Eating Disorders Awareness Week — [Mr Adrian Bailey in the Chair]

– in Westminster Hall at 9:30 am on 27th February 2019.

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Photo of Kirstene Hair Kirstene Hair Conservative, Angus 9:30 am, 27th February 2019

I beg to move,

That this House
has considered Eating Disorders Awareness week.

It is a pleasure to serve under your chairmanship, Mr Bailey, for this very important debate. As we are in the middle of Eating Disorders Awareness Week, this is a timely day on which to remind ourselves of the good work that has been achieved in the past year, but also to look forward to where we want to be by this time next year.

I want to take this opportunity to thank Beat—the Eating Disorders Association—and the many other charities that have been in touch with me ahead of the debate for their sheer hard work and determination to keep this issue at the forefront of the Government agenda. I see many of you in the Public Gallery and want to say thank you for all that you do.

There is always great cross-party support in debates on eating disorders. I have been in this place for only 18 months, but it is the debates in which we are all travelling in the same direction that are so powerful, because we show our constituents that we can agree, and when we do, this place is much stronger and improves lives much more quickly.

As we know, eating disorders affect more than 1.25 million people throughout the United Kingdom, but that is a conservative figure, because many sufferers have not yet been diagnosed or identified. It is for that reason that this debate is opportune. We are all here today for those in the Gallery, for those who are fighting for this cause, for those who are currently fighting this debilitating disease, for those who have fought and come through it and for those who are currently living their daily lives as normal but may suffer at some point in the future. My colleagues and I will always fight your corner, and I am delighted to see many hon. Members here today to support the debate.

I wish to begin with the topic of stigma, which is the focus of the Eating Disorders Awareness Week campaign this year. As we know, eating disorders affect all age groups, genders and backgrounds. An eating disorder is not a diet gone wrong, a fad or a phase. It is not caused simply by a young female being exposed frequently to magazine images of skinny models or going on online platforms with similar material and deciding that they wish to look the same. It is an illness so deep rooted in the individual that it leads to devastating consequences for those who are suffering and for those around them.

Photo of John Howell John Howell Conservative, Henley

My hon. Friend has talked about the effect on constituents. I have to say that, in this case, it was the effect on me, because a close member of my family suffered from an eating disorder. The help that was available was pretty close to negligible. Does my hon. Friend think that there is much more that we can do to increase the help available for people whose family members are in that sort of situation?

Photo of Kirstene Hair Kirstene Hair Conservative, Angus

My hon. Friend is absolutely right. The sufferer of course needs specialist support, but I will go on to speak about how I believe that we also desperately need to support families and, indeed, all those around them. This disease is so complex that it is often difficult to treat and, trapped in the disease, sufferers feel that there is simply no way out. Many believe that if the disease does not take them, they will take their own life, just to rid themselves of it. No matter how strong an individual is, an eating disorder is so all-consuming that once it has taken hold, some people believe that they will never live a normal life again, and many do not: the condition becomes chronic for about 20% of sufferers.

Normally, a series of events has encouraged the person’s mind to think differently about their body image. Perhaps they have decided that they are not good enough: one too many times, people or life events have created a narrative in their mind that they are inferior to those around them, or perhaps life is out of control in many aspects—nothing is going right. They compare themselves with others around them and see only the negatives in their own life and the positives in other lives, but they can take back control of one aspect of their life—control of what they eat. That may well start off as a diet, but not a diet that would be followed by a normal individual, which often fails. It soon becomes a focus and then a more extreme calorie-counting exercise that involves hiding food, burning off every calorie possible and social isolationism. Before they know it, the candle is burning at both ends. Before a sufferer has identified that they need help, the registered impact on their body is always perceived as being caused by some other reason. There is a voice inside a sufferer screaming that too much food is being consumed or not enough exercise is being done—praise when they miss a meal or hear the sound of a rumbling stomach. That voice inside a sufferer will not and cannot go away.

The loved ones around a sufferer see their daughter, son or friend fade into a shadow of their former self; they are helpless in every way. Parents struggle and are in emotional turmoil. They know that if their daughter falls and skins her knee, they can bathe it, put a plaster on it and make it better. If their son is upset because he is struggling at school, they can get him the support that he needs. We have solutions, and it is human nature to want to fix and help those we love. However, when it comes to eating disorders, everyone is helpless and feels hopeless. No one, unless they are trained, can provide support, other than the individual themselves. Many, if not all, sufferers who have managed to recover will say that it was the hardest journey that they have ever taken, but having spoken to some of Beat’s bravest ambassadors, we have seen at first hand the amazing, inspiring individuals they can become—but that is only if we help them.

As a result of the stigma attached to eating disorders, black, Asian and ethnic minority people, lesbian, gay, bisexual and transgender people and people from less affluent backgrounds are less likely to seek and get medical support. Research developed ahead of today’s debate showed that four in 10 people believe that eating disorders were more prevalent in white people than in other ethnicities, yet research shows that they are just as common or more common in the BAME community. Thirty per cent. thought eating disorders were more likely to affect the more affluent; in fact, they evolve at the same rate irrespective of education or income. Sixty per cent. of respondents believed that they affected only young people. That is having a significant impact on adults coming forward for support, and we see men and boys not being referred as soon as girls and females.

The statistics might not be surprising, but we have to challenge them continually. They are preventing certain groups in society from appealing for help, and creating an inequality in support. As a result, people are more ill by the time they are referred, making the recovery process much more difficult and sometimes impossible. We have seen fantastic work by members of the royal family as well as other notable figures, who have raised awareness of mental health disorders and who seek to break down the barriers to people speaking out, but also recognise that it is okay to talk and okay for someone to say that they need help.

When sufferers reach out for help, they have often been suffering for years. They need urgent specialist help immediately. The average cycle of relapse and recovery lasts six years, and there must be constant efforts to reduce that. To undo months and years of torture, specialists need time and resources to allow a patient to open up, to analyse, to find out the root causes, to get under the skin of the issues and to develop the mind to fundamentally change—a long-term approach, but a life-changing one.

Families, too, need guidance and support on how to deal with this troubling time. Many do not know where to go for support. This was one comment from the social media campaign that I ran before the debate:

“When anorexia arrives in a family it is like throwing a grenade into a home and watching it explode...caring for my daughter has impacted on the mental health of all those in my family.”

That is why I agree with my hon. Friend John Howell that family-based therapy would provide a much-needed support base throughout the recovery process.

Without the investment of time, those patients will be back in our GP surgeries and hospitals time and again. We must look beyond weight. This is an issue of the mind, so whether it is a case of referral or recovery, it cannot be determined by the number on the scales. As a result of the digital campaign that I ran, I heard from many people up and down the country, and I thank them for coming forward with their stories. One person, who wished to remain anonymous, said that

“my granddaughter never got so thin but she died nearly 7 years ago at the age of 19 and I feel that if there had been some positive help she would have been alive today.”

She had been disregarded simply because her weight was not low enough. Recent research shows that GPs do not have adequate training for supporting individuals who have an eating disorder, with three in 10 sufferers not being referred when required.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Transport)

The hon. Lady is making an excellent speech. I am troubled by the fact that, a year on, services in York are still completely inadequate. On Friday, I spoke to GPs who are trying to manage individuals with eating disorders. They have been instructed to take patients’ blood, to monitor the electrolytes, and to weigh them frequently, without the psychological support and clinical competencies that are necessary. Is it not absolutely essential that GPs receive the training that they need, so that we can put in place the holistic services that patients need?

