It is a pleasure to serve under your chairmanship, Mrs Osborne. I pay tribute to the Backbench Business Committee for granting this three-hour debate. I know that the Committee had to negotiate with the Liaison Committee so that we could hold the debate during eating disorders awareness week. This debate is therefore timely as well as important. Others in the House clearly agree, as can be seen by the number of hon. Members present. I know how difficult it is to commit to this slot on a Thursday afternoon, particularly when serious issues such as violence against women are being debated in the main Chamber. I am conscious that several Members are trying to perform the parliamentary feat of being in two places at once.
Eating disorders have not been debated in the House since 2007, a considerable time ago, yet over the course of the past few weeks I have become aware of several hon. Members and members of staff with family connections to those with eating disorders. Just this afternoon, I received an e-mail from an hon. Member’s chief of staff, who told me the moving and difficult story of his wife’s experience with an eating disorder. I pay particular tribute to my hon. Friends the Members for Enfield, Southgate (Mr Burrowes), and for Wells (Tessa Munt), and Mrs Glindon, who applied with me for this debate and have significant knowledge of and interest in eating disorders.
Some 1.6 million people in this country have been or are currently known to be affected by eating disorders. That is a massive number, equivalent to nearly 2,500 in every parliamentary constituency. However, the number of unknown sufferers is also of significant concern. The true number of those who suffer is not fully understood due to the paucity of data relating to those who are not in the system. The Department of Health acknowledges that unreported cases of eating disorders are a huge problem, and the true figure could be higher than 4 million, which is 6.5% of the UK population, or about 7,000 people per constituency.
Those statistics are staggering. As someone relatively new to the issue, I was not aware that the numbers were quite so large. How many of those people are men, and are there data identifying the proportion of sufferers who are men of whatever age, and the proportion who are young men?
My hon. Friend raises an important point. It is thought—I emphasise “thought”—that about 11% of sufferers are male, but interestingly, they are among the fastest-increasing groups.
The figures that I have given do not take into account the families of those who suffer, meaning that the social footprint of eating disorders is breathtaking. Be assured—to refer back to my hon. Friend’s point—that sufferers are by no means all teenage girls. That is one of several myths about eating disorders that need to be exposed.
A constituent of mine, Cherie Hinchliffe, wrote to me saying how pleased she was that the hon. Lady was holding this debate. She wanted to say that eating disorders destroy families, and that GPs do not know enough about them. Doctors, dentists, local hospitals and schools do not know enough about them; the media know about them but report them in a terrible way. Does the hon. Lady agree?
The hon. Gentleman is absolutely bang on. Many parents of sufferers have commented to me that they feel their GPs do not understand enough, and nor do schools and colleges. I will cover all the points that he raised later.
The fastest increase in eating disorders has been among young men. As well as facing the mental health problems typically associated with female sufferers, they are coming under more pressure than ever before to conform to a stereotype of the body beautiful. Imagery in magazines and advertising plays a significant role.
Of particular concern is the prevalence of eating disorders among gay and bisexual men, who are twice as likely to be sufferers as heterosexual men. I understand that eating disorders in gay and bisexual men are even more linked to concerns about body image than in heterosexual male or female sufferers. Although males account for only 11% of the total of those with eating disorders, the percentage is increasing, and we should be conscious of that. In the 10 years up to 2011, the number of hospital admissions for men suffering from an eating disorder rose by 67%. Furthermore, there is evidence that undiagnosed disorders are even more commonplace among men than among women. The scale of the hidden problem could be immense.
It is not only the young who are afflicted, although there is certainly a trend towards eating disorders manifesting at an earlier age than ever before. I was particularly moved by my contact with a woman whose daughter started suffering from anorexia nervosa at 10 years old but was not diagnosed for years, as her GP and other medical practitioners thought that she was too young to have the condition. Eating disorders are also being diagnosed much later; some sufferers present in their 50s and 60s, and there is evidence that increasing numbers of sufferers manage their conditions not just over the average of seven years, but for decades. An increasing number of people in their 30s and 40s have lived with their eating disorder for more than 20 years.
“Eating disorder” is a term used to describe a wide variety of conditions, some well known and others far less so. Obviously, the best known and most recognisable is anorexia nervosa, in which a sufferer intentionally deprives themselves of food and has a body weight at least 15% below the recommended minimum. People
with anorexia have an extremely distorted view of their own body and a fear of gaining weight. However, anorexia is but one condition among several. Eating disorders also include bulimia, which in many cases is harder to detect, as sufferers may maintain a normal-looking weight. However, it is achieved through bingeing, purging and fasting, and like anorexia it can cause long-term damage.
From my research for this debate and my conversations with many sufferers of eating disorders, I have learned of many other conditions: binge eating; compulsive overeating; food neophobia, an extreme fear of trying new food; and compulsive over-exercising. A year ago, I met a young man who ran up to 30 miles every day. There is also selective eating: sufferers eat only an extremely limited range of foods.
Bulimia is a disorder linked closely to low self-esteem, emotional problems and stress. The sufferer may think constantly about calories, dieting and ways of getting rid of food that they have eaten. It is actually more common than anorexia, but it is more hidden, because people with bulimia usually maintain an average or just-above-average weight. Bulimia can go unnoticed for a long time while sufferers feel incredibly ill and unhappy.
Those with bulimia become involved in a cycle of eating large amounts of food and making themselves sick, cutting down or starving for a few days, or trying to find other ways to make up for the food that they have eaten. It can cause them to become so hungry that they eat large amounts of food because their bodies crave nourishment. Some people do not vomit, but instead take laxatives, which are especially dangerous. Just because bulimia does not cause the extreme weight loss of anorexia does not mean that it is less serious. Sufferers need help and support, as the side effects and consequences can be serious. I appreciate that I have given a very rapid description of some eating disorders, for which I apologise, but I am sure that other Members will wish to discuss some of them in more detail.
I do not wish to generalise, and I apologise if my next remark causes any offence, but in many instances, due to the extreme control with which sufferers approach their food consumption, eating disorders are a type of addiction. However, unlike addictions to alcohol or narcotics, a fixation with how one controls one’s calorie intake must be faced and addressed every day of a sufferer or recovered sufferer’s life. They cannot simply remove food from their lives in the way that others might develop strategies to avoid alcohol, for instance. They must eat to live. For sufferers, by necessity, that battle will occur three times a day for the rest of their lives.
Eating disorders are not trivial conditions. Anorexia kills about 20% of sufferers, and 40% never recover. It is the single biggest killer of all mental illnesses. It has been dismissed for too long as a problem of teenage girls who just need to get a grip on their eating patterns. That is far from the truth. Eating disorders are serious, potentially fatal, mental illnesses, which, even long after a sufferer has recovered, can have long-term implications for their health. The impact on fertility is well known, but there are many other serious implications. Abnormal heart rhythms are commonplace, even in teenagers with
eating disorders. In fact, heart damage is the most common cause of hospitalisation for those suffering from eating disorders, but the kidneys and liver are also badly affected, and reduction in bone density leading to osteoporosis can happen in sufferers, even before there has been any physical manifestation of a problem.
As chair of the all-party group on body image, I have been privileged to work with a number of leading charities supporting those suffering from eating disorders and their families. I pay particular tribute, during eating disorders awareness week, to Beat; many of its members are in the Public Gallery. I also pay tribute to Anorexia and Bulimia Care and the Succeed Foundation. I vividly recall hearing the moving stories of ABC members at a reception hosted by my hon. Friend the Member for Wells a few months ago. These charities all do fantastic work with sufferers and their families, and to ensure that the wider community—Members of Parliament, the medical profession, schools, colleges and universities—have a better understanding of the signs of eating disorders, and how to help those in the grip of such a disorder and those who may be at risk. They also work with the media to ensure that they understand the importance of the portrayal of responsible images on advertising and in editorials.
My hon. Friend is making a powerful, moving speech. These issues have been discussed and debated before, but there seems never to have been any progress in addressing the issues and tackling the problems. Why does she think no progress has been made in the past 10, 20 or 30 years? These things were known about, yet there seems to have been no move forward.
That is a difficult question. Later, I may even suggest that we are moving backwards. Unfortunately, these are hidden conditions that the media and others have chosen, occasionally, to trivialise. They are not trivial and they need much higher priority.
I congratulate my hon. Friend on securing this debate. On the subject of this being a hidden illness, in recent times mental health has risen up the agenda, and attention has been given to the topic in the House, which has shone a light on the issue of mental illness. Why, even in the field of mental illness, has this area in particular not received attention, when its mortality rates are the worst?
My hon. Friend makes an important point about the mortality rates, compared with those for other mental illnesses. In this place, we have made great strides in being far more open and willing to discuss mental illness. This illness is hidden, and has not received priority or generated the attention that it so desperately deserves. It is incumbent on all of us to ensure that the Minister, who I am sure is listening, gets that message loud and clear.
Whenever we approach a public health concern such as this, one of the biggest things we have to do is educate the public. The media are an important partner in that. Does my hon. Friend agree that the media’s obsession with the cult of celebrity, and the focus on that, is holding us back on a significant public health issue?
My hon. Friend is aware of the work that I do with the all-party group on body image. We have been sending that message to the media time and again. We need more realistic images in magazines and publications. Shortly, I will quote a 21-year-old sufferer from anorexia who made that point to me powerfully.
The causes of eating disorders are complicated and varied, and although there may be broad similarities, it is dangerous to suggest that any two individuals will have identical experiences or paths into illness or recovery. I know from talking to sufferers, experts, charities and families that genetics, low self-esteem, stressful life events such as death or divorce, academic pressure, and cultural and social pressures, can all contribute. For every sufferer there will be different triggers or different combinations of triggers. It would be naive to suggest that a single cause could be identified. However, an issue that brought me to this debate is the social pressure to conform to a stereotypical view of the ideal body image, so ably demonstrated to us in advertising and magazines.
Last November, I attended an event in this place organised by Anorexia and Bulimia Care, and was impressed by the moving account given by Katie Waters, a 21-year-old student, who told MPs:
“Six years ago the eating disorder well and truly look over. The stress of GCSEs in a high-achieving all-girls…school meant my weight dramatically plummeted and I…developed anorexia.
During this time I did everything—speech and drama exams, piano exams, I sang in the choir, I was in school plays, actively taking part in church activities and of course was buried under a mountain of homework. I constantly pressured myself to be perfect at absolutely everything.
But the trouble is, when it comes to weight and body size, the images I frequently saw in the media of apparent perfection were unattainable. We have only just been recently made aware in the last few years of the transformation airbrushing and digital photo techniques do to women’s bodies in the media. So what I was seeing from such a young, vulnerable and impressionable age was actually not a real person.”
To those who dismiss the impact of the images we routinely see in the media, I hope the words of Katie, and other sufferers like her, will hit home. Although I do not claim that such images are causing eating disorders, they are contributing to them, and editors and advertisers can work to portray more realistic and positive images.
I should like briefly to mention the relatively new phenomenon of pro-ana websites. First appearing in the 1990s, these sites are numerous and are often characterised by a frequent migration to different web addresses or blog sites. Ana, or thinspiration, is portrayed on many of these sites as not a serious mental illness, but a lifestyle choice, and although those supporting the sites claim that they can provide the only forum for socially isolated sufferers, solid academic studies support the claim that they do damage.
I hope that you will accept my apologies for joining the debate late, Mrs Osborne. Does my hon. Friend agree that the progress we are making on making it much easier to filter out pornography, violence, abuse, anorexia and self-harm from the family home is welcome?
I commend my hon. Friend on the work that she is doing in that area. I sincerely hope that we see some progress on that, so that these websites, which are proliferating—there is evidence of a 470%
increase in just one year, between 2006 and 2007—can be prevented from being accessed from family homes. US studies have shown a clear correlation between increased body dissatisfaction and viewing such sites.
We live in a complex, changing world where higher numbers of people than ever suffer from mental illness, and so it is with eating disorders. It is not just the number of sufferers, but the severity, that is increasing. What would have been considered an eating disorder 20 years ago might now be regarded merely as a bit of disordered eating. I do not say that in any way to dismiss the seriousness of disordered eating, but to demonstrate that the conditions now have to be a great deal worse to be recognised as such, and to make a sufferer a priority for treatment. That is one of the serious issues that I would like to mention.
