Body Image and Mental Health

Exiting the European Union (Transport) – in the House of Commons at 2:17 pm on 23rd July 2019.

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Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care 2:17 pm, 23rd July 2019

I beg to move,

That this House
has considered body image and mental health.

I am delighted to open this debate on this very important matter about which a number of parliamentary colleagues are showing increasing concern. How we think and feel about our bodies can affect any one of us at any point in our lives. I am sure I am not alone in not liking my body shape and in wanting to lose more weight. Frankly, we know there is no magic route to that. We just need to eat less and drink more—[Laughter.] I should say: eat less, drink less and exercise more. Too often, however, people are seduced into seeking body shapes that are less than attainable. While for most of us that is an aspiration, for some people it becomes uncomfortable and an obsession that does them no good.

This is a particular issue today, because the pressure on people, especially young people, to achieve an idealised image is everywhere. Often, the images that people are being subjected to are unattainable because those images have been airbrushed and touched up. Those shapes are really not what any normal person could begin to achieve.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

The Minister is quite right. Some of the television reality shows today put pressure on young people, particularly young girls, to imitate shapes, weight and size, and all that goes with that. This is a timely debate and we need to have a good look at this issue. At the end of the day, young people get very disappointed and that can have an effect on their mental health. That is the important point we should not lose track of.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

The hon. Gentleman raises an issue close to my heart. When we talk about so-called reality TV programmes, it is as if the people participating in them are normal people. The reality, however, is that they are not normal people. They are semi-professional celebrities who have often undergone enhancements to become attractive to be chosen to go on these television programmes. The whole thing starts to develop insidiously in a culture, making people think that they should aspire to look like that and that it is normal. Everyone is chasing a lifestyle that is frankly not attainable.

We have all enjoyed watching such programmes. I often say that we have become a nation of voyeurs, but perhaps we all need to remind society that there is no quick route to fame, fortune and success—that comes as a result of hard work—and that spending a bit of money on a nip and tuck and a lip filler will not be the route to earning a lot of money. We all need to start to address that, because we have allowed magazines and our media to develop this image. We have been complicit in it happening, because we have enjoyed that entertainment, but we are reaching a position where our society is extremely unhealthy.

The problem has been made particularly acute by the growth of social and digital media, which have increased exposure to unrealistic and unattainable images of beauty. As we all know, when we are browsing on our iPad we can look at one thing and straight away be bombarded with sites that squirrel us down a route where we are exposed to more and more such content. People who are looking at unrealistic body images will see ever more images that they aspire to. There is another insidious thing: a friend of mine was speaking to me only last night and said that she was looking at cosmetic procedures when, all of a sudden, an advert popped on to her screen encouraging her to spend a few thousand pounds so that she could learn to administer lip fillers herself. She thought how horrendous it is that our social media does that.

Photo of Mary Glindon Mary Glindon Shadow Minister (Environment, Food and Rural Affairs) (Farming and Rural Communities)

Is the Minister aware of the Be Real campaign’s latest report, “The Curate Escape”, which looks at young people and their images on social media? Two thirds of young people edit pictures of themselves before they put them on social media, and the report makes a lot of really good recommendations. The Be Real campaign has been fantastic in recent years, focusing on health and wellbeing, rather than weight and people watching their weight. If she is not aware of the report, would she like a copy?

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

I thank the hon. Lady for raising that point—I have heard of that campaign. It is disturbing that so many people alter their images. None of us is perfect—God help us if we all were—but for people to think that they need to alter their appearance because they are unhappy with it, and for that to become normalised, is quite a sinister development in society. At the risk of being trite, perhaps we should be telling everyone to learn to love themselves.

Photo of Bambos Charalambous Bambos Charalambous Labour, Enfield, Southgate

Is the Minister aware of the Good Childhood report, which states that girls who share pictures or videos of themselves are less happy with their appearance than those who do not? Is she aware that the Children’s Society are campaigning for a greater understanding of what makes children unhappy, and does she agree that we need to focus on that?

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

Yes. The Children’s Society is doing some excellent work in this space and it always has a lot of expertise to share. We have to address this issue collectively as a society, because if we do not start equipping children with the tools to look after themselves and the right attitudes, that damage is set up for life. The hon. Gentleman is absolutely right to raise that point and I encourage the Children’s Society to engage with us more on what we can do to support it.

The Government recognise that poor body image is a common problem. Approximately 70% of adolescent girls and 45% of adolescent boys want to change their body weight or shape. We also recognise the impact that idealised body image can have on lesbian, gay, bisexual, and transgender people particularly, on ethnic minorities, and on those with disabilities or serious illnesses.

The Mental Health Foundation recently published a very informative report on body image. Some of its findings are shocking: 20% of adults feel shame, 19% feel disgusted, and 37% of teenagers feel shame in relation to their body image. This should make us all stop and think. When it comes to teenagers, we all recognise that going through adolescence is a difficult time, when we are at our most vulnerable, including to the outside influences that tell us that our body shape is not as it should be and that we are not as perfect as we could be. I welcome the recommendations made in the foundation’s report, which is aimed at public and commercial organisations and gives us things that we can do to help ourselves.

Having a negative body image affects the way that we feel about ourselves and it can affect people’s aspirations and confidence. In the most extreme cases, it can lead to eating disorders, depression and even feeling suicidal. I know that Paula Sherriff is as concerned as I am about this issue, and I commend the work that she has been doing specifically on eating disorders. The increases that we are seeing in suicide and self-harm among young people are incredibly worrying. Much of this is being driven by young women and girls, but we must not forget the boys either. It is important that we work to raise awareness of the problems of body image that many people face and hopefully prevent them from developing issues in future.

Clearly, social and digital media companies are key players in this debate, because they contribute to the volume of material that encourages people to think negatively about themselves. Young people are put under such pressure to have the perfect image, the perfect body, the perfect relationship and the perfect clothes—the perfect everything—and that places unrealistic expectations on them. As hon. Members will know, we are in close dialogue with social media companies to encourage them to act more responsibly over the content on their platforms. We have held three summits so far; the most recent was only last week. We have said that, ultimately, we will consider legislation if they do not clean up their act. That said, Governments can always be three steps behind the development of technology, so I would much rather that we worked collaboratively and co-operatively to address this content.

So far, I have been encouraged that the companies have committed to increasing their efforts to protect users from harmful suicidal and self-harm content online by coming together to establish and fund a strategic partnership with the Samaritans. That work is commencing. They will look not only at self-harm and suicide, but at pro-eating disorder content. We will continue our meetings with social media companies.

I was particularly concerned to see that a number of sites and materials are available that contain harmful content such as pro-anorexia messages. It is completely unacceptable that this sort of content is easily accessible to vulnerable young people. We are having talks with Amazon about removing books from its retail sites, but we need to ensure that social media companies are vigilant about taking down content published on their sites as well.

In the face of these modern challenges, central to tackling the problems in future is empowering our young people to improve their emotional resilience and wellbeing, so that they feel confident in themselves and in seeking support if they feel they need it. We are investing in massive improvements in mental health provision in schools. We have a new workforce that we are rolling out. We also need to make sure that children can access mental health support and we are investing in more provision in child and adolescent mental health services. As part of making health education compulsory in schools from September next year, it will be absolutely essential that we teach children how to protect their mental wellbeing. That will cover unrealistic expectations about body image. I hope that that will allow young people to recognise what is normal—what is normal, and is there any such thing as normal?—and what is an issue for them and others, as well as to know how to seek the right support when issues arise and to know that it is accessible to them.

