‘I hid it very well’

So I really felt for a long time that people should talk about this more because as I learned more about loneliness, I learned that it didn't mean something was wrong with me, it was just really human, and it just actually was a warning sign to me to say, or an alert to say, Hey, the relationship quality that you want,

you are not getting and therefore you're feeling lonely. So once I realised and learned more about this and learned about the impacts that long-term loneliness can have on health, I thought actually I'd like to do something. I wish there was something available for me at the time that could have demystified a lot of things and helped give an explanation and context so I would've been supported to make my way through loneliness and then out of loneliness with the right support.

So really that it came from my own experiences of loneliness and also realising that pharmacists see patients struggling with loneliness all of the time. And I think often we know that, but we don't necessarily do anything about it. We are not comfortable. We feel like it's outside of our scope. We feel like it might open Pandora's box and be too much,

and we wouldn't know what to do with it. So I thought, well, actually there's a lot that we can do that doesn't take much time, doesn't cost much, but could be deeply transformational for our patients, shifting them away from, or again, helping them through their loneliness experience. So that was really the drive.

contribute to someone feeling lonely. But before I touch on some of them, I just want to remind us all that being lonely or experiencing loneliness is a human experience that at some point we will all have. So loneliness is not a mental illness. It's really important to distinguish here. Loneliness can increase your chances of experiencing depression or anxiety, and if you were depressed and anxious, perhaps you might feel more lonely, but it is not a mental illness, it is really human,

right? So when I give you these numbers, it might be surprising on the one hand, and on the other hand, well, we're humans who transition through lots of things in life, and there are times that we would be at increased risk of loneliness. So let me talk about a couple of those things. So things like triggers. So for example, if you've had someone bereaved, if you have moved out of home to go and study at university. So all these lifestyle or influencing factors can

increases your chance of feeling lonely. But as pharmacists, we also see patients at high risk because of perhaps more demographics or other influencing factors such as socioeconomic status, or if you've come and you're a migrant or you don't speak English and you're in an area that's just English speaking, there's information showing patients on opioid replacement therapy programmes,

they're at high risk of loneliness. New moms, all the new moms that come into the pharmacy, there's a life transition there where suddenly they are having a different identity or an identity crisis and they're not necessarily surrounded by people. And a really interesting and important point here also is that loneliness doesn't just affect the elderly population.

So contrary to what might feel like an obvious sum being elderly and therefore feeling lonely in Australia, in fact the population most at risk of loneliness currently are the 18 to 25 year olds. So let's all just let that sink in for a moment because when you're in that peak time of feeling like you imagine, life is great, to imagine that there are so many people feeling lonely is profoundly disturbing. And I think you touched on it before, we've got a different landscape.

The kids are engaging with technology all of the time. Now, technology per se doesn't necessarily cause loneliness. It's how it's being used. So think of all the places where we used to hang out, go to the movies and you might see someone have popcorn, and now you sit at home and watch Netflix. You used to go to, as a mom, perhaps the library for library time to collect some books, and now you might listen to audio. There's meetings of the team and Zoom.

So all of our interactions either being replaced with or being impacted by technology. So for young adults who are using, not even going to university, I mean there's a lot of courses that are still online. So there's a limit in the amount of actual time that you can have for opportunities for social connection, but also social skill development is being impacted. Covid is a contributing factor also.

So the next phase at the moment, people term, this era, the last 10 years or so have been a race for attention. So you've got all this social media and all the marketing, and we're really in a battlefield of trying to get your attention. What they're talking about with AI and AI bots and agencies is really a race to grab your intimacy and they call it the weaponization of loneliness.

So if you've got someone who's feeling vulnerable due to feeling isolated and or lonely, then if you offer them some shiny new object that's there all the time and really feels like it's understanding you and knows you well, and they're not showing any of the nuances of what it is to be a human, they're not disappointing you. They're not letting you down. They're not confrontational. They're available 24 hours a day. Then there's something alluring about that if you're feeling vulnerable.

And the challenge with that is you can't replace the nuances of what it is to have face-to-face human connection. We are wired as human beings for human connection in real life, human connection. Now technology, if you're in a remote area and you can't access in, it can be useful to connect people, elderly people into generational connections. It can facilitate. But if we get into the path of it replacing human interaction, then there's real concern about the future of humanity actually in that

space, which I've gone a bit deep there. We've gone all into ai. But.

and it's just creating more and more division and separation. So there's so many social aspects as well causing it. So I guess I would say with all of this going on in the environment, I guess it makes sense that a lot more people are impacted by loneliness. What are your thoughts?

nature of loneliness. And the challenge also with loneliness, we've touched on it before, is if we are not talking about it, if we're health professionals, for example, not discussing it, then we are not empowering our patients and other people, other humans to realise, oh, this is just a sign to me that my social relationships are not where I want them to be, and I'm not nurturing that. So what can I do?

