Women’S Mental Health

– in the House of Commons at 1:31 pm on 3rd October 2019.

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Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Environment and Climate Change), Liberal Democrat Spokesperson (Transport) 1:31 pm, 3rd October 2019

I beg to move,

That this House
notes with concern the rise in mental ill health among women, with one in five now experiencing common mental disorders and young women the most at-risk group;
recognises that women’s mental health problems are often rooted in experiences of violence and abuse;
believes that mental health services often fail to respond to women’s specific needs, including their experiences of trauma;
calls on the Government to ensure that the gender- and trauma-informed principles of the Women’s Mental Health Taskforce are adopted by mental health services and that women’s mental health needs, including their experience of violence and abuse, are prioritised and taken seriously in all mental health policy, strategy and delivery.

Constituents often come to us at their lowest point, and we see them going through anxiety, depression and trauma. Poor mental health affects not only the individual, but everybody around them. Women are far more likely to experience serious mental health issues. Young women are at the greatest risk, with one in five having self-harmed and 13% having been diagnosed with post-traumatic stress disorder.

Over the course of this Parliament, there has been a great deal of talk in this House about mental health, which is progress, but the opportunity to discuss women’s specific needs when it comes to mental health services has been limited. Ten months after the publication of the final report of the Women’s Mental Health Taskforce, little has changed. There is a long way to go before our mental health services work for women. There is an obligation on Government to step in and respond to the growing crisis in women’s mental health with a substantive policy.

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

I very much welcome the work of the Women’s Mental Health Taskforce, its report, and the principles laid out in it. Does the hon. Lady share my concern that those principles will not be effectively implemented unless there are clear targets and concrete commitments from the Government, and that the next stage needs to be a full strategy on women’s mental health, with those targets and commitments in it?

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

I could not agree more. We need a strategy. More than half of women who experience mental ill health have a history of abuse, meaning that their conditions are rooted in experiences of gender-based violence. In yesterday’s moving debate, we heard many harrowing examples of that. We have a long way to go if we are to change the whole culture around domestic violence and treat its consequences. When it comes to treatment, we must ensure that frontline mental health services for women are trauma-informed. There is a legal framework that we could use; it is called the Istanbul convention. We signed up to it back in 2012, but so far we have failed to bring it into domestic law.

One consequence is that we do not have enough rape crisis centres across the country. Earlier this year, Fern Champion, a survivor of sexual violence, came forward after being turned away by her local rape crisis centre. She launched a petition asking the Government to ratify the Istanbul convention, which has so far received 171,000 signatures. It is hard to suggest that we can do the groundwork to support women and their mental health challenges effectively when there are fewer than 100 rape crisis centres across England and Wales. This is simply not good enough if we are to support women effectively and prevent them from developing serious mental health problems after suffering abuse. Ratifying the Istanbul convention would mean that the UK was upholding international standards on survivors’ rights.

Earlier this year, I tabled a Bill that would guarantee mothers a health check-up six weeks after giving birth. Depression before, during and after birth is a serious condition that is unrecognised and untreated for nearly half of new mothers who suffer from depression. Statistics suggest that mothers are afraid to speak up, and 47% of new mothers get less than three minutes to discuss their mental health with a healthcare professional. Conversations about the reality of motherhood and perinatal depression are still few and far between. This is a huge problem—and not just for the mother; undiagnosed mental health problems in mothers have serious consequences for the newborn child and their development.

I have been campaigning for better treatment of eating disorders. Eating disorders disproportionately affect women, although they do not discriminate. Women in the LGBTQ community are particularly susceptible.

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

I am absolutely in accord with the hon. Lady. Before she gets off the subject of perinatal illness, she will agree, I am sure, that it is a shocking statistic that in the UK, suicide is the leading cause of direct maternal deaths occurring within a year of the end of pregnancy. Perinatal mental illness can actually lead to a loss of life among mothers. We need to do so much better for them in those early mental health checks.

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

Absolutely. Post-natal depression is hidden, and the NCT’s “Hidden Half” campaign addresses that. Anyone who has been a parent knows that parenthood is not easy. Probably all mothers go through some form of depression, or feel really down after birth. I keep saying that if anybody had asked me how I felt, I would probably have said, “Oh God, I am not feeling particularly well.” The problem is in not addressing that early on, because these things can develop into something much more serious. That is why it is very important that there be a check-up six weeks after birth for women, not just for the newborn child.

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

I thank the hon. Lady for giving way again; she is being very generous. A number of my constituents have been in touch about perinatal check-ups. My constituent Catherine told me of her experience:

“I asked for a 6 week check with a GP—this was, at best, brief. Physical symptoms were looked at, but nothing was checked with regards to my mental health. There needs to be a standard physical and mental health check for ALL new mothers.”

Does the hon. Lady agree that we need to do better?

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

Yes indeed. I talk to campaigners, who are now looking at the new general practitioner contracts that are going out. That is definitely a way forward, but we also need to ensure adequate training, because people have to ask the right questions. The issue is sort of stigmatised; everybody thinks, “You’re a new mum—you should be on top of the world.” Nobody really wants to admit that motherhood can be very difficult, and that one does not always feel great. We need training, so that when new mums come in, they are asked the right questions.

Going back to eating disorders, they have the highest mortality rate of all mental health conditions. There are about a million sufferers from eating disorders. That is an epidemic of illness that is going undiagnosed and untreated. We must do much better. Our NHS is not well equipped to spot the problem early and treat it. Waiting times for adults have been shooting up over the last few years. Outdated methods, such as the body mass index measurement, are still being used to diagnosis the condition, but that fails to recognise that at the core of an eating disorder is a mental health, not a physical health, problem. Despite increasing public and professional awareness of eating disorders, medical students receive only two hours of training in the condition and its treatment during their entire time in medical school.

Those are just a few examples of where our NHS does not work for women’s mental health. We need a strategy. The Women’s Mental Health Taskforce did some extremely important work, but its recommendations have been left on the shelf. A Government strategy would help individual trusts to make the changes required to implement the recommendations. The Liberal Democrats have championed the fight for better mental health care for many years, and we believe that mental and physical health should be supported equally by our services. I have highlighted a few areas where women’s mental health provision could be improved, and I am looking forward to the debate and to the Minister’s response.

Photo of Sir David Amess Sir David Amess Conservative, Southend West 1:40 pm, 3rd October 2019

As a man, I make no apology for contributing to this debate, Madam Deputy Speaker, because I come from a household in which four of my five children are women. My late mother had a big role in my life and, of course, I do have a wife. I am prepared to say that I think women are the fairer sex but, by and large, they do have the tougher deal in life. I certainly would never fancy giving birth to a baby, and there are so many other things that women face that men do not.

I congratulate Wera Hobhouse on allowing us to debate this subject. I agree with all her points, and I just want to pick out a few other subjects that colleagues may not talk about later in the debate. With World Mental Health Day just one week away, I am pleased that the hon. Lady has secured this debate because, as she said, reports indicate that one in six people has experienced a common mental health problem in the past week—truly shocking. With a population of roughly 65 million in the UK, almost 11 million people need to access publicly funded support. The prevalence of mental health issues is similar for men and women in the UK but, as I have said already, women have to deal with different challenges. The House of Commons Library’s superb briefing on this topic makes it clear that the greater caring responsibilities and a high risk of domestic violence are contributing factors to the challenges that we are discussing today.

I was not in the Chamber yesterday for the Second Reading of the Domestic Abuse Bill—I was in my House of Commons office—but I was dumbfounded by the speeches. Paula Sherriff may sit on the Opposition Benches, but she is a thoroughly wonderful colleague in every respect. She has had some terrible issues to deal with over the past few months and beyond, and I think of her struggle and hope that colleagues are rallying round to support her. We then heard the speech from Rosie Duffield the likes of which I have never heard before. It was so brave and truly shocking, but she was prepared to share that with colleagues. Naz Shah then told us about her life and I just could not believe it. It must have taken enormous guts and courage to speak publicly about it, knowing that all sorts of people on social media are going to pick up on the issue while not necessarily being sympathetic. It was a wonderful debate, and I absolutely agree with Mr Speaker that the tone used yesterday and today is far better than that used in recent months.

Women are more likely than men to experience anxiety, depression, post-traumatic stress disorder and eating disorders, as the hon. Member for Bath said. We need to entirely recalibrate how the media puts ideas into young women’s minds about how they should look and how they live their lives. There is so much pressure on them to have the perfect figure or the perfect look, which is unreasonable and definitely adds to mental health issues. The suicide rate for young women has more than doubled in the past 10 years, which is shocking. Such facts are easy to speak about, but it is for the House of Commons to try to come together to think of some solutions.