Photo of Kirstene Hair Kirstene Hair Conservative, Angus

The hon. Lady is absolutely correct. I will come on to speak about that in detail. I hope the Minister will give further detail on how she is approaching that with other Departments.

In any five-year medical degree at UK medical schools the average amount of training in eating disorders was 1.8 hours, and one in five gave no training at all. The concern is not confined to one part of the United Kingdom; it is a widespread issue across all nations. That seems absolutely extraordinary, given that this is one of the most fatal mental health disorders, affecting 1.25 million people. GPs must be able to tell the difference between a healthy exercise routine and a compulsive one, low body-mass index and lack of nutrition, and going through a diet phase and the beginning of an eating disorder. They must recognise the clear indicators and how eating disorders manifest in order to deliver the right treatment plan, but to do that they need training.

I would like to see further encouragement of self-referrals and more work with schools, where many members of staff may be able to identify unusual behaviour. I warmly welcome the approach taken by my secondary school, Brechin High School, which has appointed a member of staff to lead on mental health who has a support base within the school and is linked up with the local primary schools, so that at the end of primary school, when an eating disorder—or any mental health disorder—may begin to develop, that support is monitored and continued as pupils enter secondary school and progress their education. I am keen to hear from the Minister how the training aspect can be addressed. I would like to hear from the Scottish National party spokesperson how the Scottish Government could do more to include training within university tuition, and how they will address the role that schools can play in early intervention.

When help is needed, how long do we have to wait? Waiting time targets have been a focal part of the campaigns run by many charities for years. In England and Wales, by 2021, 95% of eating disorder referrals for those under-19 are due to reach a specialist within four weeks, and within one week for urgent cases. Will the Minister confirm that the Government are on track to deliver that target, which is already making a huge impact? Along with the charities, I warmly welcome the ambition shown by this Government.

This is not a political debate and I do not wish to make it one. However, once again, when I wrote to the Scottish Government asking why they refused to equalise that target for young people, no substantive reason was given. I have also asked the Scottish Minister for Mental Health about that, and I look forward to her response. The UK Government have stepped up to treat under-19s. I encourage work so that those targets continue to be ambitious. We know that the sooner patients are seen, the higher the chance of recovery and the lower the long-term cost to the NHS. The current 18-week target in Scotland simply has to be addressed. When sufferers determine they need help, their illness is more likely to be treatable, but by the time they may be seen, the likely outcome is much more negative and potentially fatal. I want my constituents to have the same opportunity for early intervention as people south of the border. I want the Scottish Government urgently to address this needless inequality.

As we know, those with an eating disorder often take up to three years to identify that they have such a disorder. Sufferers must do two things: realise something is wrong and wish to make themselves better. When a sufferer comes forward, given their scepticism about all those trying to help them, we have a moral responsibility to grasp their ask for help and support them as a matter of urgency. That requires step-by-step help, to nurture these fragile but wonderful people and not let any of them fall out of the system.

I want to conclude with a point about social media, which is a force for good in many ways, but a stain on the life of many families, which recognise it as the tool that tore them apart. All age groups regularly browse online to determine what everyone else is up to or to catch up on the news, but they normally see only positive news. I have not seen one Instagram image of anyone in this room getting up in the morning, doing mundane things, such as washing the dishes, or having a bad day at work, because we submit only positive images. However, if we also put out negative images, things might feel slightly more normal.

Social media is a platform for showcasing the positive aspect of our lives, with no balance of the negative aspect that we encounter every day. For someone with an eating disorder, or any mental health disorder, that only accentuates their problems. Recent cases have made us all stop and think. There is so much pro-ana and pro-mia material promoting a harmful mindset, which forms or heightens an eating disorder. We must not forget that this material is often put up by sufferers themselves, so we must push supportive materials towards those who promote such images and material.

I do not believe that that is above any of the social media companies. The Secretary of State for Digital, Culture, Media and Sport made a hugely positive step forward in that respect earlier this month. Will the Minister explain the conversations that her Department has had with the Department for Digital, Culture, Media and Sport? Social media platforms cannot take all the positives of social media, but refuse to take responsibility for some of the damage it causes.

In summary, I would like to thank all hon. Members for supporting this debate. I know that it is close to the hearts of many in this place. I hope that the Minister will show those who have suffered, those who are suffering and those who do not yet know that they will suffer that this Government are on their side. I hope the Minister will show that we will never rest on our laurels, but will continue to address the flaws and increase our ambition, reduce waiting times, develop support and facilities for all who need it, wherever they live in the country, intervene early and offer the right support throughout the whole process, expel the postcode lottery of support, encourage our world-class universities to improve teaching programmes, so that they are in line with the impact this disease has on so many, and ensure that social media companies play their part in bucking this trend. We have to help those who are, through no fault of their own, helpless about their own aid. For many it will be the first time in their lives, because that is what Government is here to do: help you when you cannot help yourself.

Photo of Adrian Bailey Adrian Bailey Labour/Co-operative, West Bromwich West

Before I move on to the other speakers, I point out for the record that the intervention was made by Rachael Maskell, not Louise Haigh, her close friend. However, I noticed that she did not notice; confusion reigns. I call Paul Farrelly.

Photo of Paul Farrelly Paul Farrelly Labour, Newcastle-under-Lyme 9:47 am, 27th February 2019

Thank you, Mr Bailey. I congratulate Kirstene Hair on her success in securing this debate during Eating Disorders Awareness Week. I thank Beat, the eating disorders campaign group, for its unstinting efforts on behalf of the more than 1 million sufferers across the UK. After this debate, from 11 o’clock to 3 pm, during the lobby of Parliament, I am hosting a drop-in event with my good friend, Jeremy Lefroy, in room R of Portcullis House; colleagues here and those listening can go there to find out more about Beat’s work.

This debate follows that secured last October by Wera Hobhouse, which shows that support for this cause is truly cross-party. We also had a debate on the subject in September with the children’s Minister, Nadhim Zahawi, highlighting the issues for vulnerable children going into adulthood. In that debate, I focused on concerns that regularly pop up in my area of north Staffordshire for young adults suffering from anorexia, bulimia and other eating disorders, which have such devastating effects on them and their families.

The impact on young adults is one example of a core concern of the Parliamentary and Health Service Ombudsman’s groundbreaking 2017 report, which I will focus on again today. This suffering and vulnerability does not stop when children reach the age of 18. However, in my immediate locality—Newcastle-under-Lyme, Stoke-on-Trent and Staffordshire Moorlands, which have a population of well over 600,000 people—the commissioning of specialist support and treatment does stop at the age of 18.

Staffordshire is served by six clinical commissioning groups, with one common accountable officer. The budget for specialist, post-18 eating disorder services in the four CCGs serving the centre, east and south of the county is £428,000 a year, but for the North Staffordshire and Stoke-on-Trent CCGs, it is exactly zero. Sufferers who, up to the age of 18, had been used to specialist support in the community or at in-patient facilities have to rely thereafter on the hard-pressed, overstretched and generalist child and adult mental health teams. It is a postcode lottery—an “unwarranted variation”, in the NHS jargon—that has persisted for far too long, is patently unfair and lets local families down badly.

Of course, the last thing those families and their children want is the publicity that would bring pressure to bear on the CCGs to change course and give them the specialist support that is available just a few miles down the road. Last September, however, after our debate here, one of my constituents, Sarah Pustkowski, was brave enough to speak out publicly about the effects on her.