In my home city of Southampton—not in my constituency, but in that of Mr Denham—is April House, a unit specialising in eating disorders, which I have had the privilege of visiting, and where I met service users and health care professionals. I attest to the outstanding work done there. Some of the service users and staff are here today. I admire their courage and determination.
I agree with the firm message that I received from staff at April House. With all eating disorders, there is a critical window of opportunity when a sufferer has been diagnosed, wants help, has acknowledged that they have a problem, and are reaching out for the assistance they desperately need. That opportunity can easily be lost if help is not available at that time.
The hon. Lady is making a powerful speech. I was concerned when I received an e-mail from one of my constituents, a student nurse, who wrote:
“I am currently on a mental health placement and two of my clients have eating disorders of varying degrees, however cannot seek support for their eating disorder due to cuts in services.”
Does the hon. Lady share my belief that, having raised awareness of eating disorders and encouraged sufferers to seek help, we must not then fail to provide the support and assistance that they need?
The hon. Lady makes exactly the point that I am coming on to: it is critical that when sufferers feel that they can reach out for help and acknowledge that they have a problem, the help is there for them. A delay of six to nine months can be dangerous—or, indeed, fatal.
Is my hon. Friend satisfied with the level of knowledge among medical professionals? Is there a job to be done in raising awareness of what they should be doing and of the signs that they should be looking for among sufferers of these disorders?
I have been struck by the number of times that relatives of sufferers have contacted me to make the point that their family member was slow to get a diagnosis, or to say that the GP dismissed the eating disorder as nothing more than a teenager being a bit fussy about their food. It is critical to raise awareness, not only among the wider community and the media, but among our general practitioners, because we need
these disorders to be identified earlier so that damage to growing bodies, in the instance of young people, does not become permanent.
As well as the medical profession being aware of these conditions and the first signs, should not parents have some knowledge of the indications, so that they can help their children earlier, before the condition gets too serious?
One of the messages that I have received from parents is that they already feel enormous guilt, in some instances completely unjustifiably. They feel shame for what is going on with their child, and as if they are somehow to blame. They are not, and I find that in the majority of cases, parents were the fastest to identify the condition. They instinctively knew that something was wrong with their child, even though they might not have been able to put their finger on what exactly it was. I have heard some terrible tales from parents, which I will come on to—I assure you, Mrs Osborne, I am getting towards the end—about the responsibility and burden placed on them. I have even heard about parents who have been told that it is their fault. It simply is not.
We do not fully understand what causes eating disorders; it is complicated. All the parents I have spoken to have done the most fantastic job in supporting their children. As one sufferer’s mother said to me on the phone just yesterday, there is nothing that she would not have sacrificed to get her daughter the help that she needed. Had the mother been able to buy private health care, she would have sold her house to do it, so desperate was she for her daughter to get well.
I know how long sufferers have had to wait to gain admission to April House—something that has been emphasised to me incredibly strongly—and the picture from around the country is that the average wait from diagnosis to treatment in a specialist unit can be as long as nine months. For sufferers, that is simply far too long. As we move from primary care trusts to clinical commissioning groups, it is imperative that awareness of the scale of the problem is uppermost in the minds of GPs, who will be responsible for commissioning the relevant services.
I have mentioned briefly one significant theme, but I would like to mention it again. It is a message that has come from the parents about the impact on families. The effects are many and varied, and certainly include huge feelings of guilt and despair, and lack of comprehension of why this has happened to their child, or why an individual might choose to deprive themselves of the necessary nutrition to lead a healthy life.
I apologise to the hon. Lady, who is making a brilliant case on behalf of the sufferers of eating disorders, for intervening on an excellent speech. Given the shame and guilt she has mentioned, which are big factors, does she agree that it is fantastic that constituents of mine have got in touch with me to ask me to attend this debate? All of us have constituents who have got in touch with us on this issue and have talked about their experiences. Their coming
forward helps to dispel some of those feelings, and some of the myths and rumours surrounding these conditions. Will she congratulate them with me?
I thank the hon. Lady for that intervention. One word that keeps being used is “stigma”. She is absolutely right to highlight the bravery of individuals, some of whom were perfectly happy to be named; when I told Katie Waters that I wanted to quote her, she was over the moon that I was going to quote her in Parliament. Others did not want to be named but still wanted to tell their story. They have all been phenomenally brave, including those in this place who have contacted me and talked about their personal stories.
I have had mothers contact me to tell me that when their child was diagnosed with an eating disorder, they were accused of abusing their child. The assumption was made that they must have harmed their child for her or him to have developed an eating disorder. I am not saying that that never happens, but from my experience, the parents and families of people with eating disorders have been caring, loving, supportive, desperate for knowledge and help, and in many cases prepared to sacrifice absolutely everything for their family member to be well again. I therefore pay tribute to charities such as Beat and ABC, which have recognised that this is not a condition of the individual, but affects entire families, wider networks, friends and colleagues.
Beat is working in partnership with Student Run Self Help, which runs a number of support groups in universities throughout the country. Both organisations have heard of a number of cases in which students have not been able to access treatment, or have been able to access only intermittent treatment, due to a lack of co-ordination and flexibility on the part of GPs and eating disorder treatment services at their university and in their home location. They have asked me specifically to highlight to the Minister the serious problem with 18-year-olds going off to university. We know that people are most likely to develop an eating disorder at 17, so that is a vulnerable age.
What sufferers need above all else is continuity and stability of treatment, which Beat originally thought could be achieved by enabling people to register with two GPs at one time. However, after consideration was given to who would have overall financial and clinical responsibility for the patient, discussion turned to the proposal that the home GP could have those responsibilities. This should encourage greater communication between the home GP and the GP with whom the student is registered as a temporary patient at university. In addition, it is likely to be argued that the student should be able to register with more than one eating disorders unit—one at home and one at university—so that they can receive the necessary care during both term time and the holidays.
I am conscious that other Members wish to speak and my contribution has been somewhat lengthy, so I shall conclude my remarks with a tribute to one of my constituents, whom I first met at April House this time last year. She has gone out of her way to keep in touch with updates about what she is doing to raise awareness of eating disorders. She has certainly improved my knowledge and understanding, and is shortly to take part in a charity sky-dive to raise funds for eating disorders awareness. What struck me about Becky was her willingness to open up about her battle with anorexia and some of the stark truths.
Hampshire is a fortunate county, with excellent schools and sixth-form colleges. Even in schools and colleges rated as excellent, however, eating disorders can flourish. Transition from school to college can be difficult for many, and at times of change, stress and pressure, eating disorders can frequently manifest themselves. Even where teachers and head teachers are good, concerned and caring, and where pastoral care is superb, young people can fall victim to these disorders. I hope that in some small way this debate has helped to raise awareness and understanding in this place. I sincerely thank all those in the Public Gallery for attending, and I thank colleagues for their contributions this afternoon.
It is a pleasure to serve under your chairmanship, Mrs Osborne.
I congratulate Caroline Nokes on raising this issue and in particular on her comprehensive survey of some of the problems experienced mainly by young people but, as she said, not exclusively so. She presented her case clearly and did a very good job.
It is important for us to send a message from this place today: quite naturally, human beings come in all shapes and sizes. There is no perfect body or shape, each one of us is different; we are genetically predisposed to look a certain way. It is important for us to say that as loudly and as often as we can, to counteract the loud noises often experienced in the media by young people about what they should look like.
Before I move on to the specific area that I want to cover, it might be worth giving an example not of a constituent but of someone I know through my family friendships: a young woman who is now in her 20s and has been studying violin since the age of five. She is a talented and well trained young musician and was offered a contract to play at an international festival in, as it happened, the south of France. The contract specified what body size she should aim to be—that says so much about where we have gone with the issue—by the time of the event. That was outrageous, and agents who become involved in such contracts should be ashamed of themselves.
I want to speak about an eating disorder that affects young people with type 1 diabetes. It is informally known as diabulimia, but the medical profession does not recognise that title and, to be fair, it is not an accepted name. In so far as I use it, I do so as shorthand to describe a quite complex phenomenon. I pay tribute to Diabetics with Eating Disorders—DWED—and particularly Jacqueline Allan who provided me with briefing to enable me to take part in this debate. Diabulimia is a condition, although not officially recognised as such, that affects mainly but not exclusively young diabetics. For clarity, I emphasise that I am talking about type 1 diabetes, which people are born with a predisposition to, and which has nothing to do with lifestyle. Some people are born with something that is likely to trigger diabetes at some stage, and too often we confuse type 1 with type 2 diabetes when they are absolutely not the same.
Sufferers of type 1 diabetes are exclusively prone to suffer diabulimia. If a young diabetic does not take their insulin, their level of blood sugar—glucose—increases,
as medical science has known for a long time. However, young people have discovered that when that happens, the glucose cannot be converted into energy, and in turn the glucose is removed through the natural process of urination. Consequently, necessary calories are also lost, so manipulating their insulin intake may lead to rapid weight loss. If the intake of insulin, which is needed to stay alive, is manipulated, diabetics can achieve rapid weight loss. That information is circulated all the time in the social media on Facebook and Twitter, and young diabetics who want to lose weight are learning from other young diabetics how to lose weight rapidly. I will move on shortly to the consequences for those young people.
First, it is important to give some context for diabetes and associated problems. Young female diabetics aged 15 to 30 have a nine times higher death rate than their non-diabetic counterparts, which is an alarming statistic. According to a BBC report last year, of the 26,000 avoidable deaths from diabetes, the highest increase is among young women in that age range, which bears out the point made by the hon. Member for Romsey and Southampton North. According to the Joslin Diabetes Center and DWED, having type 1 diabetes increases the chances of developing an eating disorder twofold, and 40% in that age range regularly manipulate or omit taking their insulin, which they need to survive, in order to lose weight.
At first glance from the perspective of young people who want to lose weight, that seems like a way of using their condition as a means of doing so easily. However, the problem for people with type 1 diabetes is that deliberately increasing their blood sugar levels may have serious consequences and lead to early death. In the long term, as the hon. Lady said, there is a risk of fertility problems, which are common in relation to other eating disorders, but for diabetics there is also a risk of loss of limbs, kidney damage, blindness, heart damage and many other serious complications.
There may also be serious short-term consequences. When a type 1 diabetic stops taking sufficient insulin to balance their blood sugar levels, the body produces ketones, which are highly acidic and dangerous, and above a certain point might lead to diabetic ketoacidosis or DKA, which is always fatal if not treated quickly.
The health system is very poor at dealing with this problem because it is not officially diagnosable and the reaction of health professionals is often confused, at best, which might lead to courses of action that can have serious consequences, including death. Sufferers report being told that diabulimia does not exist—it does not exist as an official medical term—and consequently they have been discharged with no treatment. Sometimes they have been designated as non-compliant. If the health professional does not recognise what they are looking at, they assume that there is a problem with lack of co-operation from the patient and simply discharge them, which may have dangerous consequences. I will give an example in a moment.
In other cases, such people have been diagnosed as anorexic or bulimic, and treated for a condition that they do not have, often with fatal consequences. DWED reports that sufferers have sometimes been treated by eating disorder specialists who have little or no knowledge or understanding of diabetes, or by diabetes specialists who have little or no understanding of eating disorders.
I welcome the right hon. Gentleman raising diabulimia, about which I knew absolutely nothing prior to calling this debate. A constituent of my right hon. Friend the Secretary of State for Communities and Local Government contacted me to inform me that treatment of the condition is incredibly rare, and they were aware of only one hospital in south London that specialises in it. Can the right hon. Gentleman confirm whether that is correct?
The hon. Lady is correct. I intend to address that issue when I bring my comments to a close, and I will make suggestions for what we need to do.
The consequence of people being treated either by a diabetologist who does not understand eating disorders, or by an eating disorder specialist who does not understand diabetes, is that they can be signposted to an unsuitable service altogether, or unforgivably, they will not be taken seriously when they have a serious problem.
An example I have been told about involved a young woman sufferer who was told that she was too heavy. That is not to say that she was heavy; she was very light, but she did not meet the criteria for being light enough to have an eating disorder, and was consequently told that she did not qualify for any support. The advice that she was given was that she needed to relax about food. Anybody who knows anything about diabetes knows that the relationship diabetics have with their carbohydrate intake is crucial to their well-being, so to say to a diabetic, “Go away and get more relaxed about eating”, could put them in a position where their life is threatened. Subsequently, the young woman concerned had to be admitted as an emergency case to hospital with ketoacidosis, which, had it not been treated quickly enough, would have been fatal. That was somebody who had presented themselves in the health system, looking for help, but was told to go away and get a better relationship with food.
