My name is Steve Trumbull and I'll be facilitating the webinar tonight. I'll focus, as you can see, is in collaborating to recognise and address the mental health impairments of loneliness. I'm a GP myself by background but my current role is as head of medical education at the University of Melbourne. I'm going to introduce tonight's panel, although you've already had the bios disseminated and if you wanted to read more, there's a tab at the bottom of the libraries that you can have a look at to find out more about who's who. Also you'll see that there are there's the opportunity to ask questions so we'll come to that in just a moment. But before I would like to have a quick hello to each of the panelists. Now first of all we have Dr Michelle Lynn who's a psychologist based at Swinburne University. So hello Michelle and welcome to tonight's webinar. Thanks Steve for having me. It's a pleasure. So you've really got your whole career involved around loneliness. What triggered your interest in that area? I actually think I stumbled into that. I was actually a social anxiety researcher and also focused on looking at people with serious mental illness and loneliness obviously is a condition that afflicts both of these conditions as well. And I happened to be doing a postdoctoral research fellowship at Washington University in St. Louis and stumbled into doing or measuring loneliness in one of my studies and it just kind of snow got from there. Okay great well it's good to have your expertise tonight. We've also got Dr Jonathan Ho who's a general practitioner in Wagga Wagga. So welcome Jonathan and I think you're sitting outside there in Wagga so showing off the climate up there in rural Australia. Welcome. Now you do a lot of work with youth in a rural setting and have you found loneliness to be an issue for that particular group? Loneliness I think especially for the youth they might not be able to put a label on it they might be able to recognize that something's just not right but as a GP it's a great opportunity that you can actually engage with them and walk through this particular journey and it's more of a conversational journey sometimes they might actually come up with it themselves that they actually feel lonely or you can assist them in just asking them what do you think loneliness is and they might actually recognize actually they're feeling quite lonely. Absolutely great well good to have your expertise tonight too and finally but certainly not least Lisa Brophy now you're a social worker and professor at La Trobe University again here in Victoria. My interest in loneliness really came about because I've worked in mental health for pretty well all of my career in all sorts of different roles most recently in research and probably my research experience intersected with the experience that I had when I was actually working in the community with clients that a profound experience of people is to feel lonely. They might describe that in all sorts of different ways as Jonathan suggested but still this profound sense of sometimes people having very minimal contact sometimes the only contact that they have are professionals that are working with them and a lack of intimacy in their lives and I could see and I think they can see too that this is really having such a significant impact on their general health and well-being and then I became really interested in this I got on to Michelle and said I hear you're really into this and managed to get myself on the Australian Council but the Council in Blind Manifest is expert advisory of scientific advisory groups so that's been a great thing for me. Fantastic so immediately you've got a network in a community of practice in the area that's wonderful. Okay so welcome to all of you and obviously we're over a thousand people now on the webinar so each of the participants is a contributor and we look forward to hearing your questions. There's a chat box that you have there for General Chat and there's plenty of conversation going on there already we're already hearing from everywhere from Perth to Queensquiff via Mendes Creek and Darwin so that's great it's a really good diverse group so please do chat between yourselves there and if you've got a question you'll see there's a tab down the bottom there which is appropriately called Ask a Question so please click on that if you wanted to ask a question and that will be circulated by the staff at the Mental Health Professionals Network and presented to the panel as a question when it's the right time. So what's going to happen now is that we've got a couple of case studies that have been already circulated each panelist is going to give a short response to the case studies as it relates particularly to their area of practice and there'll be some conversation between the panel hopefully a more broadcast than the budget speech last night anyway we'll get to that and also then we'll move into a Q&A opportunity which will be where we'll have responses to the questions that have come up from the audience and that's really where we want to spend the majority of tonight's activity in responding to issues that are important to you as participants in this webinar. I wanted to particularly remind you of the learning objectives of the webinar sorry learning outcomes where they are so these are really important and we need to check at the end that we've met these so please let us know via the chat board if we haven't. The first one is looking obviously at the factors that are associated with loneliness and what distinguishes loneliness from just being alone. Also distinguishing between loneliness and depression using appropriate language when we're working with clients who we think might be suffering from loneliness. The barriers particularly the physical barriers geographical barriers and things like that that might inhibit social interaction and finally we don't want to finish tonight without giving you a chance to consider in your own context what might be a referral pathway you could use to support people who are experiencing loneliness so they're learning outcomes for tonight. What we're going to do now though and I'm sorry to be dancing around on the slides a bit but we're going to get into the case studies as I say you've already read those so we won't go through them again. The reason they've been chosen is I guess to draw attention to two quite different people who are both possibly experiencing loneliness and we'll have Michelle particularly talk to the first one from the psychology perspective Jonathan giving a general practice perspective then we'll move to the second case study Lisa speaking from a social work perspective and then Jonathan from a general practitioner perspective but always looking at how the professions can work together in order to get the best outcomes for our clients. So that's what we'll do now we're doing well on our timing so we'll move straight to Michelle you're going to talk to us about the case of Dean. So I'm going to kick off here on the first case study which is Dean and I identified actually the two major changes in Dean's life so there's a change in parental responsibilities so in this case two adult children have actually moved out of home and also a loss in his occupational role so socially he would have two social losses here that were there before and now no longer there. So I think what's really important if Dean is unable to recognize these changes is to acknowledge that these two major life changes are probably occurring in a short time frame and if Dean does report stress or loss or uncertainty around these events I think it's really important to empathize with Dean it's really important to acknowledge that you understand that that's actually a change. He may not recognize that but I think it's important to identify those two changes then moving on I think there's a couple issues here with the way Dean has kind of thought about himself