Sarah is 25 and developed anorexia nervosa when she was 16. She is slowly recovering—touch wood—but her father says that she is not out of the woods yet. Her case shows how long the anomaly in our area has persisted, because her dad first approached me in 2014 when she was 20 to relate what a cliff edge they had fallen off, in terms of specialist support.

Until then, Sarah had access to the excellent Kinver Centre, a hospital in Stafford just down the A34. When discharged, however, all the expert support that the family was used to stopped, because our CCGs failed to commission it. The Kinver Centre can admit people from all over the country, not just the county, but not from north Staffordshire, Stoke-on-Trent or Staffordshire Moorlands, because our CCGs provide no funding. Sarah and her family are not alone.

Since the autumn, we have been working with sufferers, concerned local health professionals and providers, and Beat to resolve the situation. A business case has been drawn up for the two CCGs as part of their annual prioritisation process, which aims at consistent commissioning across the county. The professionals involved are more hopeful than before but, with intense financial pressures on our NHS, I pray that the dawn does not again prove false in the coming weeks.

Something that should help to make the case and, one would hope, to inform and form Government policy, is information as to what happens across the country as a whole. Last October, after our debate here, we asked the new Secretary of State which of the 190-plus CCGs in England also did not provide specialist 18-plus eating disorder services. His written reply stated:

“This information is not held centrally…NHS England does not hold information about all of the specific services commissioned by individual CCGs.”

But specialist in-patient units are commissioned by NHS England, so the response could have been more helpful.

The Secretary of State’s reply went on to say that the Government were investing £150 million in community-based care for eating disorders, which will mean that

“70…new or extended…services are now either open or in development”,

which will benefit

“at least 3,350 children and young people a year”.

We are still, however, at a loss to know precisely where. Perhaps the Minister could write to us with some more details after the debate.

In December, we served freedom of information requests on all 190-plus of England’s CCGs about the full extent of their services and funding. As hon. Members who have done that before know, it is a mammoth exercise that takes quite some following up. Thankfully, only a handful of CCGs did not respond and are being chased, and about 25 swerved the questions and gave little meaningful information, but the overall picture for adults and young adults is certainly better than the situation in North Staffordshire, and no doubt in the areas of many hon. Members present.The majority do provide specialist 18-plus services—in the community, at least.

There is still a glaring hole in the picture of specialist adult in-patient provision, however. Most CCGs defaulted on that question and referred it to our old friends at NHS England. Coming full circle, we formally FOI-ed it, too, in the new year. Under the statutory limits, a reply was due by last Thursday, but despite chasing, none has yet come. It would have been good to have had it by the end of last week to inform our local business case, and it would have been respectful to the families and sufferers for NHS England to have responded before this awareness week.

I am sorry to speak at length about our travails, but the saga demonstrates only too clearly how difficult it is for conscientious campaigners such as Beat, the families and the MPs who support them to lay their hands on the information they need. If it is difficult for us, it is fair to ask how Ministers can draw up effective and informed policy, and make sure that recommendations for improvement, such as those in the Parliamentary and Health Service Ombudsman’s report, are put into practice.

One of the five core recommendations in that report was that

“The Department of Health and NHS England should review the existing quality and availability of adult eating disorder services to achieve parity with child and adolescent services.”

It is that lack of parity, and the progress in reducing it, that we have been so frustratingly trying to get to the bottom of in the last six months. If the Minister has more information, I hope that she will share it with us and, importantly, ensure that NHS England does, too.

Several hon. Members:

rose—

Photo of Adrian Bailey Adrian Bailey Labour/Co-operative, West Bromwich West

Before I call John Lamont, I inform hon. Members that I intend to start calling the Front-Bench spokespeople by 10.30 am at the latest. After some simple arithmetic, that works out as about five minutes per speaker, if we are to get everybody in, as I intend to. I will not impose a hard time limit now, but each speaker should bear that in mind.

Photo of John Lamont John Lamont Conservative, Berwickshire, Roxburgh and Selkirk 9:55 am, 27th February 2019

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend Kirstene Hair on securing this important debate during Eating Disorders Awareness Week. She made a passionate, well-informed and thoughtful speech, which I learned much from.

In my area of the Scottish Borders, some great charities and organisations work with young people to overcome issues such as eating disorders. There are now counsellors in every high school in the Scottish Borders, so teenagers have someone to speak to at school who is not a parent or teacher. We also have a specialist eating disorder nurse based in the Scottish Borders and some great work is done in the child and adolescent mental health service to support younger people.

I am sure that there are many good examples around the country. My hon. Friend Alex Chalk has spoken to me about the Brownhill eating disorder clinic in his constituency. He holds the clinicians and the work they do for his constituents in high regard.

Treatment across Scotland is patchy to say the least. In the Scottish Borders, there are no community tier 1 services aimed at preventing the onset of eating disorders locally and waiting times for help are far too high, as we have heard. I will focus on the impact that technology can have on the issue. The all-party parliamentary group on technology addiction looks at how smartphones, tablets and social media can have a detrimental impact on our health.

We have all seen the shocking stories about how diet pills, some of which contain lethal substances, are readily available to buy on social media, or how eating disorder-related hashtags and accounts are available and easily accessible to vulnerable people. Some of the content is more subtle. Platforms where we show only the best of ourselves mean that young people in particular can find it harder to feel content with their lives. Online images of thin and happy people clearly act as a trigger for some.

Social media platforms are working to tackle the issue and remove negative content, and so they should be. The idea of allowing the promotion of a category of mental health illness that kills so many people is completely unacceptable. I agree with those who argue that the likes of Facebook, Instagram and Twitter are on their final warning and that if they do not step up to properly tackle the issue, it is time to regulate. Given the clear link between mental health and social media use or abuse, there is certainly a case for requiring tech companies to mitigate the negative effects of their product, as the tobacco and alcohol industries are required to.

Although TV, films and social media are undoubtedly part of the problem, it is important to recognise the good work that some do. There are more documentaries and storylines in our soaps raising awareness about eating disorders. Social media platforms are also taking some action to tackle the issue. For example, Instagram has rolled out a warning that displays when users search for pro-eating disorder content and offers them help and support.

Photo of Matt Warman Matt Warman Conservative, Boston and Skegness

I thank my hon. Friend for giving way and for making an excellent speech. Does he agree that this process should be about more than warnings and that there should be a proactive attempt to stop this sort of material being visible in the first place, which needs to be algorithmic and technology-based, so that people can recover in the community?

Photo of John Lamont John Lamont Conservative, Berwickshire, Roxburgh and Selkirk

I absolutely agree with that important point and the social media platforms that are responsible for their content need to understand it much more clearly. They cannot just allow a free market, as it were, on their space, and if people are putting content on it that is clearly leading people to harm themselves, action needs to be taken, either by the companies themselves or, if they fail to do so, by the Government.

Perhaps above all, a vast array of online communities has been set up by people who have been through this experience and want to offer support. The internet can provide something that is immensely powerful—the sense that someone is not alone if they suffer from an eating disorder. That is what makes this issue so complicated. When it comes to eating disorders, the internet is both an enabler and potentially a powerful tool for good.

We will never get to a situation where eating disorder triggers can be removed entirely from social media. So, instead let us use technology as part of the solution, as best we can.

Photo of Tim Farron Tim Farron Liberal Democrat Spokesperson (Environment, Food and Rural Affairs) 10:00 am, 27th February 2019

It is a pleasure to serve under your chairmanship, Mr Bailey. I, too, pay tribute to Kirstene Hair, who secured this debate and made an excellent speech, and to the other colleagues who have contributed to it so far.