Another issue I would like to talk about is gender identity, which has been the subject of quite a number of negative reports in our newspapers in recent months and, indeed, on Radio 4 this week. This is about people’s sense of self and physical appearance and about them wanting to change their gender identity. We have been aware of the issue of gender dysphoria, but there has been quite a lot of comment, and the House and the public need reassurance that the treatments available on the NHS, particularly for children, are appropriate.

To put the issue in context, gender dysphoria is where a person experiences discomfort or distress because there is a mismatch between their biological sex and their gender identity. That is incredibly difficult for anyone to deal with, but young people, in particular, will find it difficult. Many Members will have had representations from constituents about access to services to cope with gender dysphoria—I know that because I have signed many letters on the issue. It is essential that someone suffering with gender dysphoria receives the right support—support that really considers their holistic needs—because gender dysphoria often exists alongside other morbidities, and we must make sure we treat the whole person. Where appropriate, people should receive specialist treatment.

The Gender Identity Development Service for children and young people is provided by the Tavistock and Portman NHS Foundation Trust. There has been lots of concern in the press about that trust, but having discussed the service with NHS England and visited it, I would like to try to give Members some reassurance and to address some of the points that have been made about the service.

The first thing I think the service would like to get across is that gender should be seen as a spectrum. The whole treatment pathway is based on allowing children to explore their feelings in a safe environment. Not all children referred to the service will go on to transition. That is an important point to recognise, because if children have the time and space to work through their feelings, that will perhaps lead to a different treatment pathway.

I know there has been lots of concern that too many children are being referred to the service, but I would like to reassure the House that the service takes children through treatment in a very exploratory way around gender, and more than half of the children referred do not go on to transition. The service will treat each case as individual and complex and will address some of the co-morbidities that come along with gender dysphoria—lots of concern has been raised about the fact that some of these children are also on the autism spectrum.

It is important to recognise that, compared with services internationally, the service is very much at the conservative end of provision, which has led to it being criticised as far too conservative by some aspects of the lobby in favour of more services. However, where we are dealing with children who have not reached the age of majority, and where some of the treatments they may go through may be irreversible, the whole issue of consent is clearly important.

It is important to note that this aspect of service has grown quickly, and it has done so in an absence of public scrutiny. I can understand why there will be some public concern about it, so I would like to reassure the House that I am working with NHS England to do a proper review of the research around this service and the ethics of it to establish a proper framework for consent, recognising that we are looking at treatments that may have long-term consequences.

I can assure the House that the service works hard to ensure that consent is robust and that young people who might receive hormone therapy receive adequate information about the nature and consequences of that treatment. Such consent is not a one-off decision; it requires ongoing dialogue with the service. It will also require some assessment of the capacity and competence of the individuals consenting.

It is important to assure the House that this issue is very much under review. My starting point is that nothing should be undertaken in this space that would be irreversible for anyone under the age of 18. With that in mind, NHS England is putting in place a new policy and a new service specification for children’s services, and will thoroughly consider the issues that have come up in the press recently. Clearly, those issues will be a matter for debate, and many Members will have an interest in them. It is important for public confidence, as well as to enable access to services, that we have a proper, ethical debate around consent and the clinical evidence behind prescribing long-term hormone treatments.

Finally, I want to say a little about cosmetic procedures and regulation. I am pleased to see the right hon. Member for North Durham in his place—he is my conscience on these issues. It is fair to say that they are becoming increasingly common, and as they do so, they are becoming increasingly risky. Increasingly, it is becoming normalised for young women, in particular, but not just young women, to seek cosmetic procedures to alter their appearance.

I was pleased to launch an awareness campaign around cosmetic procedures earlier this year, which I have driven forward to make sure not only that we encourage people to properly consider the risks of any procedure they might undertake, but that they do not just wander down to the hairdressers and book a Botox appointment or a filler but really take steps to make sure they are going to a reputable provider. It is important that people fully understand the risks and where to look for a safe procedure. We have made sure that there is good material on the NHS website, and we are encouraging people to access that information when they are considering having any kind of procedure.

However, there is a really important message that we must give, which is that anyone considering having anything done to their appearance should not seek an operation overseas. There are some very disreputable operators advertising—for example, there are holidays in Turkey with a procedure. That is hugely dangerous, and I am afraid that the NHS is picking up the costs of those procedures. That is obviously something we need to address properly.

We will look at stronger regulation of the sector. Again, I would say that no one under the age of 18 should seek a cosmetic procedure. We have come to think that having some kind of lip filler is just like going to have a haircut, but when it goes wrong the results are much worse than having to let our hair grow back. Therefore, no one under the age of 18 should be seeking such procedures, and we need to do a lot more to make people realise exactly what the risks are.

Photo of Bambos Charalambous Bambos Charalambous Labour, Enfield, Southgate

Obviously, the harm is done with young people early on, and they are very impressionable—we have mentioned reality TV, and the Digital, Culture, Media and Sport Committee is looking at its impact. Does the Minister not think that we should try to teach positive body image at school and provide support at school for people who have concerns about their body image? That would be a wise investment of Government funds and would actually help young people to address their concerns and anxieties at every stage.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

I agree with that. Through the new personal education that will be rolled out next year, we will have the ability to address that issue. I would just say that we need to be careful about this and to give some scrutiny to what the content of that might be. We have to really make sure that people respect the fact that we are all different and we all come in odd shapes and sizes, but everyone is beautiful. That is a really important message to convey. It will be incredibly challenging to get that content right, and we do need to bring some scrutiny to that.

Body image is clearly a strong contributory factor in many cases of mental ill health. I am pleased that we are starting to tackle some of these issues, but there is a long way to go. We have reached a stage at which the herd has gone so far down the road that the idealised view that everyone is a size zero model whose perfectly coiffed, long, naturally blonde or brunette hair has no shades of grey and no curls has taken hold. It will take a long time to turn that juggernaut around, but in the interests of a healthy society we all need to get a grip.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Mental Health and Social Care), Shadow Minister (Mental Health) 2:40 pm, 23rd July 2019

Let me start by welcoming the Minister to the Front Bench. I am glad that she is still in her post, and I sincerely hope that this is not her last appearance at the Dispatch Box in her current role. She has been collegiate, engaging and very co-operative, and I thank her for her kind words about eating disorders. I agree with most of what she has said this afternoon.

Body image” is the term that is used to describe the way we think and feel about our bodies, which can have an impact on us throughout our lives and cause poor mental health and a lack of wellbeing. While the association between body image concerns and poor mental health is definitely not new—we have been discussing it for decades, and I am sure that we will still be discussing it for decades to come—I think it is fair to say that the problem is worse now than it was just 10 years ago. There is a far greater exposure to the media and to social media, and there is also our need to have everything, right here and right now, in the impatient and judgmental world in which we live. As the Minister said a few moments ago, we still have a long way to go in tackling this issue. Would it not be great if we recognised that, literally, one size does not fit all?

Body image concerns are extremely common, and vary in severity. Not all body image issues will affect mental health. However, it is important to be aware of the risk factor, especially among young people, as the risk of developing an eating disorder is closely associated with poor body image. The Mental Health Foundation has undertaken a great deal of research in this area, and recently conducted a survey of 4,505 UK adults aged 18 and above and 1,118 UK teenagers aged between 13 and 19. The results showed that one in five adults felt shame about their body image, 34% felt down or low, and 19% said that they had felt disgusted because of their body image in the last year, with 13% saying, very worryingly, that they had experienced suicidal thoughts and feelings. The survey of teenagers revealed that 37% felt upset and 31% felt ashamed in relation to their body image.

