We thank Dr El-Baalbaki and colleagues for their thoughtful comments on our recent paper. We agree with their cautious interpretation of the results of our meta-analysis.

We were interested in their suggestion that befriending serve as a comparator condition for more structured treatments such as collaborative care, to tease out the specific benefits of the latter over and above the general effects of increased attention and support, and to explore the cost-effectiveness of these complex organisational interventions. Although this makes good sense in design terms, it does, however, relegate befriending to the status of comparator rather than active intervention. The recent Mental Health Foundation report The Lonely Society? (www.mentalhealth.org.uk/campaigns/loneliness-and-mental-health/) highlights the impact of loneliness on health, and its findings are supported by the Royal College of Psychiatrists. ¹ We would therefore want to complement Dr El-Baalbaki and colleagues' suggestion with further research specifically exploring the role of befriending as a potential alternative therapeutic intervention for certain groups such as isolated older adults.