Without doubt, eating disorders have acquired a greater profile in recent years, and there are two things that are apparent and that we can learn from. One is that, as a society, we are better at talking about these things, and organisations such as Beat, which has already been mentioned, do outstanding work in making people feel that the stigma around these issues is something that we, as a society, need to get over, and therefore people will feel more comfortable about coming forward, which is good.

The second lesson that we might learn is that we are a society that, for some of the reasons that have already been mentioned, increasingly breeds poor mental health. So, I will focus my remarks on the support—or lack of it—for young people living with mental health conditions and particularly for those with eating disorders in my constituency of Westmorland and Lonsdale.

Very often, it is the parents who come to me first. Parents come to me with two clear emotions: one is terror; and the other is guilt. It is absolutely essential that we are clear to people with eating disorders, and indeed to those who love and support them, that there is absolutely no need for guilt; there is no blame attached whatever. Likewise, we need to tackle the fear and the terror, which often stem from a lack of understanding or an absence of hope as to where to go next, by showing that there are things that we can do to help.

In my constituency, we estimate that three quarters of young people with eating disorders were not seen within the target time of one month, and that 100% of those with an urgent need were not seen within the target time of two weeks. That is not acceptable, but what is even more terrifying is that the numbers involved are ludicrous. In the year up to August 2018, a grand total of 13 young people in South Lakeland were registered as living with eating disorders, which is baloney: we all know that that is not true. I would comfortably say that the real number is 10 times higher. In my office, we deal with at least one new case of an eating disorder every single week. So what is happening, such that our young people with eating disorders are falling through the gaps? We need to look at a whole range of things, but I especially ask the Minister to investigate personally why this is happening, particularly in South Lakeland but—I suspect—around the country as well.

One GP got in touch with me about this issue. I will not name her, but she was very keen for me to share her experience with everyone here in Westminster Hall and everyone who is listening. She did not have any training at all in mental health while she was gaining her qualifications, but she has sought to bring herself up to speed on it in her job. She is a general practitioner. She does her best to help young people and indeed people of all ages presenting with mental health conditions, but she feeds people into the system, or refers people into it, and there is no triage.

There is no general triage once a young person has been referred for help: “Does this person have anxiety?”; “Does this person have an eating disorder?”; or, “Does this person have some other condition?” That person could be referred to the wrong silo and then sit there for months, undiagnosed or misdiagnosed. I am sure that is one window into why such pitifully low numbers of people are being diagnosed, against the backdrop of what I think are many hundreds of people living with a condition who are left in desperation and not even getting the beginnings of the support that they desperately need. We are failing to catch our children and our young people when they are at their most vulnerable, so how can we then go and help them?

Anorexia nervosa has the highest mortality rate of any psychiatric disorder in adolescence. The consequences for someone of not getting the right treatment are absolutely huge and extremely serious. However, even those who are diagnosed—this goes for younger people and for adults—may not get the help that they need. Colleagues have already referred to the fact that people will have experience—I have, with constituents of mine—of being told, “Frankly, you’re not thin enough yet. Come back when you are. You are not manifesting physical conditions to back up your mental health condition, therefore come back later on.”

Would somebody who had been fortunate enough to have been diagnosed with cancer at stage 1 be told, “Clear off till you’ve got stage 4. Come back when you’re at death’s door”? Come off it, but that is how we treat people with mental health conditions and in particular people living with eating disorders. There are people with eating disorders—I can think of some who I know myself—who may have experienced no appreciable or noticeable weight loss. They still have an eating disorder, which needs to be tackled, and tackled quickly.

In Cumbria, three years ago—to the week—we were promised a specialist one-to-one eating disorder service for young people. Three years on, it still does not exist. That is why so many people will be cynical about promises made at this time of year at events such as this. We want to see real delivery for all of our young people in every part of the country.

Finally, the Government—rightly—emphasised preventive care in the NHS long-term plan just a few weeks ago. However, just a few days before Christmas they had sneaked out the funding cuts for public health, which is genuinely preventive care. Those cuts included a £500,000 cut in preventive health care in Cumbria. At the moment in Cumbria, we spend 75p per child on preventive health care. If we want to support those people who may struggle with eating disorders in the future, it is vital that we invest early and invest now. That will be not only more efficient and more effective, but far, far kinder.

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock 10:06 am, 27th February 2019

It is a pleasure to serve under your chairmanship this morning, Mr Bailey, and I thank my hon. Friend Kirstene Hair for securing this important debate in Eating Disorders Awareness Week.

According to YoungMinds, one in 12 teenagers in the United Kingdom suffer from eating disorders, and about 25% of those with eating disorders are noted as being male. Statistics for 2017-18 recorded that 536 Scots were treated for eating disorders. Eating disorders are complex illnesses that take many forms, such as anorexia nervosa, which was mentioned earlier, whereby people erroneously believe that they are overweight.

The root causes of these disorders are unclear, but they may include things such as career choices. The biographies of many jockeys speak of crash dieting and sometimes dehydrating themselves with the aid of saunas, to reach a low weight prior to a race. The image of the ballerina is of a slight and fragile figure floating through the air. What must it take to maintain such a body image? In show-business, there are child stars of stage and screen for whom the limelight proves too much, or perhaps they fear losing popularity during the transition to adulthood. How will growing up affect their future career?

It is important not to stereotype and to be alert to the fact that eating disorders befall people regardless of their age, gender, race, or socioeconomic circumstances. What is clear are the dangers associated with the resulting malnutrition and the serious complications, such as osteoporosis, low blood pressure, heart failure, oedema and anaemia. Anorexia can be life-threatening; it is one of the leading causes of deaths related to mental health problems. Every single such loss is a tragedy for the individual themselves and their family—indeed, the unnecessary loss of a life is also a tragedy for the nation.

Binge eating is characterised by an uncontrolled addiction to food, involving over-eating and exceedingly fast eating in secret, whether the person is hungry or not. And bulimia is a combination of the worst elements of both anorexia and binge eating.

Encouragement to seek treatment at the earliest opportunity will no doubt enhance the chances of recovery, which very often is a long-term process, requiring an immense amount of support from professionals and family members. However, as with any addiction, the person must acknowledge their problem—in this case, unhealthy eating—and they themselves must want to seek assistance. Anxiety and depression are common threads, whether as a cause or a result of an eating disorder.

I acknowledge the good work of the child and adolescent mental health staff of NHS Ayrshire & Arran, but from the complaints I have heard at surgeries from my constituents about waiting times for appointments, it is clear that the numbers of those much-welcomed professional staff do not match society’s demand for their time and support. When individuals with eating disorders reach out for help, we as a society must grasp that hand and be there for them. I welcome the new guidelines for Scotland announced at the beginning of this week, which it is stated will assist in providing a range of approaches to mental health issues, ensuring that help is available when and where it is needed.

In closing, I ask both Governments to continue providing vital funding for much-needed support services for persons afflicted with eating disorders and their heartbroken families—heartbroken does not sum it up; it does not describe the agony and the pain that those families go through. I also ask them to consider whether there needs to be enhanced control of slimming and dietary products, especially the marketing of those products to young and vulnerable individuals. I understand from the news that only this week, concerns were expressed by Food Standards Scotland that DNP—dinitrophenol, an industrial chemical—is being illegally marketed as a slimming pill, which FSS considers to be potentially lethal. It is still available to purchase on the internet, and we as a Government need to rein in social media platforms that permit, condone, or have a policy of turning a blind eye for the pursuit of profit, regardless of the health and wellbeing of our young people. As a Government, as has been said earlier, we must seriously bring those people to book for the damage and harm that they are causing to families throughout the United Kingdom.