Perhaps more worrying are the results from Be Real’s Somebody Like Me campaign. The researchers spoke to more than 2,000 secondary school pupils aged 11 to 16 from across the UK, and found that 52% regularly worried about how they looked, 30% isolated themselves because of body image anxiety, and 36% said that they would do “whatever it takes” to look good, including considering cosmetic surgery. Similarly, 10% of boys surveyed by the Mental Health Foundation said that they would consider taking steroids to achieve their goals.

As the Minister said earlier, we must recognise that body image challenges affect boys as well as girls, and men as well as women. Unfortunately, my hon. Friend Chris Evans is not present, but he has previously spoken powerfully about the body image challenges that he faced as a younger man, and I think that he is a great ambassador for this issue.

It is a shame that more Members on both sides of the House are not present for such an important debate. I understand the significance of today and the fact that other things are obviously going on, but for the benefit of those who are watching in the Public Gallery and others who may be watching at home, I want to reiterate my support, and that of the Minister and other Members in relation to this issue.

The shocking statistics that I have cited highlight the need for more support and help. Perhaps most worrying is the finding that a desire for the option of cosmetic surgery appears to be more and more widespread. I welcome what the Minister said about the need for stronger regulation, because cosmetic surgery has almost become normalised. Many of my friends have lip fillers and Botox treatments. I have not succumbed to either as yet, but people are now moving away from breast augmentation and talking of “bum lifts” and “Brazilian bums”.

A young and beautiful lady from a constituency not a million miles from mine, in Leeds, went to Turkey—last year, I believe—to undergo one of those procedures, which involves the injection of fat into the bum. I am not sure whether that is parliamentary language, Madam Deputy Speaker. She was a mum of three beautiful boys, and she never came home. She died during the procedure. I understand that inquiries may well be pending in that case, but it is very worrying that people are going overseas to seek cheaper treatments when there may be issues relating to, for instance, regulation.

Given mainstream television programmes such as “Love Island”, which shows girls as young as 21 who have already undergone plastic and cosmetic surgery, it is hardly surprising that those who watch such programmes aspire to the same treatments. The same applies to tanning salons. In those reality programmes, everyone is bronzed and slim, and the people watching think. “I want to go to one of those.” It is very worrying, partly because some of the less scrupulous tanning salons do not necessarily follow the regulations that are so important to avoiding skin cancer.

It has been widely accepted in many different body image studies that those who are most at risk of developing mental health problems associated with poor body image are women and members of the LGBT community, but, as has already been pointed out today, that does not mean that we should dismiss the incidence of such problems among other groups, although they are not as prevalent. There is no group of people who have not been identified as having certain risk factors or anxieties associated with how they view their body image.

Airbrushed photos have appeared for decades in the media, from the early glossy magazines such as “Just 17” in the 1980s to the internet today. Throughout the internet, images are portrayed that invade people’s lives daily. Indeed, when undertaking research on this subject, I found that the search results on the internet were not giving information about the history of airbrushing, but were offering tips and trying to sell software enabling people to airbrush their own photographs. It should come as no surprise that the increased number of airbrushed images across the internet that are accessible to millions of young people have played a part in the huge increase in the number of people suffering from body-image anxieties in recent years.

During the Minister’s speech, my hon. Friend Mrs Hodgson and I were looking at an internet picture of Serena Williams, the famous and phenomenal tennis player. She recently appeared on the front page of “Harper’s Bazaar”, and had specified that she did not want the images to be airbrushed. I should add that those images were themselves phenomenal. It was a great lesson, and I hope that other celebrities will consider doing the same. Some have had their pictures taken make-up free, which is also a great thing to do.

We have also seen an increase in the number of television programmes that heavily promote the idea of a “perfect body type”. As I said earlier, “Love Island” is probably the most topical and talked-about programme of the moment. It focuses primarily on young men and women, all of whom can only be described as nothing less than beautiful. Even the show’s host allegedly admitted in 2017 that it portrayed unrealistic body image standards, and, at the start of the current season, Twitter was alight with comments from viewers about how inadequate the contestants were making them feel. I understand that a “plus size” person has featured in the programme this year. I have to say that I have never watched it—my research evidence comes from the internet, and from friends and, dare I say, staff members who do watch it—but I understand that the producers’ concept of “plus size” may not be the same as ours.

I love to read glossy magazines—many of us do when we get the time—and sometimes looking at the models I do think, as somebody who would love to lose a bit of weight, “Crikey, could they even put in someone who is average-sized?” The average UK female dress size is 16, and some of these models, frankly, look unhealthy.

I want to share a story. I went to a big department store in London just before Christmas last year, and I asked for a dress that was out on the rail in a concession in the store. The size I wanted was not available and the lady working there said to me, “Oh, I’ll have a look in the back for you, as that doesn’t mean we haven’t got it; we just only display sizes eight, 10 and 12.” There is so much that we can do working with the corporate world as well to change these attitudes, and it is very important. We cannot overestimate the impact of little things like not displaying bigger sizes because the designers do not want that look.

“Love Island” is far from the only culprit in the world of television. In recent years there have been many programmes, including “The Only Way is Essex”, “Geordie Shore” and “Made in Chelsea”, that seem to focus on what for many is an unattainable body type. It is almost an oxymoron to call them reality shows when in actual fact they do not portray the reality of the way the average person looks.

The TV programme “Loose Women” has to be applauded for its body confidence campaign last year. It is easy to think that people in later life do not suffer from body image anxieties, but a Mental Health Foundation study found the contrary: approximately 20% of adults aged 55 or over admitted to feeling anxious or depressed specifically because of their body image. Campaigns such as this are incredibly important by helping to show people that their anxieties are shared by many. Indeed, a friend of mine will often say that everyone is too busy worrying about how they look themselves to ever notice how someone else looks, and I do wonder how much truth there is in that.

Sadly, however, that does not appear to be true of how people in the public eye are judged. Body-shaming and trolling of celebrities are prevalent in the media and are on the increase. when Gemma Collins took to our screens last year as a contestant in “Dancing on Ice” she received the most appalling treatment from not only the public but also, disappointingly, one of the judges, most of it based solely on how she looked.

Sadly, it almost appears to be acceptable in today’s times for those we unaffectionately term “keyboard warriors” to hound and troll people who are well known. As politicians, we all, sadly, suffer abuse on social media too, and I am certainly not immune from that. Reference is often made to the fact that I am overweight, by saying, for instance, “You fat cow.” That is absolutely unacceptable, as it also would be if the trolls were referring to somebody as too thin. It saddens me greatly to see that.

All too often the social media companies are turning a blind eye and refusing to take action over comments that are ruining lives. I am sure we will all at some point have received a message after reporting a post on social media saying, “It does not contravene our rules and regulations.” Indeed, I reported something to Facebook a couple of weeks ago and the reply was, “It does not contravene our community standards,” which raises the question of what on earth its community standards are. The term “standards” here is an oxymoron, perhaps. I have often wondered how far someone would have to go before these companies took any action. A Mental Health Foundation study found that 22% of adults and 40% of teenagers said that images on social media cause them to worry about their body image. Personally, I would like to see much more regulation around social media and much more robust complaint mechanisms that make reporting easier, with more complaints upheld and firm action taken.