within the social context there's some reluctance here for Dean to actually socialize about his wife I guess I really would like to explore what this reluctance is about and also what role did he think he was playing in his social network before he was retrenched did he initiate any of these friendships or did he maintain them or what kind of role did he and I guess what kind of specific role did he play in that relationship dynamic and also if there's that reluctance what would it actually mean if he did socialize with these friends without his wife so not being dependent on her and if it does elicit some discomfort I think it's really important to ask why and it might be tied to perhaps unhelpful assumptions about about his ability to initiate and maintain friendship so it's really important to address those things if they do come up. I think one thing that we often miss and not very good at is actually goal setting a lot of people who do feel lonely don't necessarily want to have a goal of making many many new friends I think we need to figure out if Dean actually would like to does he want to make new friends or actually just rebuild the current social network that he has or just gain more confidence. On top of that does he actually have the resources to actually do those things so are those goals actually realistic there are a lot of people as you would know actually don't have a rich social environment maybe in Dean's case you know he might be socializing or was socializing at his work and within his family settings but he may not have had any kind of strong friendship networks around him does he even have the ability to access you know interest groups so can he afford to go to the gym or does he have access to libraries close by is he in a rural area you know it's really important to kind of figure out the context that he's embedded in and again I think this is tying back to does he actually have the financial ability to support some of these social activities in terms of coming from a CBT perspective I think it's really important to identify Dean actually hold any kind of negative assumptions about new friendships often we find that people who are lonely often have assumptions that friendships should be easy or should be organic or should just flow but actually friendships do take a lot of work and sometimes well most of the time it comes with being an acquaintance and from that acquaintance status it moves towards a friendship status through hard work so I think it's really important is there any kind of negative assumptions about making friends is important to identify those ones and sometimes people have these negative assumptions because they've had negative experiences you know people who may have let them down the path or you know people who they assume would have their back didn't have their back and you could even occur within the family context managing those unrealistic or unrealized expectations of making new friendships often when people are older as well they have these expectations of oh it's not much of a point in making new friends you know and well you know if I make new friends they move away it's going to be too hard or I'm too old to make new friends you know those kinds of unhelpful thinking is not it's not going to help you target that loneliness severity so again another thing another common assumption is that people would think well friendships should just click and should be organic if I meet someone I should immediately like them or they should immediately like me again it's not a one-size-fits-all and there's so many people in the world like they need to understand it might be a trial and error process and also getting deemed to think about what does it mean for him to develop a meaningful relationship so what's actually meaningful for him because what is meaningful for him is not going to be meaningful maybe for someone else and maybe even the way men might relate to friendships so think about friendships not be quite different to women men may generally may feel I guess satisfied with friendships that hold a particular kind of conversation that might not be sufficient for women for example so what is it specifically for Dean himself it might not be a gendered kind of typical response from Dean so it's really important to hear what he wants thank you Michelle that's great that's a really good start for us really important and it's interesting some of the things that have come up already in the chat about people who are suffering a loss such as after divorce and whether that sort of fear of getting hurt you're talking about friendships and I guess some of the challenges involved in making sustaining friendships and whether a much more intimate relationship becomes a way to contemplate such as after a divorce which has been quite painful actually that's quite a common I guess concern that a lot of people actually do talk about especially men after after divorce often they find themselves in a position where maybe their partner may have taken some of the friendship networks with them post divorce and they find themselves kind of needing to rebuild and what we're talking about long enough here just making sure that people understand that this is not about lack of social skills it is more lack of social confidence in terms of rebuilding those networks again so it's really important that in general we always nurture our friendships and our social networks regardless of what stage we're in because it's really important to always have that safety net of friends that can support you through these difficult times and even if there's a financial cost involved in having activities that cost is well offset by the benefits of contact with people absolutely okay great thank you for that another issue that's come up before we move to Jonathan's perspective is about older people and the issue of loneliness in the elderly is it something that you wanted to address in particular Michelle or should we put that to later yeah we can address that now if you like sure so what is specific to an older person who finds themselves lonely by I guess the inevitability of losing important people in their lives as they've got older as well it's a really really difficult question because bereavement for example is a huge factor and sometimes people who are bereaved may surround themselves with people who may be friends but they never feel it's the same thing and it never replaces that loss of that meaningful relationship it's a very difficult question but you know how do we it's impossible to replace those things and so how do we then still live and flourish and thrive post bereavement I'm not sure if anybody else has any ideas but I think it's important that we do look out for people who are in that position as mental health professionals I think it's possible to rebuild and I have seen clients who have been caring for their spouse and you know 50 years of marriage and the spouse passes away you know those steps like you know getting them into social structures like going to the gym and making new friends and speaking to people actually those things can help and I have seen people repartner post bereavement as well and actually into their second marriages so those things are possible but it's a difficult journey and really does require the support of people around them as well as mental health professionals or their doctor yeah now just before we go to Jonathan again I'm sorry to put you off again Jonathan but I'm just curious in Lisa's view on this concept of the labour within the relationship and it can be hard work and a lot of that does seem to fall to women in relationships is that a fair comment look I think so and I think that's what's often found that women will often be taking up this emotional labour so and what I mean by that is you know the person who makes contact with friends and family and organisers events and all of those kind of things and often I