I have two former Ministers behind me—my hon. Friends the Members for Thurrock (Jackie Doyle-Price) and for East Worthing and Shoreham (Tim Loughton)— who have more expertise in this subject than me and who did great work. I really am glad that this subject has at long last reached the top of the political agenda. I sat on the Select Committee on Health for 10 years and although we held inquiries into abuse in institutions in which people with mental health issues were detained, we never really tackled what lay behind those issues, so I am glad that we are highlighting them today. Since 2010, Back Benchers have come together to put pressure on Governments of different persuasions to set up the Women’s Mental Health Taskforce, which was a clear indication of the Conservative party’s commitment to understand and address problems with current women’s mental health support. It was also announced at the party conference in Manchester that funding will be made available for 1,000 extra staff in community mental health services.

I congratulate the Under-Secretary of State for Health and Social Care, my hon. Friend Ms Dorries, on her appointment, and I wish her well. However, my hon. Friend and parliamentary neighbour, the hon. Member for Thurrock, spent two days at the Dispatch Box just before we—how can I put it delicately?—formed a new Government responding to points about mental health issues. She was a first-class Minister, and I thank her very much for her work highlighting the mental health challenges that women face. I am glad to see her here today, and I shall enjoy listening to her speech.

My hon. Friend used to be the Parliamentary Under-Secretary of State for Mental Health, Inequalities and Suicide Prevention and was kind enough to meet me together with my constituent Kelly Swain and her team at N.O.W Is The Time For Change. Kelly works tirelessly to provide alternative therapies and wellbeing classes to people of all ages. Before my hon. Friend left office, she seemed to have a magic wand, because I find that Kelly Swain is now pushing at open doors in trying to spread her message throughout Essex, so I thank my hon. Friend for that. The all-women leadership team led by Kelly Swain works so well together, and I am glad that local organisations, along with the clinical commissioning groups, are now considering how they can integrate and support the ideas that Kelly has promoted.

Another trailblazing constituent is Carla Cressy. I look to the hon. Member for Dewsbury at this point, because she was present at a meeting with Carla and my hon. Friend the Member for Thurrock. Again, it may seem strange to have a chap as the chairman of the all-party parliamentary group on endometriosis, but it was decided that I should chair it, and I am very proud of that. I now understand the damaging effect that the condition can have on women’s mental health, and I salute my constituents. Carla’s charity is called Women with Endometriosis, which seeks to provide comprehensive mental health support to any woman facing that uphill battle, and I will continue to support her work in any way that I can.

Something that both those charities have in common, other than the brilliance of the two founders, is a commitment to pulling down barriers and removing any stigma around mental health. As the hon. Member for Bath so rightly said, it is difficult to talk about these topics, and people can be branded very unfairly. We must do something to change people’s perception of women who have mental health issues, and there are still more barriers to be brought down. I have been in this place for 36 years—some people might say that that is too long, but I still have a bit more that I want to do—and there are still issues to tackle, and my two constituents have brought the challenges home for me in very different ways. Both their organisations provide tailored support to individuals, and they are always ready to listen without judgment. That is a basic requirement for mental healthcare at any level, and it would be a great asset to our nation if we could provide that service to every person who required it.

As the hon. Member for Bath rightly pointed out, mental health issues are probably the most difficult healthcare issues to deal with. When I first became a Member of Parliament, I did not see many people with mental health issues at my surgeries, but now that is a regular occurrence. Of course, people with mental health issues need our time, but Members of Parliament are not necessarily equipped with the expertise to give advice and support; we try to signpost people in the right direction. I am sure all Members would say that, although they are very grateful for their local mental health services, we could all do better. That is where the real investment needs to be made.

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

I go to many schools. Mental health problems often start early, when people are teenagers, so does the hon. Gentleman agree that it is important that mental health services are also provided through schools? That is where we are falling very short.

Photo of Sir David Amess Sir David Amess Conservative, Southend West

I entirely agree. That is why I am so pleased with my constituents Carla and Kelly. That is exactly what they intend to do: we have written to schools, and they are going to go in to try to help and support not just sixth-formers but younger children. The hon. Lady is absolutely right about that.

I want the Government to ensure that people throughout the country who are not fully aware of the challenges women face are aware that there is help and support available. I know my hon. Friend the Minister will share with the House what support is available.

One group that needs particular attention is women who are serving time in prison. To express some sympathy for people who are in prison perhaps is not the cool thing for a Conservative to do, but we used to have a women’s prison local to me—Bullwood Hall, in the constituency of my right hon. Friend Mr Francois—and I remember visiting it for the first time and being shown around. Of course, so many of those women were convicted not as a result of violence but following domestic abuse, infanticide and all sorts of issues like that.

I am grateful for the briefing from the Howard League for Penal Reform, which states that a recent study found that more than 50% of women in prison report a history of violence and trauma, which contributed to 8,317 cases of self-injury in 2017 alone. We all understand that prison’s fundamental role is to deliver justice to people who have done wrong, but as the focus shifts towards rehabilitation, I very much want the Ministry of Justice to re-evaluate the practical support that is made available to female inmates.

I must say, Madam Deputy Speaker, that I am delighted that there are five Members from Essex in the Chamber. We have a real issue with mental health provision in our county, and I know that we all speak with one voice not only in expressing gratitude for the services we have but in hoping they will be developed and expanded. Of course, my hon. Friend Vicky Ford has the prison in her constituency.

As I said, a recent study found that more than 50% of women in prison report a history of violence and trauma, and the issues of self-injury are very distressing indeed, but I am glad that in 2018-19 the NHS in England spent £12.2 billion on general mental health. That is a huge amount of money, but I think we all want to ensure that it is well spent, and I would be very pleased if some of it found its way to Carla Cressy’s charity and Kelly Swain’s charity.

I am proud of my party’s continued effort to treat mental illness with the same seriousness as physical illness. In all the discussion of figures, it is essential that Ministers and officials remember that women’s lives are on the line. Every year, 1,604 women commit suicide. That is absolutely horrendous. Looking at these Benches, I am reminded that it was reported nationally only this week that a young member of my party committed suicide, which must be awful for those who loved that individual. Units are busier than ever before and, as a result, they are under increasing stress. If we do not take swift and effective action to address these challenges, there is a very real risk that the number of suicides and instances of self-harm will increase further.

I have received a number of briefings from various groups asking me to call on the Government to introduce various plans and schemes, and I am sure colleagues will be supportive of such programmes. My message, though, is plain and simple. As a group of politicians, whichever party we belong to, we should always remember that we are sent here to serve our constituents. That is why I am so pleased that my constituents Carla and Kelly have got off their backsides with real enthusiasm for sharing the message that we must support women with mental health issues. I pay tribute to Carla, Kelly and all those women throughout the United Kingdom who are doing everything they can to improve the care of women who suffer from mental health issues.

Photo of Ellie Reeves Ellie Reeves Labour, Lewisham West and Penge 1:56 pm, 3rd October 2019

It is pleasure to speak in this debate. I thank Wera Hobhouse for securing it.

Although the issue of women’s mental health is wide-ranging, I will limit my contribution to maternal mental health, an issue that is close to my heart given that I am eight months pregnant with my second child. In response to a recent survey by the National Childbirth Trust, 50% of women reported that they experienced mental health or emotional difficulties at some time during their pregnancy or in the year after their child’s birth, yet many women are reluctant to admit to having difficulties. Society tells us that being pregnant and having a baby should be a wonderful, joyous time, but for many the reality can feel quite different. All too often, women do not discuss their problems because they feel embarrassed, ashamed or worried that health professionals would think they were not capable of looking after their baby.

I think it is important for me to say that I was one of those women. With my first son, I suffered from pre-natal depression, which led to an exacerbation of anxiety and obsessive compulsive disorder. At the time, I did not have enough knowledge of the condition to do anything about it. It is not something that gets talked about, so I did not know how to ask for help. This time around, I have been able to spot the triggers and deal with any problems before they escalate. I also had the confidence to tell my history to my GP, who was able to give me some options. At times, preventing the onset of pre-natal depression this time around has felt like a daily battle, but it is one that I am pleased to say I have won. However, for too many new mums, their mental health difficulties remain hidden, with research by the NCT showing that nearly half of new mothers’ mental health problems are not picked up by a health professional.

A simple solution would be to ensure that the six-week mandatory post-natal baby check included a mandatory maternal check. However, despite National Institute for Health and Care Excellence guidance, a six-week maternal check is not included in GPs’ contracts, which means there is no specific funding for it. As a result, the NCT found that a third of mothers had three minutes or less for their maternal six-week check; a fifth of mothers were not asked about their mental health at all at their six-week check; and half of mothers who wanted to discuss an emotional or mental health problem at their six-week check did not feel able to do so. With rushed appointments and without the right questions being asked, it is not really surprising that many women keep their problems hidden.

Photo of Kevan Jones Kevan Jones Labour, North Durham

My hon. Friend is making a very good point. Does she agree that we need not just to look at GPs and that one visit, but to try to ensure that we embed in health visitors and other professionals who come into contact with new mothers the importance of looking for early signs of mental illness?

