element of the Smile Speak Share initiative needs to be as powerful in preventing loneliness as the ‘Slip! Slop! Slap!’ campaign was in preventing skin cancer. By prompting awareness and action, clever messaging will support the adoption of preventative behaviours across the population.

Considerations

1 The messaging is the central strategic element of the initiative, providing consistency nationally and a tool for implementing local solutions

2 The messaging will raise awareness of the risk of loneliness and the value of positive, preventative attitudes and habits, such as Smile Speak Share that supports individuals when they are experiencing loneliness by creating a more positive social environment

3 The messaging will support and complement other positive community messages, such as ‘R U OK?’, etc

4 The messaging needs to be shaped in a way that is culturally appropriate and non-discriminatory in multi-cultural Australia

5 The messaging needs to apply to a life-time. It would be communicated as part of a national campaign, including, but not limited to:

for children & young people – as a positive component of anti-bullying campaigns (without detracting from child safety messages)

for adults – in encouraging socially aware activity and providing positive role models for children

for employers – in dealing with the risks of a lack of social cohesion and mental health issues in the workforce, isolated workers, and workers on extended sick leave

for businesses – in front-line services and customer relations training as well as in corporate social responsibility activities

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for community and volunteer organisations – in building social capital for their cause and organisation

6 The messaging will be staged to raise awareness of loneliness and its risks, to promote a preventative solution, and to be tailored to specific target groups

7 The messaging would, desirably, be created in a manner which was free of intellectual property constraints

8 The scope of the vision is to change behavior by people in all age groups, nationally, who are consciously or unconsciously affected by loneliness, resulting in a measurable reduction in loneliness and improvement in social connection

9 Until funded, a national campaign would be outside the preliminary capability of the initiative. Nevertheless, it would be well within the scope of Element 2 Community Ownership, Engagement and Action of the Smile Speak Share initiative to use and trial some simple messages, with guidance from psychologists and advertising strategists.

Element 1: The Message – in summary Messaging will be simple, clear, culturally appropriate and promote simple action

responses Messaging will be free and able to be used in diverse contexts from the cradle to the

grave Messaging will shape and form the implementation strategy of the initiative Messaging can initially be developed and trialed on a local community level, and be

tested and refined prior to rolling-out nationally

5 Element 2 - Local community ownership, engagement and action

Vision: Traction in dealing with loneliness will be driven at a local level by identified community partners. They will steer the creation and evolution of positive, socially rich initiatives. In these local communities people will Smile Speak Share every day, lonely people will be identified and their needs responded to

Local community leadership groups will:

promote the messaging – awareness and education encourage adoption of the messaging locally support and guide an action research process recruit, train and support a diverse volunteer base raise awareness of loneliness highlight the value of positive social connection identify gaps in services and products support local initiatives which respond to local needs ensure the measurement of the effectiveness of interventions and local initiatives

The Joseph Rowntree Foundation and the Joseph Rowntree Housing Trust in the UK developed a loneliness action research program, which is outlined in the article, ‘How can you reduce loneliness in your neighbourhood?’ (see Attachment). It is proposed that the Smile Speak Share initiative would adapt this process, or develop a similar one, to provide a project process which could be used throughout Australia.

Considerations

1 Positive social environments can be created with local leadership, evaluating existing services and employing volunteer inputs to have a positive effect on people in close geographical proximity.

2 A community leadership group will be identified in each locality to encourage and influence the community and existing businesses, organisations, services and groups to adopt and integrate the Smile Speak Share messaging, to raise awareness of loneliness and encourage and advocate for positive action to address loneliness in the community.

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3 The local community leadership group will either lead a loneliness action research program itself, or support a suitably qualified group to do so. The tasks of the leadership group will include:

raising community awareness overseeing the recruitment and training of volunteers ensuring that a gaps analysis is undertaken support and advocate for necessary new local initiatives to be developed ensuring and promoting measurement of the effectiveness of interventions.

4 The local community leadership group will advocate for good practice in design of local initiatives based on:

sustainability community integration targeting co-production with the target group focus on prevention/preventative behaviours

It will also encourage collaboration and information sharing.5 The local community leadership group will actively advocate a social investment approach to

reducing loneliness. They will encourage local business to actively seek business opportunities to contribute to reducing loneliness in their communities as well as in their workforces. They will encourage an increase in volunteer contribution as well as the funding of new services based on demonstrable results.

6 Three local community initiatives are proposed to be commenced by the Friendship Project during the concept development proposal period - in a metropolitan, a regional and a rural area. Preference will be given to localities where there is known leadership capability and the capacity for local funding.

Element 2: Local community ownership, engagement and action - in summary Local community leadership groups will use Smile Speak Share messaging to create

positive community attitudes They will base their local process on an agreed model to investigate, research and tailor

solutions for local needs They will support and advocate for initiatives which address loneliness locally The development plan will include three pilot local initiatives:

- metropolitan- regional- rural

6 Element 3 – Social impact funding

Vision: Investments are made by businesses, philanthropic foundations and government into services, products and activities which achieve adequate financial returns and social impact. This impact will be measurable reductions in loneliness and/or increases in social connection

Key to this proposal is the commitment to achieving measurable results in the reduction of loneliness and/or the increase in social connection.