It is no coincidence that an increase in social media use is accompanied by an increase in body image issues, which in turn is accompanied by low self-esteem and poor mental health. While I appreciate that social media also has many positive aspects, we must ensure that these are not outweighed by the negatives. As parliamentarians, we all have a duty to do whatever we can to hold social media companies, TV producers, advertisers, magazines and individuals to account where they are seen to be promoting negative or unachievable body images. We also have a duty to ensure that the correct help is available so that everyone, specifically our young people, are able to use vital services and support to help combat the growing link between body image and poor mental health.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health) 2:54 pm, 23rd July 2019

It is a privilege to speak in this debate. Indeed, it is always a privilege to speak in debates about mental health, and, having worked as a psychologist prior to coming into Parliament, I always think my timing has been good, because 10 or 15 years ago we would not have been speaking about mental health, and the doors to any conversation about it would have been firmly closed.

I am always grateful that these issues are prioritised by Government. The Minister has been doing a fantastic job in this regard, working cross-party, and she has all our support. I thank her for the work that she has done and I too hope she continues in her place; if I could send in a recommendation or something, I would be very happy to do so.

Photo of Andrew Griffiths Andrew Griffiths Conservative, Burton

I am not sure a recommendation from the Opposition Benches will help.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

Indeed.

Body image is a very important issue, and it is an interesting one as well, because it is coming more to the fore through social media and through society in current times, when there is this striving for perfection. As we heard, in the past that might have been about looking through glossy magazines , but now it is all about how glamourous we can look on Facebook or Twitter, how many friends we have, and how many people want to befriend us because of the way we look—because they think that equates with our being some kind of fantastic person, when of course it often does not. And sometimes the most glamorous of people can also be the most shallow, I have to say.

Society is encouraging stereotypes that place great stresses on our young people today, and that has an adverse impact on their mental health. Social media companies must look at this in much more detail in terms of regulation, as we have heard. I have been very pleased to contribute to the work done through the Department, which is looking at issues of social media abuse and the impact of social media on young people’s development and mental health and how they relate to the world. It is almost as if we have become an artificial world rather than engaging with each other in our day-to-day lives just as we are, with all our diverse shapes and sizes being the norm.

Photo of Andrew Griffiths Andrew Griffiths Conservative, Burton

The hon. Lady is raising some very important points, and I think we all recognise that young people are under more stress and pressure than ever before, particularly through social media. Does she agree that schools have a key role to play in trying to provide support for young people? I am sure that, like me, she welcomes the new Trailblazer programme that the Government have offered, but does she agree that if we can ensure that young people feel able to ask for support and help in the classroom—in the school environment—we will have a better opportunity to tackle these issues at the very start and help those young people before the problem gets worse?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

Yes, those points are well made. We must do much more in the classroom to help young people grapple with social media issues and pressures, and to develop positive mental health and coping strategies so they can do that. We also have to help parents, like me and others here today, to understand social media; often children are far ahead of us and it can be very difficult for us to regulate what is happening online and make sure it is safe and secure.

I also commend the work of the all-party group on mentoring and the Diana Award. I recently went to a number of their events, one up in Scotland at Holyrood and one at Westminster just a few weeks ago. They are doing fantastic work to help young people who are being bullied in school and to provide peer mentors, because often, as we know, young people listen to other young people rather than parents or teachers. The work they are doing is going a long way in giving young people skills to understand how to challenge bullying, and to promote good mental health and to understand that it is very important that we support each other in society, rather than doing each other down. I commend them for their work.

I am chair of the all-party parliamentary group for textiles and fashion, which is undertaking an inquiry into inclusion in the industry. We have started our inquiry sessions, which have been extremely interesting. We have heard that although the industry is trying to become more diverse and to promote more diversity among its models and the work that it prints, there are still many challenges and barriers for young disabled people and plus-size people in becoming models or getting into the industry at any level. We hope that the inquiry will highlight and raise awareness of the issues and ensure that the industry lives up to our expectations that it should be inclusive and diverse, just as the United Kingdom is.

The all-party parliamentary group on psychology recently conducted a research study that showed that although the number of abusive posts to politicians was almost equal across the genders, the content was quite different. Whereas male politicians were criticised for their position on a policy, female politicians were much more often criticised for the way they looked, held to account for not wearing the right things in Parliament—according to whoever they thought was the fashion guru—or trying to do them down based on their personality or personal appearance. That shows the stereotypes that must be overcome and the challenges in feeling confident in politics. We must support everyone to make sure we have a diverse Parliament moving forward.

When I highlighted this debate online today, my constituents asked me not to forget to mention how men are affected in terms of body image. That is such a good point. We often speak about the impact on women, and I have been doing that in much of my speech. They said, “Please don’t fail to mention how men are impacted because this is increasingly an issue in society, and the same stereotypes apply: having to be really buff, no matter what your day entails or if you are running about trying to juggle lots of different things. Always having time to go to the gym and to look fabulous and have all the best clothes etc—these things also put pressure on young men.” I attended a very sad but poignant tribute at the weekend to my constituent Ryan Coleman, who sadly took his own life. We really cannot underestimate the pressures on young men’s mental health nowadays in society. It is incumbent on Governments across the United Kingdom to ensure that young men as well as young women feel able to come forward, be referred and take up services; there is often much more stigma for young men in accessing services and acknowledging some of these issues.

We have spoken about cosmetic procedures. I do not have too much detail to speak about on that, but I am aware that there is not much regulation of such procedures and it is important that we get on top of that. As the Minister and the shadow Minister mentioned, when things go wrong, it is not just like having to go back to the hairdressers and getting a different colour put on. Cosmetic procedures can have a permanent impact on people, or affect them for a very long time, so regulation in this market is important. Other markets may be diminishing, but this market is growing exponentially so we definitely need to have regulation in place.

When I worked with people who have eating disorders, we knew from the research that body image was a core part of the issue that people struggled with. It is not just about weight; it is about cognition. It is about how people think about themselves. I worked with young people who were growing thinner by the day and had anorexia nervosa but felt that they were fat. When they looked at themselves in the mirror, they saw themselves as overweight and strove to lose more and more weight. When an eating disorder develops over time, we know that cognition becomes affected. That is why it is very important that people can be referred to local services. I know how difficult that can be.

When I was doing some work in mental health primary care, the problems in referring someone to tertiary care and eating disorder services were almost insurmountable. People had to go through the community mental health team. Weight comes into it again. They might not be quite at the threshold, but everyone in the family and the clinicians knows that the person is developing an eating disorder. We must have services that accept people, and a clear clinical pathway. Otherwise, by the time people arrive at the service that they need, their condition has deteriorated so much that they may need to be admitted to hospital.

We also need to ensure that we can treat people with eating disorders as close to home as possible. They often need cognitive behaviour therapy or family therapy, and families really need to be involved in that care. If the care is taking place 20 or 30 miles away from where the person lives, it is so difficult for families who are grappling with all the other demands on their time to be as involved as they really want to be.

Ahead of Mental Health Awareness Week this year, the Scottish Government announced a new advisory group on body image and young people’s mental health. It is important to have that group up and working; to be thinking about the issues that test young people today. We need to be ahead of the curve. The Scottish Government also recently announced a package of funds for social media advice for young people. We are very aware of the impact of social media. When we are looking through magazines, we can put them down and go off and do something else, but social media is constant. I see this with young people, including my own children: as soon as their phone rings—ding ding—they have to look. Social media is almost like an addiction. I am sure that the companies love that because people are becoming so reliant on it. We need to make sure that our young people have varied lifestyles; that they get out and about in the fresh air, as my mum used to say. I am repeating my mother now. I hope she is listening. I never thought that I would get to that stage, but there you are, I am. It is important for health.

I am extremely pleased to have spoken in this debate. I am pleased that it has been given time in the main Chamber, where it should be, that we are prioritising mental health and that we are discussing the important issue of body image.