Photo of Patricia Gibson Patricia Gibson Shadow SNP Spokesperson (Consumer Affairs) 10:11 am, 27th February 2019

I thank Kirstene Hair for having secured this important debate, and I am delighted to participate in it, although I wish it was not necessary. A debate about Eating Disorders Awareness Week is, of course, very important.

Despite what we have heard, in so many ways, we have come so far with regards to this illness. I think back to someone of the stature of Karen Carpenter, who died in 1983 at the age of 32, when I was 15 years old. Those of us among the general population who mourned her passing did not appreciate what an eating disorder was. It has to be said that we are still learning, but we are having this debate during Eating Disorders Awareness Week, at a time when the general public are more aware—and becoming much more aware—of an illness that so many people can fall prey to. This week is an international event that aims to raise further awareness of the issue of eating disorders, and the stigma that too often goes with them. Charities work hard to encourage people from all walks of life to come forward, because as we have heard, this illness respects no gender, no class and no race.

This week, the UK eating disorder charity Beat has continued to work very hard to break down the barriers that so many people face when they try to access support. It is important that those living with this condition and their families know that they are not alone, so sharing stories of how an eating disorder has affected others from all walks of life can be a powerful tool. Those who are in the darkest days of this disorder can be greatly comforted by hearing the stories and experiences of those who have lived with it, but have come through it and are in recovery. However, we also need to remember, as we heard earlier, that eating disorders can still be present during the process of recovery, and indeed can overshadow a person’s entire life, even when recovery might seem a long time ago.

One of the key barriers to tackling eating disorders is that too often, they are stereotyped and not taken seriously. Only by continuing to raise awareness of the struggles that sufferers go through, by talking about eating disorders in places like this and by supporting charities in their outreach work, can we make the change happen that we all want. We have heard—it is worth repeating—that social media has brought added complications to dealing with an already complex condition. Our young people are immersed in social media, a forum that projects so-called “perfect” images of lifestyles and bodies, and given how much young people are exposed to those images, it is not difficult to see how a young, vulnerable person could lose sight of what looks healthy or real. We know about the scandal of particular websites advising people on how to not eat without it being noticed by friends and family, which is very chilling indeed.

We need to continue to drive improvements in mental health services and ensure that everyone who needs high-quality mental health services, including people with eating disorders, has access to the care that they need when they need it. There is no denying that there have been positive first steps in increasing the visibility and public awareness of eating disorders and mental health challenges over the past decade. However, the demand on mental health services is so great that we must always seek ways to do better by those who need the specialist support that those conditions require.

Challenges remain for mental health services across the United Kingdom, and it is worth remembering that since the year 2000, the number of people diagnosed with eating disorders has risen by 15%, and hospital admissions for adult males suffering from an eating disorder have risen by 70% over the past six years. That demonstrates the scale of the challenge that we face. On top of that, on average, it takes about 149 weeks before those experiencing an eating disorder even begin to seek help—that is almost three years lost. Offering support in ways that match young people’s lives—in fact, these days, all people’s lives—means increasing the amount of online peer support that can assist with recovery. That peer support allows someone living with this disorder to pair with a trained volunteer who has recovered from an eating disorder, who can share their experiences and offer support as and when it is needed.

Having this week dedicated to raising the profile of this illness, talking about it, and recognising its complexities and its stigma is a good start, and represents very good progress from where we were in the 1980s, when so many of us could not understand how Karen Carpenter died or appreciate the full extent of the difficulties that her family had gone through. We have come a long way, but we have a long way to go, and this debate shows that we are keen to go further down that road.

Photo of Chris Evans Chris Evans Labour/Co-operative, Islwyn 10:17 am, 27th February 2019

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate Kirstene Hair on having secured this debate, especially during this important week—Eating Disorders Awareness Week. Last month, we had a debate on eating disorders, during which I revealed my own struggle with body dysmorphia when I was a teenager. Since then, I have gone on a journey. My mother spoke to me after that debate and asked, “Why didn’t you say anything?” I said, “Well, it was normal. That was how I thought everybody acted. I wanted to look that way, and it was normal and personal.” My mother said, “The only thing I noticed about you during that period was that you were a little bit obsessive and compulsive about things”, but that was a symptom of what I was going through.

I am one of the lucky ones, because my body dysmorphia went away on its own. I feel that I have gone on a journey since our previous debate. So many people have contacted me, including people I know or I have met through my job as a Member of Parliament, and talked about their personal struggles with eating disorders. Those I thought of as confident, or those I looked up to, have said to me that they struggled with the problem of an eating disorder. For them, it was a personal and private battle, as it was for me. I pay tribute to those people for the courage that they have shown in admitting that they had a problem.

I also pay tribute to Beat for all the work it does to ensure that people feel they have a safe space in which to talk about the problems they are going through. As Patricia Gibson has said, such a space did not exist when I was suffering from body dysmorphia in the 1990s, but it is there now. Another thing I learned when I met Hope Virgo and her fantastic Dump The Scales campaign team was that eating disorders are not necessarily about weight. So many people go to their GP, but get turned away because they are not light enough. They do not get help, so they turn to other mechanisms to cope.

A number of Members have talked about social media. I want to make it clear that in many respects, social media is a force for good. However, as the hon. Member for Angus said, there is so much pro-ana and pro-mia content, and it is widespread on social media. Instagram has made progress on banning images that contain suicide or self-harm. It has banned certain hashtags, but that does not stop people from going into them. It is a real problem. Some websites I have looked at are helpful and provide the type of support that sufferers of eating disorders need. People are allowed to post a diary. They meet a community that is there to help them, but other websites mask their communities. They start off by saying, “Yes, there is help for you”, but then it suddenly moves on to, “How to hide your eating disorder from your parent”, “How to hide your eating disorder from your school”, and “Anorexia and bulimia are normal.” I should make it clear that if someone does not have an eating disorder, those images of eating disorder will not bring one about. However, such images do affect the most vulnerable in society.

A recent BBC investigation in 2018 led to Instagram placing more harmful hashtags relating to eating disorders on an “unsearchable” list; if somebody enters one of those terms, no results will appear in the search box. Instagram now has more terms—including alternative spellings of “suicide” or “anorexia”, using “1” instead of “I”—that, when searched for, direct people to help and health warnings. One search term had 38 alternative spellings that could still be used by users to access harmful images. It is all very well Instagram using warm words to the Government about banning those harmful images, but it does not have moderators. It is self-moderated. If someone proactively searches for content that is against the rules, there is a good chance they will find it.

I do not want to eat into others’ time. I pay tribute to Wera Hobhouse for the work she has done in bringing eating disorders to the fore. I spoke in her earlier debate, too, so I will bring my remarks to a close. The Government have to be careful when they regulate social media. The content could simply be driven underground into WhatsApp groups or the dark web. I raised this issue with the Prime Minister a couple of weeks ago at Prime Minister’s questions. She agreed to the Minister for Digital and the Creative Industries meeting me, Beat and Hope Virgo, who has her “Dump the Scales” campaign, to talk about how we can bring about a system that discourages eating disorders and provides the support that people need. I make one advertisement for Hope’s campaign: if people have not signed her petition, please do so. She is up to 68,000 signatures this morning. She needs 100,000 for the petition to be debated here, so that we can bring about a serious debate on eating disorders.