Photo of Ellie Reeves Ellie Reeves Labour, Lewisham West and Penge

That is absolutely right. Health visitors have a huge role to play, and we know from our constituency work that they are under a huge amount of strain and often the same issues apply. Health visits are often rushed, not through any fault of the health visitor, but because of the pressures and constraints they are under. The situation for both GPs and health visitors needs to be considered.

The NCT is currently running a campaign that I fully support. It seeks full funding for the six-week maternal post-natal check, so that GPs have time to give every new mother a full appointment. It also seeks to improve guidance for GPs on best practice around maternal health, with dedicated appointments for the six-week maternal check, and to encourage the disclosure of maternal mental health problems. Finally, it wishes the NHS to support GP education in maternal mental health. The consequences of not tackling maternal mental health are far reaching, with around 20 new or expectant mothers taking their own lives ever year. Maternal mental health problems are considered an adverse childhood experience, and urgent action is needed.

I will end by championing some of the great support that is available to new and expectant mothers in my constituency, and which plays a fundamental role in maternal health and wellbeing. Bromley, Lewisham & Greenwich Mind offers a Mindful Mums course and a volunteer-led maternal befriending service. Our children’s centres offer drop-ins, mindfulness and breastfeeding support. Mytime Active offers a comprehensive pre and post-natal fitness program in Bromley leisure centres, which I know has been instrumental in me not developing pre-natal depression this time around. Bromley Libraries offers free Baby Bounce and Rhyme and other activity sessions, and there are local NCT groups and baby cafes, to name but a few. I thank the dedicated staff and volunteers, without whom such services would simply not exist.

However, those organisations cannot do it alone, and their budgets are already stretched. Since 2010, 12 children’s centres in Bromley have shut. Bromley library staff have been on strike since June due to cuts to the service, and Mind is operating with waiting lists, such is the demand for its maternal services. Without proper investment in maternal health, and without breaking down the stigma surrounding pre and post-natal depression, women will continue to suffer alone. I hope that the Government are listening, and that this debate will be the start of much needed change.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. Before I call the next speaker, may I say to the hon. Lady that however difficult it might be, it is wonderful to hear the truth spoken in this place, especially in an atmosphere that for decades—indeed, until very recently—considered childbirth to be some form of weakness, rather than the process through which every human being arrives in this world. Speaking the truth, and dealing with matters as people deal with them in their everyday lives in the constituencies that we represent, is terribly important, and it marks a refreshing new attitude to the way we do business in the House of Commons.

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham 2:03 pm, 3rd October 2019

I concur with every word of your comments, Madam Deputy Speaker, and the response to this debate, and the one we held yesterday on domestic abuse, has shown this Chamber in a much better light than that of a week or so ago. These are things we can agree on and that are of acute, everyday importance to our constituents.

As I have said previously, I have been in this House for 22 years and we never used to debate subjects such as this, and rarely held debates on children’s issues or many social issues. It is absolutely right that we hold such debates much more regularly these days, and they are enhanced by the personal, often emotional, harrowing and brave testimonies of hon. Members who bring such experience and richness to the debate. They show that we do have some understanding of the complex, complicated and challenging issues that face so many of our constituents every day.

I had not intended to speak in this debate, but I was moved by the contributions from my hon. Friend Sir David Amess and Ellie Reeves. I have a long-standing interest in this issue, and I declare an interest as chair of the all-party group for conception to age two—first 1001 days. That issue has growing traction and importance, and it should be mainstreamed. I also chair the charity Parent Infant Partnership, PIP UK, and co-chair the all-party group on mindfulness. If any hon. Members present have not attended a mindfulness course, I reiterate that they are available on Tuesday afternoons, usually at 5 o’clock in Committee Room 7. Given the stress of recent weeks, attendance has been noticeably higher and perhaps of more benefit than usual.

I am slightly daunted by speaking in this debate. Yesterday I said that I was daunted by speaking in the fantastic debate on domestic abuse, on the basis, first, that I am a man, and, secondly, that I am not from Wales. Today I am daunted, first because I am not a woman, and secondly because I am not from Essex, which seems to have a dominant geographical impact on the contributions that we have heard and will hear.

Next week we will celebrate Mental Health Awareness Week, and we will also relaunch the charity PIP UK. I have just written a letter to the Minister, and I very much welcome her and the huge amount of experience that she brings to her role from her health background. I am glad that perinatal mental health featured in the remarks of the hon. Members for Bath (Wera Hobhouse) and for Lewisham West and Penge, because that is where I think we can have the biggest impact on the mental health of future generations.

A few years ago, the Maternal Mental Health Alliance produced a valuable piece of work that estimated that perinatal mental health issues affect at least one in six women. Too often that happens in silence, which is why it is so important that the hon. Member for Lewisham West and Penge recounted how it happened to her—why would it not happen to somebody just because they happen to be an MP? The cost to the nation of perinatal mental health issues was estimated at £8.1 billion every year, which is probably an underestimate. We can add to that the cost of child neglect in this country, which is estimated at £15 billion and is often born out of problems with attachment in those early years, even before the child is born, and particularly if a woman is facing huge stresses and challenges, or domestic violence and so on. The statistic that I gave yesterday, which I still find hard to believe, is that a third of domestic violence cases start during pregnancy. The cost of getting this issue wrong is more than £23 billion a year. That is so much more than the more modest investment we could make to get this issue right and prevent those problems and the huge issues they create, financially but also socially—problems that are often lifelong for future generations.

We need better attached children, and attachment dysfunction has gone under the radar for so long. It is therefore essential—I am glad that the hon. Members for Bath and for Lewisham West and Penge mentioned this—that the vital six-week checks on new babies should also include the physical and mental health of new mums, particularly first-time mums. I make no apology for repeating that health visitors have been an important component in helping with those checks, and one great achievement of the coalition Government—I was also part of the shadow health team when we worked on this—was the substantial increase in health visitors. That was based on the Kraamzorg programme in Holland, which we went to see. It showed that if we work intensively with new parents in those early stages, we can prevent many problems from happening later on. Health visitors are such a good investment to ensure happy, healthy, stable new parents who are able to interact in a sensible, robust, proper and healthy way with their children, and that is in the best interests of kids and their parents.

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

The health visitors in the early weeks when I was first a mother, and subsequently, were wonderful and a real lifeline. We do need to continue with that, but the problem is that it is not systematic enough. Making sure that a mandatory six-week health check is done by a GP and a health professional is the way forward. Currently, the system is too haphazard and we need to have a much more watertight system to get help to every woman who needs it.

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

We need both. The health checks are NICE-recommended, but alas not mandatorily funded or instituted across the country. Frankly, all GPs need better training on mental health and mental illness prevention generally, and especially on perinatal mental health.

It was a huge success of the coalition Government that we recruited almost the 4,200 target for health visitors that was set back in 2010. We have lost as many as 30% of those now, since the responsibility for health visitors went from the NHS to local authorities. I am not saying whether that was the right move or not, but, given the cash constraints on local authorities, health visitors have turned out to be a soft target. That is a hugely false economy and certainly needs to be revisited as a priority by the health team.

The lifelong importance of early attachment should not be underestimated. It has been judged that for a 15 or 16-year-old suffering from depression—an all too common problem among teenage children in schools—there is around a 99% likelihood that his or her mother was suffering from depression or some other form of mental illness during or soon after pregnancy. The correlation is as close as that. Not getting it right during the conception to age two period will have an impact on many children for their childhood years and, for too many, continuing into their adult years too. Maternal mental health is very important, not just for the mother herself but for her children and the surrounding family.

Let us not underestimate the impact this has on fathers as well. I will be ruled out of order if I go too much into the subject of male mental health—although I hope we have a debate on male mental health too—but the impact of poor attachment between a mother and baby has significant impacts on fathers. It is important that they are also given every help and support to have that attachment to their children. Too often, children’s centres and other support mechanisms are mum-centric and we overlook the role of the father. The father has an important role to play in the life of the child and an important support role to play in the physical and mental health of his partner, the mother.

The Government have done an awful lot in recent years to raise the profile of the importance of mental health and flag up how we need to do much more. Importantly, they are also investing much more in mental health. We talk about the parity of esteem between mental health and physical health, and we all agree that that is necessary. Much has been done to reduce the stigma that was attached to mental illness just 20 years ago. It is good that so much more money is going into the area. We have a shortage of mental health practitioners and we need to make sure that we prioritise recruiting, training and getting them in service as soon as possible.

The criticism I have is that last year’s Green Paper on mental health included a lot about school-age children, which is important, but virtually nothing on pre-school-age children and perinatal mental health. Shifting the age profile forward and making it more about prevention and early detection—rather than dealing with the symptoms of a child who may already be damaged because their mother was damaged in their early years—is the way we have to go. We have to do much more in schools, but we need to do so much more before children get to school, by working with their mothers and fathers at an early stage.