think men you know suddenly got to invest in that themselves and it may require a new set of skills that they haven't even really been introduced to or haven't thought were going to be necessary for them to develop so even talking about the fundamentals of who organisers family events and so forth might be a way to get started in thinking about that because it may be that other people in the family or other friends aren't necessarily abandoning that person it's just that those links have been lost somehow perhaps through the loss of that person who's done the labour around it if you like yeah absolutely alright well thanks for those insights well back to you Michelle just again with this case tell us more about about Dean with Dean is that we got in thinking about a behavioural approach again this is very unlikely to be a social skills aspect to that that the fact that he doesn't have social skills and therefore his lonely for us is about social confidence so what are the safe and feasible options for Dean like for the clients that I've worked with for example post-marital, post-divorce or due to significant life changes you know asking them to join a group is just completely unfeasible especially if you also work with clients with a serious mental illness they may feel very judged with particular activities or very self-conscious about you know going to a particular shared group type setting so how do we kind of make these options safe and also feasible and doable and kind of setting them up to success for me when working with some clients I would kind of focus on participating and making efforts rather than actually going yeah you should make a friend actually the fact that you are going to you know setting where it allows those opportunities to happen that's great and then the next time perhaps saying hi to someone and the next time actually learning about someone a little bit more even if it's a superficial way so taking those steps and and not be afraid of small talk because small talk then opens up more deeper conversation and a lot of people again so I hate small talk I don't want small talk but actually small talk is an opener and a step for people to kind of get to know you so that would be the way I would look at a behavioral activity for him or be a behavioral approach and just getting him to kind of build his confidence over time rather than go and make a new friend again you know as clinicians we've got to be mindful about what will work for your client. That's a really good segue into hearing from Jonathan about his perspective of the small talk concept in that I think a lot of people observing general practitioners say there's an awful lot of small talk in the consultation but in fact it's important so what can you tell us Jonathan your response to Dean's case? GP the specialists have a quite unique perspective because often the patient actually chooses us as the specialist rather than another doctor referring a patient to another doctor so the other thing that's unique is we have a longitudinal relationship as well and so that we might not be able to approach the subject right off the bat it might just be a blood pressure check and you might not get that opportunity but you might have that opportunity later on. The other thing is as a GP particularly working in a regional setting it's a privilege to actually work with I call my brothers and sisters allied health, other practitioners and we with a concern as a patient of course are able to share information as well as to build on each other's expertise so I might actually get, not get from Dean that he's known me but I might actually get that from one of my colleagues and that could actually guide me with my conversation with Dean. Sorry go on Jonathan. No I'm good, go on Steve. I was only going to say that that continuity that GP offers so important that's your perception as a social worker is it Lisa that you would see that longitudinal connection with GP the continuity is very important? Oh look I think it's such a rich thing that I think it's such a rich thing that GP's can offer that continuity and we often see people especially in the mental health service system engaged in what's a very fragmented care system and GP's can be that really good base that is the person that maintains that continuous relationship and I think it's often what people say they want people to give them more time and they want people to give them continuity. Absolutely and I guess building trust can only really come through spending better time with people and maybe revealing a little bit of the authentic self. I'm just curious Michelle I've heard you mention before that you work with clients who say that when I show my true self people don't like it so how do we deal with that if we encourage clients to put themselves out there a little bit and they say well people don't like what they see that's awfully difficult. Yeah I think it's really important that's a very common experience that people say so if I really show who I am that people are not going to want to be friends with me because the audience sees weakness so really there's an issue of their self-esteem here and how they think they perceive themselves is really important to check for any kind of occurring social anxiety as well because that can really contribute back to loneliness but I think my take on this when the client says that to me is actually maybe you're actually going to the wrong people you need to be finding your tribe and the people that who like you for who you are often people what they do is they then put up this front of this person that they're not and trying to kind of relate to people that way and people can kind of sense something not quite right and kind of pull back and so how do you convince your clients to actually say well actually you're just going to the wrong people and you should maybe perhaps try this or perhaps there are people around you that are better fit for you but you just haven't quite got there yet so it might be a trial and error process. Yeah and there's been quite a lot of discussion in the chat group about the use of alcohol with the way of getting some confidence in social situations but that's got to be a flawed strategy I would have thought. And that's also very consistent with people with kind of problematic levels of social anxiety as well using alcohol especially with young people using alcohol to actually then be more confident to actually talk to other people but then the alcohol actually makes them act a little bit silly and then they get embarrassed that he may have said something and then they can't remember what he said so it becomes a vicious cycle. Absolutely so obviously I mean I must say I share an age with Dean so I've got a lot of sympathy as well as empathy for him and his situation that he's found himself in and obviously there are many factors that have led to that but let's look at the next case study now and as I say it's unusual for us to have different cases but they're two quite different cases and people will have read the story of our next case and the situation that she's found herself in and Lisa you're going to talk about your responses to this situation so over to you. Here we have Jess's situation where she's kind of been knocked up and pregnant and knocked off her trajectory and she's had this kind of significant loss of friends and social network that's been a kind of very disruptive event in her life where she's moved away from her home and her family and all her informal supports really. She's got some new ones but she's had a significant erosion of her informal support network and I read Jess's story and I think about how disempowered she is and how she must feel as well and also the amount of stigma that we see and perhaps the reaction that's happened around her pregnancy but also that might translate to her own feelings of self stigma as well and I also see her as a young person who