Skin Conditions and Mental Health

– in Westminster Hall at 5:00 pm on 25th January 2022.

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Photo of James Gray James Gray Conservative, North Wiltshire 5:00 pm, 25th January 2022

I remind Members that Mr Speaker has asked us to wear our masks if at all possible and to maintain social distancing where we can.

Photo of Edward Leigh Edward Leigh Conservative, Gainsborough 5:01 pm, 25th January 2022

I beg to move,

That this House
has considered skin conditions and mental health.

I want to start my speech by making a point that I will make at the very end: mind and skin are linked, and we have to take action on both if we are to break the vicious cycle of psychological harm. I suppose, really, I should declare an interest right at the beginning of this debate. It is not a financial interest but a personal interest: I have rosacea, which makes one’s face red and can ultimately deform it, and I take antibiotics every day. There are many more serious conditions—I do not make a great thing of it—but only today, in relation to something else I said on a completely different subject in the House of Commons, I have already received one email accusing me of being a red gammon head and a ruddy-faced buffoon.

I take it very lightly, because I know I am already old and ugly, but for young people this kind of personal abuse about their appearance is deeply upsetting and drives many people into deep psychological harm, because mental health and physical health are intrinsically linked. Knowledge of this link has driven recent advances in NHS service delivery and underpins much of the thinking in the long-term plan. Although that has led to the development of trailblazing and new services for many people with long-term conditions, for some reason people living with skin conditions continue to have dire access to psychological services. Indeed, in 2020 the all-party parliamentary group on skin, which I chair, published a report on the mental health issues faced by people living with skin conditions. It demonstrated that the psychological impact can be severe, in terms of the effect on people’s work, education and healthcare use. We should all worry about this, as 60% of us live with some form of skin condition.

Since the publication of the report, the developing impact of the covid pandemic has inevitably made a bad situation worse. One of my colleagues—who might speak in the debate—said that he was told by his GP only recently that he might have to wait a year for an appointment about a skin condition. With many patients with inflammatory skin diseases now experiencing a 12-month wait for a first appointment with a dermatologist, the stress and anxiety experienced by many individuals has risen significantly. I therefore want to spend this debate outlining the need for commissioners and health leaders to rethink how the NHS provides psychological care for people living with a skin condition.

The APPG’s report on the mental health associated with skin conditions is available on the group’s web pages. The report was based in part on a survey conducted by dermatologists and psychologists of 500 skin patients, with evidence also collected from 100 clinicians and 16 dermatology-related charities. The report was led by experts from the British Association of Dermatologists. The survey part of the report found that 98% of skin disease patients felt that their condition affected their emotional and psychological wellbeing; yet astonishingly, all the patient representative and professional organisations providing evidence stated that the NHS mental health provision for skin was “poor” or “very poor”. In addition, over half the patients surveyed did not even realise that they could ask for help with managing the mental health impact of their skin disease. That clearly demonstrates just how under-resourced services are in this part of the NHS.

I would like to draw the attention of the House to some other worrying findings that our research for the report highlighted: 93% of patients surveyed said that their skin condition had a negative impact on their self-esteem; 83% said their skin condition negatively impacted on their sleep; 73% said their skin condition negatively impacted on their intimate relationships; and 5% said that they had contemplated suicide. Sadly, I have been informed by healthcare professionals working in our NHS dermatology services that patients living with skin conditions are at increased risk of self-harm, as we well know, and that a number of them, sadly, go on to take their own lives.

There is also a great economic impact, with the double whammy of skin disease and the psychological burden associated with it. Some patients surveyed said that their skin disease had been so distressing that they had felt they had to give up their job. Let me read a brief excerpt from a quote in the report:

“When I turned 19 it [the eczema] became so bad that I couldn’t participate in normal life anymore due to the pain…I had to give up my job as I am always too unwell.”

Of course, our skin is implicated in everything we do and it is often not understood that skin conditions affect not just the individual living with them but their wider family. As for the impact on intimate relationships, let me read out another quote from the report:

“My skin is often too painful to have intimate relations with or to even to hug or kiss my partner. I had to postpone my wedding as I can’t cope with the idea of a flare up on my wedding day.”

Recent research and evidence suggests that parenting a child with a chronic skin condition can trigger parental stress, and the all-party group’s survey also included responses from some children. Every one of the children surveyed indicated that their skin condition had negatively affected their mental wellbeing, with the vast majority reporting that it had impacted on their performance at school. One of the children is quoted in the report as saying:

“I was so depressed. I felt like I was rotting away inside an alien growth on my face. I didn’t wanna exist like that. I wanted to chop my own head off.”