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

The hon. Gentleman made an important point about the reduction in funding for local authorities. When it comes to trying to provide holistic support to the family and mother, does he share my regret at the closure of so many hundreds of Sure Start centres since 2010?

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

I do not want to make this a partisan issue. We can have a debate on this subject, and there have been some cuts to support services that have obviously not been helpful and will have some of the long-term impact that I have mentioned. I have visited, and even opened in my time as Minister, several children’s centres, and many of them do a fantastic job. But many were not doing a fantastic job and were failing to do a job of work for the 15% of the most deprived communities for whom they were originally most intended.

The failure to comprehend the importance of children’s centres is to put too much trust in bricks and mortar. Many of the outreach services that went with children centres were more important, and they were not getting out enough. We have children’s centres that have worked really well in my constituency, and we have not closed any in West Sussex, largely because we put them in the right places and turned them into what I call a Piccadilly Circus of services. They have district nurses, health visitors, mental health nurses and social workers hot-desking and sharing information about various families, especially vulnerable children and others, to give a wrap-around, comprehensive support mechanism. The challenge so often for children’s centres is getting the parents—particularly dads—to come across the threshold. Some children’s centres do that really well, but many do not. I know about the importance of children’s centres, but I also know some of their weaknesses. It is the services they offer and the outcomes they achieve that are so much more important than the amount of bricks and mortar that exist to provide them.

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

The hon. Gentleman is making an important point, but, with the greatest respect, West Sussex did not have the kind of cuts to its local authority funding that many more impoverished areas such as Manchester and other big northern cities did. He is right that it is not just about bricks and mortar: it is the support services that were also cut that have had the greatest impact on young families in those areas.

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

Nice try. West Sussex was the least funded shire county in the whole of England. Do not try and tell me that supposedly affluent areas such as West Sussex have not faced financial challenges. I do not know about the hon. Gentleman’s constituency, but the gap between the per capita funding that children get in my constituency and many of the London and other municipal boroughs is substantial. It is a question of how that funding is used and prioritised.

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

I will give way, now that I have set this hare running.

Photo of Kevan Jones Kevan Jones Labour, North Durham

The hon. Gentleman is making the fundamental mistake that Members on the Government Benches often do—the idea that every area in the country is the same. I am sure that there are many more looked-after children in inner cities such as Liverpool, Manchester and others—and even in Durham—than there are in his area. That comes with a cost, and the areas cannot be treated the same.

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

That shows a fundamental misunderstanding. I declare an interest because this was my issue. Where children are placed is not necessarily a reflection of how many children are in the care system in that authority. Children in care placed in other authorities, such as Kent, where accommodation is cheaper than in London, are paid for by the placing authorities, and they can cause challenges to the host authorities. That is a wholly different issue. The original point that Jeff Smith made was that children’s centres are part of the solution. We need children’s centres with well-trained people offering well-targeted support services to those who need them, but saying that this is purely a numerical issue, because now we have 3,200 children’s centres as opposed to 3,500, is missing the point. It is about the quality of the care offered to those who most need it.

I will wrap up now—as I see you want me to, Madam Deputy Speaker—by touching on a couple of other points affecting older girls. They include the impact of bullying, social media and bullying online, peer pressure relating to body image, the reports by groups such as the Girl Guides and the surveys showing the number of young teenage girls who do not like their appearance and would, if they could, pay for plastic surgery, which is hugely alarming. We have to give young women in particular the confidence to be able to say, “I am who I am. This is who I am, and if you don’t like it—tough.” That is something that we have a major role in getting across in society, and frankly social media need to be part of those positive messages. We still have problems with the internet and social media companies hosting sites that masquerade as sites giving advice to people with eating disorders, but which are in fact malignly encouraging anorexia and things like that.

Photo of Mark Tami Mark Tami Opposition Pairing Whip (Commons)

Does the hon. Gentleman agree that social media companies that hide behind the claim that they are just platforms and are not responsible for the content need to take a serious look at themselves?

Photo of Tim Loughton Tim Loughton Conservative, East Worthing and Shoreham

The hon. Gentleman is absolutely right, and I am glad that the Government are doing that with proposals, which are currently being consulted on, to fine social media companies that do not take down harmful comment. I am not just talking about hate crime or terrorism; this is about how it can undermine impressionable young people in particular. There are laws in places such as France about such sites, and Germany has introduced heavy fines that can be imposed on social media companies.

This is a big problem. Mental illness is a particular problem for women who might be affected by relationship breakdown, domestic violence, homelessness, housing difficulties, missed education opportunities, unemployment, financial difficulties, debt, ill health, substance misuse and interaction with the criminal justice system. Mental illness takes different guises and different forms, but the earlier we act, and with the most appropriate support, the more likely we will be to do the best job for future generations, and that starts at conception.

Photo of Kevan Jones Kevan Jones Labour, North Durham 2:22 pm, 3rd October 2019

I congratulate Wera Hobhouse on introducing the debate and welcome the Under-Secretary of State for Health and Social Care, Ms Dorries, to her new position.

I welcome this debate because it is another opportunity to talk about mental health. As was said earlier, at one time it would not have been spoken about, but our debates, which have in large part been cross-party and consensual, have changed people’s attitudes. That is the real difference that we have made. The hon. Members for Southend West (Sir David Amess) and for East Worthing and Shoreham (Tim Loughton) were right that this is the House at its best—disagreeing politely, but ensuring that issues that frankly are not very popular are debated consensually. I welcome that. These debates have made a real difference in changing people’s attitudes to mental health. I pay tribute to the charities that have recently been involved in various campaigns, because eradicating stigma is a big issue that we still need to work on in our discussions about mental health.

The hon. Member for Bath pointed out in her introduction to the debate that one in five women can at some stage experience a common mental health issue, whether depression or anxiety. Often, they are the ones at greatest risk, especially young women. Although all the evidence suggests that men are more likely to take their own lives, there is an increasing danger among young women of taking their own lives. The statistics have not really budged since 2012, and I think the same is true for the suicide rate among women generally, which at the moment I think is 5.4 per 100,000 of the population. Those rates have remained static for the past 10 years. Some great work has been done on suicide prevention, which led to a slight drop—although I notice that the figures recently went up again—but we need to put more effort into looking in detail at the underlying reason why the suicide rate among women remains static.

The other issue is that women are more likely to suffer from mental illness because of trauma, such as domestic violence and sexual abuse, and issues around body image, which the hon. Member for East Worthing and Shoreham spoke about and which I will come on to.

I welcome the work of the women’s mental health taskforce, which reported in 2018. Let me put on record my thanks to Jackie Doyle-Price for the work she did. She was a great champion not only for women’s mental health but for the entire mental health agenda. Not only was she always available to speak to Members, but I know from speaking to charities and others working in the field that her door was always opened. She listened; she made sure she got change; and she can be proud of the work she did.

The taskforce’s report touched on something that is quite self-evident, but which we sometimes forget—namely, the clear link between poverty and socioeconomic conditions and women’s mental health. It found that 29% of women in poverty experience poor mental health. Another issue touched on, which was raised by the hon. Member for Southend West, was prisons. The report highlighted the depressing statistics for women self-harming in prison, which are obviously linked to other issues such as poverty, which has already been mentioned, and substance abuse.

I agree totally with the report’s conclusion that we need to link those issues up and take an holistic approach, but I would go one step further. I have spoken about this before, but we also need to hard-wire mental health and wellbeing into all public policy, whether nationally or locally. We need a system whereby any policy being developed should be tested against a matrix of mental health indicators before implementation, and I would include spending decisions in that. The hon. Member for East Worthing and Shoreham talked about spending cuts, and although we might disagree about their effects on Sure Start centres for instance, making what the Treasury might see as easy cuts leads not only to problems locally but to more expense for the taxpayer in the long term. We should certainly look at that when we are spending money, because while the call is often for more money—which we do need in mental health—we also need to ensure that it is spent correctly and joined up. We could achieve a lot more if we took a joined-up approach.

Let me give two examples of where not having that prerequisite for testing is leading to problems and costing the taxpayer and society more. One is the Department for Work and Pensions and its employment and support allowance assessment. I am clear that people should be encouraged to work, and we all—let us be honest—know that the right type of work is good for people’s mental health. However, we should not have a system that is very blunt in terms of assessment and that takes little account of those living in our communities with long-term mental health problems.

A constituent in her late 50s came to see me a few months ago, having lived with long-term mental health issues in the community. She went for her ESA assessment and got no points. She was then virtually suicidal. I intervened, although, frankly, it should not have taken me to intervene. She then had a mandatory reconsideration, and her payment was reinstated. If we look at that woman’s history, it is clear that she is not going to work, but the process did not take that into account. If that person had then been sectioned, had gone into hospital or had—let us be blunt—taken her life, that would have been a huge cost to society.