DWED has some aims that I hope Ministers can address, and I shall go through those now. First, it wants to establish the principle, which I strongly support, that no diabetic with an eating disorder should be misdiagnosed or told, “There is nowhere to put you”, which is what is commonly said to them at the moment. That comes back to the point made by the hon. Member for Romsey and Southampton North.
Secondly, for type 1 diabetics with eating disorders—what I have termed as diabulimia—the condition needs to be properly recognised as a serious and complex mental health problem. I do not think that it is controversial for the hon. Lady to refer to it being a mental health problem, because although, in all the cases that she gave, there are serious physical consequences, the springboard often relates to mental health, relationship with body image, and so on.
Thirdly, those who seek treatment should receive the correct treatment with respect and compassion, on the basis of a multidisciplinary approach. In the example that I gave, there was not enough expertise in one specialism to be able to satisfactorily deal with the problem. Such an approach requires the Department actively to promote an understanding of the problem, so that health professionals catch on to what is happening. Protocols probably need to be in place, so that when somebody presents themselves with such a condition, health professionals know what to do.
The only people raising this problem, apart from me in today’s debate, are DWED, who work together with other bodies, such as Diabetes UK. DWED currently exists on an income, in the last financial year, of £9,000, which is not even enough to employ one full-time member of staff. DWED operates on the basis of having previous sufferers who are volunteers, under the co-ordination of Jacqueline Allan, who I mentioned earlier. I do not know whether it is more appropriate for support to come from foundations or the Government, or somebody else. I am not talking about needing hundreds of thousands of pounds, although I am sure that DWED would welcome that, but some way needs to be found to support the one organisation that is campaigning on, and raising and dealing with the problem. Given the importance of its unique role, I hope that the Government can find some support—not only for DWED, but for the issue as it exists across the health service.
Finally, just as it is vital that health professionals take a more multidisciplinary approach to this and other eating disorders, it is equally important that the Government take a more joined-up approach. I could have made the same criticism of the previous Government, and I realise how difficult it is to get a joined-up approach to eating disorders and many other things. However, on medical cases, there needs to be co-operation between different Departments, because a stronger push is required on the issue of body image and how that is dealt with. Perhaps it is not best dealt with by the Department of Health, but at the same time, some of the health issues involved need to be addressed.
Perhaps I can put an alternative view to the right hon. Gentleman. In my experience, people do not like being told what to do by the Government. If we acknowledge that the media are among the biggest perpetrators in pushing forward images that we should all aspire to, do we not need a good, populist campaign to educate the public that actually, curves are great?
The hon. Lady makes a good point. There is this idea of politicians wagging our fingers and saying, “This is what you should do”. For a couple of years in the previous Government, I had the responsibility in the Home Office for drugs policy, and one thing I know is that middle-aged men like me—perhaps I am flattering myself there—are probably the worst people to go into the media and say, “Actually, you should not be taking drugs.” A subtle, sophisticated approach is needed. A lesson from that, which applies equally here, is to provide information to young people so that they know the consequences of what they do. One problem we are dealing with is that people think there is an easy way to lose weight and to get to be the shape that they, or others, think they should be. Action has to be taken smartly, on the basis of real information about consequences, but it still has to be done.
The hon. Lady anticipated my next point, which is the responsibility of people in different industries. There is relentless media hype about what the perfect body shape should be, and the irresponsible attitudes often displayed by the fashion and entertainment industries need to be highlighted. Looking round the room, there might be one or two people who can remember what it was like to be a teenager—[Interruption.] I take that back. Several people around the room well remember
what it is like to be a teenager, and one experience that we probably all share, and that every teenager in history has shared, is insecurity. They have not developed into who they are going to be, and they are insecure about everything, including their appearance—as is obvious, I have long since given up worrying about my appearance—the way they present themselves to the world, what it is to be cool, and all those things. A lot of that is dictated by what they read in magazines and see on cable channels—even on mainstream reality television shows.
It is wholly unrealistic for the industries that show those images to say, “Well, that’s a matter for the Government.” They have a responsibility to provide for young people role models that are realistic, that are just like the rest of the world, that show young people that they do not have to look like those images to be an acceptable, successful and attractive member of society. That responsibility is not just for Government or politicians, but for everyone who is in a position to influence how these things are presented to young people in particular, and to society in general. I hope that, as a result of this debate, we can at least move that agenda along a little further.
I appreciate being called to speak, Mrs Osborne, particularly because I am going to nip off later to the second debate in the main Chamber. I hope that my hon. Friend the Minister will forgive me. It is a pleasure to serve under your chairmanship, Mrs Osborne.
I begin by paying tribute to my hon. Friend Caroline Nokesfor securing this very important debate during eating disorders awareness week 2013. She is respected by hon. Members on both sides of the House for her knowledge of this issue. I thank her for the tireless way she is championing an issue that is one of the most pressing and, if the medical profession’s statistics are to be believed, one of the most rapidly growing health issues that the nation faces. Indeed, male admissions to hospital are up by 68% in 10 years.
I also pay tribute to the all-party group on body image, of which my hon. Friend is the chair and which exists to inform the media, the fashion industry and wider society of the complex issues arising from poor body image. Body image is, as reported by the First Steps charity, which works in my constituency of South Derbyshire, one of the most significant causes of disordered eating behaviour. It is heartening that such groups exist and it is evidence that, in some small measure, awareness of the issue is starting to grow. Only a few years ago, the very idea of a group committed to improving body image would have been met with a roll of the eyes and a dismissive comment, yet the reality has always been that women, and now increasingly men, spend fruitless hours examining themselves critically in front of the mirror and obsessing over every lump and bump. They are often driven to self-loathing by what stares back at them.
Poor body image and a media full of unrealistic and unobtainable examples of body shapes that we are told to emulate are undoubted drivers in individuals who go
on to develop eating disorders. Many who suffer low self-esteem and poor body image, especially men, go on to suffer serious mental health problems, often manifested in eating disorders and chaotic, dysfunctional and disordered lives, and suffer lifelong unhappiness. Therefore, the focus of the all-party body image group is more than welcome; it is essential and, indeed, it is a weather vane for how attitudes towards such real human issues are changing for the better as awareness of these issues improves.
Eating disorders are a complex issue to discuss in just a few minutes. It is a shame that this debate is not getting the priority that it deserves, perhaps by taking place in the main Chamber, but I am very grateful to the Backbench Business Committee for allowing the debate to be held in Westminster Hall. The number of MPs and, indeed, members of the public here today is testimony to the issue’s importance. Having the debate in the main Chamber would have gone a considerable way towards assuring sufferers that Parliament is at least serious about raising awareness of these issues and the problems that people face.
Of course, not all people with eating disorders come forward to get the help that they need. The most accurate figures of which we are aware are those from the National Institute for Health and Clinical Excellence. They suggest that 1.6 million people in the UK are affected by an eating disorder, of whom about 11% are male. Worryingly, the most vulnerable group are our young people, particularly those between the ages of 14 and 20.
Bearing in mind that we have heard from previous speakers in the debate that there is a critical window for intervention to support these people, and given that the incidence of these disorders tends to occur in the mid to late teens, does my hon. Friend think that there is a case for more education of our schools and teaching staff so that they know what signs to look for?
Absolutely. I thank my hon. Friend for her intervention; she is absolutely right. We have been debating in the main Chamber what should go on the curriculum for personal, social, health and economic education. Perhaps the Minister can reflect on that in his speech. I apologise to him again for the fact that I will not be here at the end of the debate. I will read his speech in Hansard next week.
It is the case that 1% of the population between the ages of 15 and 30 suffers from anorexia. About 40% of those who suffer never fully recover and 30% suffer the illness in the long term. Official figures show that eating disorders rose by 16% in England from 2011 to 2012. The scale of the problem is therefore hard to ignore.
This subject raises issues pertaining to public health, mental health, nutrition, education and the way in which families are supported in dealing with disordered eating behaviour at an early age. That final point is, for me, the most important one and the one on which I shall focus in the few seconds that I have left. I am referring to how we raise awareness of disordered eating behaviour in such a way and at an early enough stage that recognition and treatment are possible and at a time that predates the long-term physical health problems that eating disorders can cause.
So many who suffer from eating disorders start to experience their troubles as children and adolescents. Many suffer in silence, and in so doing curse their lives, not just with a disordered relationship with food, but by destroying both their physical and their mental health in the process. That will probably affect every aspect of their lives: their career, their relationships and even, sadly, in some cases, their ability to become parents themselves.
The underlying cause of much disordered eating behaviour is a person struggling to cope with anxiety, stress and poor mental health. The cause of that anxiety and stress may be bullying. It may be an escape from abuse or traumatic events. The cause may be a lack of control, bereavement, poor parenting or simply uncertainty over one’s place in the world. However, the cause is undoubtedly psychological. The illness therefore deserves genuine sympathy and understanding, not dismissive attitudes, which compound the problem. Perhaps over time, the disordered eating behaviour may be modified through self-discipline or self-awareness. The sooner someone gets the treatment they need, the more likely they are to make a full recovery.
For the reasons that I have set out, this issue deserves at least equal priority with other physical and mental health problems. We cannot ignore or be indifferent to the obvious consequences of eating disorders. We have only to look at those who so bravely suffer them to see why we as a society must do more to tackle them, and we must start by raising awareness of their existence, their causes and their cures.
It is a pleasure to speak in this debate under your chairmanship, Mrs Osborne. I, too, thank the Backbench Business Committee for allowing the debate. However, I particularly thank Caroline Nokes for securing the debate. She and I are members of the all-party group on body image and, in calling for the debate, she has shown the commitment to, and concern about, the issue that demonstrate why she is deservedly the chair of our group.
Before I had decided to speak in the debate and while I was pondering whether I would be able to spare the time before returning to my constituency, I received a number of e-mails from people across the country, as I am sure other hon. Members did. One was from a young constituent of mine who is just 17 years old. This is why she asked me to attend the debate:
“Recently I have been having problems with my eating and raising awareness would mean people like me can get the help we need and feel less ashamed or judged. This issue is incredibly important to me and you showing your support on Thursday would really help…This serious mental illness is affecting someone you know right now in your constituency.”
What could be more compelling than that?
Today, I would like to be quite parochial and speak about services in the north-east. When looking on the internet to find out where these services were, I was quite concerned to find out how limited they are, but, fortunately, in the north-east we have a unique service; it is the only specialist provision outside hospital services
in the north-east. The Northern Initiative on Women and Eating has worked in the area for 24 years; it is referred to as NIWE. Last year, according to its annual report, it helped 1,344 people with eating disorders. For the rest of my speech, I shall refer to them as people with eating distress, as NIWE feels that it is a more appropriate way to describe how people suffer when they have problems with eating. It has also helped 141 carers and supporters of people with eating distress and 636 professions have called on its expertise.
As has been said, 1.6 million people in the UK have eating distress, more than 90% of whom are women, and an increasing number of men are now affected. The figures include only those who are in-patients in NHS treatment, and therefore leave out people who have not come forward or have not been diagnosed and those who are receiving private treatment or being treated as out-patients or in the community. Eating distress is a general term with which people are more comfortable. It covers those diagnosed with conditions such as bulimia, anorexia, eating disorders not otherwise specified and binge eating. Problematic eating habits seriously interfere with people’s lives, as hon. Members have pointed out.
Some people have not even shared their disorders with others. The high levels of stigma have already been pointed out. When people have eating disorders, it often goes unreported to GPs or other medical services, due to shame and the fear that people’s futures could be jeopardised if anything were recorded in health records. That fear needs to be removed. Sometimes people have lived with eating issues for many years, managing in secret and suffering in silence.
Under-reporting is exacerbated because many eating issues are due to a fundamental lack of self-esteem, which can be brought on by bullying or abuse. They are difficult to diagnose medically and not all GPs have enough specialist knowledge, as we have learnt this afternoon. I do not apologise for repeating some things that have already been said; I do not think we can say enough about what the issues are and how they affect the lives of sufferers.
Eating distress carries the highest mortality rate of any mental illness. During the past two years, hospital admissions in the north-east for eating distress have risen by 16%, compared with 8% for all other admissions. Unfortunately, the figures also show that the highest rates are in the north-east. Overeating is increasing, and the serious long-term health risks of obesity are being highlighted.