Photo of Kevan Jones Kevan Jones Labour, North Durham 3:07 pm, 23rd July 2019

I begin by agreeing totally with Dr Cameron: the debate is important. Last week we had a debate on mental health; we have two this week, one here today and one in Westminster Hall on Thursday afternoon on the Mental Health Act 1983. That is good because the more we talk about mental health issues, the more we normalise them. The hon. Lady is right. I have been a Member of the House for more than 18 years, and it has changed. The more we talk, the better. She makes a very good point.

Ministers are going into the twilight zone at the moment; seeing whether they are going to come out of the reshuffle. I add my thanks to the Minister to those of my hon. Friend Paula Sherriff. The Minister has been a passionate advocate for mental health and she deeply cares about it. We know when a Minister gets it, and she does. I hope that she survives whatever happens over the next few days. The other thing that is unusual and does not get a great deal of publicity is the fact that she is prepared to work across party and across the House, and to listen to alternative viewpoints. I wish to put that on the record.

I pay tribute to the Mental Health Foundation for its excellent report. I know that the Minister was at the launch. I think it was the first time that body image and mental health had been brought together. The hon. Member for East Kilbride, Strathaven and Lesmahagow talked about eating disorders, and the stark facts that come out of the report should concern us all.

It is important to say that it is not just young people who are affected. As my hon. Friend the Member for Dewsbury said, 20% of the adult population in the UK feel ashamed of their body image and 34% feel down about it. In some cases, that will not lead to mental health problems, but in a lot of them it will. If people have anxiety about their body image, it leads to related conditions.

According to the report, 34% of young people feel upset about their body image and 31% feel ashamed of it. We cannot insulate young people from society—we should not even attempt to do so. Living in society can be difficult and challenging at times, and young people face the added pressure of social media.

Photo of Ruth Jones Ruth Jones Labour, Newport West

I thank my right hon. Friend for making such a positive speech in this important debate. Does he believe that social media and advertising have a significant impact on young people, and does he agree that the Government need to take more vigorous steps to ensure that young people are protected from images that can lead them to form negative views of their own body?

Photo of Kevan Jones Kevan Jones Labour, North Durham

I completely agree with my hon. Friend. I will go on to speak about the role of advertising because, as she will know, it has changed. When we were growing up, adverts were in magazines or on television. Now, they are accessible to young people 24 hours a day, seven days a week on smartphones and tablets. That has changed the pressure on young people, as is highlighted in the Mental Health Foundation’s excellent report.

Before I come on to advertising, I will touch on the issue of cosmetic surgery, which the Minister raised. Members may want to know why I am interested in the subject. It is down to a force of nature, my constituent Dawn Knight, whom the Minister has met. Unfortunately, several years ago a cosmetic procedure on her eyes led to the horrific situation that she can no longer close her eyelids. As the hon. Member for East Kilbride, Strathaven and Lesmahagow said, such procedures are not easily reversible. It is not like someone changing their hair colour and not liking it. The procedure has had a devastating effect on Dawn’s life. I pay credit to her, because she has been determined to campaign on this issue. I know that she has met the Minister on a number of occasions to highlight the dangers of cosmetic surgery.

The Minister referred to regulation. I have been calling for regulation in this area for five years. I do not think there is a lack of political will, and certainly not from this Minister, but I am told that the Department of Health and Social Care is so scarred by the Health and Social Care Act 2012 that it does not want to bring forward any more health-related legislation. I say to Ministers that they must. This is the wild west because there is no regulation.

The Minister rightly warned people not to go abroad for such procedures, because standards are not high. Sadly, I have to say that they are not very high in this country either. Dawn’s case and the cases of numerous women that Dawn has documented over the years show that surgery that takes place in this country is sold like a commodity. It is not sold as something that could threaten or change people’s lives; it is sold like any other product. I am sorry, but it is not like any other product. Some of these procedures are very dangerous and can result in death.

The problem is the way the industry is structured. There are groups that give the impression that they employ surgeons and that they are hospitals. One that I have spoken about on behalf of Dawn and other victims—that is what I call them—is the Hospital Group. One would think that it is a hospital that employs surgeons and nurses, but it is not. It is a sort of marketing facility company that has a hospital and flies in surgeons from Europe, sometimes on a daily basis. They fly in, operate and fly out again. The aftercare treatment is non-existent in some cases. As Dawn’s case shows, when people try to sue the individual, they find that their indemnity insurance does not cover the resulting legal case.

What we need is a properly regulated system. The fly-in, fly-out surgeons need to be banned. I am sorry, but it is not acceptable. People say, “We have the General Medical Council,” but that is another of my hobby-horses. It is an organisation that is ripe for reform. The Government have promised reform of how the GMC operates, but they have not brought legislation forward. We need legislation to reform it because, as I will say in respect of another organisation in a minute, I am never a great fan of self-regulation. I was one of those who campaigned to take regulation away from the Law Society. Self-regulation has clearly failed. Nearly five years on from her complaint against the doctor, Dawn Knight is still fighting. It is not a user-friendly process for anyone to get redress for their complaint and we need to address that as a matter of urgency.

Cosmetic surgery is advertised and sold like any other commodity. There used to be two for one offers on Facebook and elsewhere—buy one procedure and get another procedure free. There were time-limited offers. Those should all be banned; they should not be allowed at all, because some of those procedures are very dangerous and people are often not aware of the dangers. I would argue that such a ban is part of the regulation we need. This is not a multimillion-pound industry, but a multibillion-pound industry and it is exploiting people’s poor body image.

Before anyone had any type of cosmetic surgery, I would insist that they had a mental health assessment. Not only should the risks of the surgery be explained, but we should question whether people actually want the procedure.

Advertisers use “Love Island” to promote the idea of young women having procedures to enhance their appearance. That reinforces the image that somehow there is a perfect body to be had, but also the idea that these procedures are risk free. Having spoken to Dawn and other victims of cosmetic surgery, I know that these are not risk-free procedures. In many cases, they lead to mental health problems afterwards during the recovery process.

As the Minister rightly said, the ones who pick up the tab are us—the taxpayers. Not only do we pick up the bill for the correction of the surgery when these organisations fold themselves into new companies and go into bankruptcy, meaning that people cannot get any redress; we also pay for the mental health services for those individuals afterwards.

I say again that we need more regulation of advertising. The Advertising Standards Authority is a toothless tiger. The Mental Health Foundation’s report says that last year the ASA upheld a complaint against the producers of “Love Island” for promoting cosmetic surgery as part of the advertising package around the show. But anyone who has dealt with the ASA will know that it is slow and that it is not proactive. One of the report’s recommendations is that it should be proactive in looking at adverts in advance to ensure that they are pre-screened before they go out. Again, though, that involves self-regulation, and it does not work.

I accept that we have a Government at the moment who do not like regulation and who want to strip it out. We are possibly going to get more of that nonsense over the coming months from the new Prime Minister, but I take the clear view that the state needs to protect people when they are being exploited. On cosmetic surgery, I take the clear view that people who want to have cosmetic surgery have the right to choose what to do with their money, but they should have a fully informed choice rather than being pressured by glossy advertising.

Online advertising and body image have already been raised in the debate. We have heard about the way in which adverts and other images are photoshopped and that this is somehow a positive thing that every young person should look forward to. The Minister also mentioned Botox and fillers. Those procedures are not cosmetic surgery in the sense of people going under the scalpel, but I would argue that they are equally in need of regulation because of the appalling effects when things go wrong. According to some adverts, people can simply go along in their lunch hour and have a Botox or filler treatment and then walk away in the afternoon, but those are medical procedures. They are advertised on social media and elsewhere, but Botox is a prescription drug, and it is interesting that people seem to have access to it even though they have no qualifications at all. No qualifications are needed for injecting someone. Madam Deputy Speaker, I could inject you with Botox this afternoon—not that you need it—without any qualifications or training whatsoever. The Minister was right to say that the problem with the way in which social media algorithms work is that anyone who enters the term “Botox” into a Facebook search, for example, will then be bombarded by adverts not only for Botox and fillers but for training courses on how to administer them. People can actually sign up for those courses in order to earn money.

