Body Image and Mental Health

Part of 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

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.