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

I have been an MP for a relatively short time, and I find increasingly that trying to access services or get universal credit throws perfectly healthy people into mental health problems, because it creates anxieties and delays. I am not surprised that a lot of people are being thrown into mental health problems, because our public services are increasingly not responding in a humane way to people’s needs.

Photo of Kevan Jones Kevan Jones Labour, North Durham

I agree, and I will come on to the other example I have in a minute. Those problems then result in a cost to the taxpayer. If we had road-tested the ESA policy in terms of mental wellbeing and assessment when we were developing it, that would have helped the situation.

The other example, which the hon. Lady has just referred to, is universal credit, which is creating huge problems for many of my constituents. They are going up to six weeks without any money. That is having a huge effect on women’s mental health, because the main carers in most of these households are women, who have to juggle budgets. Again, we should have thought beforehand about the cost to society and the taxpayer of the added mental health problems generated through this policy.

On women in prison, it saddens me a little that the Government have now taken up the “lock them up and throw the key away” agenda in the criminal system. We need to reduce the number of people who are actually in prison, and especially women. If we look at the evidence and at the reason why women are in prison, we see that it is linked to domestic violence, mental health problems and substance abuse.

In County Durham, I pay tribute to Durham police and the crime commissioner Ron Hogg, who introduced Checkpoint in 2011. He did that because he was sick and tired of putting women shoplifters through the criminal justice system when what they really needed was help. If we look at the statistics and at the changes that the programme has made, we see that it is cutting reoffending rates. It is addressing the real issue, which, in most cases, is domestic abuse and mental health issues.

In addition, we need clear pathways. The report says we need joined-up local services. That is not just about the acute sector and GPs; it is about the voluntary sector as well, and we need to ensure that it is part of that joined-up local system. Certainly, in my experience, it is delivering local services and good value for money very effectively for local communities. In my constituency, I have a fantastic project called Just for Women, which deals with women who have faced domestic violence and mental health problems and who have been in probation. The project staff do one simple thing: they allow time, and they talk to people. They use crafts and other things to get women’s confidence back. If we sit and talk to the women in that project, we find that most of them have been through every programme possible—they have gone through systems and systems. We need to ensure that we put in place a system that works.

Finally, I want to touch on body image. I welcome this year’s report by the Mental Health Foundation, which focused on the link between body image and the nation’s mental health. In the report, one in five UK adults said they felt ashamed of their body image and 43% of women had low self-esteem when it came to their body image. That does lead to psychological effects.

I agreed with the hon. Member for East Worthing and Shoreham when he talked about the internet companies. They have a huge responsibility in ensuring that the messages they put out do not perpetuate the myth of the perfect body image. That is leading not only to psychological problems but to people having unnecessary cosmetic surgery and interventions, which are harmful to them.

I have challenged Facebook, for example, to ask why it continues to carry adverts for Botox, which is a prescription drug. Just try to take one down; my constituent Dawn Knight, who has been campaigning on this, tried to take one down, but it cannot be done. These companies should take a proactive approach to blocking these adverts, because they are not only perpetuating the image of the perfect body, but are, in some cases, I think, actually breaking the law. If social media companies such as Facebook will not change, there needs to be legislation.

In conclusion, I welcome the debate, because we are talking again about mental health. Is this about money? Yes, it is. We do need investment in mental health services. However, we also need to ensure that we have that joined-up approach to not only services but methods and processes. That can reduce people’s mental illness and ensure not only that we have a society that is content with itself but that, when people do get into crisis, there is a service and support there for them.

Photo of Jackie Doyle-Price Jackie Doyle-Price Conservative, Thurrock 2:36 pm, 3rd October 2019

It is, as usual, a pleasure to follow Mr Jones, who is always a fixture in these mental health debates, as, indeed, is Wera Hobhouse, and I congratulate her on securing this debate.

I thank Ellie Reeves for her very honest contribution. It is about time we were honest about the fact that childbirth is hard and that what happens after we have given birth is hard. We could be forgiven for buying into the myth that it is all hearts and flowers, but the reality is very different indeed for many women and their families. It is absolutely fantastic that she made that very honest contribution today. Those of us in this place need to be frank about our own experiences to make the system better.

It is a glib thing to say that it is a man’s world, but, frankly, it is. On so many levels, the health service, in terms of both physical and mental health, does not work well for women. I was therefore pleased to have chaired the women’s mental health taskforce with Katharine Sacks-Jones from Agenda, and I thank her today for her contribution. It is important that we look at women’s mental health, as distinct from that of men. In the same way, we ought to look at mental health through the prism of other things that end up being discriminatory. For example, there is the whole gamut of neurodiverse conditions, autism and attention deficit hyperactivity disorder. There are more mental health issues in people who have those conditions, and, frankly, we are not doing enough for them. That also plays out in further discrimination against women, because they are often diagnosed much later with autism and ADHD, and they are then not equipped with the tools to manage their conditions.

It was absolutely fantastic to get buy-in from people with real experience on the women’s mental health taskforce. My hon. Friend Tim Loughton talked about perinatal, and that was of course a big part of it. It is interesting that we are debating this issue today, just a day after that amazing debate on the Domestic Abuse Bill, because abuse is often a common factor underlying the prevalence of mental ill health in women.

We set up the women’s mental health taskforce because we were seeing an increased prevalence of mental ill health among women between the ages of 16 and 24. There is no doubt in my mind that an underlying cause is abuse, particularly the rise of sexual abuse and violence.

The women’s mental health taskforce concluded that we needed more by way of community services to support women, and one important part of that was improving the support for victims of sexual violence. I completely agree with the right hon. Member for North Durham about the contribution that voluntary services can make in this space. When I was the Minister, one of the messages I always gave to commissioners was not to medicalise everything. Voluntary services, particularly in mental ill health, can give so much additional support to people. That wraparound support can be as important to someone’s recovery or ability to manage their condition as any medical intervention. In welcoming my hon. Friend the Minister to her post, I ask her to continue giving that message to commissioners, not least because, as well as delivering the services well, voluntary services often provide much better value for money. So let us continue to do that.

I was pleased that earlier this year the NHS published its strategy to deal with sexual violence and to provide sexual violence support services. Within it was a commitment to a lifelong package of care for survivors of sexual abuse. The voluntary sector—the hon. Member for Bath mentioned rape crisis centres—has a huge role to play in making sure we continue to support victims of sexual abuse.

Women are often a secondary consideration in the way we deal with many problems, and by definition that becomes discriminatory. We have had a lot of debates in recent months about gangs and the problem of young men carrying knives and stabbing each other and the fact that there are far too many deaths, but another aspect of that gang culture that is not talked about enough is the grooming of girls. It is almost like Rotherham never happened. We must make sure that when we look at gang culture, we do not just talk about young men stabbing each other or the drug trade that goes with it; we must also tackle the grooming of young women, otherwise the incidence of mental ill health among women aged 16 to 24 will only continue to rise.

One thing not yet mentioned in this debate is the review of the Mental Health Act 1983. We must make sure that when we look after women with severe mental ill health we are not doing harm. We need to deal with some of the practices that still exist in our treatment of people with mental ill health. We used to think of people with mental ill health as an inconvenience to be managed. Thankfully, we are becoming much more enlightened, but there is still poor practice that needs to be weeded out. I repeat that abuse is often the underlying trigger that exacerbates a woman’s mental ill health, and when we treat women, we should not compound that harm by handing over the control of someone who has been sectioned to their abusive partner. Under the Act, however, when someone is sanctioned, the next of kin is effectively given control over them, which only compounds the harm. I have heard some incredibly distressing testimony from people who have been through exactly that. As that work continues, we must empower patients, including women who are victims of domestic abuse.

We have heard reference to eating disorders. We have actually made considerable progress in improving eating disorder services, but we need to do much more for adults. The health service needs to empower women, not just tell them to run along. Many Members will be aware of the campaign by Hope Virgo, the Dump the Scales campaign, but the really telling thing about Hope’s testimony is this: she has been through anorexia, she understands her condition, and she can see when she needs help, but when she goes to her GP, she is weighed and told she does not have a problem. That shows a fundamental misunderstanding about how eating disorders play out and how they should be managed. Members have discussed the need to make sure GPs behave better. One reason GPs do not behave as well as they should when dealing with mental health is that they are not adequately trained. I encourage the Minister to have that conversation with the royal colleges to make sure mental health training is a mandatory part of doctors’ training. The earlier we identify someone who needs help, the more effective that support can be.