All this emotional turmoil was experienced by a child living with cystic acne. Clearly, if we do not support such children, the distress that they experience in relation to their condition may have a long-term impact on their future wellbeing.

There are some good services out there. The report highlighted a few trailblazers, such as the specialist IAPT —improving access to psychological therapies—service in Sheffield and the well-established psycho-dermatology services in some London hospitals. Psychological interventions are also being tested, and approaches involving cognitive behavioural therapy, merged with mindfulness and self-compassion, are showing great promise.

Nevertheless, our report demonstrates that there is very much a postcode lottery, with many hospital dermatology services not having access to psychological services or clear pathways to refer people at risk to the support they need. Alarmingly, less than 5% of dermatology clinics across the UK are providing any level of specialist mental health support for children and young people. And believe it or not, but in Wales there are no dedicated psychological clinics, and there are certainly none in Lincolnshire. Only a very small minority of trusts have such clinics.

This is a ludicrous situation. Research shows that psychodermatology clinics are more cost-effective to run, compared with managing skin patients with psychological distress in more generalist healthcare settings. Therefore, I urge the Minister to consider how funding is allocated and spent in this area. Covid has made things worse for dermatology patients, with poorer access to face-to-face consultations further preventing assessment and identification of mental health issues.

It is not just our report that stresses the need to embed in dermatology services psychological screening and access to psychological intervention. That is also a feature of most of the recent treatment guidelines that have emerged from reviews of the academic literature and consultation with experts. For example, the recent guidelines of the British Association of Dermatologists on the treatment of the depigmenting skin condition vitiligo make it clear that access to psychological support should be available.

Furthermore, while some conditions might be primarily psychological in nature, they pretty much always present in dermatology services. For instance, skin-specific delusional conditions and medically unexplained itch disorders can be devastating, and without clear access to psychological services, such patients can be put at considerable risk of having their underlying condition go untreated. Again, recent British Association of Dermatology guidelines in this area of practice make it clear that services need to be developed to meet the needs of this specific group of patients. However, investment has not been forthcoming.

As I draw to the end of this speech, let me share another disappointing fact with the House. The all-party parliamentary group has looked into the mental health of skin patients and service provision on two prior occasions, in 2003 and 2013. Our most recent report shows that, despite a general recognition of the need for better care in this area—and leaving aside the more recent impact of the pandemic—most of the recommendations of the previous reports have, I am afraid, not been acted on by Government. That seems to ne to be an indictment of those responsible for the planning and commissioning of these essential services.

What should we do? We can start by building parity of esteem between dermatology services and other long-term conditions, both in access to specialist dermatologist care—which would of itself reduce the psychological impact—and in access to psychological services.

In order to achieve that, our report makes a number of recommendations. All NHS dermatology units must have regional access to psychodermatology services, with clear pathways for patients to be referred to for appropriate psychological intervention or support. There must be a stepped care pathway that starts with good quality screening and enables patients to speedily access the most economic and effective psychological services that they require and deserve. This is already in place for many other long-term health conditions, such as diabetes, but not for skin conditions. This cannot remain the case; it is simply not good enough.

To achieve that, we need to increase staffing in dermatology services and improve the dermatology and psychological training of all NHS staff who have regular contact with patients with skin conditions. That includes training for trainees, primary care clinicians and secondary care specialists.

Research funding for psychodermatology should be prioritised. It should focus on the development, evaluation and implementation of a range of psychological and educational interventions for patients with skin conditions. The inclusion of patient support organisations in service development is critical to amplify the patient voice and to ensure that patients have clear access to some of the excellent services available in the community. NHS mental health funding provided to local commissioners must urgently be used to invest in and improve mental health services.

In conclusion, I commend our report on mental health and skin disease, which demonstrates the alarming lack of psychological support available to people living with a skin condition. It provides national policy makers, commissioners and local service providers with an expert consensus on how mental health support for people with a skin condition should be structured in a range of clinical settings. This can be delivered cost-effectively.