We are leaving it in the space of shame and stigma where people internalise the experience of loneliness to feel like something's wrong with them, to feel like they're not worthy of love or connection to feel like they can't reach out long-term. Loneliness has maladaptive cognition affects meaning that people start to feel like even though you need connection as the remedy, you start to withdraw more socially because you feel judged because you feel like people don't get you, you are not worthy.

And so it's kind of counterintuitive. You actually step further and further away from people rather than being open to the connection that you need to start to shift you through that experience. So I think to answer your question, I think there's a lot of work to be done because we are not even talking about it.

The US surgeon general in the US put out an advisory on how America should address this, and part of a statement that he talks about, which I really think gives context, is that we need to be approaching loneliness the same way we have been approaching other public health issues like obesity, smoking, and tobacco, and even over there they talk about the opioid crisis. That is the degree of impact that loneliness can have on help. They're on par.

And if we can understand that as health professionals, which is why I created the evidence-based training programme, if you really comprehend the impact that this has, then I feel like it's a professional responsibility that we start to do something about that. So yes, I agree with your sentiment.

So loneliness is a subjective experience that if I feel lonely than I am lonely. Whereas social isolation is a number. So for example, if you see someone living alone, they're isolated or they don't have many interactions or no interactions, then they would be classified as isolated because that's objective, that's a number. Whereas you can be in a room full of people. I mean, I'm sure we've all experienced this and still feel lonely.

So coming back to your question, you can be introverted or extroverted and still feel lonely. It just depends on the person. So there's no prescriptive number of how many or how much contact you need to as a protective factor against isolation or loneliness or loneliness specifically. Sorry, there's no specific number. It's just what your individual needs are, your individual social needs. So an important part of working through loneliness is identifying or what do I need?

Am I someone who likes to engage with a couple of people or do I like being crowded? What is nourishing for me? And then make sure that you can craft that. And if you don't know, well, that's part of this beautiful journey that loneliness can offer is that ask you acknowledge this is feeling like I'm lonely, giving people the language to acknowledge it, and then really assessing what makes me feel good, what environments make me feel good, what kind of people, what kind of conversations,

and then go forth and create that landscape for yourself. So it's not a simple answer other than to say everybody's individual, their needs for social connection are very different. Everyone can experience loneliness. But if you go through the process of learning about yourself, knowing what makes you feel connected, and if partly this is about connection to yourself, am I being authentic as a person in the world? And if I'm being authentic, then what kind of people share those same values?

And then when you engage with them, that's more likely to be meaningful connection. And then you determine whether you need a little dose of that or a lot of dose of that, a larger dose of that you get to determine based on when your cup feels full in its simplest terminology.

So internally, what happens when you're feeling lonely, really at the core you feel like there's something wrong with you? What is wrong with me that people that I'm not connecting in with other humans, and it's so visceral. So just at the core of what it is to be a human to connect, that if you are not connected, it feels like something is wrong with you, you're not looking at other people blaming them, you're feeling like, what am I deficit in? What is not good enough about me?

And then what happens is you start to, as I mentioned, kind of withdraw further. So I think the stigma and the shame stops people admitting that they're lonely and therefore stops 'em getting the help they need to move through it. So it's a real deterrent to addressing loneliness at a high level in the last six months in Australia and globally. But in Australia, there's been a shift. You'll see A, B, C doing reports or radio interviews on people who are lonely. So there's some help.

There's some shift going on where people are starting to talk about it. And I have people tell me that they're lonely. When I experienced loneliness, I couldn't say the word. I remember I was telling a friend about this idea of a programme that I was going to create to help address this. And when I mentioned the word loneliness and she's one of my best friends, I whispered the word. It wasn't on purpose.

