School-based social prescribing to address youth loneliness: a pilot randomised controlled trial

AimsYouth loneliness is associated with poorer mental health, educational disengagement, and adverse long-term health outcomes. While social prescribing shows promise in reducing loneliness in adults, access for young people remains limited as most pathways sit within primary care. Schools offer a near-universal point of contact and may provide a more accessible referral route. The INACT study aimed to pilot a school-based social prescribing pathway and assess its feasibility, acceptability, and preliminary signals of benefit for loneliness and related outcomes. MethodsPupils in Years 4, 5, 7 and 8 (ages 9 to 13; n=672) across 11 schools in London, Manchester, and Leeds were screened for loneliness. Those reporting elevated loneliness (n=140, 20.8%) were randomised to social prescribing or signposting. For follow-up, the social prescribing arm was capped at 41 pupils, and a matched subset of the signposting group (n=45) was followed longitudinally. Outcomes were collected at baseline, three-, and six-months. Feasibility indicators included recruitment, uptake, engagement, and retention. Acceptability and appropriateness were assessed using validated implementation measures and qualitative interviews with pupils and link workers. ResultsOne in five pupils reported elevated loneliness. In the social prescribing group, 83% initiated the pathway, attending a mean of 5.09 sessions, with most delivered in person. Implementation measures indicated high feasibility, acceptability, and appropriateness. Interviews highlighted the importance of relational support and personalised activity matching, although some younger pupils needed support completing questionnaires. Preliminary analyses showed reductions in loneliness at three-months in both groups, with somewhat greater reductions in the social prescribing arm. ConclusionSchool-based social prescribing appears feasible and acceptable, with early indications of benefit. Schools may offer scalable infrastructure for addressing youth loneliness beyond healthcare pathways. A fully powered multi-site trial with economic evaluation is now warranted to determine effectiveness and long-term value. Trial registrationClinicalTrials.gov: NCT06656663