I want to finish by picking up on an issue raised by several colleagues, including my hon. Friend Sir David Amess: that of people in prison. We all know that prison should be a place where people go when they have done bad things, but anyone who visits a prison wanders around thinking, “A lot of these people shouldn’t be here at all.” They are people who have fallen out of society and been failed by the state. That is particularly the case for women. The more we can do to get that early intervention the better. We should not be allowing people to fall out of the care of society and then dealing with them only when they become a nuisance. That applies to people who have been through the care system and been victims of abuse.

Photo of Kevan Jones Kevan Jones Labour, North Durham

Does the hon. Lady agree that one of the problems that pertains particularly to women prisoners is that of short sentences, which do not give enough time for rehabilitation and over time disengage people from services outside and, in a lot of cases, from families and other support networks?

Photo of Jackie Doyle-Price Jackie Doyle-Price Conservative, Thurrock

The right hon. Gentleman puts it very well. In those instances, we are just doing harm. We should be able to identify when somebody needs help. Just taking them away and putting them in prison without any programme of support only puts them on a conveyor belt to more offending. We need to make sure we are picking people up. There are some fantastic tales of how people do that. I once met a lady who had been convicted of drink driving after she reported herself. She had gone through a period of grief. What good would it have done to make her serve a prison sentence? It would have compounded her grief; she would have been away from her family; and she would have lost her job and probably her home—if she was renting—which would only have put her on a conveyor belt to disaster. We must be much more enlightened and make sure that our prisons are for people who are going to harm society, not people who are harming themselves.

I could say so much more, Madam Deputy Speaker, but time is limited, so I will finish there.

Photo of Patricia Gibson Patricia Gibson Shadow SNP Spokesperson (Consumer Affairs) 2:47 pm, 3rd October 2019

I thank Wera Hobhouse for bringing forward this important debate about women’s mental health.

As Sir David Amess and Mr Jones indicated, the prevalence of poor mental ill health among women is similar to that among men, but there is undoubtedly a marked gender difference in the rates for different types of mental illness: as we have heard, women are more likely than men to experience anxiety, depression, post-traumatic stress disorder and eating disorders, and we know that young women and girls are at more risk of self-harm. Recently, in my constituency, I had the privilege of visiting a mental health charity called Penumbra, which is in Ardrossan. It supports young people living with self-harm, as well as a range of other mental health challenges.

Reports published recently by organisations such as the Women’s Mental Health Taskforce have highlighted the fact that particular social inequalities faced by women, such as having greater caring responsibilities and sexual and/or domestic abuse, can have a negative impact on their mental health. Most commonly linked to poor mental health is the issue of living in poverty. In view of those facts, it is helpful and informative to debate mental health challenges faced by women in particular.

As Tim Loughton reminded us, there was a time, not so long ago, when poor mental health was not really talked about, but now we are more enlightened. There is a recognition that our mental health is as important as our physical health and that, when we face challenges with mental health, it is nothing to be ashamed of. It is therefore right and fitting for the subject to be debated in the House. Our concern with mental health ought not to be a party political matter. We are all concerned about it. Resourcing the illness and safeguarding those who are at risk matters a great deal.

Let me now say a few words about measures that we are taking in Scotland to try to deal with this problem, although whatever action is taken, it will never be enough to provide the treatment and support that women who suffer from poor mental health—and, indeed, anyone who suffers from poor mental health—need and deserve.

In Scotland, as in every other nation, we face challenges relating to mental health provision. I am pleased that, in the face of those challenges, the Scottish Government were the first Government in the United Kingdom to have a ministerial post dedicated to mental health, I am also pleased that they invested £1 billion in mental health in 2017-18, and that mental health spending increased by 3.2% over that period. With some innovation, I think, they have outlined their vision for approaching women’s mental health in their “Mental Health Strategy 2017-2027”, adopting a rights-based approach to mental health which realises the rights of women as outlined in the United Nations convention on the elimination of all forms of discrimination against women.

The Scottish Government’s “Programme for Government,” published only a couple of weeks ago, pledged to improve existing mental health support for women throughout Scotland, including perinatal support, and support for women who need more specialist help and those with the most severe illness. In terms of pounds and pence, that commitment was part of a programme budget for mental health increasing by £15.3 million, from £70.2 million last year to £85.5 million—an increase of nearly 22%. Of course, in the face of what some people may call a poor mental health epidemic, there is always a need for more resources, and it is the challenge of all Governments to work to meet those demands.

I want to say a word or two about the particular mental health challenges that can affect new mothers. They have been mentioned by a number of Members today, including Ellie Reeves and the hon. Member for East Worthing and Shoreham. New mothers and expectant mothers are an “at risk” group when it comes to poor mental health, and I am pleased that the First Minister of Scotland has given a commitment to spend £50 million on improving access to mental health services for them.

Of course treating mental health and providing support services for women who live with, or are at risk of developing, poor mental health is important, but it is also important that we all understand how much more can be done to safeguard women’s mental health in the first place. We obviously need a more joined-up approach. In Scotland, child and adolescent mental health services are working with schools, which is very important, but we should seek to deliver better training for teachers as well as GPs—who were mentioned by Jackie Doyle-Price—to deal with, and identify more confidently, poor mental health in children. We can always do better in that regard, as well as, of course, not forgetting to address the mental health of the GPs and teachers who are in the front line.

It is also important and necessary to mention—and it would be remiss of me not to do so—the effect of austerity measures on women and their mental health. We know that they are most affected by such measures, because much research by, for example, the Joseph Rowntree Foundation bears that out. Psychologists Against Austerity has made clear that cuts to public services are directly linked to mental health problems, and that women living in poverty are more likely to suffer post-natal depression. That finding was backed up by a study in The Lancet, which found that poverty increased maternal depression.

Actually, that should not surprise us. Poverty can be very isolating. If you are living in poverty, you have few choices about how to spend your time. You cannot always afford to meet up with friends, or afford the bus services that provide access to local services and amenities. You cannot simply leave your home for a change of scene, as you may struggle to treat yourself to a visit to the local café. All around, your world shrinks if you are living in poverty. Sometimes finances are so desperate that your world shrinks to simply your own four walls, and that sense of isolation can form a direct bridge into poor mental health. As the hon. Member for Thurrock set out, that overlaps with conditions such as autism, which often lead to poor mental health, as a sense of isolation of any kind has a significant impact on our mental health.

We know that austerity disproportionately affects women and, sadly, we also know that single household payments as the default for universal credit payments can exacerbate that isolation and loss of financial control. The loss of financial control is a common element in abusive relationships. I am proud that my former colleague, the former MP for the constituency of Banff and Buchan, Eilidh Whiteford, brought forward a private Member’s Bill to ratify the Istanbul convention. Sadly, the convention has not yet been ratified by the UK Government, which is deeply disappointing.

When we know that universal credit has been implemented in ways that negatively impact claimants’ mental health, we should seek to do something about it, as the hon. Member for Bath has pointed out. We know that single parents, 90% of whom are women, are more than twice as likely as any other group to experience persistent poverty. There are obvious things we can do to better safeguard the mental health of those women. As the right hon. Member for North Durham has said, that could actually save money in the end.

I sincerely hope that the Minister will be persuaded, in the light of the debate today, to have conversations, which may not always be easy, across Government Departments about how women’s mental health—and, indeed, mental health in general—can be better supported. This is not just about us thinking about resources to treat poor mental health, important though that is. It is also about giving more thought, more effort and more understanding to what is needed. It is about determining what factors lead to poor mental health and dealing with them, so that ultimately we see fewer people, fewer women, needing treatment for poor mental health, which affects far too many of our constituents. Dealing with the underlying causes of poor mental health is not just about what we can afford to do; it is about what we can afford to leave undone.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Mental Health and Social Care), Shadow Minister (Mental Health) 2:56 pm, 3rd October 2019

I congratulate Wera Hobhouse on securing this important debate and thank all Members who have spoken in it. I also welcome the Under-Secretary of State for Health and Social Care, Ms Dorries, to her new role. I look forward to having some robust debates with her across the Dispatch Box in the weeks and months to come.

We have heard some excellent contributions this afternoon. The hon. Member for Bath discussed how important it is to consider trauma-informed services. She also talked about eating disorders, and I thank her for the excellent work that she has done in that area. My hon. Friend Sir David Amess—may I call him my hon. Friend?—spoke passionately about his constituents, Carla and Kelly. I have had the pleasure of meeting them, and I would like to applaud them for the wonderful work they do on endometriosis, which, as he knows, is a subject close to my heart. He also talked about prisons. I had the pleasure of visiting a local women’s prison on the edge of my constituency a few weeks ago, and it was incredibly interesting to talk to the women about their experiences there. It was striking to learn just how many of them had a history of mental health problems.

My hon. Friend Jeff Smith discussed how crucial it was that post-natal women were offered a six-week standard maternal check. My hon. Friend Ellie Reeves talked movingly about her own experience of pre-natal depression and how important it is that the mum’s mental health is considered at the post-natal check. We also heard from Tim Loughton about the importance of maternal mental health and about how crucial it is that early intervention is offered as soon as possible. That is something that the whole House can get behind, and I thank him for his contribution.