currently lacks a lot of the support and advocacy that she might need to actually be able to negotiate this situation and I think it's actually really important to start thinking about how to get Jess kind of back on track if you like because what we know is that otherwise if she continues on this trajectory of not being engaged in education not being engaged in employment and really I think you could even say that she doesn't even have adequate safe and stable housing at the moment. I'm not sure how sustainable living with her aunt and uncle actually is then I think she's got some really important risk factors happening around perhaps ending up on a trajectory where she does end up being diagnosed with a mental illness when in fact now might be the time to actually really start thinking about the social determinants in relation to Jess's situation it's interesting how Lowman can actually invite us to actually start thinking more about the social determinants when it comes to mental health and education, employment and housing that's such an important place to start where Jess is concerned but actually in having conversation with Jess I would still say that it's actually important to ask about Lowman and it's how she feels how does she kind of describe her situation there's this kind of idea about how does she construct the presenting problem if you like, what does she see happening and this is about really seeing Jess as an expert on her own life and sending that message to her that she is the expert and is being lonely a meaningful way to talk about what's happening or if she's got a different kind of language around that with someone like Jess who's already got tier 12 and is probably pretty articulate or we can assume that she might be then that's going to be important but maybe if we might think about someone who doesn't have like young men for example that I've worked with in the past can have a lot of difficulty articulating what's happening to them and I think Jonathan actually touched on that but even so it's important to get a sense from Jess about how she wants to talk about what's happening and I suppose the message for me here is that it's really important for Jess to be starting to think about rallying the supports that are around her and actually talking about her situation because otherwise there's the possibility that that will erode as well and she won't have the support that she needs in the longer term and that means that we're kind of in this together of talking to her about what's happening and what we might be able to do about it and it's a very important time to act. I couldn't stress more about to me when I read this case study I think it's really important now to be starting to think about Jess and her social relationships. So the good news is that loneliness can be a motivation as well as an inhibitor of social connection so this is about the idea that feeling lonely can often mean that we actually want to connect with other people and want to do something about it so that might be something that we could connect in with Jess here and Jess actually start talking to Jess about how she could be more empowered in her situation how can she actually get some more control over her situation and getting started with those kind of conversations can actually be good in terms of thinking about what are her values, what are her preferences, what choices if any does she have. I was thinking a young person like this has got so much to teach us about social media and what platform she likes to use and is it Instagram or is it like she probably doesn't think Facebook's old hat now or whatever and so those experiences that she's having on social media will be really important to explore and think about as well and maintaining that sense of again that her being the expert here but what are her strengths she's already talked about how she wants to do nursing, she's already got 12, there's a lot happening for her that could be built on and we just talked about these issues around social identity and that sense of self and what the literature would tell us is that actually having some kind of bond or sense of belonging something in common with other people and whether she constructs that online or she constructs that through the country town that she's living in but something that actually enables her to rebuild her sense of self and social identity might depend on contact with other people, other like-minded people it's really interesting when you read the Loan Minister literature I think it's actually a bit silent on families and family engagement but I can't help but think that in this case we've got a very important situation in relation to Jess's family she's about to have a baby, I know there's conflict and there's difficulties and we might be reacting quite strongly to the idea that her parents have made such a drastic decision in sending her off to the aunt and uncle but on the other hand it may be important to actually engage with them and connect with if Jess gives us permission to do that. I suppose again in terms of her being an expert on her life then her defining who she sees as family now might be actually important, who does she see as the key supports in her life and who are the family members that she think would be available to support her. We've already talked about community connection and there's lots of possibilities for community connection I think that would really depend on Jess's preferences really. I was kind of hoping that one of the things that Jess might like to do is actually learn to drive you know for example there's lots of the VicRoads has a program that where volunteers assist young people to learn to drive that would be something that could be very enabling when it came to community connection in a country town. I'm sure a lot of the people on the webinar have got experiences of how to assist people in these more isolated situations and finally peer support is another area that I'm very interested in. It's a growing area in terms of being seen to provide significant optimism about the kind of support that can be offered to people and that kind of shared lived experience can be really important in terms of engaging people, building trust and all the things that are probably really important for Jess currently. I'm very attracted to this particular study, the community navigation study. It's kind of in some ways encapsulates a lot of what I've been talking about in terms of Jess. What they're doing it's a study in the UK and it's linked to this idea of social prescribing. Now the other thing about the community navigation study is that it actually also includes some, a small amount of financial support for people, so £100 in the UK and I think that's actually really an interesting thing because what we've got here is someone, Jess is probably on Newstart and this has been a lot in the news recently and it's going to be very difficult for a young person to be managing on that very low income. So finding some way of enabling Jess to get access to extra financial support might be important and that's where my family might come into that or there might be other resources that she can draw on. But being socially focused is all about enhancing an individual's social world. So this study is really about thinking about mapping, helping someone map their social world. Then developing knowledge of the local community. So really having a sense of what's available for people. The community navigators are really about being future focused and looking for positive solutions and using the person's strengths and resources. So being there with someone and guiding them. Now I suppose this is aspirational isn't it? We don't necessarily have community navigators in all the places where we're working but we might have people who can in some way adopt this role in relation to someone that we know is experiencing loneliness. So being person-centred