I say this to anyone suffering from an eating disorder: you are not alone. Look at the people around this room—not just the MPs, but the people in the Public Gallery. There is support there for you. This is personal and private, but when you find the courage to talk about it, there are people there for you. I urge anyone with an eating disorder to find it in themselves to talk to someone.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Housing, Communities and Local Government) 10:23 am, 27th February 2019

I thank Kirstene Hair for securing this important debate. It has already been said that this debate has cross-party support, and we have come a long way in recognising and understanding eating disorders. I find it depressing that although we have made this progress, increasing numbers of people are suffering from eating disorders. We must get away from just talking and start getting some change. I hope that Eating Disorders Awareness Week will bring about that change, so that we do not stand here next year without having made significant progress.

I will limit my remarks to the research that Beat has done that shows that eating disorders do not discriminate, and the importance of early intervention and prevention. Over the past five months, I have been campaigning to raise awareness. I have spoken before in this place about the need to recognise eating disorders early. Stories such as Hope’s highlight how ludicrous it is for people seeking help to be told that they are not thin enough.

At the heart of any improvement to eating disorders treatment lies education—of our medical staff, of the whole of society, of schools and of families. I have personal experience of a family member with an eating disorder, so I know very much how families and friends suffer around a sufferer. It is not just the sufferer who is affected, but those around them.

Eating disorders are too often trivialised and seen as an illness that exclusively affects one type of person. That is reinforced by research released this week by Beat, which found that discrimination was ingrained in how we view eating disorders. Beat’s research found that four in 10 people believed that eating disorders were more common among white people, and nearly 30% thought that eating disorders were most likely to affect people from higher socioeconomic backgrounds. The reality is that eating disorders do not discriminate.

The tragedy of eating disorders is that they are preventable. By focusing on early intervention, the numbers of those suffering can be greatly reduced, but the stereotypes around eating disorders mean that certain people are far less likely to recognise the condition and seek or be referred to treatment. For example, ethnic minorities are substantially less likely to be referred to eating disorder services than white patients, but once referred, ethnic minorities receive the same treatment as white patients. A central problem is what doctors and the public understand about the population of people who suffer from eating disorders. The network of family and friends who surround those with eating disorders make a great deal of difference to their recognising the condition and receiving the correct help.

Research on specialist out-patient family intervention for children shows that it is highly effective and reduces the need for in-patient care, which eases pressure on the NHS. New ways of looking much more holistically at the treatment of eating disorders are highly effective, and we should look at them. The research identifies the importance of a truly joined-up approach to recovery, ensuring that the community around an individual with an eating disorder is supportive and supported by the medical team. Those types of programmes are being run in select areas across the country, and they must be extended, given their positive outcomes.

Treatment for eating disorders is a postcode lottery. We need to look at that. We must set standards and deliver training that will help doctors and medical staff to identify people who need treatment, regardless of any preconceived stereotypes. Additionally, it is vital that we continue to listen to the stories of real people who have suffered from eating disorders, and hear what they have to say about their experiences of the system.

The last thing I want to mention is the Local Government Association’s “Bright Futures” campaign. It highlights to councils across the country the importance of increasing funding, and ensuring that all the promised £1.7 billion for children’s mental health is spent in children’s mental health, not elsewhere. Prevention and early intervention, as we have heard several times today, are absolutely key to saving many lives from being destroyed, including those of friends and families of sufferers. Together, we can make a real difference, but let us make it happen, rather than just talking about it.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health) 10:27 am, 27th February 2019

It is an absolute pleasure to serve under your chairmanship in this debate on Eating Disorders Awareness Week, Mr Bailey. We have certainly raised awareness today, cross-party, and have paid credit to the week. We will continue to work together on this.

I thank Kirstene Hair for introducing this important debate. She feels strongly about this issue and wants to contribute. She mentioned that she had contacted the Minister for Mental Health in Scotland and would like an appointment with her to discuss services. I am sure we can work together to take things forward, and to ensure that collaboration throughout the United Kingdom continues.

We want to improve our services. Today, we heard that there are gaps in eating disorder services in just about every area. We have also heard how things have moved on. When Karen Carpenter had an eating disorder and sadly died, there was not much awareness at all. Now, there is greater awareness, but that has raised demand. It is incumbent on us to ensure that we are able to meet that demand, so that when young people, or people of any age, come forward, they get help in a timeous fashion.

The hon. Member for Angus spoke about stigma, an extremely important issue. She also spoke about how the stigma affects ethnic minorities, particularly males, and prevents them from coming forward. We must do much more to ensure equality in service provision, and send the message that eating disorders do not discriminate. We must support everybody who comes forward.

I want to thank the voluntary agencies who work in this field so tirelessly: the Beat campaigners, many of whom are here today; our NHS staff up and down the United Kingdom, who do their utmost every day, often going beyond the call of duty in the work that they do; and the Scottish Eating Disorders Interest Group, who also do a great deal of work in the field.

Rachael Maskell talked about the lack of psychological support, which I hope the Minister can comment on. We have heard eating disorders described as being about weight, which is wrong on so many levels. It is psychological as well as physical. Relying simply on physical manifestations of eating disorders means that many people do not get the treatment they should at the time that they should. Often people who have, for instance, bulimia might not have a reduction in weight, and it will therefore not be obvious to a practitioner unless they have specialist, or at least additional, training in primary care and specialist services.

We have spoken a lot today about anorexia and have mentioned bulimia, but there has been no mention of obesity, interestingly, around which there is a real stigma across the population. We need to do more to make sure that those who suffer from obesity have psychological support, too, because their journey to recovery is extremely important. Again, that is linked with mental health.

Crucially, John Lamont spoke about technology and images online. We have done a lot of work in the all-party group on textiles and fashion, which I chair, to look at the impact of social media and the industry on body image, and the negative and stereotypical images that very few of us will ever live up to, and should not aspire to. Often the images are not healthy, either. Much more has to be done. I agree with him on what he said about regulation of the companies, the information that is put out, and being proactive.

We also heard from Tim Farron, who spoke about lack of support and comorbidity, mental health issues being very much conjoined with eating disorders. When I worked as a psychologist in mental health services, often referrals would come in for individuals who had depression or anxiety, but underlying that was a long-standing eating disorder. That is why it is important that training in primary care reaches out across community mental health teams, and is not just given to specialist eating disorder services, because often the initial referral will not give an indication of the underlying difficulty.

Bill Grant spoke about bulimia and the new guidelines for Scotland, which he welcomed. We know there is an issue with providing services for people in rural areas in a timeous way. I am pleased that the Scottish Government have dedicated £54 million to look at that. There will be new guidelines in line with SIGN, the Scottish intercollegiate guidelines network, and we look forward to collaborating on taking those issues further.

My hon. Friend Patricia Gibson spoke about peer support, which is extremely important. Young people are often much more able to reach out to other young people, so I ask the Minister: what best practice is happening around that, and what can we roll out across the United Kingdom? One of my local schools, Duncanrig Secondary, is doing mental health peer support work very successfully. It is that type of project that young people grasp hold of to make a difference for each other. I pay tribute to the Trust Jack Foundation in my constituency, which reaches out to young people with mental health problems and has filled a gap in our local services in Stonehouse. Its service is being used assiduously by our local young people.

Chris Evans spoke about his eating disorder, body dysmorphia, and personal struggle. That is such an important message to give in Parliament. In coming forward and seeking support, he is a role model for others, so I thank him for that. He also spoke about why it is so important to have person-centred and holistic care, and I entirely agree with that.