The only regulation around this is Facebook. Dawn Knight has raised the matter directly with Facebook, but I understand that the only thing anyone can do is to say to Facebook that they no longer want this on their feed and take it down. I have written to Sir Nick Clegg, who has now gone off to live with the beautiful people in California, to ask him why Facebook is carrying those kinds of adverts and bombarding vulnerable people with adverts for Botox and other fillers. Those adverts have no disclaimers about risk, and there is no quality control over the individuals offering the services. As the Minister said, they could be people in hairdressers and other such places. Well, I am sorry, I know Facebook is earning money from those adverts, but it should ban them. I know that the vulnerability of young people is a matter of concern for the Minister, for Dawn Knight and for me. They could be getting access to these procedures without knowing the risks, and they are being targeted by the social media companies. I am waiting to see what response I get from Sir Nick Clegg and the beautiful people in California. Hopefully, they will take some action against this.

This is a serious issue, not just in terms of the way people are personally affected; it costs the taxpayer money when cosmetic surgery goes wrong and when people need mental health support. We also need regulation. We are all focused on Brexit at the moment, and perhaps this is another area that will not be addressed over the next few months. I hope that that is not the case, and I know that the Minister will continue to argue for this reform, as she has already done in Government. I also know that my constituent, Dawn Knight, will not leave this issue alone. I will not do so either, because people are putting themselves at risk and it is the duty of the Government to take action in Parliament to protect individuals when they need it. There is a lot of pressure on young people when it comes to body image. All I would say to those young people today is this: think positively, and be kind to yourself.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Justice), Liberal Democrat Spokesperson (Environment and Climate Change) 3:25 pm, 23rd July 2019

It is a real honour to speak in this debate, and I regret that not many people are here to participate in it, but as we know, today is today. Even though I have only recently become a member of Parliament, I echo the comments about what a pleasure it has been to work with the Under-Secretary of State for Health and Social Care, Jackie Doyle-Price, and I hope that she will continue in her post.

We have talked about many issues, and I want to pick up on what has been said about the cynicism with which advertising exploits vulnerable people. I will be speaking mostly on eating disorders, and many victims of eating disorders already have a massive problem, even before they go online. If they then order slimming pills online, for example, they will be bombarded by adverts persuading them to buy even more, which they then do. That is nothing short of exploitation, and we need to be alert to that.

We are all ultimately affected by our body image. People might say to me, “Well, you look all right”, but we all think, “Well, this could be better and that could be better.” We all want to please the people around us and ourselves when it comes to what we look like, and that is nothing new. It is only unusual or harmful when it so negatively affects us that it is the only thing that guides our lives. There is a certain intolerance surrounding having to have a particular look, and that is where the real danger lies. People feel they have to look in a particular way rather than feeling that it would be fun to look this way or that way and to be playful with what they look like. Instead, they are being shoehorned into a particular image, and anyone who does not fit that image can be badly affected and develop serious mental health problems, including eating disorders. I have been campaigning on the particular issue of eating disorders and mental health.

This debate is important for millions of people across the country, and I hope that we can set an example today by honestly exploring the issues. In fact, I think we already have. In a culture that is obsessed with image, we must talk more openly about the impact that body image scrutiny has on our mental health. It has been said before that we are focusing too much on how we look, rather than on who we actually are as people and what we can bring to the table, whether we are short or tall, male or female. That is one of the obsessions of our society: we are always thinking about what we look like, rather than about who we actually are.

For the past year, I have been campaigning for better treatment for eating disorders. Speaking openly about such conditions is more important than ever, because early identification and intervention are key. Mental health conditions thrive in the shadows and are protected by our ideas about what is and is not appropriate to talk about. Eating disorders have a reputation, and sufferers who do not fit cultural stereotypes are often afraid to speak out or, worse still, are refused help.

Photo of Kevan Jones Kevan Jones Labour, North Durham

The popular image of eating disorders is that they mainly affect young women, but does the hon. Lady agree that young men and people of all ages are increasingly likely to be affected?

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Justice), Liberal Democrat Spokesperson (Environment and Climate Change)

The right hon. Gentleman is absolutely right, and that has been explored in several debates on eating disorders. We are somewhat hemmed in by stereotypes, and I wonder whether our age is particularly prone to that. We think eating disorders are a particular thing, so for a long time they have been a problem for young girls, but they affect people of all ages, and men increasingly. As we have explored today, body image and mental health are not gender-specific, but men suffer in silence more, because they are much less likely to talk about things, and subsequently they seek help a lot later, which can be dangerous. In fact, it is well known that the highest number of suicides are among men between the ages of 18 and 25, because men—this is a cultural stereotype that we can hopefully overcome—just do not talk about their body image, anxieties and mental health as much as women.

Research by the Mental Health Foundation published last March shows how common it is to have body image concerns, and we have heard many other statistics today. One in five UK adults have felt anxious or depressed about their bodies in the past year, and that anxiety can turn into long-term mental health problems, such as eating disorders. Across the country, eating disorders affect 1.25 million people, which is probably a conservative estimate. My work in this area supports that suggestion, and the sufferers that I have met come from a range of different backgrounds, but they are united by their dissatisfaction with, and need to control, their body image. Dr Cameron has already talked powerfully about that.

Of course, eating disorders are far more complex than stress over body image. They are serious conditions that ruin, define and, all too often, end lives. However, the seeds of emergent eating disorders can often be spotted in stress or anxiety about body image. For the more than 1 million people who were identified as having an eating disorder, the outlook is not good. On average, it takes 85 weeks between someone realising they have an eating disorder and that individual receiving treatment. That lost time can be the difference between full recovery and living with a permanent disability or disorder. The Government targets introduced to limit child waiting times for eating disorder treatments were a positive step, but thousands of adults across the UK need the same measures. We need to consider the waiting times for adult sufferers of eating disorders, and I know that the Minister has already looked into that.

Understanding eating disorders better is key to improving treatment. Many sufferers still report being turned away and refused referral, because doctors have told them that they are not thin enough to be treated for an eating disorder—I know that the Minister has talked to Hope Virgo, who has been running the “Dump the Scales” campaign—but an eating disorder is not just about someone’s body mass index. By talking about eating disorders, especially in the context of body image, we can start to grasp how damaging that can be. We must educate everyone, from sufferers’ families to doctors, about the many different forms that such conditions can take and how best to treat them. Eating disorders have the highest mortality rate of any mental health condition, and our mental health policy must reflect that. This is a crisis, but we are not treating it as such.

Early intervention is key. Schools, doctors and support workers must be equipped with the tools to identify when body image concerns are becoming dangerous. Furthermore, we must change the cultural conversation around body image, which can be done on many levels. As we have already heard today, social media companies have a responsibility to police the content on their websites, ensuring that anything that actively incites self-harm is taken down. Eating disorders are on the rise, and many adult sufferers are failing to receive the early intervention they so desperately need. We must do better for those suffering in silence and start having a conversation about body image, mental health and the awful reality of life with an eating disorder.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 3:33 pm, 23rd July 2019

I think we can all agree that this been an eye-opening and interesting debate, and I start by thanking all the hon. Members present for making such excellent, personal and candid speeches. I also want to continue the theme of hoping that the Minister will still be in her position at the end of the day, because, as everyone has said, she really takes on board the cross-party consensus on many such issues, doing so with regard to the matter rather than the politics. On these things, there is always more we agree on than we disagree on. Having reinforced her embarrassment, I will now move on.