is another aspect of this. Being individualised and working with the person's needs, goals and preferences and Michelle's already talked about the importance of being able to talk to people about their goals and working with the person rather than doing too is so critically important if we're going to have that kind of message of wanting to empower people and help them make their own choices about their lives. And this fits with this final aspect of the principles of community navigation which is allowing the lonely person, if that's how they're defining themselves, to direct the pace and the journey that they take together with the navigator. And if you read the paper it talks about this role model which is really about helping people affect goals. Is it realistic? What are your options and how can we find a way forward? And I think it's actually a great study that I encourage you to look at but hopefully it's a useful way also to think about how we might engage with what's happening with death. And that word navigator really jumped out when you were talking about that strategy and it's a simple skill like learning to drive. I mean it just sounds perfect in that it's a way of overcoming a physical barrier to loneliness if she can access the vehicle to be able to transport herself and importantly her new baby to see other people away from the aunt and uncle. And I have heard it said that teaching a teenager to drive is a perfect way to engage without eye contact. That you cannot sit face to face without risking an accident. So it's a really good way to get supportive interaction teaching a useful skill. So it's a fabulous concept because Jonathan back to you clearly, sorry, Jess is going to walk through your general practice door with a baby in her abdomen which is looking forward to the arrival of. She must be at significant risk of postnatal depression. Is this something that you confront in your practice? So often it might be as simple as when you're doing your Edinburgh depression scale that sort of flags either risk of mental health or some psychosocial problems. And if loneliness is actually identified as part of that some GP practice tips could be one is I find that a lot of young people these days find it really hard to show the authentic view. They're exposed to Instagram where perfection is displayed on a daily basis in Facebook this photoshopping and I think of an incident where I have a person that I know that I highly respect that has the mullet test where he used to just have a mullet and you'll have a third of people that just wouldn't care. A third of people that will love it. But there will be a third of people that don't like mullet and that's okay. The other thing is with young people they're great at harnessing technology and adopting new technology to actually use it for good. That could be actually carpooling for example if she is 18 she doesn't have a license. She can find an app and get some support that way or even exercise groups particularly if she's in a small town. There's often thumbs up, thumbs down Facebook pages in small rural communities and it's great to connect. The other thing is I think a lot of young people tend to be quite afraid of putting themselves out there. It's sometimes helpful just to have that conversation with them saying just because it's uncomfortable doesn't mean it's actually harmful and just encourage them to take that step. Lastly I think she's in a very unique position because she's able to get it that other people won't get it. For example she can look out for people in the community that she might resonate with finding her people and she might be able to connect in that way. Fabulous. Speaking of technology I think we've lost your video so we've got a still image of you looking rather chipper but anyway if we can get you back I know it's gone dark in Wagga but there you go. Thank you for that input. Was anything further you wanted to say about either case Jonathan? I did cut you off a bit earlier from the first case. I think as a GP we want to actually start the process of this conversation. I like to believe that when people come to me I want to have a safe environment for them and a safe relationship which will actually enable them to have safe conversations and to actually explore real life issues for them. Sure great. Alright well thank you for that. Let's now move to the participants questions particularly and there's been quite a few. One thing that leads on we started talking about depression particularly the risk of postnatal depression in Michelle but I mean depression is a mental health issue. It's a psychiatric illness. People have been talking about there being an effective range of mood disorder before we start to get into depression. Is that something that will draw a firm distinction between about people having loneliness as an emotional feeling versus sort of depression as an illness. Yes look I think that's really important to understand that loneliness and depression are related but they're actually not the same construct so we do know that loneliness is actually an antecedent to more problematic depression such anxiety and paranoia but the way we can kind of think about loneliness is actually the negative view of the way you see your relationship whereas depression is very much the negative view that you see of every single part of your life so I think for mental health professionals you can assess that like how negative is it kind of much more global or is it very specific to just their relationship and not conflicted too and I think as mental health professionals we're not very good at doing that ourselves. Okay Lisa any thoughts from you about that distinction? Yeah I think it speaks to the idea that it's important to really understand where someone's coming from and the degree to which perhaps those profound feelings of sadness and so forth might be what's actually behind the difficulties that they're having relating to other people or whether we're actually seeing these other kind of disruptions and changes actually impacting on someone's social connection so and it really speaks again to that building of trust and the continuity and the getting to know someone. I suppose what we're really and it can be quite difficult if someone presenting and they can't quite understand the way they're feeling being able to unpack that with someone and taking the time with them and we you know in pressured services that can be difficult but it speaks to how important that is. Yeah so picking up on a question from Jennifer would social anxiety be a precipitant to loneliness would we see that as a combination? So you have done some studies on that so loneliness and social anxiety actually have a reciprocal relationship so even though loneliness is an anti-season to most of the social anxiety those who have high levels of social anxiety are also more likely to be lonely previously it was always kind of thought that's kind of more related to depression but actually that relationship with social anxiety is much stronger so the way I kind of think about loneliness is I always assess and identify any kind of problematic social anxiety that will get in the way of actually I guess being around people because that would be a major barrier if we don't actually address that. Okay any thoughts from you Jonathan I think we've got you again? Yeah I think I'm bouncing off Michelle You look like you're sitting around a campfire singing Kumbaya Yeah it's beautiful weather in Mogawaga if you want to visit but like a lot of young people actually do get more and more insular and more and more isolated and often they will get into the gaming a lot of the non-faceless things and when you sort of take that away for example if they have sleep problems and you go oh it's all that screen time that you're doing you're actually really taking away their one lifeline to social connections so it's often just being very slow and a good