Of those on NIWE’s waiting list for support and help, 10% are from my constituency and the wider North Tyneside borough. I would like to thank it for helping people from north Tyneside, who, over the past two years, made up 25% of its attendees. Of the people with whom NIWE works, 61% are under 30. NIWE was keen to stress, as was my constituent, that there is a greater chance of recovery with early intervention. Sadly, NIWE also tells us that 70 people are on its waiting list for group therapy. Waiting times are too long, but it simply lacks the capacity to address the issue further, and every day it receives new names.
There is particular concern in the north-east from NIWE and public health leaders over the growing numbers of young people in the north-east, due to the student groups, who are at risk. We have a number of universities. Although NIWE is supported by North Tyneside,
Newcastle and Gateshead primary care trusts and Newcastle council, and receives funding from charities, such as the Northern Rock Foundation, it operates on a shoestring.
Many treatments target core eating disorder pathology, primarily weight restoration, but there is a need to look at efficacy and effectiveness in minimising harm and reducing the personal and social costs of chronic illness. NIWE has therapy groups, which are proving successful, that address the underlying determinants of eating distress, but I have to keep returning to the fact that it is underfunded. NIWE has found that people from across the area who are recovering from an eating disorder want recovery groups to be set up, because they help them to progress and maintain their recovery, which must be the ultimate aim of anyone who comes forward to address a problem. The Stay Well group helps such people, but NIWE is, again, trying to raise more funds to support that vital service. It tells me, as I think we all know, that such services need more provision and we need more to be spent on recovery, because, sadly, there is a high relapse rate and many people go through a revolving door. It makes sense to invest in support for people in recovery, because bed rates for those with eating distress are between £450 and £750 a day. In terms of economics, the Government should look at supporting people in recovery.
Support for families and friends who are carers and supporters is important. There are effective family-based interventions. NIWE offers an initial listening and signposting service to under-18s and their families, but it wants to do more. I know that I am pleading for NIWE, but I am sure that those here today know of many other organisations in a similar situation, with the ability, but simply not the capacity, to help. People call NIWE wanting an appointment or asking for other services, but it finds that need far outstrips capacity.
I mentioned that eating distress is becoming more common among the male population and minority groups, including the transgender community. NIWE has been able to introduce some support for young men and others who come to it, but a lot more work needs to be done. Before I make a plea to the Minister on what needs to be done, I shall pay testament to NIWE’s work by quoting some users of its service. One person said:
“NIWE has saved my life and is trying to help me make sense of it.”
“I think this is an unbelievably amazing service. The counsellors in the session were brilliant. I just wish there were more of you out there for all the people still struggling.”
“A relaxed and non-critical atmosphere which enabled me to speak…without feeling isolated.”
There are more quotes, but those demonstrate how organisations such as this are critical and why they need full recognition and support in the health service.
Raising awareness of serious mental health issues and the profile of services is always crucial. With so much pressure on clinical commissioning groups in their new role, specialist non-acute services are in danger of flying under the radar and losing out in commissioning plans. Mental health services are often poor relations when it comes to health funding pots. Acute eating disorder services will be funded through specialised commissioning frameworks, and will often be large regional services remote from many of their users.
Small local services, especially ones focusing on early intervention, are therefore vital, but there is a great risk that such services will not be commissioned.
As has already been mentioned, we need a comprehensive awareness-raising programme in schools and youth services. Organisations such as NIWE try to provide that, but much more is needed—more training for professionals and, above all, more money for services, such as NIWE, and more support and acknowledgment. I make a plea to the Government that, following this debate, they will help groups, such as NIWE, that are doing so fantastic and fundamental a job for our communities.
I congratulate my hon. Friend Caroline Nokes on securing this debate. I was privileged to support her application to the Backbench Business Committee and, with others from across the House, to commit firmly to this debate. I hope that, at the very least, one thing that comes out of it will be a greater number of Members of Parliament pressing for improvement.
I, too, am straddling debates and trying to be in two places at once. I apologise, Mrs Osborne, for the fact that I must leave to go to the Marriage (Same Sex Couples) Public Bill Committee, which is continuing its deliberations.
All of us must declare an interest when it comes to eating disorders. All of us have to accept that we know a friend, family member or constituent who is dealing with the issue, and if we do not know one, we are out of touch with what, sadly, is the reality. All too often, that is a hidden reality, which is why I so welcome our shining a light on this important concern.
I do not come to the subject as a great expert, but I have been involved over the years—I share this with the Minister—in the issue of addiction, which is similar. I increasingly see great similarities between the issues. There is the profound loss of freedom; the diminished and, sadly, lost lives; the effect not only on patients, but on family members and all those around them; the health concerns, and the wider social concerns for society; and the whole process of treatment and recovery, with individuals, their family and society at large having to make a long-term, continual commitment. That matters, in terms of the quality of treatment and the support from family members and peers. All those issues should be promoted.
Although there are, sadly, the negatives—I will predominantly talk about the problems—I have been particularly impressed by the power of recovery. The positive stories of those in recovery are immensely powerful, and we must given them a much louder voice.
I have said that I am no great expert, but from those close to me and from constituents, I have learned that we cannot find one magic solution, or seek a simplistic or generalised one. Eating disorders are complex and contradictory, and in many ways there is ambiguity as regards recovery. That makes them particularly problematic, in terms of illness, mental illness and recovery. They are highly resistant to change; unlike with a physical illness, the patient wants to hold on to these disorders as a method of coping, so they are inherently hard to treat.
I want to concentrate on treatment and recovery. We must accept that we have a problem, and I would be interested to hear the Minister’s response to that. We have a problem in terms of the prevalence of eating disorders. They are on the rise in the UK, which has one of the highest rates of hospital admissions in Europe. The most vulnerable may well be teenagers, but eating disorders cover all genders and ages. Indeed, it is right to mention boys: 25% of those affected at school age are boys, whereas I understand that 10 years ago that figure was 10%. We also have an NHS problem—I have to say that—and a family problem in relation to how families are involved.
Does my hon. Friend agree that there might also be a problem in schools? We need to talk more about the issues with children at a very young age. Teachers can be part of that process by aiming to explain some of the issues and making young people feel more comfortable about body image.
Very much so. The guidance is all on the side of early intervention. Indeed, the Government are very much on that side, and I am sure that there is a cross-party call for early intervention. That is a key area, and we must tackle the issue through not only better treatment, but profoundly better education and prevention, as well as culturally, through the media. That is an area on which we can give our views, which we are airing here, and where we can be part of a changed culture, but it really happens at an early age.
I particularly point to the pressure on services and waiting lists—an issue that has already been mentioned. The pressures on GPs and others for referrals to out-patient and in-patient services are growing. Anorexia and Bulimia Care—I pay great tribute to that leading national charity, among other good ones, on eating disorders—has told me that adult sufferers can wait up to nine months or even a year to receive treatment. That is profoundly damaging for adults, but think of young children who are susceptible to rapid weight loss waiting, at a time when they are growing. That wait for treatment while the right service is found could quickly put their life in danger.
Training in the complexities of eating disorders has been mentioned, but the general training that should be mainstreamed for GPs does not exist. Health professionals wrongly diagnose patients, mishandle their cases and lack sensitivity and proper judgment. Short time allocations for appointments mean that GPs cannot get to the heart of the physical and emotional needs of patients, who require time and cannot simply be moved on quickly. They need a proper rapport with GPs and investigations that involve the wider health community. With the pressures on GPs, are patients properly followed up, rather than allowed to slide into both physical and mental danger?
Sadly, among the most common causes of death are heart failure and, indeed, suicide, and the issue therefore needs to be grappled with properly and carefully. We must ensure sensitivity in the handling of that long-term involvement—because shortages in treatment services mean
that patients end up falling back on pressurised GPs for the monitoring of their health and safety—but, sadly, that does not happen.
We have too few specialist in-patient units for eating disorders. The NHS has St George’s hospital, Tooting, a mental health unit largely for adolescents, which offers general mental health provision. Children who are already traumatised are going there; they are even more traumatised after going to units that do not have the specialists that we want them to see. We want more eating-disorder-only establishments. I will return to that in due course.
As has been mentioned, there is a profound issue about parents and carers. Parents raise the issue of their needs, and the important role that they play in recovery; those things are sometimes ignored or excluded, particularly if the child lives at home, as 16-year-olds often do. I understand that carer support services can be hard to find in several counties, and parents complain that they are simply shut out from the practical care of their children. That is totally contrary to the way that child and adolescent mental health services were set up to deal with such cases, but sadly, it happens all too often.
We have already taken up the issue of the statute with the Under-Secretary of State for Education, my hon. Friend Mr Timpson, who has responsibility for children, and I look forward to meetings with the Minister of State, Department of Health, my hon. Friend Norman Lamb in relation to mental health. The Children Act 1989 seems to lead to a statutory anomaly, in that those aged 16 and over are given the right to refuse treatment for an eating disorder; there is therefore the prospect that they will be sectioned, and that that will be on their health record for life.
In effect, the Children Act enables GPs to tell children aged 16 and above that they can refuse treatment, which might sometimes undermine the work and values of parents. The number of complaints that I have received on that issue reflects the fact that it is a systemic concern. One set of parents told me about their 16-year-old child who was living at home—I know that this illness covers all ages and not just 16-year-olds. They were responsible for feeding and looking after her, but were excluded from her care. Such treatment might well have perpetuated the illness, and the dire straits that she was in; she may have been at the stage of trying to manipulate the system. These 16-year-olds, who are often intelligent and able young people, know the system as well as anyone else, and their manipulation of it can hinder the practical medical process of recovery.
Mental health legislation, including the Mental Capacity Act 2005, and the inherent jurisdiction of the High Court are interwoven in the treatment of this complex condition. We must also consider how we link in the organisations on the ground, such as CAMHS, to ensure that we involve all the relevant bodies in the health and care of our loved ones. Stigma and public misconception are also important issues, as the attitudes of the public and of health service professionals can hinder treatment.
I want to leave the final word to the experts—the families, who, sadly, have never wanted to be experts in this area. These are the sorts of stories that I hear all too often. One constituent became concerned about their daughter’s sudden loss of weight. They went to their GP, who made a referral to the local CAMHS team,
which passed the matter on to the specialist eating disorder unit at the Royal Free hospital. The first appointment came up a couple of months later. The girl saw a consultant and dietician weekly or fortnightly. She attended various groups and family therapy sessions, but at no time did she receive any individual therapy.
Four months later, the child became abusive and violent towards her family. Despite attending regular hospital appointments, her intake of food was becoming more and more restricted. Her weight loss continued until she became skeletal. At times, the parents were in desperation. They phoned the hospital, pleading with it to admit their child, because they were reaching a point where they just could not cope. The response from the hospital was that in its opinion hospitalisation was not deemed necessary.
The parents felt completely helpless and as if they were battling the illness on their own. That went on until they found a helpline number for Anorexia and Bulimia Care, which proved to be a lifeline. A doctor eventually saw their daughter, who was so poorly that they were unable to get a blood pressure reading. There was no hospital involvement or admission at that stage, but the parents realised how important it was, and that their daughter needed to be admitted. Indeed she was admitted, not to an NHS clinic, but to Rhodes Farm clinic, which provides exceptional care. ABC underwrote the cost of treatment. We have been battling ever since to try to get the health service to take some responsibility for that cost of treatment.
Since then, there has been progress. No one would say that the girl is out of the woods, because it is a continuing process, but for her to be able to take food, gain weight steadily, feed the mind and the brain, and engage with processes has helped. The parents have said that without the support of ABC, they dread to think where they would be today; it saved their lives.
I have another example, which involves not lay people but a local doctor, who says:
“doctors know all about Anorexia and the best way to treat it, and the latest development in treatment—WRONG!”
She goes on to say:
“The help was not there. The doctors at best were sympathetic, at worst were downright dangerous.”
This is the mother of an intelligent and gifted daughter. She said that she could have been anyone’s 15-year-old, and yes, it could have happened to a boy as well as a girl. She was a normal loving child. The mother told me what happened:
“We went to doctors, paediatricians, bowel specialists. They found nothing wrong with her stomach. I told them of my worries. ‘Oh no. She is not thin enough to be anorexic!’”
The daughter was asked whether she was eating. “Yes”, she said. “Well, you need to eat more, sweetie”, her mother said. The daughter promised that she would try,
“But she didn’t. Always there was an excuse.”