Increasingly, internationally, social enterprises are being formed and philanthropic foundations, as well as government, are directing their investment toward business models which achieve measurable social impacts.

In New South Wales, social investment bonds have been established by Westpac with investments made into three social impact programs where measurable outcomes are achieved. The NSW Government pays for agreed program outcomes which are preventative in nature and when it is demonstrated that those outcomes (eg having children arrive at school learning-ready) will save government significant future expenditures. That income allows the payment of a dividend to investors. This is only one model of social impact investment which is now being used across the

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world. Philanthropy Australia advises that other states in Australia are in the process of establishing similar social impact funding arrangements.

The Smile Speak Share initiative would, in consultation with its Consultative Body, develop a business case for submission, by an agreed charity, to targeted philanthropic foundations, or other funders, for a social impact investment which would:

undertake the development and national roll-out of the Smile Speak Share messaging provide small amounts of seed funding for local community leader groups, to assist in

undertaking their action research and developing local responses pay, as required, for agreed social outcomes of measurable reductions in loneliness and/or

increased social connectedness maximize commercial opportunities, including incomes from training and merchandising, as well

as payment for results – such as lessened risks - from insurers and other parties

Considerations

1. There are many businesses and agencies which will benefit from immediate or future reductions in expenditure because of timely loneliness preventative and protective behavior interventions. These include:

employer expenditures on lost productivity and insurance due to mental health or workplace social disconnection

health and workers compensation insurers who have client cases exacerbated due to loneliness

government expenditures on health, mental health and community safety service providers who are spending a disproportionate amount of time and cost on

client support which is driven by loneliness philanthropic funders who will be requested to fund future restorative initiatives

because clients’ loneliness has progressed to a chronic level, with all of its concomitant costs.

The intent is to create a business model which will harness current or future savings for these organisations by effective, timely preventative loneliness interventions. The specific business model may be similar to the NSW Westpac model mentioned above, or may be modeled on another overseas example in the emerging social investment area.

2. There will be business opportunities for commercial services which arise out of the local action research. These include provision of new services as well as opportunities for sales of training products for staff training by employers, insurers, volunteers and service organisations.

3. A well-crafted message (as was ‘Slip! Slop! Slap!’) would give rise to the potential for income flows from merchandising.

4. In order to demonstrate the effectiveness of the initiative, it is a requirement that a reputable external organisation, such as a university evaluation unit, be involved in the establishment of a rigorous measurement framework. This framework will need to measure initial assessments of individual and the community characteristics, and measurable changes at the individual, community and national levels, which will be reflected in reporting mechanisms to funders. There are existing valid and reliable measures of outcomes which could be used, such as the UCLA Loneliness Scale, in initial assessment and measurement of change in individual cases of loneliness. There are a range of measures which can be used to assess social connection. Work will need to be done in determining the most adequate measurement scales and to assess the economic value of changes in social outcomes.

5. There are currently large corporate foundations which are looking for viable social investment opportunities

6. The funding will need to be phased to reflect a proficient implementation strategy, which would include the following staged sequences:

The initial development of the messaging and the measurement framework

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Any limited requirement for seed funding of three proof of concept pilots in a metropolitan, regional and rural context

A national messaging campaign Seed funding, as required, for the roll-out of local initiatives across the nation Commercial off-set payment for performance outcomes

Element 3: Social impact funding - in summary There are social investment and funding models which can be used There is a wide range of businesses and agencies which will achieve significant savings if

there are investments in effective prevention and protective strategies, as well as community behavior transformation

There are established methods to measure outcomes and international models for economic valuation of those outcomes

7 How will Smile Speak Share operate?

Vision: The initiative will be sponsored by a collaboration of organisations and persons. The concept will be developed by the Friendship Project under the guidance of a Consultative Body. Once sufficiently established as a viable proposition it will be gifted to an agreed charity to pursue and develop.

Considerations:

1 The scale of this project can only be achieved through collaboration or undertaken by a national organisation.

2 The messaging will be designed to be used to have global application, especially through social media, and it is expected that there would be strategic partnerships with similar international initiatives.

3 A key principle will be that the initiative is focused on measurable outcomes with the messaging supplementing, complementing and enhancing the work of existing service providers, agencies and groups, rather than cutting across either their purposes or messaging.

4 A Consultative Body will be created to guide the concept development of the initiative.5 The Consultative Body will be asked to commit to meeting periodically (probably monthly) to

provide guidance to the Friendship Project in developing the proposal for implementation.6 The Friendship Project will undertake development work on the initiative on a voluntary basis

and fund $10,000 of other expenses. It will seek the assistance of other volunteers. Where the cost of development would exceed the available resources, it will seek the advice of the Consultative Body about appropriate sources of funds to pursue necessary development.