Today we have heard about the impact that negative body image can have on people’s mental health, and I will particularly address the mental health of children and young people. It is clear that more needs to be done to promote healthy body image, which should start as early as possible.

I pay tribute to the Mental Health Foundation for its comprehensive research and campaigning on this topic. It has found that even children under the age of six have reportedly felt dissatisfied with their bodies, so promoting a healthy body image from an early age is therefore a crucial step. It is obvious from what we have heard today that more needs to be done to ensure that happens.

It is heartbreaking to hear that more than half of children and young people have been bullied because of their appearance, and that one third of teenagers say they have felt shame because of their body image. The Children’s Society has found that children’s happiness with how they look has not improved since the mid-1990s, and young people themselves say that body image is their third biggest area of concern in life, after their education and employment prospects. Why, then, are we failing to address poor body image when it is such a crucial issue?

It is clear that educating young people about their bodies is an important step in improving their body confidence, so do the Government have plans to ensure that schools cover body image concerns as part of the introduction of compulsory relationships and sex education in 2020? More needs to be done to promote healthy body image and good mental health among our young people.

Classroom-based teaching should not only extend to teaching children about their bodies; more needs to be done to ensure that children understand how to use social media safely, understand how to improve their self-esteem and understand their emotions. Can the Minister outline how the Department for Education is tackling these issues in schools? I know the Minister is here representing the Department of Health and Social Care, but the Under-Secretary of State for Education, Nadhim Zahawi, the Children’s Minister, was here a moment ago, and they should be in close contact on this.

Children who are concerned about their body are less likely to take part in physical activity. We can all remember our school days, and I am sure we were all concerned about that. This is concerning when we know the health benefits of physical activity, so promoting positive body image can have benefits for physical health, as well as for mental health.

The mental health consequences of poor body image can be severe. Although having body image concerns is not a mental health problem in itself, having such concerns can be a risk factor for mental health problems. Mental health support should start where children need it, which is in school. Can the Minister tell the House what interim funding has been offered to schools to provide mental health support, given that the Green Paper’s proposed support package will not be rolled out nationally until 2023? Schools really cannot wait another four years for this support because, as we know, they are already struggling with their current budgets.

Where mental health problems develop, early intervention and support from mental health services is crucial. Too many young people who are not able to access the mental health support they need from child and adolescent mental health services are left waiting for treatment on waiting lists for far too long or are turned down for help because their condition is deemed to be not bad enough. The best way to stop our young people developing eating disorders is to make sure they do not have to wait until they have an eating disorder and until they are bad enough to get that help. For children and young people who need support from CAMHS, there needs to be specific support to help them with body image concerns. What are the Government doing to ensure that support is in place?

According to a survey of family doctors, nearly all GPs worry that young people with mental health problems will come to harm because of difficulties in accessing treatment on the NHS, which should absolutely not be the case, and I know the Minister agrees. As was said at Health questions earlier, it is time to ring-fence funding for children’s mental health budgets to ensure that mental health services for children are properly funded.

I have spoken mostly about the impact on children and young people, because it is vital that the causes of poor body image are addressed early to ensure that children and young people think positively about their bodies and therefore go on to think positively about their bodies as adults. People with long-term conditions, such as cancer, and new mums can also have particular body image pressures and concerns, so it is important that as well as mental health services, other health services are there to support people when that is required. In some other cases, the issue is not due to mental health but can become a mental health issue if the matter is not addressed earlier.

According to the Mental Health Foundation, cognitive behavioural therapy—CBT—and other talking therapies can help people who are struggling with body image concerns, but we know that access to talking therapies can be a bit of a postcode lottery. Will the Minister explain how the Government plan to try to end that postcode lottery?

It is worrying to hear about body image concerns among lesbian, gay and bisexual people. One third of adults who identify as lesbian, gay or bisexual have reported experiencing suicidal feelings in relation to their body image. It is therefore important that lesbian, gay and bisexual people have access to support that is tailored to them. Has the Minister taken steps to ensure that lesbian, gay and bisexual people have access to appropriate mental health support?

As we know, trans body image is often linked to a specific condition called body dysmorphia, which means it is not included in the statistics I just mentioned. Trans people face specific challenges in accessing mental health support, so it is vital that the Government ensure that mental health support tailored to trans people is available throughout the country. Will the Minister explain what steps the Government are taking to provide mental health services for trans people in this regard?

We have heard today about the profound impact that social media, celebrity culture and advertising can have on young people and adults and their views of their bodies. Too often, the content shared on social media is having a negative impact on mental health. That is why it is vital that more is done to protect children and young people and vulnerable people online, including from harmful images that can affect their body image. Far too often, social media companies turn a blind eye to harmful content. More really does need to be done to stop such content appearing online. I commend my right hon. Friend Mr Jones for mentioning Facebook, as well as a former Member of this place and what he might be able to do in that regard.

I am reminded of all those pro-ana websites. I never even used to know what pro-ana meant—I did not realise it was even a thing—but when I see some of those websites and some of those YouTube stars, and the sort of body image that they present as being obtainable and the norm, I think more really should be done to take those images down. I also include in all that the fact that the movie world, Hollywood, TV and Netflix have a responsibility to promote a healthy body image when they cast their shows and movies. I will not name any particular show, movie or artist, but I have in mind a particular example of casting that really does, in my opinion, promote a very wrong body image. That does cause harm. The harms caused online need to be seen and treated as public health concerns, which, as shadow public health Minister, I am passionate about.

Labour is calling for a regulator with teeth that can take serious action against social media companies and for an enforceable duty of care to deal with the harms, hate and fake images that many online companies allow to flourish on their platforms.

The Government heeded Labour’s call and announced a regulator in the “Online Harms” White Paper, which is great, so it is now imperative for a regulator to be put in place as soon as possible. Will the Minister let the House know when that regulator might be expected? The process might take many months, and meanwhile children, young people and vulnerable adults are left at risk of severe online harms. The Government need to move faster and to go further, and perhaps we might see that under the new Administration—who knows—but it is clear from this debate that more needs to be done to tackle harmful content and body stigma, and to provide appropriate mental health support for everyone who needs it. Following this debate, as we have all said, I hope that the Minister will still be in her job and able to tackle this.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care 3:45 pm, 23rd July 2019

I shall not detain the House for too long, because I think it has heard enough from me for one day. I thank Members for their generous comments, even if they might be career-limiting.

In this debate, however, there is consensus across the House. We all fully recognise the problems that we face and the need for decisive action to tackle them. I will certainly continue to work with all Members to do exactly that, because this is too important and—I make this observation—the people out there expect us to work together more often than not. Such subjects should not be a political football, and it is too important to ensure that we are tackling harms.

Paula Sherriff made the observation that the debate might not be as well attended as previous ones, but to be fair we have had many such debates in this space. Many Members, even if not present this afternoon, clearly have a keen interest. I am utterly at one with her when she expressed her concern about a context in which we have normalised unrealistic body image. Such images have become so normalised that it will take a lot of effort to address it. She also referred to the incident of the lady who, sadly, died as a result of accessing a Brazilian butt lift from a surgeon in Turkey. Unfortunately, she is not the only such person from this country. It is the most dangerous cosmetic procedure that can be undertaken and, as a consequence, is banned in this country. None the less, despite the ban, people are still bombarded with images and with adverts for where they can seek the procedure. That brings home the fact that we need to do much more to make people aware of the risks.