The problem got worse. It is a familiar story:
“Every time we mentioned food or insisted on eating, she threw plates, broke things, kicked, screamed, destroyed her room. Her brain was now completely malnourished, starved of even basic nutrients. She had the look of a wild, caged animal. She told us…she was a bad person and wanted to die. ‘Please let me die mummy’ she would scream.”
Eventually, the parents got her to casualty and were told that she most likely had anorexia. The doctors said
that a referral would be made to the CAMHS team. The parents were desperate. Their child had become psychotic and was in danger of starvation. The mother said,
“Even though I knew, hearing the doctor actually say ‘Anorexia’ made it real. ‘Anorexic? No way! She’s normal. She’s clever. She wouldn’t do this. She is not one of those silly girls!’ The guilt. The feelings of desperation, the sheer magnitude of what was happening was overwhelming. What a terrible parent I was! How could I have let this happen? How could I have not realised?”
There were no terrible parents involved in that story. This is an issue that must be tackled at an earlier stage, so parents do not go through that desperate nightmare. In conclusion, there is a good end to that story—well, not so much an end as a positive outcome.
Another parent who had the help of ABC and who used Rhodes Farm clinic said that they considered their daughter to be one of the lucky ones who has, through that excellent treatment facility, been given the chance of having a full life again one day. They said, “For every such one, there are 100 others who are not receiving the care they need or deserve for this dreadful illness, but hopefully they will.” As hon. Members on both sides of the House have said today, we can, hopefully, help to change that.
I congratulate the hon. Members for Romsey and Southampton North (Caroline Nokes), for Enfield, Southgate (Mr Burrowes), and for North Tyneside (Mrs Glindon) on recognising the importance of eating disorders awareness week 2013. As we have heard, more than 1.6 million people in the UK are affected by eating disorders; they are young, middle aged and older. They are every age from eight to 80, and they are women and men. This serious mental illness has the highest mortality rate of any mental illness.
Over the past 25 years, the incidence of eating disorders has increased enormously. There are many possible contributory factors. I observe the tiny size of models, actors and actresses, and screen, tabloid and magazine heroines and heroes; the cult of celebrity; the obsession with gyms and exercise; the constant barrage of advertising through every medium; the pressure on us to diet and to eat low-fat, low-calorie food; the ranges of “light” foods on sale and the so-called “healthy eating” regimes. There is bullying and name calling in the playground, in the workplace and during our leisure, and pressure to remove what is called excess weight and achieve someone else’s idea of a perfect body shape. We have life on the run. Eating on the go is now more common. There is an absence of what I used to have: formal lunchtime at school, at which a teacher sat at my table and watched me eat—even the semolina. If a child takes in a packed lunch, they can give it away or bin it, and no one has any control or sight of what they are eating.
[Mr Charles Walker in the Chair]
I also observe that things are different from when I was young, which was quite a long while ago. Young women are often physically mature at a very early age. It is confusing for an eight, nine or 10-year-old to find out that they are much larger than their friends; they will not necessarily understand that their body is getting ready for full maturity.
We can even look to an escalating divorce rate, which means that many of us are single. There is huge social pressure to have a partner, and there is the implication that in order to count, we must be gorgeous, attractive or at least half of a couple, rather than an individual, with our own rights and responsibilities. I recognise that I am saying this on Valentine’s day. My list, of course, is not exhaustive, but feeling inadequate, worthless and lacking in self-esteem are common factors, and the list starts to provide some clues to the settings in which eating disorders can be triggered, and how they are sustained. That constant pressure has contributed to the suffering of those 1.6 million people, and their families and carers.
So often, eating disorders are evident when a patient perceives that choosing whether they eat or not is the only area of his or her life where he or she can exert complete control. Anorexia and bulimia are serious mental illnesses, and need recognition and the appropriate responses from our national health service. In the next few minutes, I will refer to anorexia, but I want it to be noted that my concerns also relate to bulimia and eating disorders generally.
Most patients with an eating disorder in this country struggle to find effective treatment. They may find that a GP looks at the figures, and not what is in front of them—the patient. I refer to cases where patients are told that they are “not ill enough”, and that their body mass index would need to be lower for them to qualify for referral for help or treatment. When they do qualify, in many cases patients are admitted to medical wards in hospitals where the nurses unfortunately know little about psychiatric problems, and even less about nutrition. Patients are given little or no family therapy or individual therapy.
Others go to psychiatric units, where they are offered psychological support, but where their physical problems and need for weight gain are severely neglected. The few good dedicated units, which combine re-feeding with therapy and education, are mostly privately run. However, at £700 a night, these units are often out of the reach of most families, unless their primary care trust or its replacement NHS organisation funds the treatment.
I want to concentrate particularly on the problems facing children and young people with anorexia and bulimia. In hospitals all over the country, there are children and young people—some as young as seven or eight—who are being treated by doctors and nurses who have very little training in dealing with eating disorders, and who often have no knowledge of how to set a safe target weight. Sometimes, they weigh patients who still have their clothes on, or who have their pockets filled with kitchen weights, or who have their stomachs filled with three or four litres of water. Families are not given the support they need, or clear-cut advice. Patients see a different doctor or specialist at each appointment, and the appointments are too far apart. Little heed is paid to the patient’s physical condition. I have heard about children attending out-patient clinics because of their weight loss, but having neither their pulse nor their blood pressure taken. Monitoring pulse and blood pressure is vital if we are to prevent a child from collapsing, and if we are to know when a child needs hospital admission.
There are very few doctors who specialise in the treatment of children with eating disorders, so the waiting lists for children who need to access those doctors are often dangerously long. Eating disorders must be a condition that students are taught about in medical school, and awareness of them must be included in the postgraduate training of GPs, psychiatrists and paediatricians. If children were seen early in their illness by professionals working as part of a multidisciplinary team, so that parents were given the consistent, sensible advice they needed on how to re-feed their child, and if patients were seen by a family therapist and an individual therapist, as well as having a medical doctor who understood the long and short-term risks, and who could make a referral to an in-patient unit before the patient became irreversibly damaged, we would have fewer chronically ill adults in later life.
No one should die from an eating disorder. At present, however, there are more deaths from eating disorders than from any other mental illness, and it is estimated that 10% of all sufferers of eating disorders die as a result of their condition. For adults, the courts always support an application for nasogastric feeding, but tragically the request for a court order is often made too late, or not at all. However, working with children with eating disorders reveals another serious problem, one that interferes with the ability to help them. That problem is the implications of the Children Act 1989, which deems children of 16 capable of making their own decisions about treatment. However, anorexic patients rarely want to eat voluntarily. Although many of them are crying out for help, the guilt wrapped around food and eating means that they need someone to help them to eat, and not someone to ask their permission as to whether they would like to eat.
Despite an excellent ruling a few years ago, which in summary states that anyone who seeks to starve themselves to death is not competent to make decisions, we nevertheless require 16-year-olds to give written consent before they can be admitted to a medical unit. There are some units where, in order to protect themselves and their staff, this permission is sought from 14 and 15-year-olds. Once children are in the unit, if they refuse to eat, no staff member would dare use a nasogastric tube for fear of being sued. Until the passage of the Children Act 1989, units treated anyone under the age of 18 and fed them if and when necessary, requiring only parental consent. What a ridiculous situation we are now in. The reality of the current situation leaves parents feeling completely ineffectual and frustrated. It also leaves the child feeling quietly victorious, as they go on their way home with medical permission not to eat.
Today we find ourselves in the ludicrous situation whereby staff have to tell parents of often very ill children who will not consent to eat that they must wait until their daughter or son loses another x number of kilos, whereupon that young person can be sectioned under the Mental Health Acts and treated compulsorily. That puts lives at increased risk, and being sectioned is an overly serious response to the problem. We should seek a more appropriate solution. Being sectioned jeopardises any hopes that that child in recovery might have of joining the armed forces, for example, or becoming a doctor or nurse, which is particularly sad, because when they have recovered, many of these children are attracted to working in the caring professions, such as
health care. The Children Act might need to be amended, so that we are able to treat children who are damaging their health through starvation before they become so ill that their lives are in danger.
The hon. Members for Romsey and Southampton North, and for Enfield, Southgate, and I have met the Under-Secretary of State for Education, Mr Timpson, who is the Minister with responsibility for children, to explore the legal situation regarding the Mental Health Acts. I am very glad that the Minister of State, Department of Health, my hon. Friend Norman Lamb is here today. I am grateful to him for agreeing to meet us to explore whether practical solutions are available, or inventable, to allow those who care for young people with eating disorders to trigger some action short of using sentencing as a route to treatment and help.
I particularly want to recognise the work of two charities. One is the Somerset and Wessex Eating Disorders Association, or SWEDA, which is a user-led registered charity based in Wells in Somerset, in my constituency. It works on the principle of self-help, and its phone number is 07511 499 494. It has an online “health unlocked” community, and people can seek support and advice about self-help through that group.
The second charity is, of course, Anorexia and Bulimia Care, or ABC, which is a national registered charity that also happens to be based in my constituency. It is doing an amazing job. ABC was founded and is governed, run and supported by people whose lives have been touched by eating disorders. It offers kindness and compassion to sufferers at a time when they are desperate and alone. It has staff, professional advisers and a national network of volunteers, all of whom are carers or recovered sufferers. It provides positive, practical advice by telephone, by e-mail and via its website. It also offers a befriending service, and a range of literature and training advice. Lastly, it has a young people’s blog, called “To be honest”. ABC’s work is fantastic and its telephone number is 03000 11 12 13. That number will lead to a parent helpline, a sufferer helpline and a self-harm helpline.
We need a fairer system. Every child who develops an eating disorder should have access to first-class treatment, rather than the somewhat cobbled-together, inadequate provision that most have to accept. It is time that this life-threatening and debilitating illness was taken more seriously, and I truly hope that the Minister will consider what changes might be made to ensure that fewer lives are lost, recovery comes more quickly and families do not suffer the terrible consequences that often come with loving a patient with an eating disorder.
Lastly, I appeal to all those who suffer from this challenging mental illness: there is hope, and there is help out there for you. Our responsibility is to make sure it is better and easier for you to accept treatment and help.
It is very generous of you to call me, Mr Walker, because I had not intended to speak in the debate. I am not sure I will detain Members long, because I am not sure what I am going to say.
Twenty-four hours ago, the debate was not on my horizon at all, but in discussion with colleagues yesterday, I was very taken by some of the numbers that were bandied around. Today, having heard the opening speech by my hon. Friend Caroline Nokes, I felt compelled to say something in the debate. I come relatively new to this issue. I have sat here listening to powerful, passionate and informed speeches, and mine will be nothing like that. However, I hope it will give an insight into the epiphany I have had over the past 24 hours.
The numbers have been referred to many times this afternoon, but what strikes me is that although 2,500 people in my constituency may suffer from an eating disorder, not one has contacted me, either before the debate or in the two and a half years I have been a Member of Parliament. I hope that is because the services they receive from the primary care trust and the mental health trust are exemplary, but I would be surprised if that was the case. I therefore encourage constituents who are struggling to access the services they need to contact me.
I was also struck by the fact that 1.6 million people nationwide have been identified as suffering from an eating disorder, but that number could be as high as 4.2 million, because we count only those who have presented and who are seeking treatment. Another thing that struck me was that a quarter of those people could be men.
As I said, I came new to this subject. Following my discussions yesterday evening, I eventually went home. My children—I am fortunate to have two, who are 22 and 20—were up. Our television is currently broken, so one of our pastimes is talking to each other, which is a novel experience, I have to admit. We got talking about what I had been discussing—this afternoon’s debate and my intention to come along and perhaps make an intervention to highlight the fact that a quarter of those suffering from an eating disorder may be men.
I was surprised by my children’s responses, and I am going to refer to them. I have texted my children to apologise to them in advance, in case I embarrass them. I was shocked because both of them talked about friends and acquaintances who had suffered from eating disorders. What took me aback most, however, was that they both admitted that they had probably had an encounter with some form of eating disorder. For the record, that has not manifested itself in anything particularly serious, and they both see what the pattern was at the time, but it could have been serious, and that is why I felt compelled to speak.
I want to say a little about what my children said, and about what I think the reasons behind what they said were. My son, Tom, is 22. He is a fitness trainer and he runs a gym. He is a health fanatic: he is very fit, he is always at the gym and he plays rugby football. He recognised some time ago that he was getting to the point where, however much exercise he took, he still felt there was too much fat on him. He was deliberately avoiding food and certain other things to try to slim down. There is not an ounce of fat on him, and he does not need to do that. He knows that now, but at the time, for whatever reason, he felt he had to change his body shape.