The report also outlines the urgent clinical need for healthcare professionals to be equipped with the necessary skills and resources to provide the holistic care that patients need. This must include patient assessments and care that treats the mind and skin together; otherwise, we will not break the vicious cycle whereby problems create psychological problems that in turn exacerbate the skin condition. We ultimately hope that through the publication of this report and debate, the need for action will be made clear to policy makers and service commissioners working in Government and the NHS. I look forward to hearing from the Minister.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport) 5:14 pm, 25th January 2022

Thank you for calling me in this debate, Mr Gray. I also thank Sir Edward Leigh for bringing this issue to the Floor of the House.

I want to raise the case of one of my constituents who experienced topical steroid withdrawal and the side effects of that as a result of the treatment she received for her eczema. I very much concur with the conclusions of the right hon. Member for Gainsborough on the steps that now need to be taken, not least in instituting mental health support in the care pathway.

Having been prescribed topical corticosteroid medicines over a long time, my constituent experienced a very severe reaction upon withdrawal that caused far worse symptoms than those her eczema preparations were intended to treat. The nerve pain was unbearable and inescapable; the skin split and bled; it was sore and painful. The oedema impacted on her care and was debilitating in itself. Those symptoms, exacerbated by the insomnia she experienced and by not going out—being housebound—therefore had a massive toll on her mental health.

The Medicines and Healthcare products Regulatory Agency and the Commission on Human Medicines have reviewed the impact of withdrawal and the over-prescribing of those preparations, which they often are because people need to treat their skin condition continually. As a result of an investigation under the yellow card system, they identified how poorly managed the condition is and how little known.

It comes back to the need for education around dermatology. At each GP practice, there should be a doctor who not only specialises in dermatology but has a good understanding of topical steroid withdrawal, who can therefore manage the pathway of patients. Patients should regularly see their GP for a review of the application of their medicine. It is even harder to trace what happens because there is no coding for this condition. We need to see coding to help to trace exactly what is happening. However, without proper research and investment in research into dermatological conditions, alternative preparations for the treatment of skin conditions are not being advanced at the pace that they should.

The debilitating process that my constituent suffered over not just days and weeks but months and years had a massive impact on her mental health. Depression is one of the side effects listed for these preparations. However, there is no point listing such conditions in the small print; we need to ensure that those side effects do not happen in the first place. We therefore need to ensure a proper review process within the education given to patients and the availability of other services.

That is why I support IAPT—improving access to psychological therapies—services being made available to people undergoing this treatment so that they can get the support they need. It is also worth noting that 81% of the people who experience topical steroid withdrawal are women; I notice that imbalance across healthcare and I will raise it every time. We continually fail on women’s health, and that needs to be looked at specifically.

Finally, I would like to say that there is good support from charitable organisations. Globally, the International Topical Steroid Awareness Network is looking at this issue, as well as Scratch That—I know it is quite a name for a charity—which does fantastic work supporting people and building a network, particularly to help people with their mental health issues. It suggests that it can advance support by building a community, but also by giving people hope. People with a debilitating illness often particularly need hope. I trust that a proper pathway for people with TSW—but, more importantly, prevention—will be developed.

Photo of James Sunderland James Sunderland Chair, Select Committee on the Armed Forces Bill, Chair, Select Committee on the Armed Forces Bill 5:18 pm, 25th January 2022

It is a great pleasure to serve under your chairmanship, Mr Gray. I want to talk about mental health support for those with skin conditions, which is something that is often forgotten about by health providers across the UK and beyond. That is surprising, because 60% of British people currently suffer or have suffered from skin conditions at some point in their life. Those figures are comparable with cancer—it is a much bigger problem than we recognise. Some 98% of skin disease patients currently report that their condition affects their emotional and psychological wellbeing, yet only 18% have received any form of psychological support. That is a dichotomy that I want to explore very briefly—notwithstanding my sore voice, for which I am very sorry.

A key reason why support for these conditions is so important is that recent studies have proven that there has been an increase in psychological distress, and in the last two years in particular. That applies in particular to adults over 18 and children aged between six and 16. For over-18-year-olds, there has been an increase of distress from 20.8% in 2019 to 24.4% in March 2021. That in my view is a reflection of the pandemic, from which we have all suffered.

A study of adults over 18 also found that 26.1% of respondents reported self-harm thoughts at least once between March 2020 and May 2021. That is a hidden danger that we must all be aware of. It is even worse for those who are a bit younger. Among children aged six to 16, 39.2% have experienced some kind of deterioration in mental health since 2017—no doubt as a result of schools being closed and the isolation we all suffered from during the pandemic. For me, this debate is about the hidden dangers of the pandemic and the mental health cost on individuals.