listener to explore what drives some of their behaviours and some of their thoughts Okay what about the use of the word loneliness I think there's been some conversation about whether that can be a sensitive word it's almost a pejorative word that you're lonely what does the panel think about that I think with loneliness I was just going to say that I mean I think there is stigma around loneliness and even to the point where it's a problem for doing research because when you want to do research on loneliness it's partly about recruiting people who might identify with that and I think there's actually been some difficulties in that area is that right Michelle That's correct I think the way you ask depending on the population as well sometimes when you ask a particular cohort are you lonely they'll say no but if you actually say oh do you like companionship or do you want more meaningful relationships they'll say yes so it's this idea of like if I say I'm lonely or use the L word then it must mean I'm a loser or there's a connotation of fragility and vulnerability when in fact it should be seen as you know to actually connect with other people just like hunger authors but the word lonely has this stigma around it and I wonder are we you know back in the phase of depression where people kind of use depression used to be a word that nobody can talk about you know do we need to kind of build more awareness around that term and I did hear somebody say that it's different it's okay between being lonely and being alone that obviously we need to distinguish between those things as well as part of that spectrum towards depression there's a normality about being alone at times to even know cold chisels saying about loneliness quite effectively yeah so I mean sometimes people use the word solitude which is solitude is actually wanting to be alone but not actually being distressed by it and it's actually quite okay and often people say well I'm alone by myself all the time and I'm not lonely that's great but when we say the word loneliness is actually whether you're with or without people but you are actually distressed by it so you know those who are better within strong social structures can be lonely as well because they don't have the depth of those relationships that they yearn for so and again of course I guess our idea of lonely people as well as like the older adults by themselves you know just sitting in a you know sometimes nursing home kind of looking sad they might not be lonely but it's important to ask do they need companionship or do they need do they want some company for example sure and I do oh sorry go on with that yeah I just wanted to mention that I like that kind of idea that what you're seeing is a mismatch between the person's kind of what they want in terms of meaningful social relationships and what they actually have so and that's going to vary across different people but the other thing that I wanted to raise that really bounces off what Michelle said was that I've done quite a bit of work with people in residential communities like supported residential services and those kinds of places and it's amazing how profoundly lonely people can be in a congregate living environment so we can make assumptions about the idea that people are actually in an environment where they're surrounded by other people and yet what they say is that they have these profound feelings of loneliness so much about not feeling safe in those relationships all the difficulties that can come with congregate living that means that people don't have that meaningful connection with other people and sometimes that just isn't talked about with people like people just don't ask about it because they kind of make assumptions that oh you're surrounded by people you can't be lonely and they're in a nursing home yeah yeah they're in a nursing home or all sorts of places yep I'm intrigued by one of the chats that's come up here with people saying that a really important part of establishing a relationship with a client is naming their emotions and recognising them for what they are and helping them and maybe by naming loneliness for what it is where we're helping people so that's obviously got to be something to be judged by the health professional Yes I think that's absolutely the case it's not a one size fits all the way where we kind of deal with loneliness with each person because the predictors of loneliness are also different for each person but the awareness and whether they are open to actually being lonely whereas there are other people who just go no I'm not it's just this immediate reaction of just a pushback which I've seen as well and in fact when I do actually measure their loneliness they're actually the most lonely in a group setting you know just amazing how they just reject the idea that they are lonely so it really depends on the person and you knowing your client and you actually building or having that rapport to have that conversation Yep I must say that working the last couple of months in the Alice Springs detention centre and also in remote communities around the Northern Territory there are a lot of people crammed together and the detention centre it's a really lonely place for a lot of people whereas the remote communities which on the map look lonely can be just wonderfully sustaining communities so I guess we can't make assumptions about people's experience until we actually ask them what's going on which comes to a question that was asked before about for Jonathan really I guess as a GP one of the great joys of the job is the longitudinal connection with people and also being part of a supportive network of referral options the shift towards large general practices and transient doctors and sort of patients who shop around a little bit is this a challenge to the relationship that can help detect and assist people with loneliness in general practice? It is a challenge like I related as when I had my hair cut and I found out that my hairdresser was pregnant and I knew that for a big chunk of the time I wouldn't be able to get my hair cut by her and a lot of people when they know that you are from a big city they can be quite suspicious, they're polite but quite suspicious they really want a genuine doctor like an old school doctor that really cares for them that is there for the long haul and that they don't have to rehash that story over and over again because for them seeing another doctor can be quite a difficult and sometimes a very disempowering experience for them. You have touched on one of the great similarities and professions between hairdressing and general practice the parallels are enormous in terms of that relationship and the trust that is viewed in the two so thank you for drawing attention to that. I thought I was the only one that had picked that connection. Other points of conversation I'll just see what other questions have come in. Social media is a big one and I have heard of Instagram Jonathan has already mentioned that the impossible models and role models that have put forward on that but on the surface you'd think that social media was the logical solution to loneliness that Jess must be able to connect from her rural location. What the panel think about our reliance on social media and does that help or hinder our approach to loneliness? I think it's about the way social media is used. Is it used to initiate new relationships or is it used to maintain existing ones that you've got face to face and I think with the later is actually a lot more helpful. So it's not about social media per se but how do we use social media in addition to that we don't actually know whether social media actually predict more loneliness. We don't actually have that data at the moment and we are trying to get that data but I think it's very easy to blame social media but you know the truth of the matter is that these products out there are used to attract users