My daughter, who is 20, is incredibly slim. She suffered the reverse problem from my son: people would accuse her of perhaps having an eating disorder, when she did
not think she had one. The problem was that that gave her cause for concern and made her ask whether she perhaps did have an eating disorder. As it happens, she does not; she is fine—she is just a slim girl. Both my children therefore felt under pressure because of the way other people saw them, or because of their perception of the way other people saw them.
I know the reasons behind eating disorders are complex, and we have heard about them, but the thing that concerns me most is the idea of body image, of perfection and of trying to be something that we cannot be. We know the numbers: only 5% of us could ever get close to the perfect image we see in the press and the media. The rest of us are struggling to conform to that or just to be comfortable in ourselves. That is one of the main drivers of this issue. Those who get past their brush with an eating disorder may do so because they see through that. However, if there are other pressures in people’s lives—pressures relating to relationships, family breakdown, the future, money and education—they might trigger the body image issues that push people towards having a fully-fledged eating disorder.
The other thing that surprised me is that eating disorders are on both sides of the gender divide, and they affect old and young alike—there is pressure on not just the young, but all of us. However, I want to focus most on young men such as my son, who perhaps felt under pressure to change his image.
There is the statistic that gay men are twice as likely as straight men to suffer from an eating disorder, and I can see how that could well be true. However, when we hear that the proportion of men, including young men, suffering from eating disorders could be between 11% and 25%, how can we have any confidence that those figures are accurate, given that one is more than double the other? We do not know how widespread this problem is. Gay men may be more prone to coming forward to seek help, and straight men may not seek help. I do not know, and I suspect we will not know until we do more research. However, we do know that there has been a 68% increase in 10 years in the number of men presenting with an eating disorder, and the number is still rising. We therefore need to take action.
One remark that struck me earlier was from my hon. Friend Mr Burrowes, who said that if we are not aware of a family member, a friend or a constituent with an eating disorder, we are out of touch. Well, I have to say that I probably was out of touch. I feel less out of touch now, and I am grateful to my hon. Friends for putting me back in touch, but that, I think, is one of the issues, and I referred to this earlier in an intervention. I am not sure that, as a parent, I fully understood some of the tell-tale, early-warning signs, and I do not know how we get that information across to parents, especially parents of boys.
We have to help parents accept that these problems are not their fault, and they need not to feel the guilt that is perhaps associated with this issue. They can then signpost those who are suffering towards help at an earlier stage, rather than hiding the issue from themselves because it does not fit with the way they view their family set-up.
We also need to educate young men. We need to say that eating disorders are serious and affect not only young women, but young men. If young men do not seek help, that can have ramifications for the rest of their lives. We therefore need to help them deal with any stigma that might be associated with that.
The problem, which is obviously serious, has only come to my knowledge in any great detail in the past 24 hours. The condition affects all parts of society and all ages, and crosses social divides. I hope that through debates such as this one, and awareness week, and the information that I have been provided with, we can push the agenda a little further onward, so that we can help those who are in desperate suffering, many of whom suffer in silence. I am grateful to my hon. Friend the Member for Romsey and Southampton North for obtaining the debate, and I am grateful for the opportunity to speak, and to become more informed about an important issue.
I apologise for not being here at the beginning of the debate. I was co-sponsoring the debate in the Chamber on violence against women and girls and could not be in two places at once. Like my hon. Friend Stephen Metcalfe I did not really expect to speak in the debate, but I want to pay tribute to my hon. Friend Caroline Nokes, who has not only taken a huge interest in the issue but has taken on a leadership role. She has persuaded me to out myself—but not in the way my hon. Friend the Member for South Basildon and East Thurrock might think. It was the speech that you made, Mr Walker, that inspired me to think that those of us in a leadership role who have had problems must take on the responsibility of talking about them. If we do not, people will think that we glided to the top easily and that life was easy.
I am 14 stone, but as a 17-year-old I was not. I had many issues that I did not understand, which caused me, one day, simply to stop eating. I had no support. I was at boarding school, and boarding schools in the ’70s were not exactly sympathetic to young boys who had problems. I felt, for whatever reason, under enormous pressure, and my weight plummeted to 8 stone. I did not know what was happening. All I knew was that I could not eat. I just stopped eating. A memory that has always stuck with me is being at school with a plate of food in front of me, and knowing, in my head, that I wanted to eat. I said, “I want to eat this: I know there is something wrong with me.” Intuitively, I knew that, but I could not eat. I remember taking a pea and putting it in my mouth, and simply not being able to swallow it. I want people to imagine how frightening that is. I was not hungry, but I knew I had to eat.
It was only years later that I began to understand what I was then going through, and I shall explain later how I got out of it, but it was not through the help of any outside party. I was under a huge amount of stress. I would get blinding headaches, and take aspirin to try to deal with them. That lead to addiction to the aspirin, and they did not help. I knew I was under a lot of stress because I would vomit every day. It was not bulimia. I did not have anything in me to be sick; but clearly I was under huge stress. I have five children, and thank God
nothing has gone wrong with them, but when they have stress symptoms such as tummy aches I can relate to that. I understand that the tummy ache may not be from eating something wrong, but from some sort of stress. I think that that has made me a little more empathetic as a parent.
Other factors are fear—fear of failure in school or of letting down parents, for whatever reason; relationships that do not work; and, probably, a huge amount of anger, as a teenager. For reasons that, again, I did not understand at the time, there was a lot of anger. I know no one ever saw me smile. I suspect that a strange combination of stress, fear and anger created a tipping point for me, as a 17-year-old, when I just stopped eating. The reactions were varied, and none was particularly helpful, with a lack of understanding from my school. My parents did not know what the hell was going on, but they were concerned. My mother, who is a Jewish mother, would say, “Eat, eat.” That is the Jewish mother’s solution to everything: “You must eat more”.
The problem was not what is perhaps usually the problem with many women—body image. It was something else. Clearly it was psychological, and I approach the matter very differently. It is not simply about the physical body. In my view unless the mind is healed the body will never be healed. In coming up with a solution I begin with the mind: eating was not going to work, because I had not sorted out whatever was going on up there in my mind. I did not get much sympathy from the school other than isolation and teasing from a lot of the other boys. I certainly did not have any therapy, because men in boarding schools do not have therapy. It is just not the done thing. I had to help myself.
I am aware of other stories. A girl in my constituency had huge problems, one of which was that she could not get the care she needed, because at certain times her body mass index was not quite right. I thought that was a stupid reason for not looking after her. One could tell straight away that she had a problem. It is a bit like what happens with speed bumps in the road. A lot of traffic goes up and down a road, but unless a certain number of people are killed we will not put speed bumps in it. That seems a little counter-intuitive to me. My constituent’s parents told me that her second problem was that she would go in for four or six weeks and be given a quick fix, and hey presto suddenly everything would be sort of all right. She would be fed up a bit, and her BMI would be got over whatever the magic mark is, then she would be sent back out again. That was three or four years ago—so it is a recent example of the problems and the lack of understanding of the issues.
I was lucky. Eventually, after three or four months of being able to eat hardly anything, I found one thing I could eat. If I went down to the Chinese restaurant I could eat fried rice. I found something I could start to take in. That is how I began to repair my body slightly—through an attraction, for whatever reason, to fried rice from a Chinese restaurant. However, the big positive thing for me was a change of environment. I was lucky enough to get into Harvard, and that different environment outside the UK gave me, suddenly, a lot of self-confidence. It gave me a place to go from an unhappy space in my life. Even today I probably do not understand what was going on there, but I was clearly unhappy, so moving to a more friendly space where I could almost reinvent myself helped me to get a lot better. One of the advantages
of being skinny was that when I got to Harvard—and I was very skinny—they said, “Why don’t you come and cox the Harvard crew?” I was a crewsman and coxed at 120 lb, which is the minimum weight. I was certainly the tallest cox on a national level at university. I never really found out what was going on at the time. I was lucky enough to be able to figure a way to help myself, which perhaps most people are not.
I have come up with some thoughts on what we can do for people who cannot help themselves in the way I was lucky enough to. First is education—for those in the health care profession, who I still do not think are up to speed. I get the sense that many general practitioners do not understand the issue or are not sympathetic. Teachers also need to be educated. They need to spot what is going on and to respond. Parents need to be better educated to spot what is going on, to see what the symptoms are and to try to ensure that their child, whether a boy or a girl, receives the help they need.
The problem is a mental health issue; it all starts with the mind. There are no short-term fixes. An individual needs long-term help—it is not two, four, six or eight weeks. There is no timeline to this. I appreciate that we have budget constraints, but mental health care is almost the orphan when it comes to health care in this country. There are many forms of mental illness, which we have talked about in other debates, and eating disorders are a mental health issue. I ask the Minister to look into the issue to see how we can provide more support for people.
As I said, I was lucky enough to help myself. I want to thank my hon. Friend the Member for Romsey and Southampton North for helping me come to talk to hon. Members about my experience. It is helpful that people out there know that there is life after going through something like this. I went on to be well educated; I went to Harvard and Oxford. I made some money in the City, and I am here today as a Member of Parliament. There is life after anorexia, though I would not recommend the latter. I look forward to hearing the Minister’s speech.
It is a pleasure to serve under your chairmanship, Mr Walker. I congratulate Caroline Nokes on securing this important debate, particularly as we mark eating disorders awareness week, and on the extremely powerful case that she made in opening the debate. I, too, want to commend the work of the all-party parliamentary group, because it has ensured that this debate has been incredibly well informed. The debate has provided us with an opportunity to highlight the issue not only in Parliament, but, hopefully, in the media and the wider health sector, including among national health service staff, so that we can all examine what more we can do to help those with eating disorders. I also commend the personal contribution of Mr Newmark, who showed extreme courage in sharing his experiences with us today. He has really helped to inform the debate, and I thank him for sharing those personal experiences.
I pay tribute and offer my appreciation and thanks to Beat, a national eating disorders charity, and it would be unfair not to mention also Anorexia and Bulimia
Care, and some of the other local charities that hon. Members have mentioned. According to Beat, eating disorders affect 1.6 million people in the United Kingdom, which is one in 39 people or 2.6% of the population. Statistically, that means that around 2,000 people at a top premier league club home game will have an eating disorder; 11 passengers on a jumbo jet; or more than 200,000 people here in Greater London. Therefore I am pleased that, throughout eating disorders awareness week 2013, Beat will highlight that the illnesses are far more common than perhaps most people would think or appreciate. The theme of this year’s campaign is “Everybody knows somebody”. It is a laudable aim of the campaign to encourage people to reach out to others—whether a partner, work colleague, best friend, brother or sister—to talk about the illnesses, to express their concerns and to seek help before they reach hospitalisation stage.
Eating disorders primarily affect young women aged 18 to 25, but of course not exclusively. Most people would consider them as a young girls’ disease, and there is a great deal of stigma and misunderstanding still attached to the issue. Conditions such as anorexia, bulimia, binge eating and compulsive overeating have high mortality rates for mental health illnesses. Up to 20% of those affected may die prematurely. I was interested in the contribution of my right hon. Friend Mr Howarth regarding diabulimia, which is something I was not aware of, so I thank him for sharing that with us today.
As we have also heard, an increasing number of men—some 20% of those affected—have an eating disorder. An important contribution was made by Stephen Metcalfe in highlighting that issue. However, there can also be issues with older people, particularly the elderly and frail, for whom recognising an eating disorder may be problematic. Beat is right that the problem can affect anyone at any time in their life.
The media have a central role to play in the issue and, in many ways, have a great responsibility. Some media images of excessive thinness must play a large part in encouraging, particularly, young people to aim for an unrealistic body weight and risk becoming anorexic. What has perhaps been more worrying is the recent trend in social media that could encourage eating disorders. The hon. Member for Romsey and Southampton North and others have raised that issue in their contributions. I am a father of three young children. I have two sons—one has a birthday today; he is a teenager, because he is 13—but I worry particularly about my daughter, who is 11 and very conscious of some of the unrealistic images that she gets bombarded with. It is a concern of mine, as a father, and no doubt of other hon. Members who have children. I can see how the problem could start to escalate. There were concerns earlier this year with online sites such as Instagram, which appeared to allow users to view pictures encouraging eating disorders and self-harming. According to press reports, some of the messages on the website encouraged people not to eat. That is incredibly concerning, because Instagram has more than 80 million users worldwide. The growing influence of a variety of social media and the popularity of phone apps give people, especially young people,
access to images that encourage the individual to believe that an eating disorder—we have heard this in the debate—is a lifestyle choice. Surely that is wrong, especially as the number of hospital admissions for eating disorders is growing.