Wera Hobhouse is an absolute champion in the field. She has collected thousands and thousands of signatures, and we support her work across this House in a truly cross-party effort to ensure we get the services that people require. I am sure the campaign that she runs to raise awareness will be successful in making a difference to people.

When I worked in psychology in the NHS, it was difficult at times to bridge the gap between primary, secondary and tertiary care, and difficult for people to be referred smoothly. I have raised that with Ministers in Scotland. When people present with an eating disorder, they do not always say, “I have an eating disorder. Can you help me?”, so it is key to have the training in place and a smooth care pathway—the two issues that I want the Minister to comment on. I know she is dedicated on this subject. I have met her numerous times, and I am keen to hear what she says today.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Mental Health and Social Care), Shadow Minister (Mental Health) 10:37 am, 27th February 2019

It is a pleasure to serve under your chairmanship, Mr Bailey. I sincerely thank Kirstene Hair for securing this very important debate today, particularly during Eating Disorders Awareness Week. I was deeply moved by her powerful opening speech and I thank her and Wera Hobhouse for their persistence in bringing the issue to the House. May that never stop.

It is only four months since we were last here speaking about this issue and how we could work together to remove the stigma around eating disorders. Many colleagues here today also spoke in that debate and I thank all of them for taking the time to be here again today. I have been struck, as I am sure many have, by the collegial nature of this debate. That is important and it is what people who experience eating disorders, and their families, want. They want us to put our party colours to one side and work together to try to bring about the much needed improvements in this area.

My hon. Friend Chris Evans talked eloquently and powerfully about the issue. As we all know, it is brave to talk about our personal experiences in this place, and he talked about his own experience of body dysmorphia. He also talked about the bravery of others, but I hope he takes time to reflect on his own bravery and courage. I am very proud of him and I thank him.

I also want to reflect on the comments made by John Lamont about what happens in schools, which is incredibly important. The hon. Member for Angus also touched on it. I recently attended one of the high schools in my area and talked about what psychological support was available to children, specifically teenagers.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I apologise that I could not be here earlier; I was at the Northern Ireland Affairs Committee. Over the years, I have had the opportunity to help some of my constituents, particularly ladies, who have had eating disorders, and we have been able to sort those things out. I have noticed a dearth among males, who unfortunately seem not to address these issues. I commend Chris Evans for speaking about that.

The hon. Lady talked about helping schools, youth groups, and other youth network facilities. I believe that there is a need for trained officials who can notice disorders and step in early. Early diagnosis and early intervention is the way forward. Does she agree?

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Mental Health and Social Care), Shadow Minister (Mental Health)

I thank the hon. Gentleman for his intervention. Frankly, a debate would not be complete without an intervention from him. I absolutely agree. When I was speaking to the professional at the Mirfield Free Grammar, she told me that much of what comes through her door relates to eating disorders, crucially in boys as well as girls. Sometimes we continue to stereotype that eating disorders affect only women. The reality is quite different.

As a number of Members have suggested, social media can be a double-edged sword. I will talk about Beat in a moment. Beat does excellent work and has fantastic online resources, as do a number of other mental health charities. However, other sites that we have heard about that encourage people with regard to suicide and their eating disorders can be problematic to say the least.

The Government have made a commitment that, by 2020, 95% of children and young people who are referred with an eating disorder will be seen within one month, or one week if it is considered urgent. That is obviously very welcome, but with 2020 just around the corner I am concerned that, given current workforce and funding pressures, that will be difficult to achieve, or will possibly result in manipulation of waiting time figures. A patient will get a first appointment within the timescale, but any follow-up or effective treatment will still come many months, or even years, after referral. I would be grateful if the Minister would say how it will work in practice.

Although that is all well and good for children and young people, there are still no clear plans for adults with eating disorders. I recently visited a NAViGO service in Grimsby that supports people with eating disorders, and I was struck by how many people who were older than me were experiencing in-patient treatment.

My hon. Friend Paul Farrelly talked about his constituent Sarah. I have a constituent who was diagnosed with an eating disorder at 16. Owing to the severity of her illness, she was sadly admitted to hospital for a lengthy stretch. On her release, she attended fortnightly appointments with an eating disorder specialist. As her recovery was going well, my constituent decided that she would like to take up an offer of a university place in Manchester, because despite her very difficult illness she had achieved the most fantastic A-level results. She saw going to university as a positive step in her healing and as a way of getting on with her life. The local NHS trust that delivers mental health services in my area informed her that she would have to transfer over to mental health services in Manchester.

Neither my constituent nor her family thought too much about that, as it was not raised in such a way that allowed them to foresee any issues. However, five months on, my constituent is still waiting for the handover to be completed and, sadly, during that time she has suffered a serious relapse and is once again looking at in-patient care. I recently attended the all-party parliamentary university group, and we talked about transition when people go to university, and about mental health in general. We need to look at that in some detail.

Photo of Paul Farrelly Paul Farrelly Labour, Newcastle-under-Lyme

Clearly, the administration in the health services that led to that outcome is of grave concern. It is also concerning when specialist services in a particular area stop for young people when they turn 18. Only those people going away to university or college in areas that provide such services, or those people whose families have a lot of money and can fund treatment privately, have the prospect of change. The people who are left are effectively discriminated against.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Mental Health and Social Care), Shadow Minister (Mental Health)

I thank my hon. Friend for that intervention. I absolutely agree. We had a very interesting discussion at the APPG about whether we could do more pre-screening when people go to university. We must also remember those in further education, not just those in higher education.

I ask the Minister whether what happened to my constituent would have happened had she been suffering from a serious physical condition. Earlier, a colleague made an analogy with cancer—“Your cancer is only at stage 1; we’re not going to treat you until it becomes more advanced.” As we all know, eating disorders carry the highest mortality rate of any mental illness; yet this young lady has been left to suffer, in a new city, away from family and friends and without any support network. We all have to ask ourselves how on earth that was allowed to happen.

I commend the fantastic work being done to raise awareness of eating disorders and to support sufferers, and crucially their carers and families, by the charity Beat, some of whose representatives are in the Gallery. They work relentlessly to battle against the stigma of this dreadful disease, and to push for better access to services and treatments. When my office spoke to them about the case of my constituent, they said that sadly it was very typical of the stories that they hear every day on their helpline. How many families are going through the same mental torture day after day while waiting for that elusive appointment confirmation to drop through their letter box?

With no specific waiting time targets for adults with eating disorders and poorly funded mental health services, many overstretched mental health trusts are unable to put the necessary resources into those vital services, and treatment availability has become a hideous postcode lottery, as my hon. Friend the Member for Newcastle-under-Lyme highlighted. Service access and levels of funding vary widely from one area to the next.

Furthermore, there is a huge disparity between access to adult services and to those for children and young people, with adults on average waiting twice as long. The eating disorder charity Beat has had a huge rise in calls to its helpline over the last year. In 2017-18, Beat staff helped 17,000 people, and they estimate that by the end of 2018-19 they will have helped more than 30,000. It is commendable that they managed that increase in demand so well, and I know that with more funding they could help even more people.

In October 2018, following an eating disorder storyline, which Beat had been very involved in helping with, on the popular teenage soap “Hollyoaks”, calls to Beat’s helpline spiked to more than double those in any previous month. That highlights the need to raise awareness about eating disorders and, crucially, to quash the stereotypes and stigmas so that more people know that they can seek help earlier. Reportedly, it could take an adult with an eating disorder more than two years before they realise that they have an issue, and up to another two years to seek help. More needs to be done to increase awareness and access to treatments.