for fun purposes not necessarily always for meaningful, strong connections they are really favouring very brief type of relationships and less of the meaningful stuff. So it's still really hard we don't have that data to actually tell them that that's the case. I wouldn't mind in terms of my experience it comes from my own children actually who have both kind of grown up in this digital age and with something very important that one of my children said to me that I thought was really interesting was that a lot of the problems that people have on social media are the same problems that they have outside of social media. So people who might be particularly sensitive to things that other people are saying who might be very worried about their appearance, those kinds of things. It's often not just generated by their experience on social media and I think that's an interesting perspective on the idea that sometimes we can conflate social media as being the kind of problem whereas it might be what's telling us about a problem. Sure and I'm just going to say a few words about youth suicide for people. I must say that it's something that still stays with me, a greeting father at a friend's funeral saying that please don't look for your friendships on social media. That was something that really had stayed with him after his daughter's suicide. Maybe it was blaming the messenger but as was said the algorithms do seem to be set for popularity rather than through the connection between people. I think we do also have responsibilities to educate children in terms of how we do relate to people and how do we build those meaningful relationships where you don't have those social structures around you. For example we see that a lot of young people experience high levels of social anxiety upon exiting university because they don't have that structure anymore of education what they were used to and then actually needing to seek help. They don't actually deal with it until they come out of university or vocational training and realize there are no more strong social structures around me. We need to be teaching young people how to develop healthy relationships, how to initiate and maintain those relationships in school because once at least the education system is a lot more difficult. We definitely see that amongst the medical students who have a very intense medical school experience and then enter the workforce, the health scenarios, it's really quite challenging. Can I ask a question for Michelle in particular that whether loneliness is something that we can feasibly address only with psychosocial or medical interventions and you know there are other approaches. Look I think speaking from a psychologist's point of view I would say no, I think it's everyone's responsibility whether you're in the mental health field or not. I think it's really important for community approaches as well that we can use the strength of the community to help us. When I think about loneliness I can think about targeting I guess we're kind of approaching our problems. Our case studies here today are at an individual level. Can we target the relationships of the people that they have around them? Do we target it via their community? Or do we actually even think about kind of larger structures like societal interventions? What's the messaging around adopting good relationships and maintaining good friendships throughout your life. There's so many I guess tears that we can kind of think about addressing loneliness. There's probably a consequence of multiple factors. We can't just limit ourselves thinking about this is the only way that we can combat loneliness because there's probably multiple factors that drive it. Absolutely. We had a conversation with Jonathan earlier about this issue of being a little bit candid about ourselves and I don't know that we've really nailed this one. People are asking online about whether it's appropriate for us to disclose not only a little bit about ourselves but about our own loneliness. Is that a way of destigmatising loneliness by saying to our clients that I've been lonely too or is that making it all about us and an inappropriate self-disclosure. What do people think? How much should we give ourselves a personal experience of loneliness? I'm just sort of referring to my slides I think in point three of the GC practice tips was don't be afraid of showing the authentic you just want to make sure I clarify that that's really advice that you give to the patient to encourage them to be authentic but at the same time as a practitioner I think that we do want to not do any more harm and sometimes disclosure there'll be times that might be harmful if it's disclosed at the wrong time but I wanted to bring it to Michelle and Lisa to get their opinion on that. What do you think about being authentic? Well I just think being authentic is the key thing but I think we have to be very careful about the kinds of assumptions that we might make and the great differences that can be happening in terms of the inequalities that people face. Us as relatively privileged middle class people our experience of loneliness can be actually quite different to some of the people that we work with who have such a profound experience that it's very hard for us to truly relate to. So I think I've come unstuck around that kind of stuff myself in the past so we have to be really careful. Whereas on the other hand we've talked a lot about the idea that we're an opportunity for people to have a conversation about what can be a really difficult thing to talk about and I think some self disclosure in the context of building that conversation and enabling that conversation is really important to do. So I suppose it's about our own reflection on the appropriateness of what we're doing now and even asking the person, how did it feel for you when I talked about my stuff? Was that useful or not so useful? Yeah and I mean really it's not just idle chat, that conversation contains an awful lot of training and expertise in judging how to communicate. It's a therapeutic exchange. I'm always taken by the statement that we have to be therapeutically continent in an interaction and that we're not going to let any of our stuff out but I guess it's a finely judged balance and event and what have I done for you is clearly the question we should be asking. I mean I think the other thing about that is that sometimes it is hard for us to have what we might consider be difficult conversations and talking about intimacy for example. I think these are sometimes for us to talk about have you got any friends and all those kind of things but actually talking about people's experience of not having touch, not having anyone to be intimate with. That can be a much harder conversation but that might actually be getting to what's really happening for someone in relation to their own minutes. Again it's about building trust and being able to have those kind of conversations. Absolutely. Alright well thank you for that Q&A session. I found that really helpful for myself I must say in my own practice. I think now we should hear from each participant, each panel member just a couple of minutes summing up what they see as being the key issues or the key things that have come out from tonight's discussion. So maybe if we start with you Michelle what would you say in a couple of minutes has been the key things that you wanted to get across tonight? I'm probably going to speak from Lisa's point as to actually it's a normal signal for us to connect with someone and ignoring loneliness actually then leads to more problems like more severe mental health problems. So I think what's really important is that we educate ourselves and as well people around us that feeling lonely is not about being a loser or fragility is actually similar to hunger and says you've got to feed that social self and if you don't feed that then actually as much was for your