A report last year from the health and social care information centre shows that the number of hospital admissions for eating disorders has risen by 16% to 2,288, a point that was eloquently made by my hon. Friend Mrs Glindon.Of those admissions, 203 were men or boys. The statistics also reveal that more than 50 under-10-year-olds were admitted to hospital with an eating problem, and the biggest increase in admissions was among girls aged 10 to 15, which are up 69% since 2011. We must recognise that social media and pro-anorexia sites can affect those who may already be vulnerable to eating disorders and who already feel pressured. I am pleased to see that there have been at least some positive changes in the media. Last year, Vogue announced that it was banning models with visible signs of eating disorders from its glossy pages, and the editor of British Vogue pledged not to use any models under the age of 16, thereby helping to project an image of healthy models.
I also notice that Channel 4, alongside other broadcasters, has actively sought to raise awareness of body image issues, including a wide range of eating disorders, among its audiences through a number of programmes and online projects such as “Gok’s Teens: The Naked Truth”, which looked at British teenagers and offered advice on how to address their issues and anxieties, focusing particularly on teens suffering from body dysmorphia and anorexia. The programme also included an examination of the impact that the media and internet can have on young people’s body image. Clearly, the more programmes in the media highlight those problems, the better the chances of eliminating stigma and increasing understanding among the wider public. Media and social media have a role to play in addressing all of those issues, and I hope that media organisations work closely with eating disorder charities to introduce more positive stories and messages.
People who are experiencing an eating disorder often feel alone and need to be provided with good advice. We need to bring an end to the stigma surrounding the condition. There is also a need for good advice for those who may be able to spot the symptoms, such as family members or teachers, so that we can ensure that people are aware of the problems. Of course, the media have an important role to play in highlighting that. The symptoms of an eating disorder include finding reasons to skip meals, avoiding family meals or expressing a wish to eat alone, being noticeably self-conscious about body image or becoming very withdrawn. Those are all known warning signs. Clearly, anything that can help to identify the risk signs and help those affected to confide in parents or teachers can only be positive. We know that the sooner people come forward, the sooner treatment can start and the better the outcomes. Of course, we should also consider how to raise awareness in the national health service and to ensure that staff know about such conditions, can identify the signs of an eating disorder and are able to offer the right treatment as early as possible. We should consider how to ensure that all health professionals are fully aware of the symptoms.
This is not the time or the place to make political points. The Minister knows the concerns of Opposition Members about the new NHS structures, but I urge him, in the spirit of co-operation—the hon. Lady made this point in her opening contribution—to ensure that the commissioners within the new NHS structures take seriously the needs of those who may be at risk from eating disorders and ensure that their needs are seen in the round, because often a holistic approach to their health care needs is required. GPs, as commissioners of services, may not always recognise the symptoms of eating disorders. People must continue to receive the help they need when they need it. My right hon. Friend the Member for Knowsley, and the hon. Lady in an intervention, mentioned the treatment of diabulimia, which starkly highlights the issue. The experience outlined by Mr Burrowes further reinforced those concerns.
I hope that when people are diagnosed with an eating disorder they get the help they need. Clearly, different people will require different treatments, and in some cases they will need access to mental health services. When Opposition Members talk about whole-person care, we mean not only the adult social care needs of the elderly but all society’s health needs. Eating disorders are an important issue that should be included within the concept of whole-person care.
There is an increasing incidence of eating disorders among men, and both men and women are influenced by what they see in the media. Indeed, as reported in the Nursing Times, NHS figures show that there has been a 66% increase in hospital admissions for male eating disorders during the past 10 years. That rise has been blamed on the increasing pressure on men to look good, with the media again having a central role. The eating disorder charity Beat has said that men’s reluctance to be open about their health is hampering efforts to address the problem. Again, I commend the hon. Member for Braintree for his contribution to today’s debate. We should bear in mind that resources and treatments for eating disorders are relevant to both male and female patients.
I have a couple of questions for the Minister, the first of which is on monitoring eating disorders. At present, as I understand it, the Government do not collate national statistics on the number of people affected by eating disorders who seek treatment. That would be a useful tool for assessing the overall need and geographical breakdown of eating disorders. What plans does he have in place to begin monitoring eating disorders? Likewise, does he plan to review the guidance on eating disorders issued by the National Institute for Health and Clinical Excellence under the previous Government?
There is overwhelmingly broad agreement on both sides of the House that identifying eating disorders as soon as possible is important and that people should receive appropriate treatment as soon as possible, too. Again, I pay tribute to the work of eating disorder charities and the all-party group on body image, which have done so much to highlight the issue. Although they have done a great deal, there is clearly so much more that society can do to take on this challenge and to ensure that we all work together to prevent more tragedies and blighted lives.
It is a pleasure to serve under your chairmanship, Mr Walker. You are an appropriate Chair for this debate because of your interest in mental health and your willingness to speak out about your own experience, which meant an enormous amount to those who are fighting the stigma of mental health problems. Indeed, my hon. Friend Mr Newmark has done the same today. Such moments, when people are willing to speak out, are incredibly important in challenging and addressing the stigma of mental health problems in society.
I am deeply grateful to the members of the Backbench Business Committee for convening this important debate. It is good that Parliament has recently been willing to debate a number of different mental health issues in a way that perhaps has not happened in the past. Mr Walker, before Christmas you raised the issue of schizophrenia, on which we had a useful debate. The great value of such debates is that they force people to think about an issue, just as my hon. Friend Stephen Metcalfe has today. His experience of recognising the problem, perhaps for the first time, and talking about it with his children demonstrates the great value of such occasions, because they force all of us to think about an issue. Indeed, they force officials in my Department to think about the issue, too. I am grateful.
I do not want to detain everybody unnecessarily, but I will devote a little time to responding to the specific issues that hon. Members have raised. If Caroline Nokes does not mind, I will refer first to the speech by my hon. Friend the Member for Braintree. I am so grateful that she persuaded him to come speak in this debate, because he made an incredibly valuable contribution. I was struck by his remarks about the huge stress experienced by teenagers. As the father of two boys who have been through the teenage years, I am acutely aware of the pressure on teenagers and the impact that it can have on their mental and physical health. He discussed huge stress, fear of failure and anger. I was struck by what he said: unless the mind is healed, the body cannot heal. We must look at the problem holistically.
One problem with health care is that we have institutionalised fragmentation. We have managed to separate mental health from physical health, which is ultimately not a good thing. We must consider the whole person. I know that the Opposition have been talking about that. It should not be an issue for political disagreement; it is such an obvious thing to recognise.
My hon. Friend the Member for Braintree discussed the need for education and raising awareness, including among parents. The strain, stress and anxiety that parents go through must not be underestimated. Improved awareness is needed in society of this range of conditions. He said that mental health care was the orphan within the NHS, which is absolutely true. There is an institutional bias against mental health. The way that money flows within the NHS disadvantages mental health. There is an 18-week target for physical health care and a tariff, meaning that every patient takes money with them into acute hospitals. Money is sucked through into acute hospitals, and there is great political pressure from every side to maintain the 18-week target. There is no
equivalent in mental health. There is no right of access. Waiting nine months to access care and treatment is completely unacceptable. We must challenge that, and he was absolutely right to raise it. He ended on a positive note. There can be life after anorexia, however tough it is to get through it. Some, terribly sadly, do not. I will return to that point in a moment.
The hon. Member for Romsey and Southampton North made some incredibly important points. She mentioned her local organisation, April House in Southampton, and the fantastic work that it does, and she spoke about the absolute importance of raising awareness in primary care. Some people are lucky enough to find a GP who understands mental health and is passionate about it, but some are not. Families with a GP who just does not get it can be desperate; they have nowhere to turn. There is a need to raise awareness.
In the first mandate, a set of priorities published by the Government for the new NHS Commissioning Board, mental health has been given a higher priority than it has ever had in the NHS. The mandate makes it clear that the NHS is under a legal obligation to deliver demonstrable progress towards parity of esteem by 2015. That means treating mental health on a par with physical health. By placing the commissioning board under that obligation and disseminating the message to clinical commissioning groups, we will start to make progress on forcing the system to recognise the importance of treating mental health and physical health equally. It will not happen overnight, but it is a journey that we must take to improve the condition of many people. The hon. Lady discussed the impact on families and the unfair sense of guilt that many experience. She also mentioned waiting times, which in many cases are simply unacceptable.
I am grateful to Mr Howarth for his contribution informing me and others about diabulimia. He discussed the rapid weight loss that can occur with diabetes, and how some people use the condition to lose weight in a dangerous way. He also said that in too many cases, a wrong diagnosis is made and the wrong treatment given as a result, and urged me to ensure that the condition was recognised better at a national level and the knowledge disseminated through the system. I urge him to engage with the commissioning board. I am happy to work with him on that, and for him to write to me on the issue.
I am grateful to the Minister for the helpful way that he is addressing the problem. I have written to one of his ministerial colleagues on the matter. I arranged a meeting with her that she had to cancel due to diary commitments, but I would be more than happy to meet with him and anybody else he wants, including Diabetes UK and Diabetics with Eating Disorders. I am sure they would be happy to accompany me.
I am nervous about treading on other ministerial toes, but I am sure that in one way or another we can get the issue addressed properly. I am grateful to the right hon. Gentleman for informing me so well.
Heather Wheeler made a helpful contribution and discussed the need to raise awareness of eating disorders. She mentioned personal, social, health and economic education in schools. All schools are encouraged to provide young people with good, age-appropriate education about sex and relationships, but we are reviewing PSHE to establish how teaching can be improved. There is clearly a need to improve the teaching in many schools.
Mrs Glindon mentioned her local service, NIWE, and the important work that it is doing. She spoke about the number of people who are not diagnosed but who none the less suffer from eating disorders, and about the fact that they have the highest mortality rate of any mental illness. She said that early intervention was important.
I was struck by what the hon. Lady said about recovery groups. This morning I spoke at a conference on mental health. I spoke specifically about recovery and a new way of looking at mental health. We must move from trying simply to treat the condition to working collaboratively with professionals and people experiencing the condition, and we must focus on recovery. Fantastic results are being demonstrated from that shift in approach. It is frustrating that in some parts of the country, great things are happening, but it is patchy, as many hon. Members have said, and improvement is needed. She also made the point that mental health is the poor relation, as I have acknowledged. That must change.
I pay tribute to Mr Burrowes, who has had to leave, for the work that he has done on addictions, focusing on treatment and recovery. He has been committed to improving the experience of people suffering from a range of addictions. He, like other Members, discussed the growing prevalence of the condition among teenage boys, which should worry us all. My hon. Friend Tessa Munt spoke movingly. She mentioned the cult of celebrity, pressure on youngsters, variability of services around the country and access to those, the quality of care being variable and the need for much improved training and for multidisciplinary teams.
Interestingly, my hon. Friend mentioned issues of consent, a difficult area about which there are strong views on both sides. I am acutely aware of the horrible position of a parent wanting to help, but being unable to because of the legal constraints that prevent them from making an effective intervention. We need to think more about that, and the Children’s Minister is also involved in the discussion.
My hon. Friend the Member for South Basildon and East Thurrock got it right. Fascinatingly, he talked about his discussion with his children last night. I am so pleased that his television is broken, because it has led to our being given a valuable insight that we might otherwise not have had. He mentioned the increasing prevalence among males, including among gay men, which is a real concern. He also talked about the need for help for parents in understanding the condition much better.
The shadow Minister, Andrew Gwynne, was right to talk about holistic care and the need to look at the whole individual. I will mention other things that he said as I go through my speech. I wish his son a happy birthday today, as he enters his teenage years.
The hon. Gentleman asked a couple of questions. On collating national statistics, we have a long way to go on the collection and interpretation of data relating to mental health. I have a fortnightly meeting on mental health in my office, so that we maintain an absolute focus on achieving tangible improvements. We talked specifically about data yesterday. The Health and Social Care Information Centre is getting more data but is not yet able, with the resources available, to interpret those. I want the same resources applied to mental health as to physical health. That is a challenge that I have made to the system.