Beat recently undertook some research into eating disorder stereotypes. When people think of eating disorders they often think of young, white women, but that is a popular misconception. The reality is much more complex. More adults suffer from eating disorders than young people, and the number of male sufferers increases year on year, with people who identify as LGBT+ at significantly higher risk. Stereotypes prevent people from seeking and receiving medical treatment in the earlier stages, which, in turn, makes it harder for people to recover.

I am grateful that Dr Cameron raised over-eating. When we think of eating disorders, we often think of anorexia or bulimia. It is important that we consider the full spectrum of disorders. Beat’s research also found that people from black, Asian and minority ethnic and less affluent backgrounds would feel less confident in seeking help from a health professional for an eating disorder. That stigmatisation and fear of speaking out can have far reaching and dangerous consequences.

We also need to work to ensure better training for those on the frontline. Tim Farron made an important point about training for those in health professions so that they can better recognise and support those who present with eating disorders.

Another constituent of mine waited more than two years to be seen by a psychiatrist for depression and anxiety. During that time, sadly, she also developed an eating disorder. She was consuming less than 700 calories a day and avoiding any foods with even a trace of fat, and her weight had plummeted over a period of six months, but at her first psychiatric appointment she was told that she was not underweight enough to be considered to have a serious eating disorder. At her second appointment, the psychiatrist weighed her and congratulated her on her increased weight and body mass index. As hon. Members can imagine, that was the last thing that she wanted to hear. The psychological effect set her recovery back by weeks.

Sadly, that was not an isolated incident. There are many fantastic people working on the frontline of our health services, but there is also a minority who would hugely benefit from extra awareness training in what an eating disorder looks like, how best to treat it and where to refer patients for treatment.

I know the Minister well and am satisfied that she has huge compassion in the area, but equally I hope that she has listened to the points raised in this debate and will press the Government to put eating disorders higher up the agenda, make promises and set targets that will ultimately save the lives of sufferers. She will have my full support in doing so.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care 10:50 am, 27th February 2019

I thank all hon. Members who have contributed to this very constructive debate. They all showed massive care and compassion, with a recognition that we have come a long way but need to go a lot further. I am grateful for their constructive contributions.

I congratulate my hon. Friend Kirstene Hair on securing this debate in Eating Disorders Awareness Week. I thank her for her very frank exposition of eating disorders, and of the helplessness felt not only by those who are suffering, but by those around them. It is essential that we ensure that people have access to the right mental health support in the right place and at the right time, because time is of the essence. Improving those services is a key priority for this Government, as part of our wider agenda to improve mental health services.

As several hon. Members have said, eating disorders are serious: they have some of the highest mortality rates of any mental health disorder. We need to ensure, more than ever, that people get access to support as early as possible, because eating disorders quite often begin when people are young. Representations have been made today about why our targets are for children, rather than adults. Those targets recognise the fact that early intervention is best and that issues often surface when people are younger, but that does not in any way diminish the challenge of ensuring that adults also have access to services.

That brings me to a point that several hon. Members have made: the perception that eating disorders affect only young white women. They do affect adults. I have heard of a case of an elderly lady in a care home being diagnosed with an eating disorder that she had obviously been suffering from for decades. One of the tests that I will set myself is for that never to happen again, because we need to ensure that people get early diagnosis.

As Chris Evans very frankly reminded us, eating disorders affect men and boys too. If there is a perception otherwise, it may partly be because men and boys are much less likely to seek help than women and girls. We need to make it clear that the issue can affect absolutely anyone, as the hon. Gentleman showed very courageously by sharing his own experience; I am very grateful for his comments.

It is important to continue to raise awareness. We need to reduce the stigma associated with eating disorders so that people are more likely to talk about them. Like all hon. Members, I pay tribute to the campaigners who do so much to raise awareness, particularly the charity Beat, which does absolutely excellent work. I also pay tribute to Hope Virgo for her campaign and look forward to meeting her very soon.

We cannot emphasise strongly enough that this is not about weight; it is about the mind. Some of the stories that were shared in this debate were quite horrific. If there is such lack of understanding among medical professionals—if the people we trust to look after us end up doing harm because they see eating disorders as a weight issue—we have a serious problem to tackle. Of course training has its part to play, but I should add that we expect a lot of our GPs. One of the real challenges is to continue to roll out multidisciplinary GP service teams to ensure that there is much greater expertise in each medical practice, rather than relying on one individual to be the expert on everything. Frankly, they are only human beings—they are not God.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Housing, Communities and Local Government)

I thank the Minister for giving way; I know that her time is very limited. When services let people go too early, the danger of relapse is much higher. We could prevent relapses by not letting sufferers go too early, when they are half better but not fully better.

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

The hon. Lady makes a good point that I will address further if I have time. We need to look carefully at the care pathway and at the whole practice of referrals and the journey that people take, so that we can ensure that they are in a position to manage their disorder. The truth is that no one is ever cured of these things; it is a matter of managing their wellbeing to tackle them.

I thank Dr Cameron for her acknowledgment that we have come a long way. She is right that we need to ensure that we have proper specialist services to do this work, because of the risk of harm. She is also right to mention obesity, which we could do an awful more to address. I watch a lot of rubbish TV—we work long hours here, so that is my relaxation—and I am horrified by some of the channels, which basically run a succession of programmes about weight that are almost freak shows. That is not how we should be talking about the issue if we want to encourage people to access help. We need to tackle the stigma around obesity as much as the stigma around any other disorder.

Tim Farron and I have already discussed his concerns about his area. I know that there are challenges and we need to ensure that provision is sufficient. He spoke very frankly about the guilt and terror that people around those who suffer from eating disorders feel, because they genuinely do not know how to help their friend or loved one. Reducing stigma and raising awareness is partly about helping people to understand what they can do. Everybody wants to help, because nobody wants to see people suffer so much.

Social media has been mentioned a lot. I absolutely recognise that it can be a force as much for good as for bad, but I must say that we are seeing content that encourages harmful behaviour. It is about the whole psychology of people joining communities. When people use social media regularly, they can become isolated from the physical world and join an online world in which everyone is like them. It becomes normalising, and it can worsen their experience.

Equally, social media can be a community of self-help. I agree completely with the hon. Member for Islwyn that we have to be careful: of course we must challenge companies to be responsible, but it is not black and white, and we need to handle the issue sensitively. I am pleased to say that some companies are very responsive, but not all, so we will continue to challenge them. The hon. Gentleman raised an issue that particularly concerns me: it is one thing to regulate public platforms, but encrypted direct contact is having a growing impact. We need to look at Snapchat, WhatsApp and so on, because the fact is the Government are always three steps—probably more—behind technology.

The hon. Member for East Kilbride, Strathaven and Lesmahagow emphasised peer support. I could not agree more: peer support is important for mental health generally. If I could make one challenge to NHS commissioners, it would be that providing support to people who suffer mental ill health is not just about clinicians; it is about the voluntary sector and peer support workers. If we are to really step up to that challenge, I hope to see much more imagination in how services are commissioned.

I have so much more to say, but I am running out of time. With hon. Members’ indulgence, I will write to them—not least Paul Farrelly—to outline our response to the points that they raised. We have a lot of figures and have shown that we are meeting targets, but I think all hon. Members would be more confident if there were more granularity—not least because of the cases raised today in which people have not received the treatment that they deserve.

Motion lapsed (Standing Order No. 10(6)).