I just couldn't say I couldn't relate myself to that experience of loneliness because it's very painful. There are MRI studies that have been done that look at pathways in the brain and the pathways in the brain that are activated during physical pain are similarly activated when you experience loneliness. So it's physically a painful experience. So the shame and the stigma,

it's very alive in the experience. I found it, as I said, hard to say the word when I was going through it, and I feel like that, and we can perhaps get to this in a moment, part of the role of the pharmacist is to help de-stigmatize loneliness, help to normalise it so we can just talk about it. Because again, reiterating what I've said a few times, it's really human. It's really human for us to desire and crave meaningful connection and to feel seen and be heard and valued as a human being.

development. They didn't call it that. They called it funtime lunchtime, where people who were having more challenging experiences connecting in the school ground, which can be such a confronting place, they scaffold and help children learn the skills to manage negotiation and conflict and joining play. And if they're not interested in the programme, how to leave that kind of play and enter another group.

So I think ideally this starts at an early age. I mean, I think it scores something that's very much alive in my mind now is neurodiversity and difference in ways of learning and difference in ways of being. And I'll talk about the school playground, the school environment. It is really challenging heartbreakingly challenging for kids who learn differently to be in a school system who only kind of see a particular way.

And I think what's hard is unless we have support for the children to learn all children, those who are neurotypical and those who are neurodivergent to help each other bridge the gap of how to connect, then that's setting up kids for a really a lifetime of challenge in their social space. And everybody craves connection. We might need different amounts and it also might look different.

There are children perhaps or adults who don't enjoy eye contact as much as their form of communication, but they may play side by side that is just as valid, but we all need to understand that so we can respect different ways of play and different ways that connection looks. Again, coming back to your question, which is now kind of past my mind, can you just rejig my mind?

These are things that don't necessarily naturally come and also depends on what you've been exposed to in your household and how you've learned to engage. So social skill development is one core component. There are a couple of other components. It's also opportunities for social engagement. So if children aren't invited to parties, for example, if you're not being included, you don't have those opportunities. And also needing to take into account what makes someone comfortable to engage

in a social opportunity. So if someone doesn't like large crowds, and I'm going on this particular stream, it's riping my mind at the moment, but if it's very noisy or too loud when we're not giving the right opportunities for individuals to engage or to find the like-minded individuals where they feel comfortable to connect. So there's social skill development, there's opportunities again where pharmacy can play a role. Many pharmacies have health events or health

initiatives in the pharmacy. Sometimes they have educational events. These are opportunities where people can come along in an environment where they trust and they feel safe that they can come and be themselves and perhaps mingle with other people. And then there's also other things like we talked about skills and opportunities, and then some of the cognition. So as I mentioned, the brain changes over time.

If you've been chronically lonely and you might need things like CBT or some other interventions or positive reframing of your mindset to realise you're not being judged the way you think you are or you are worthy of being in certain environments. So there's a spectrum of things. At the moment, they do not have the best evidence-based approach.

That's how new this space is. In terms of research, they definitely think cognitive behavioural therapy or some of that cognitive behavioural therapy is most evidence-based, but that's for people who are chronically lonely. And then all the other initiatives are kind of being evaluated at present, not only at an Australian level, but at a world health organisation level where they have what they call, I think it's got heat maps or their maps, evidence maps, evidence gap maps.

So there's maps of a whole range of interventions, everything from companion robot pets through to social skill programmes individually or in groups. And they've kind of ranked how much evidence is currently available for the different interventions. But this is new space. And if I was to say one thing, I'd say as pharmacists, we should do something rather than nothing. And what we're doing is got little to no risk at all.

Just acknowledging that your patients are lonely goes a long way to letting someone kind of drop and feel seen. So even though I'm sharing that we don't exactly know the best evidence approach at the moment, that's not to say we shouldn't do anything. We absolutely have a role to play in helping to raise awareness and de-stigmatize and normalise and provide opportunities or encourage opportunities for social connection.

strengthen community connections. So at a very simple level, rather than prescribing a medication for someone, if you find somebody has non-medical health related social needs that we are prescribing something that is non-medical by connecting them to something in a social activity or a social service in your local area. So for example, it might be volunteering, it might be going to play bowls, it might be what's the new one? Pickle club or Pickle Pickle, pickle Ball. Pickle Ball.

But the important thing here, and I'll highlight the word, is co-producing. So this isn't a pharmacist or a GP or a trusted individual saying, Hey, let me prescribe for you to go to tennis. It's actually sitting down with a person to hear them, to actively listen to them, to understand what is meaningful to them and what would make their life great. And then helping to co-design and bridge the gap between that desire that they have and what's available in the local community.