My right hon. Friend Mr Jones mentioned something that really resonated. He said that we must hard-wire mental health information into every public policy. Once again, I am sure that all of us in the House would agree with that. It is really good to see the former Minister, Jackie Doyle-Price, here. I thank her for the excellent work that she did and for her collegiate and collaborative approach. She also made some excellent points today, particularly about the impact that sexual violence can have on people’s mental health.

Last but not least is Patricia Gibson. Like others, she began by saying that mental health problems are nothing to be ashamed of. We cannot repeat that enough; it is incredibly important. Stigma does still exist, although some excellent work is being done to reduce it. Still, we must keep repeating this until people believe it.

We know that we face a mental health crisis, and women are certainly not exempt from it. Women are more likely than men to have a common mental health problem and twice as likely as men to be diagnosed with an anxiety disorder. That feeds through to service delivery. Women account for around two thirds of referrals to the improving access to psychological therapies programme. While some of this might come from different attitudes towards sharing mental health problems, it still speaks to an undeniable truth that we must prioritise women’s mental health. In particular, we must pay attention to the mental health of young women: while 20% of women overall have a common mental health problem, that figure rises to 28% of women aged between 16 and 24.

Mental health conditions do not arise in isolation. They are not inherent to a person and are not always unavoidable. Instead, they are bound up with the circumstances in which a person lives their life. They are also closely linked to the way we are treated by others. That is something that all of us in this place should consider carefully at a time when many of us in this Chamber, women in particular, have received death threats and other horrendous abuse.

Before I go on to mention two situations that might have a particular impact on the mental health of women, I want to mention the broader issues that affect our mental health. One of the consistently recognised causes of mental health problems is financial stress: whether it is struggling to find work or being trapped in a job that does not pay enough to make ends meet, this can be a source of enormous stress. As we have heard from a number of hon. Members, there is clearly a link between poverty, austerity, deprivation and mental health. That in turn leads to people developing mental health problems: 35% of women who are unemployed have a common mental health problem, compared with only 20% of women in full-time employment. We know that women are more likely to be unemployed or in lower-paid roles than men. Industries that rely largely on minimum wage workers on zero-hours contracts, such as social care, overwhelmingly employ women.

As well as being a cause of mental health problems, economic instability can open women up to abuse by others, whether that is their employer or a controlling partner. One woman in four will experience domestic violence. As well as the physical trauma of that abuse, survivors can be left with long-lasting mental health problems. Women who suffer domestic abuse are three times more likely to develop a mental illness, including severe mental illnesses such as schizophrenia and bipolar disorder.

Addressing that serious issue works two ways. We need to ensure that services for the survivor of domestic violence, whether the police, shelters or other organisations, are better at recognising mental health problems. Our mental health services need to get better at recognising the signs of domestic abuse. One way they can do that is to be more aware of the reasons a woman might not attend a follow-up appointment. Controlling and coercive partners can easily stop someone going out to attend a medical appointment. Mental health services should be awake to that possibility, and not simply move straight to discharging people.

We have an opportunity to address that through the Domestic Abuse Bill. This is a crucial Bill that, thankfully, has not been lost due to Prorogation. We should use the Bill to bring domestic violence and mental health services closer together so that fewer people are lost between the two. Like many colleagues, I pay tribute to the emotive speeches that were made yesterday from both sides of the House—in particular, the contribution from my hon. Friend Rosie Duffield. We can all agree that she was incredibly brave when she made her extraordinary contribution. We thank her for that. Will the Minister say what conversations she has had with her colleagues about joining up mental health and domestic violence services?

Unpaid family carers in the UK are more likely to be women, and therefore more likely to be providing round-the-clock care for the people they care for. Caring for a friend or family member can have a significant impact on a person’s own mental health. That is particularly true for women carers, who are more likely to be sandwich carers, caring for young children and elderly relatives at the same time.

A survey from Carers UK found that more than two thirds of carers have suffered poor mental health as a result of caring. Carers looking after children and young people, and those who have been caring for 15 years or more, are also more likely to have poorer mental health. Carers are being let down by this Government, and this is taking its toll on their mental health. One carer told the Carers UK survey:

“I was admitted to hospital after a breakdown due to exhaustion and chronic pain. If I had had more breaks from my caring role or adequate mental health support, I might not have had the breakdown at all.”

Access to adequate support and carers’ breaks are crucial to ensuring carers do not reach crisis point. Carers’ breaks are particularly important for mental health, as nearly half of carers have used their breaks to attend their own medical appointments. The Government’s failure to set out plans to support carers properly, or address the crisis in social care, is taking its toll on the mental health of unpaid carers. We have had a watered-down action plan that promises very little action to support carers. It is time for a full national carers strategy that sets out plans to ensure carers have adequate support, including with their mental health. So will the Minister outline how her Department intends to ensure that carers have access to the support they need? Furthermore, will she commit to increasing access to carers’ breaks?

All of this has caused a mental health crisis among women. As I have mentioned, women are far more likely to be referred for basic therapy than men, reflecting both the prevalence of mental health conditions and a willingness to seek help. But a referral to these services is not a guarantee that someone will get the help they need. Talking therapies through IAPT still have a noticeably higher recovery rate for white women than they do for black and minority ethnic women. They also are not working for young women. A 16 or 17-year-old woman accessing IAPT services has a lower chance of recovery than a woman of any other age—or than a man in any age group. We have to do better than this. It simply is not acceptable that someone’s chances of recovering on the primary NHS care pathway for mental health is so dependent on their age, gender and ethnicity.

I wish to take this brief opportunity to thank some of the peer support groups in my constituency, which work so incredibly hard, particularly for those who struggle to access traditional NHS services. Stevie Morley from Take Ten offers the most phenomenal service for those who are suffering from mental health problems, and I wish to use this opportunity today to thank her. I also wish to thank Auntie Pam’s, which is based in Dewsbury and supports young mums, expectant mums and those who are just having problems, perhaps even problems conceiving. Auntie Pam’s is made up of local young mums and they are just wonderful.

The current situation is why Labour will ask the National Institute for Health and Care Excellence to carry out a full review of the psychological therapies available on the NHS, to ensure that everyone is able to access therapies that are appropriate and work for them. For some people with a mental health condition, it may be necessary to go beyond talking therapies or community support. When that is the case, we should be working to ensure they receive the best treatment possible. But too many women are still being mistreated in mental health units. Last year, more than 4,000 women held under the Mental Health Act were subject to restriction. Each woman was subject to an average of 12 restrictive interventions, which is far more than the average man was.

One example of how this excessive restriction can look in practice is seen in the case of a woman called Alexis Quinn. Alexis is an autistic woman who has spent years of her life trapped in a mental health unit. Since she escaped this unit she has shared her experience, and it is truly harrowing. After she tried to leave the unit, which she was on as a voluntary patient, she was held down and forcibly sedated. When she complained, she was locked in seclusion for more than a week. Alexis was restrained 97 times and secluded 17 times, although there were numerous seclusions which went unrecorded. When somebody seeks support from mental health services, they deserve better than that. It can never be right that we fall back on violent restraint and seclusion.

There is a crisis in mental health support for women. Today’s debate has called for more mental health support tailored specifically to women. Members have called for greater access to mental health support for domestic abuse victims, and greater support for young women and girls and for carers.

In conclusion, we need urgent investment in mental health. Our mental health services should be comprehensive and universal, and we need to invest in early intervention as a priority. Women should be able to access specialist, gender-specific, in-patient and community services that recognise the traumatic nature of domestic violence or abuse. Women experiencing a mental health crisis must be treated with dignity and respect, but too often this is not the case. On all these areas, the Government are simply not doing enough. Women deserve better than being ignored or fobbed off with services that do not work. It is time to act and deliver a mental health system that truly delivers for everyone.

Photo of Nadine Dorries Nadine Dorries The Parliamentary Under-Secretary for Health and Social Care 3:09 pm, 3rd October 2019

I hope everyone will concur that this debate has followed on in tone from yesterday’s debate on the Domestic Abuse Bill. I thank everybody for their contributions. I thank Wera Hobhouse for opening the debate. I also thank my hon. Friend Johnny Mercer, who I understand originally secured the debate—when he took up his ministerial position, the hon. Member for Bath took the debate forward on his behalf, for which I thank her.

I give many thanks to my predecessor, my hon. Friend Jackie Doyle-Price, who did a hugely commendable job when she held this position. I am determined to continue the work that she began—not least because I am sure she will be breathing over my right shoulder in every debate that I take part in. I wish to pick up on one of her comments, which fitted the tone of debate. She said that we should all share in this place the results of our own personal experiences. I was not going to mention why women’s mental health is so important to me, but that comment has sat on my shoulders since she made it—as have, indeed, the other brave contributions.