7 The key steps for the Consultative Body are to provide guidance on the development of each element of the project:

initial development of the messaging and the measurement framework overseeing the establishment and seed funding of three pilots of the community

ownership, engagement and action strategy the preparation of a social impact investment business case and/or funding application

to targeted philanthropic bodies to be submitted by a suitable organisation with charitable status

establishing an agreed model and established funding for the national messaging campaign and roll-out of the extended community application, prior to its gifting to an agreed organisation

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How will Smile Speak Share operate? - in summary Smile Speak Share needs to be a collaboration of people and organisations with

national, and potentially international, reach Friendship Project is able to harness volunteer expertise and provide limited seed

funding to establish the initiative under the supervision of a Consultative Body Each element of the initiative could be commenced immediately: the messaging;

community ownership, engagement and action; and financing

Attachment: Joseph Rowntree Foundation How you can reduce loneliness in your neighbourhood is available at <https://www.jrf.org.uk/report/loneliness-resource-pack>

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1 Lim, Michelle H & Gleeson, John F (2014) Social connectedness across the psychosis spectrum: Current issues and future directions for interventions in loneliness Frontiers in Psychiatry November 2014 Vol 5 Article 154 p1 www.frontiersin.org2 Cacioppo, JT & Hawley LC (2005) People thinking about people: The vicious cycle of being a social outcast in one’s own mind. In KD Williams, JP Forgas & W von Hippel (Eds) The social outcast: Ostracism, social exclusion, rejection, and bullying pp 91-108 Psychology Press, New York, NY3 Masi, Christoper M, Chen, Hsi-Yuan, Hawkley, Louise C & Cacioppo, John T (2011) A Meta-Analysis of Interventions to Reduce Loneliness Personality and Social Psychology Review 15:29, p2204 ibid, p2195 ibid, p2216 Swinburne University (2016) Loneliness can lead to poor mental health Media Release 1 July p27 Mackay, Hugh (2014) The art of belonging. It’s not where you live, it’s how you live Pan Macmillan Australia, Sydney, New South Wales p18 ibid pp155-1569 ibid pp163-16410 Diener, Ed & Seligman, Martin E P (2004) ‘Beyond Money: Toward an Economy of Well-Being’ Psychological Science in the Public Interest 5:1 pp1-3111 McDaid, David, Park, A-La & Fernandez, Jose-Luis (2016) Reconnections Evaluation Interim Report June 2016 Personal Social Services Research Unit, London School of Economics Unpublished, London 12 Masi, Christoper M, Chen, Hsi-Yuan, Hawkley, Louise C & Cacioppo, John T (2011) A Meta-Analysis of Interventions to Reduce Loneliness Personality and Social Psychology Review 15:29, p25913 ibid p22114 Lim, Michelle H & Gleeson, John F (2014) Social connectedness across the psychosis spectrum: Current issues and future directions for interventions in loneliness Frontiers in Psychiatry November 2014 Vol 5 Article 154 p3 www.frontiersin.org15 Fowler, James H, Christakis, Nicholas A (2008) Dynamic spread of happiness in large scale network: longitudinal analysis over 20 years in the Framingham Heart Study British Medical Journal, December 416 Harvard Medical School (2008) Happiness Is ‘Infectious’ In Networks Of Friends: Collective – Not Just Individual – Phenomenon Science Daily 5 December 17 Ibid p318 Masi, Christoper M, Chen, Hsi-Yuan, Hawkley, Louise C & Cacioppo, John T (2011) A Meta-Analysis of Interventions to Reduce Loneliness Personality and Social Psychology Review 15:29, p25719 Franklin, A & Tranter, B (2008), Loneliness in Australia Paper No 13, Housing and Community Research Unit, University of Tasmania, Hobart20 Relationships Australia (2011) Issues and concerns for Australian relationships today: Relationships Indicators Survey 2011, Canberra21 Baker, David (2012) All the lonely people. Loneliness in Australia, 2001-2009 The Australia Institute, Institute Paper No 9, Australia22 8 out of 10 Australians say loneliness is increasing: new survey at <<www.lifeline.org.au/about_lifeline_home/media_centre/_media_releases/2016_articles>>23 Baker, David (2012) All the lonely people. Loneliness in Australia, 2001-2009 The Australia Institute, Institute Paper No 9, Australia pv24 Cacioppo, John T & Patrick, William (2008) Loneliness. Human Nature and the Need for Social Connection W.W. Norton & Company, Ltd, New York, NY p525 ibid p24726 Cohen, Josh (2015) Why is midlife such a lonely time? The Guardian, 15 July 201527 As reported at <<www.beyondblue.com.au/home/about us/research projects/social isolation in older adults>>28 A copy of this video is available on You Tube29 Muir, Alice (2012) Overcoming Loneliness Sheldon Press, London30 Dowrick, Stephanie (2002) Intimacy and Solitude. Balancing closeness and independence Random House Australia, North Sydney, NSW31 Cacioppo, John T & Patrick, William (2008) Loneliness. Human Nature and the Need for Social Connection W.W. Norton & Company, Ltd, New York, NY32 White, Emily (2010) Lonely. Learning to Live with Solitude HarperPerennial, New York, NY p29733 ibid p33234 Perry, Phillippa (2012) How to Stay Sane Picador, New York, NY p72