It's comprehensive, and it's got interviews with global experts, including the World Health Organisation and other people, including pharmacists who are on the ground already doing this kind of work. So I'm going to give you a top level view of what's covered in there in terms of what the pharmacist can do. But in terms of taking a deep dive into the practicals and the health impacts, it might be worth having a look at. You can find it for PSA members, it's free.

And for other people there's a cost. But so at a high level, what pharmacists can do at a patient level is talk about loneliness, as we've mentioned, is when you identify someone, if you see someone, don't avoid the subject. What you learn in the training programme is how to talk about loneliness.

Some people might not use the word loneliness because of the stigma and shame, but you could still through conversation if speaking to someone, you could pick up if someone's not connecting with anyone and they're feeling like they have to deal with all the challenges themselves. So number one is that we can talk about loneliness. We can also increase awareness of the impacts of loneliness on health. So as pharmacists,

we give advice on healthy eating and exercise as part of holistic care. I mean, you wouldn't dispense a medication for a patient who's a diabetic and not think about the food if you know that they're coming in and eating McDonald's.

I just feel like you'd make a point because as a pharmacist, you're trusted, you know them well, you have a relationship, and you would feel an obligation, a sense of professional responsibility to just let them know in the appropriate manner to think about their food or their food choices because of the impacts it

has. And in the same way, there's a new kind of fancy term coming out, social health, same thing when you're speaking to someone, when you're advising them, when you're seeing someone in pain perhaps because of loneliness, and you need to find out through conversation. You I think have a professional responsibility to educate them, to let them know that they deserve connection and it's important for their health because loneliness can impact physical, mental, and cognitive health.

And if they know that social connection is protective, they know that, then they can go forward and do something about it. So I think we can talk about loneliness at a patient level, increase awareness of the health impacts of loneliness, but also the protective factor involved in connection. And then you could also, what you've mentioned, talk about social prescribing.

So if you know of a patient and they always talk to you about, actually, I'm going to share a story to give the perfect example I just saw on LinkedIn, a pharmacist shared a story saying that she had a particular customer who was always resistant to chatting, very closed off, and each time she tried a little bit more just to get him to open up. And one day she started to talk about fishing, and she said he totally softened and he opened and they started

to over the subsequent interactions, talk about stories, fishing stories, and she said all it needed was her hearing and understanding about him and then being patient and slowly increasing the focus on that part of the conversation. And so that was a relationship now that shifted that experience. The patient was no longer grumpy when he came in. Every time he'd softened and he would come in for that connection.

So if for example, that patient loves fishing, or as part of your job, you could look what's in your area, you could do a quick Google search if you're more savvy at that than your patient, if you know there's a fishing club for that age group and it's safe and appropriate for that gentleman, then you could suggest or you could share with him a flyer or call the organisation on his behalf or just give him the steps to take to join

that club if there's such a thing that exists. So when we talk about referring people or connecting people in a social prescribing framework, part of it could be that connecting them to something local or there are lots of social prescribing programmes that are being run out of primary health networks around Australia, and you need to go looking for them. And if you find them, then you can refer patients into this programme because these programmes have

what's called link workers. Now. Link worker is a new term, and it's kind of a new stream of occupation where the sole job of a link worker is to facilitate the connection for someone between what is meaningful to them and what is available. So that patient might need someone to hand hold their hand for their first encounter or the second, and that's what they're willing to do. Or the link worker might just call up and make the appointment for them or enrol

them in a programme, and that might be sufficient. So again, tying it back to what the pharmacist can do, talk about loneliness, increase awareness, know what social prescribing is, look for programmes that are available in your area,

specific social prescribing programmes. Reach out, introduce yourself, look at what's available in your community and have those things available that if you meet somebody, you can share what's available as a bridge between the healthcare sector and the community care sector. And I'll give two more concepts of what I think people could think about is sharing resources with patients. Flies like a CMI, but a social version, what is loneliness? There is a self-care card available.

And then also into the future, there are validated screening tools for loneliness. So in medication reviews or home medication reviews, in addition to asking about the lifestyle components, you could ask either a single item measure question or a four item measure question around someone's experience of loneliness. Some of the measures use the word loneliness, and some of them don't indirect.

But there are ways that we into the future could start to capture this data as part of holistic profile of that patient and holistic care. So yeah, these are some of a sprinkle of ideas of practically. Again, I don't want people to be intimidated. I want people just to start by acknowledging that yes, I see loneliness in many of my patients that it's really human. It's okay, learn how to talk about it so patients feel safe to open up and you as a

pharmacist feel safe. I mean, pharmacists feel lonely within the health profession. There's lots of loneliness as there are with gps also. So it's important to be able to be vulnerable yourself and share your stories with patients. So yeah, I had a bit of an average day and I felt quite lonely on the weekend. And if you are comfortable doing that, it's unbelievable what can come as a result of that honesty and the vulnerability and the connections that result there.