mental health but also we know probably for your physical health as well. Okay so we've got social determinants from Lisa we've got sort of Maslow's hierarchy from you Michelle. We're really getting down to the basics of being human here and that's what I've heard from you is about part of the therapeutic response as well is becoming human in our treatment. Jonathan I guess you're next. What are your thoughts about the main things that you wanted to bring out from today? Yeah just building on that whole humanity thing I think as humans we crave relationships but I think making a safe space as a clinician having a safe environment knowing that it's a longitudinal relationship you don't have to actually squeeze it out are you lonely but allow that person to be part of that journey whether it's just a chapter of their life story or you know it's just we just want to be part of that process. Great wonderful thank you very much. What about you Lisa what are your thoughts about the key messages from this evening? I mean I think there's three things for me. One is that we're at the forefront of de-stigmatising low-minute so I think if us having conversations and enabling those conversations as part of de-stigmatising I think that I really like to always go back to that idea of treating people as though they're experts in their own lives and helping them to find the language for what's going on is really important and then finally I think we shouldn't undervalue the importance of informal support and practical support for people around low-minutes. We're only a very small part of the resources that somebody might have available to them and we really need to be able to do that mapping and also take a non-judgmental stance in relation to those informal supports and try to be someone who's actually about helping the person we're working with to build stuff rather than deconstruct it. Okay so the formal and informal supports are really important just we've got a couple of minutes so I'm just curious again back to Jonathan before we wrap up where you sit in your practice what are the networks because that's one of our learning objectives for this evening is what might be in people's environments as a network of support interprofessional network of support. When you think about a patient who's lonely what's open to you professionally as formal supports or informal? Yeah so I sort of want to talk about this on two levels one as a clinician I think as a GP especially a regional GP it can be quite a learning experience or you have the impression that you have to do it all but being able to partner with allied health psychologists, social workers particularly in a multidisciplinary way can actually really help you to be a good clinician but at the same time being able to model that not just to your colleagues but to the patient as well it can when they actually see that hey these people are actually working together what's that all about and it can actually help them kind of like start to think oh right so maybe I shouldn't be on my phone at the waiting room maybe I should say good day to someone Oh exactly and I mean it's clear that what you've just touched on there is even as professionals we can be very lonely in our practice a very busy hospital can be a lonely place to work a private practice can be very isolating when you close the door if it's just you and the patient or you on your own it can be something that we need to be mindful of our own well-being in those sorts of environments as well okay so thank you all very much any final comment from panelists before we wrap up for the evening? I often kind of say to people that if you're not learning now you may be later so I think it's really important that we are very sympathetic to people who are lonely and that they're not a burden to our society because sometimes the way people treat lonely people is that oh my god you know you're going to take up a lot of my time but really five minutes chatting to your elderly neighbour isn't going to hurt you so I think it's really important that we do our little part as well. Sure so prevention is obviously important and also this concept of anticipating loneliness is that if a life events occurred to somebody they may become lonely so why not intervene appropriately socially before it becomes something that should come to the attention of a health professional. Absolutely lovely all right well I love finishing with everybody nodding at the same time again we're heading into election season there'll be a lot of that going on nodding in the background so let's now just talk about what's coming up I need to remind everybody that the next survey so please complete that it's really important with so many participants involved to get a sense of whether the webinars met your learning needs whether we met the objectives that were set for us I want to mention to you the next webinar that's coming up which is an interesting one on Tuesday 16th of April a couple of weeks away looking at emerging minds, complex needs and parents who are dealing with children with complex needs and supporting them so that's an important one and also an interesting thing is that MHPN is having an inaugural online conference which is held from Tuesday the 21st of May to Thursday the 6th of June I've got no idea what that actually involves technically tonight's been complex enough for me but there are three content streams mental health and the military experience and there's been some conversation on the chat board tonight about the experience of people either while they're in the military or after they're demobbed what it feels like to suddenly be without that very structured very challenging environment. Grief and loss and again that came up tonight as the predictors of loneliness arising from a sense of grief and loss and finally trauma and that's going to be a focus of the online conference but there's also been a fair bit of conversation on the chat group about the likelihood of trauma leaving people feeling lonely afterwards and contributing to that. There is a link available to you in the resources to register for the conference so we certainly hope you do. Just to talk about the opportunities to engage with your local practitioner network please do through MHPN there are various opportunities to do that through the website and also through the research survey that you are all completing right now I'm sure while I ramble on but if you are interested in joining the networks I can certainly recommend it from a practitioner's point of view and also their quack of fun getting together with colleagues who are like minded so please go to the website and do that. As always when we complete these webinars so we need to acknowledge that while the role of a practitioner is central to the health care of people with loneliness and other mental illnesses or affective disorders or emotional issues we've got to acknowledge the consumers, patients and also the people who care for them who lived with mental illness in the past and continue to do so but thank you very much to the panel in particular but also to all the people who have been so active online with the chat it's been a very vibrant conversation going on off to the side while I'm sure there's been great attention paid to what the panel has been saying so thank you to Jonathan enjoy your time there in Wagga to you Lisa thank you very much for joining us tonight and for your work in the area and also to you Michelle at Swinburne with your academic leadership for both of you really in this area it's great to know that the work's being done so that what we do as clinicians is underpinned by research so we're finishing it's a pleasure we're finishing a minute early which hopefully I won't be criticised for thank you all very much to everybody good night don't forget your feedback surveys and we hope you'll join the panel for the webinar on Tuesday the 14th good night everybody