Women’s mental health, particularly perinatal depression, is incredibly important to me because a very close member of my family had perinatal depression and took her own life—and not only her own life but that of her baby and her two existing children. It was an act that has since reverberated through my family, and for many other people. Perinatal depression is incredibly important to me, as is this role, and that is why I take so seriously all aspects of my role but particularly women’s mental health.

Women have broken down barriers, not only in mental health but in this place. I remember well the time when a previous Madam Deputy Speaker was pregnant. She spent most of her time in the ladies’ room at the back because the fact that she was sat in the Chamber and was pregnant at the time was not quite appreciated. Times have changed and sharing our experiences has now become commonplace. I think that has helped to break down the barriers in here so that we can discuss issues that are so important to so many people.

Photo of Andrew Griffiths Andrew Griffiths Conservative, Burton

I thank the Minister for sharing her personal story with us. The more we hear from Members from all parties who have themselves suffered from poor mental health or whose families have felt the footprints of poor mental health, the more we will help to break down the stigma and the more we will show to people who are listening to this debate or watching on TV that it can happen to anybody. There is nothing to feel embarrassed about and there is nothing to be ashamed of. The most important thing we can all do is talk about our mental health.

Photo of Nadine Dorries Nadine Dorries The Parliamentary Under-Secretary for Health and Social Care

My hon. Friend is absolutely right: it is about breaking down the stigma in mental health. When somebody breaks their leg, they wear a plaster cast and we can see that they have broken their leg. We cannot always see when someone is suffering from a mental health issue, so it needs to be destigmatised. It also needs to be given the same consideration as physical illness, and I think it is.

Obviously, my speech has now been dumped, because so many points were raised in the debate and I feel that I have to answer them. I shall start with the hon. Member for Bath, who raised so many points when introducing the debate. I want to answer some of her questions. One of her first points was about rape crisis centres; this year, we will spend £35 million and fund 47 sexual assault referral centres, to ensure that when sexual violence occurs, there is the best possible response for victims. The centres are available to all victims—male and female, adults, children, and current and non-current victims of rape and abuse.

I want to mention the approach the Government have taken to mental health. I took up this post just as we announced £2.3 billion of expenditure on mental health. Let me put that into perspective: my hon. Friend Alex Chalk informed me that that is more than half the entire yearly prisons budget; that demonstrates how much money we are investing in mental health. The money is going into many areas, but in almost all areas it will have an impact on women and young girls— and this debate is all about women’s mental health. It is important that women are at the centre of all mental health policy. They should be not just be siloed off into their own particular areas; they should be at the centre of everything.

Photo of Kevan Jones Kevan Jones Labour, North Durham

I understand what she says about the increase in budgets, but does she not also realise that cuts in other areas are actually adding to the problems? Therefore, it does not matter how much money we pour into mental health services. Public health funding, for example, which is devolved to local authorities such as Durham, has had a 40% cut, which means that existing services, such as those for substance abuse, have had to be cut. Putting money in one way and taking it out in another does not solve the problem.

Photo of Nadine Dorries Nadine Dorries The Parliamentary Under-Secretary for Health and Social Care

The NHS budget is not bottomless, but the mental health budget is growing faster than the overall health budget, and the budget for children and young people is growing even faster than that. One Member—I think it was Ellie Reeves—said that more people are presenting with mental health issues now than ever before. In fact, GPs agree with that, and say that a lot more people are presenting with those issues at their surgeries. That is due to many, many reasons. One Member raised the issues of the postings on Facebook and Instagram, of body image and of dieting. There are many reasons why people are suffering from mental health issues, and it is not just to do with service cuts, which are being addressed.

I need to race on with my speech because I have just three minutes left. On the maternal six-week check, we hope to ensure that that happens in all our GP contracts going forward.[This section has been corrected on 7 October 2019, column 11MC — read correction] The hon. Member for Bath mentioned the Istanbul convention. The Government signed the Istanbul convention in 2012 to reaffirm our strong commitment to tackling violence against women and girls. She also talked about eating disorders—I know that she has brought forward other debates on this issue. She also mentioned body mass index. We want all GPs to adhere to the NICE guidelines, which means that they must take a holistic approach to young women who are presenting with potential eating disorders. I am talking about taking a look at dental records, considering whether those women are still living a full life and still working, whether they are seen to be eating or whether they are absenting themselves after a meal. We need to look at everything in the round. Nobody should be referred for having an eating disorder based on their BMI alone. That is in the guidelines. We are raising awareness of that, and introducing more training for GPs, so that they are aware of this, too. The hon. Lady may be aware that I wrote an article on this subject recently, emphasising that point.

Perinatal mental health, as we discussed, is also important. According to one study published in 2014, a shocking 10% to 20% of women develop a mental health illness during pregnancy, or within the first year of having a baby. From April 2019, new and expectant mums have been able to access specialist perinatal mental health community services in every part of the country.

The NHS long-term plan, which I referred to earlier, commits to ensuring that an additional 24,000 women will have access to specialist perinatal mental healthcare, with more support for fathers and partners. I am pleased to see that NHS England has expanded the capacity of in-patient mother and baby units, which are in-patient services that support women with serious mental health issues, keeping them together with their babies, which is so important.

My hon. Friend Sir David Amess talked about female offenders. I know that women in prison often have a disproportionately high level of mental health problems, and there are also worrying levels of self-harm. We have recently published standards for healthcare for women in prison and are looking at improving care for pregnant women in prison.

The hon. Member for Lewisham West and Penge talked about health visitors. Earlier this year the Prime Minister announced our commitment to modernise the healthy child programme to reflect the latest evidence on how health visitors and other professionals can support perinatal mental health.

My hon. Friend Tim Loughton talked about the closure of children’s centres. We are investing £84 million over the next five years to support up to 20 local authorities that are seeing high demand for children’s social care. This will help to support the most vulnerable families, and I am sure that that is welcomed by everyone. It is up to local councils to decide how to organise and pay for services in their areas, as they are best placed to understand local needs.

Mr Jones talked about social media and about his constituent trying to get Facebook to take down an advert. I actually congratulated Facebook and Instagram recently for removing all the diet advertisements for miracle cures and diet teas that simply do not work. That is a step in the right direction. I also thank all the women in my constituency who have emailed me on that the issue and others.

Photo of Nadine Dorries Nadine Dorries The Parliamentary Under-Secretary for Health and Social Care

I do not have any time; I have only 30 seconds left.

Patricia Gibson spoke about poverty. Many of us in this place understand the impact of poverty and have experienced poverty ourselves, and we know that it can cause anxiety not only for women, but for young girls. We absolutely understand those issues.

Let me say to the shadow Minister that our £2 million programme Standing Together Against Domestic Violence looks at how the whole health system can better respond to domestic abuse. Like her, I was delighted that the Domestic Abuse Bill passed its Second Reading yesterday. On carers and increased access, the carers action plan published in 2018 sets out a range of ways that we will improve support for carers. We published a progress review in July this year to ensure that we focus on delivering the plan.

The shadow Minister also spoke about the use of restraint, which is abhorrent. The Government fully supported the Mental Health Units (Use of Force) Bill—a private Member’s Bill that became an Act of Parliament on 1 November 2018. The Act imposes requirements regarding the use of force, the publication of data, and how and when physical, mechanical and chemical force is used, as well as requirements for improved staff training. We want to end restraint. We know that it continues to be a routine occurrence on many wards, affecting women and girls disproportionately. That has to end.[This section has been corrected on 7 October 2019, column 12MC — read correction]

I will conclude by stating again that we are putting £2.3 billion into mental health, and that will benefit women and young girls. Never before have any Government ever considered mental health in such a way—with regard to policy, and finance to drive that policy and back it up. I thank the hon. Member for Bath for raising this very important issue. We are making progress, and I am determined that we will make more. I recognise that there is more to do and we will certainly be working on that.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Environment and Climate Change), Liberal Democrat Spokesperson (Transport) 3:22 pm, 3rd October 2019

I thank the Backbench Business Committee for granting this debate, everybody who has made vital contributions this afternoon and the Minister for her responses. If I could take one thing out of this afternoon it would be for the Government to take seriously my request for the Women’s Mental Health Taskforce recommendations to be put into a full strategy in order to bring everything together.

Question put and agreed to.

Resolved,

That this House
notes with concern the rise in mental ill health among women, with one in five now experiencing common mental disorders and young women the most at-risk group;
recognises that women’s mental health problems are often rooted in experiences of violence and abuse;
believes that mental health services often fail to respond to women’s specific needs, including their experiences of trauma;
calls on the Government to ensure that the gender- and trauma-informed principles of the Women’s Mental Health Taskforce are adopted by mental health services and that women’s mental health needs, including their experience of violence and abuse, are prioritised and taken seriously in all mental health policy, strategy and delivery.