I'm not at all proposing in terms of social prescribing that we should be doing this stuff for free. A lot of us do it anyway as pharmacists. So I think the bigger picture is we will see some larger scale pilots involving pharmacy, so we can collect the data and then determine a roadmap and a pathway. But right now, I feel like if you've done the training and you feel like you're not sure where to start,

just start small. There are stories in the training programme of pharmacists who even have, for example, a couch instead of chairs in their pharmacy. And she said to me the other day, she did it because it feels more inviting rather than clinical, and it invites people to sit and to chat. And she had a customer who went home and sewed pillows for pillow for the couch that she has in the pharmacy.

There are other stories of pharmacists who write little scribble notes when there's medication deliveries to people. So when someone's not actually coming into the pharmacy, there's a lost opportunity, therefore connection of seeing someone, her little notes that kind of just say, have a nice day, a smiley face, and you send that. Now this pharmacist visited this patient. It was during Covid at the time, she was sharing the story, and this lady had collected in an envelope all of the little

scribble notes that the pharmacist had written. That's how meaningful they were, because sometimes the pharmacist is the only person that patient will see all week. So my call to action here is, let's think about the bigger picture. Let's increase workforce capacity by knowing about the issue and then start to do little things that don't take too much time, but the morale.

It will impact the morale in the pharmacy holistically. Other staff, it's a bit contagious, and there's a job satisfaction that is so deep within that. I'm going to share one more story because it's profound. There was a story about a patient who was in the hospital, and sorry, in an aged care facility, and they were trying to do de-prescribing for that patient.

That patient didn't want the medications taken off because at the nighttime, the nurse came around to hand the medications, and during that exchange, there was a physical touch. You can feel that. You can hear that we are lucky as pharmacists, we see people all of the time. They trust us, we know them. We have the opportunity to sprinkle magic,

a little bit of magic to change the trajectory of their day. So pharmacists, to walk away here realising, I'm not asking you to take on a whole nother programme. I'm not asking you to change everything. I'm just asking you to no longer ignore seeing patients who are lonely to recognise that just by giving them a couple of more minutes of attention that that could really change the day for that person Overseas, they have supermarkets now with queues that are intentional

for people who want to chat longer. So rather than just rush them out, people sit there and talk to people for longer. If you've got capacity in your pharmacy to give someone two extra minutes, you or pharmacy assistance, everybody. If you've got capacity, it goes a long way. So I guess that's my call to action is do something, not nothing. It doesn't have to take much time. It just takes, what does it take?

It just takes a decision. It just takes, yeah, it just takes a moment of recognising that it's not always about medication as a solution, that it's actually, we are providing connection. And I always go back to the whole term community pharmacy. Community pharmacy is a community within itself. It is. So I'm just saying let's lean into that a little bit more. Let's enhance our visibility about being the community aspect of the community pharmacy.

We as staff, as employees will turn up more, we'll show up more as ourselves. We'll bring more innovation, we'll bring more creativity, we'll bring more passion. We just need permission to do that. It's going to take leadership for someone to say, I value connection in this workplace and with the patients that we serve. So let's introduce that as a cultural shift. And I can hand on heart.

I feel pretty confident to say that that will have its own beautiful flow on effects to create a nicer workplace as well as profound transformation to humanity. Sounds very big, but I do believe that.

I think we can all continue to learn so much in just how we can develop ourselves to be better and better communicators, better at understanding ourselves and understanding others and better at supporting ourselves and others in the process as well. So I.

All the pharmacy interns who come into a workplace who are about that age, many international pharmacy students and interns who are living alone, working very hard, studying very hard, don't have the finances or time necessarily to socialise, and again, a different language, perhaps you as a preceptor, as a workplace could absolutely provide an environment that could nurture that individual's development within the workplace and without,

and I've even heard stories of pharmacy internships said their preceptors have gone out of the way to invite them to football clubs with them and explained what it was about, and that was totally transformative for that person individually and as a professional. So yes, we, you're right, the 18 to 25 year olds, actually, the pharmacy profession could do a lot to do to support that cohort who currently are showing that they're at the highest risk of loneliness. So thank you for that point.