The hon. Gentleman mentioned National Institute for Health and Clinical Excellence guidance. NICE is independent. I do not know whether there is a need for a review—a renewal—of the advice. I am happy to talk further to him about that.
This is an occasion on which we should not just raise awareness of the issue as part of eating disorders awareness week, but send a clear message to people with eating disorders, their loved ones and families: we hear you when you talk about your concerns. I am determined, as the Minister responsible for mental health, to do what I can to help.
I pay tribute to the work of Beat, based in Norwich in my county of Norfolk, which does brilliant work. Hon. Members have also mentioned Anorexia and Bulimia Care and the fantastic work that it does.
Eating disorders can be tremendously dangerous and damaging conditions. The UK has the highest rates of eating disorders in Europe. But it is a disease that is often hidden, as hon. Members have said. Sufferers are often unwilling to seek help or to recognise they have a problem. Reported cases are the tip of the iceberg. It is a disease that often strikes at the young. In 2009, the adult psychiatric morbidity survey showed that 20% of 16 to 25-year-olds admitted to having “a problem with food”. That is a significant percentage.
According to the Health and Social Care Information Centre, in 2011-12 the biggest increase in hospital admissions for eating disorders was among girls aged 10 to 15. The shadow Minister, the hon. Member for Denton and Reddish, mentioned admissions of those under 10, as well—shockingly, more than 50 children under 10 were also admitted.
I apologise for not attending earlier, Mr Walker; I was in another debate in the main Chamber. I congratulate Caroline Nokes on securing this debate.
The Minister mentioned young people. Will he say what services are available for 17-year-olds in terms of continuity of care, as they move to adult services?
I will talk about that later. In so many respects, we have problems with people falling through the gap between children and adolescent mental health services and adult services, and that is matched in other areas, as well. There is a need to deal with this. The draft Care and Support Bill deals with the transition from teenage to adult services. I will return to that matter. I thank the hon. Lady for her intervention.
A generation of young people is growing up depressed and unhappy with their relationship with food. I want to tell hon. Members about a case in my constituency. Charlotte Robinson was a bright, outgoing young woman
who was about to secure straight As at A-level and had dreams of going to Cambridge—between Duke of Edinburgh’s awards and learning to fly helicopters—but tragically, Charlotte was a victim of anorexia, stolen from her family in her prime, with her whole life ahead of her. That is what I meant when I said that for some, thankfully, there is life after anorexia—but not for everyone.
Charlotte’s parents, Christopher and Pauline, who are remarkable people, have campaigned tirelessly to help others. Pauline even ran the London marathon in pink wellies, such is her commitment. They are fantastic people and their attitude was that they did not want other families to experience the same horror that they have gone through, so they have been determined to change things in their county of Norfolk. They discovered that there was no specialist commissioned service at all in their own county. This is what we find. Hon. Members have talked about the enormous gaps in services around the country.
As a result of Christopher’s and Pauline’s fantastic determination, there is now a specialist commissioned service, but it took their efforts to achieve it. Their efforts have helped to fund local centres and a helpline in Norfolk, working with NHS Norfolk and the charity Beat, which I have mentioned. Their focus is on early intervention, helping people like Charlotte—helping children, young people and adults as soon as they need help. Charlotte’s decline was dramatic and rapid and the wait, although nothing like the nine months that we have heard about, still was too long for her.
Speedy access and early intervention are critical. That is why our mental health strategy prioritises early intervention and demonstrates how timely action can help.
In many cases, eating disorders stem from low self-esteem or are linked to stress and emotional problems. That is why our support for local organisations in improving mental health services locally is so important. Our mental health and suicide-prevention strategies both include actions that local organisations can take to improve mental health in their areas: ensuring that children and parents get mental health support from birth; that schools and colleges promote good mental health, alongside targeted support for those at risk of mental health problems; that public services recognise people, of all ages, at risk of mental health problems and take appropriate, timely action; and that health services step in early if there is psychosis or a crisis, to stop more serious problems occurring.
The right hon. Member for Knowsley and my hon. Friend the Member for Romsey and Southampton North raised the problem of transition—moving from being a young teenager at home to a young adult. Often the problem is exacerbated by moving to university, where people suddenly lose contact with services that might have been available to them at home. As my hon. Friend mentioned specifically, that is where things can break down. Away from friends and family, in a new and often stressful environment and, crucially, registering with a new GP, young people can often enter a spiral of decline. The problem must be addressed.
I will now outline some of our ambitions for services. From this April, the NHS Commissioning Board will commission specialist services for eating disorders for adults and children. Having one specialist
group to ensure that specialist services are commissioned everywhere has the potential to improve the position in many parts of the country where such services are inadequate or missing. The Commissioning Board will develop a national service specification and encourage better planning, access and outcomes, helping to bridge the gap when someone moves and raising the level of care throughout the country.
We want clinical commissioning groups to commission services with early intervention in mind. We also expect adult social services to work alongside CCGs to focus existing support on early intervention, integration, personalisation and recovery. Social services have a role to play, involving service users as equal partners in commissioning and monitoring services, ensuring that services are designed for the people who use them.
Public health services can articulate the many benefits of good mental health and, because of their pivotal role in the new system, they can talk about mental health directly with members of the public. The transfer of public health to local government, alongside children’s services, social care and other services, with a seat on the health and wellbeing board, potentially gives it a prominence that it has not had in the past. The funding settlement for public health has also surprised many people, with significant real-terms increases this year and next. There is great potential for a focus on public mental health in a way that we have not had in the past, so I hope that we can take advantage in the best possible way of that opportunity.
Of course, the problem cannot be fixed by tweaking the system. A huge stigma remains around mental health, which means that in too many cases children and young people are not getting the support that they need. That is particularly the case with eating disorders, and people affected often feel marginalised and excluded, unable to talk about their suffering. The problems can be compounded if the sufferer is a man or suffering from a less stereotypical but no less serious eating disorder, such as atypical anorexia or a binge-eating disorder. Personal testimony and the courage of individuals in speaking out send a powerful message, and challenge that stigma.
The Department of Health is therefore funding Time to Change, a brilliant campaign that was started under the previous Government but continues now. We are providing £16 million between 2011-12 and 2014-15, the first time that Time to Change has had central Government funding. It will also get a further £4 million from Comic Relief, the second time that that charity has awarded its largest UK grant to Time to Change. Run by the charities Mind and Rethink Mental Illness, Time to Change is England’s most ambitious programme to end the stigma and the discrimination against mental health through activities ranging from education to publicity. It aims to reach 29 million members of the public, explaining mental health and helping them to understand conditions, including eating disorders, that might at first seem alien or scary.
I was delighted that two young women from Time to Change came into the Department of Health recently to speak about their own experiences of mental health. They spoke about how talking about their own mental health had empowered them. One said that it had,
“given me my life back”. Their stories were both moving and inspiring and I pay tribute to all those who find the courage to open up and to talk to others. Time to Change aims to increase the confidence of 100,000 people with mental health problems, helping to give them the self-belief that they need to recover.
The Time to Change campaign also works with schools to support children and young people facing problems of integration and bullying that can be caused by mental health issues. I have not only signed up to committing the Department of Health to be an exemplar employer on mental health, but made the commitment to try to get every other Department to sign up as well. We cannot encourage others to behave in the right way unless we practice what we preach. That is a challenge for Government, and I have not yet achieved that aim, but I am determined to pursue it.
The reasons for eating disorders are complex, as has been made clear in the debate this afternoon. Biology and genetics play their part, but so too does the pressure from our celebrity culture and the media. A recent controversy ignited by stick-thin La Perla lingerie models erupted only last week, and it is important to send out the message that organisations that do this sort of advertising have a responsibility; they cannot opt out. Government cannot do everything on its own. Everyone in society has a responsibility to get the right messages out. I was pleased to hear the shadow Minister’s reference to Vogue, which has made a good commitment to avoid getting out the wrong images.
This is an important point. Last week, we had a controversy about La Perla using stick-thin models for its lingerie but, before Christmas, Marks & Spencer used some “larger ladies” in lingerie advertising. Some of them were almost a size 12. What would the Minister say to those in the health care professions who cited that advert as Marks & Spencer promoting and celebrating obesity?
I take the point and I am grateful to my hon. Friend for that intervention. We have to think before we speak on these things, to ensure that we do not send out confusing messages. There is a problem of obesity in our society and it is causing serious concerns about a drift towards type 2 diabetes and a whole series of health consequences, but let us be balanced in what we say and not confuse youngsters in such an unhelpful way. In the compelling words of Marya Hornbacher, in her memoir of anorexia and bulimia, we are “turning skeletons into goddesses” and teaching our children and impressionable young people to hate their own bodies. That is why I am so grateful to my hon. Friend the Member for Romsey and Southampton North and members of the all-party group on body image for their tireless work in addressing the causes and consequences of body image anxiety. Through the Government Equalities Office, the coalition Government are conducting our own body confidence campaign, with three main aims: to raise awareness about body image and encourage a more open and public conversation; to promote a world where all healthy body shapes are represented, and people recognise that their value is far more than merely their physical appearance; and to widen the definition of beauty to include all ages, ethnicities and healthy sizes.
Pro-anorexia and pro-bulimia websites, which were mentioned by the shadow Minister, my hon. Friend the Member for Romsey and Southampton North and others, have grown significantly in recent years and are represented on sites such as Facebook. They do not cause eating disorders, but they play a significant role in exacerbating and reinforcing illness. Limited research is available, but what there is shows us that a significant number of teenage girls in particular visit such sites, including a substantial proportion of young people who already have an eating disorder. Disturbingly, nearly all of them report learning new weight-loss techniques from the sites. I am extremely concerned about those sites but cannot take legal action against them as they are not in themselves illegal and might also be hosted overseas, but we continue to explore other, non-legislative courses of action. For example, we recently worked with a media agency to run advertisements directing youngsters to more appropriate sites, because there is much good information out there on the internet, as well as dangerous sites.
A couple of weeks ago, I met security companies such as McAfee and Symantec, and urged them to work with groups such as the Samaritans, Beat and BeatBullying, as well as internet service providers, and to sign up to a concordat, speeding up the reporting of harmful content and blocking harmful websites. They told me they would explore such a concordat. In turn, the Government would be willing to facilitate and support such an initiative in any way we can.
We cannot place all the blame at the feet of the media. That would dramatically underestimate the scale and nature of the problem, but it is something we must challenge. Education and early intervention, keeping an eye out for symptoms, and providing relevant support are simple things that can dramatically increase the chances of recovery.
Sufferers have asked us to listen. My message to them is that we are listening. As I said, I have had personal experience from my work in Norfolk of the horror of this condition and its impact on families. While I am in this job, I want to do everything I can to help others to address this very serious problem and to improve the lives of those who are affected by it.
I welcome the opportunity to summarise briefly. We have had a full and interesting debate. I pay particular tribute to my hon. Friend Mr Newmark.
I am trying to send him to a different part of the country. Everywhere in Essex begins with B. His contribution was fantastically personal and moving. I am convinced that many other hon. Members in the House have had personal experience of eating disorders in their families or personally, and we must, as the Minister said, take such disorders more seriously. I was delighted to hear his words this afternoon about his personal commitment while he remains in his job—long may that be so.
I thank all hon. Members who spoke. Many were unable to be here for the full time, but they came and went. Two important debates are taking place in the House this afternoon, which were also granted by the Backbench Business Committee, so I am conscious that we have been competing with others for parliamentary time and attention. I want to take this opportunity to reiterate some of the key points that we have made.
There must be continuity of care. We heard the important point about the transition from child services to adult services, and how some sufferers can fall through the gap. Equally, that transition, whether from school to college or college to university, may be a tipping point for those who suffer eating disorders when they need continuity of care. My strong argument to the Minister is that there must be flexibility in both specialist services and GP services so that if a young person moves away to university, there is joined-up thinking and treatment, and no moment of crisis when a young person does not get the care they need.
We have heard from hon. Members about the impact of eating disorders on male sufferers. They are the fastest-growing group, but that does not detract from the fact that clearly the majority of sufferers are women, and the vast majority are young women.
One stark statistic that I want to close on is that 20% of anorexia nervosa sufferers die from that condition. We must do more to ensure early intervention so that that number falls.
I thank the Minister for his time, and you, Mr Walker, for chairing the debate. I also thank all hon. Members who took part this afternoon.
Thank you, colleagues, for such an informative debate, which was Parliament at its very best.
Question put and agreed to.