Loneliness, psychosis and tackling stigma through connection
For Loneliness Awareness Week, we are exploring innovative research being led by Consultant Psychiatrist at South London and Maudsley NHS Trust, Dr Mariana Pinto da Costa. Mariana has recently been awarded an NIHR Advanced Fellowship to investigate innovative ways to reduce loneliness among people with psychosis.
Loneliness Awareness Week is a time to reflect on the power of connection and the urgent need to address the growing loneliness epidemic - especially among those most at risk, including people living with psychosis.
Mariana's work is not only timely but crucial, as it addresses a growing public health concern recognised by organisations such as the World Health Organisation and the UK government. Loneliness has been recognised as a serious public health concern - one that impacts mental and physical health across the population.
The link between psychosis and loneliness
People with psychosis can face unique challenges in connecting with others. As Mariana explains, “People with psychosis can present with negative symptoms which impair their motivation in initiating and engaging in social contacts”.
In addition to these difficulties, they are often affected by widespread stigma, with research over the past 30 years showing that negative attitudes have worsened. “People with psychosis are often misunderstood or misrepresented in media and public narratives,” says Mariana. “Stigma and lack of awareness make it even harder for individuals to connect with others”.
She explains that due to this stigma, “people with psychosis are twice more socially isolated and lonely than the general population, which is linked with greater and more severe psychotic experiences and affects their recovery”. This contributes to a cycle of isolation and misunderstanding, often leading to poorer outcomes.
Loneliness vs social isolation – why the distinction matters
Loneliness and social isolation are often used interchangeably, but Mariana stresses the importance of distinguishing between the two. She explains, “Loneliness is a subjective feeling where the quality of connections matters. It’s the feeling of a gap or mismatch between the social connections we want and those we actually have.” On the other hand, “Social isolation is an objective state - it is the lack of social contacts”, measured by the number or frequency of relationships. “You can feel lonely even when surrounded by others if you lack meaningful connections,” she adds.
Mariana emphasises the importance of this distinction for clinical understanding, policy decisions and developing appropriate interventions. “Decision makers need to know which problem they are addressing - for example, building more community centres may tackle social isolation, whilst interventions that help build meaningful relationships, they address loneliness”.
Volunteering: a promising solution for loneliness in psychosis?
Volunteering is emerging as a potential intervention to reduce loneliness among people with psychosis - an approach now supported by NICE guidelines, which recognise social connection as a vital component of care.
Dr Mariana Pinto da Costa will be leading a study exploring whether remote volunteering, delivered via smartphones through texts, videos, or phone calls, can help reduce loneliness. In the study, patients are paired with volunteers for 12 weeks, and researchers assess the impact before, during, and after the intervention. Volunteering offers a unique opportunity for meaningful social contact,” she explains. “It doesn’t just benefit the person receiving support - it can also shift attitudes and reduce stigma for volunteers who connect with people experiencing mental illness”. This remote model is especially promising for individuals facing practical barriers like travel difficulties, mobility-related disabilities or rural isolation, while also opening up space for mutual understanding and connection - an essential step in challenging stigma and supporting recovery.
Some of the potentials of Mariana's proposed intervention
Towards a more connected and compassionate future
This Loneliness Awareness Week, Dr Mariana Pinto da Costa’s research serves as a powerful reminder that loneliness - while especially complex for people living with psychosis - is not inevitable. Through a deeper understanding of the distinction between loneliness and social isolation, a commitment to reducing stigma, and the exploration of innovative solutions like remote volunteering, her work offers both hope and direction.
Mariana is currently coordinating which NHS Trusts across the country will participate in this trial. The study is also supporting the recruitment of volunteers, helping to strengthen NHS volunteering services across participating sites. Crucially, it will contribute to building the evidence base for remote volunteering as a scalable intervention - one with the potential to reduce loneliness, improve social connectedness among people with psychosis, and enhance patient outcomes, a key priority for mental health services.
As society grows more aware of the importance of social connection, South London and Maudsley is proud to stand at the forefront of innovative mental health research, with projects like Dr Mariana's offering not only promise but practical, research-driven responses to the complex challenges of loneliness among people with psychosis. By addressing stigma and rebuilding meaningful connections, Mariana’s work points to a more inclusive and compassionate future for people living with psychosis.
We are proud to be a national leader in transforming mental health care through research, innovation and collaboration, driving forward pioneering mental health research that makes a real difference. To find out more about our work, visit: slam.nhs.uk/our-research
If you are interested in learning more about this study, please contact Dr Mariana Pinto da Costa at mariana.pintodacosta@kcl.ac.uk
If you would like to support studies that advance our understanding of mental health, find out how you can take part in research at South London and Maudsley: slam.nhs.uk/take-part-in-research