Many Members referred to the influence of advertising, and I am afraid that those organisations that profit from hosting advertising ought to have a duty of care and ensure that the material they carry does not expose people to harm. I therefore welcome the engagement that Mr Jones is undertaking with Facebook on exactly that. It is not good enough for social media providers to retreat to the defence of, “Well, we are a liberated platform, regulated by our users.” Where they become a vehicle for things that will cause harm, those social media providers have a duty of care to the people who use their platforms. We must all continue to challenge them on that issue.

We have had lots of references to “Love Island”. Collectively, perhaps we ought to challenge use of the term “reality TV”, because it is not reality TV; it is fantasy TV. [Hon. Members: “Hear, hear.”] So that might be the outcome of today’s debate—let us all talk about fantasy TV from now on, because such programmes promote lifestyles that are not normal or achievable. Let us do that.

Photo of Kevan Jones Kevan Jones Labour, North Durham

Will the Minister challenge the producers of a show such as “Love Island” to produce a series with real people in it, rather than one with the image that they are trying to portray now?

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

I could give that challenge, but the sad thing is that I do not think that any of us would watch that—although I do not think that many of us watch it now. Frankly, I like my dramas gritty and real. Ultimately, ITV broadcasts “Love Island” because it attracts many viewers—many of them among the most vulnerable group we are talking about. Again, ITV should be much more responsible, although the show is one of its biggest earners. I just regret the fact that we have become such a nation of voyeurs, and we all need to reflect on that point.

It is interesting that, because the people in these so-called reality TV shows are not known to us—they are not celebrities—we do not really see what we are doing to them in these circumstances. I do not know whether any hon. Members used to watch “Big Brother”, but there was an occasion when a contestant on “Celebrity Big Brother” effectively had a meltdown on TV. The public reaction then was very different; I think it seemed more real to people because it was a celebrity and the public were invested in them. That illustrates just how pernicious these so-called reality TV shows are, with their anonymous celebrities. These people suddenly become very exposed, and we have seen the outcome for some people’s mental health when they re-enter the real world. I know that ITV has reflected on some of those risks, but there is much more to do. As I said, let us start calling them fantasy shows.

The hon. Member for Dewsbury also mentioned the whole issue of body shaming online. We have accepted as normal some really unpleasant behaviour online. I always use the example of drinking and driving. It did not matter that drinking and driving was made illegal; it was only when it became socially unacceptable that people really stopped doing it. We need to get to that stage when it comes to how people behave online. Again, this happens because people do not see others as real people online. When people make abusive comments online, it is because they feel that they are able to. That has got to stop and we need to lead the way.

The hon. Lady also asked what it takes to make the social media companies actually do something about this. In the context of suicide content, it took a death—and it should not take a death. With regards to other content, I suspect that it will also take deaths to get these companies to do something. That really is not good enough. I pay tribute to those who are brave enough to share their experiences of self-harm and suicide as a result of what they have seen online, because they are really helping us to drag the social media companies to where they need to be.

Dr Cameron—I never pronounce it right—articulated the fact that this area is an artificial world that becomes more and more intense. When we start using the internet and looking at things on social media, we do find ourselves dragged into a deeper and deeper world of “like” content, and it is easy to cease to be objective in those circumstances. We have certainly seen that with regard to self-harm and anorexia sites; it is just constant. The journeys that some people have been through are akin to grooming. People can find themselves being groomed by online content by sheer accident. Given that context and given how we use devices these days, it is not difficult to see why people are becoming much more exposed to such risks. Safe ways of using the internet—using iPads and so on to access content—has to be central to any education we give children about looking after themselves because that level of intensity clearly causes harm.

The hon. Members for East Kilbride, Strathaven and Lesmahagow and for Bath (Wera Hobhouse) talked about eating disorders, the clinical pathways available and out-of-area places, all of which are issues that really bother me. It has to be said that we have done well on children’s access to help with eating disorders—and I think it was right to do so because if we can tackle these issues early with children, we are tackling eating disorders—but it has highlighted the risks that exist when children cease to be children and become adults. The level of service is not as good when people enter adulthood, particularly through the whole period of transition, and that in itself can cause harm. We have heard about Hope Virgo’s #DumpTheScales campaign and the fact that different clinical standards are being applied for children and adults. That is clearly something that we really need to fix and it is a key priority for me.

I also fully recognise the danger of out-of-area placements for people with eating disorders. Part of people’s recovery has to be the relationships that they have with family and friends. I have seen that very clearly with children and young people. Generally, we need to reduce the number of out-of-area placements for people with acute mental health issues, including eating disorders, but I will not be satisfied until we have no out-of-area placements at all. Having people long term in beds in hospitals is not good for their mental health. Clearly, there are cases where there is a need for intensive treatment and we need to do that, but over time, out-of-area placements really should not be a thing.

The right hon. Member for North Durham, as usual, brought to the debate his very well-informed knowledge of this subject. I join him in paying tribute to Dawn Knight and all the campaigning she has done. She has not been shy about sharing the devastating impact of what she did, telling her story of how she just wanted to enhance her appearance and the result has been absolute hell. Neither is she shy about sharing exactly what the impact will be on the NHS as a consequence of the treatment she has had to have to put it right.

This whole area of cosmetic surgery is growing very quickly, and people are quite naive in thinking that perhaps the more money they spend on a procedure, the better it is going to be. Nothing could be further from the truth, because there are the least virtuous of people in this space. As the right hon. Gentleman says, this is the wild west. These people are profiteers. Part and parcel of enabling people to protect themselves in this environment is to really talk about the risks. There are some absolute cowboys out there. The story that Dawn tells about trying to sue the practitioner who undertook her procedure shows that that is frankly impossible. When people want to become engaged in activity that is borderline criminal, they find ways of making sure that they cannot be held to account for it. Whatever our instinctive view about people’s choice, self-regulation and so on, where there is clear evidence of harm, the Government should act. We really must look at this more seriously. I am happy to continue speaking to Dawn and to the right hon. Gentleman about that.

Clearly, we need to look at the whole issue of dermal fillers. It is classed as a medical device and therefore is not on prescription, but ultimately something is being injected into the face, so we need to make sure that we are doing something about regulation. The right hon. Gentleman mentioned the role of the GMC. As he says, Botox is a prescription drug, but it is clearly being administered by people who are not practitioners. Both the GMC and the Nursing and Midwifery Council have an obligation to uphold their regulatory standards. If someone is using their prescribing power irresponsibly and not being present when the product is administered, then action should be taken, and I shall expect those bodies to do that.

Photo of Kevan Jones Kevan Jones Labour, North Durham

I agree with what the Minister says, but if we look at some of the adverts—for example, on Facebook—there is no way that people who are signing these prescriptions can actually be present. Her Department should look at this area, because there are clearly people signing prescriptions and then either selling them on for a profit or giving them to people to make money out of these procedures.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care

I am grateful to the right hon. Gentleman for amplifying that point, because we must do that. We give very clear indications that we expect the NMC and the GMC to deal with this. However, we must also send a message to people out there that people will get these adverts about how to become a dispenser of dermal fillers and think that that is all they need to do, having no idea that they are committing a criminal offence. We need to educate them as well.

I will end there, because, as I say, I feel like I have been the Government at the Dispatch Box today. I look forward to continuing discussions with all Members present, who I know care very deeply about this. It is something that we really must tackle as a matter of urgency.

Question put and agreed to.

Resolved,

That this House
has considered body image and mental health.