That is made worse as young people emerge from the pandemic and their hibernation. How do they look? How do they feel? How low or high is their confidence? What about not having been in the sun for the last couple of years for those living in high-rise blocks in London and inner cities? What about skin conditions, such as acne? What about not going to school at that key age as a teenager? What about the lack of confidence that comes from having a skin condition? I want to raise these questions today. We can easily acknowledge the problem, but the solution is much more difficult.

Having discussed mental health, I want to move on to dermatology. The number of eczema sufferers in the UK has been steadily rising for the last 10 years. It stands currently at 1.3 million people. Interestingly, eczema is diagnosed much earlier. In around 90% of cases, it is children below the age of five. Psoriasis is much more of a problem for people that are slightly older. The prevalence of psoriasis in the UK today is a similar figure, at about 1 million to 1.3 million people. I am very familiar with it myself. Psoriasis is a problem that can affect how people look, and it is just one of many skin conditions, as we heard earlier from my right hon. Friend Sir Edward Leigh. It is part of the whole panoply of skin issues that affect people so badly.

So what can we do? I want to raise three key points with the Minister. We need to improve the support for all those with skin conditions. We need to focus on the link between dermatology and mental health. First, I want to call on the Government to review their spending on dermatology to enable clinics to provide specialist mental health support for children and young people who suffer from skin problems. As we heard earlier, that may break the link between skin issues and mental health, which people are increasingly suffering from.

Secondly, we should ensure that, whenever possible, face-to-face appointments are available to those who need them. That is really important. It is about human contact and touch. A Zoom call with a doctor is fine, if people can get an appointment, but it does not recognise the problem. The doctor cannot see it nor feel it. That, for me, is very important.

Photo of Sarah Olney Sarah Olney Liberal Democrat Spokesperson (Business, Energy and Industrial Strategy), Liberal Democrat Spokesperson (Transport)

The hon. Gentleman is giving an excellent speech. I, too, pay tribute Sir Edward Leigh. This is such an important issue. I have been contacted by a constituent of mine called Margaret who is a lifelong sufferer of psoriasis. To judge from his opening speech, I think that much of what she said in her email to me would be very familiar to the right hon. Member for Gainsborough. Does the hon. Member for Bracknell agree with me about the importance of first contact with the doctor and how important it is that sufferers of all kinds of skin conditions can feel confident about reaching out to their doctor? As the hon. Gentleman says, face-to-face contact is so important. I also want to emphasise to anyone, anywhere, who might be suffering from a skin condition that help is available and they should not hesitate to seek it.

Photo of James Sunderland James Sunderland Chair, Select Committee on the Armed Forces Bill, Chair, Select Committee on the Armed Forces Bill

I thank the hon. Lady for her intervention; I could not agree more. The simple answer is that doctors cannot see anything on a Zoom call. Also, people need to be able to see a doctor to get a prescription. If someone has a skin condition, they cannot just go to the chemist to get a prescription. They have to get an appointment first in order to get the prescription, and that is where face-to-face appointments come into it.

My third point is that we need to increase the range of psychological support for all those who need it. That is part of the panoply of health support that we need. A 2014 study showed that 94% of the patients who had completed psychodermatology treatment reported reduced stress, 92% reported increased confidence, and 90% reported that their skin condition was better understood. Wow. Those figures are amazing, but if someone asks for that treatment at this point in time, it takes up to a year for a referral, which is worrying.

I want to commend the excellent services locally in my constituency. The Frimley integrated care system is one of the best in the country, if not the best. The treatment that I have had personally has been pretty good, notwithstanding the delay that we are all suffering form. Lastly, I ask the Minister to reinvest accordingly in this very important area so that young people and adults are not suffering.

Photo of James Gray James Gray Conservative, North Wiltshire

This debate can continue until 6.07 pm. However, the House will know that there is very probably a vote at 6 pm. Coming back for five minutes seems odd, so it would be helpful if we can conclude by 6 pm. We have three further Back-Bench speeches and 15 minutes to conclude them in, so four or five minutes each will be helpful.

Photo of Carolyn Harris Carolyn Harris Labour, Swansea East 5:26 pm, 25th January 2022

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate Sir Edward Leigh on securing this debate.

As co-chair of the all-party parliamentary group on beauty, aesthetics and wellbeing, I am deeply concerned about the impact on mental health of having a visible difference, particularly for our children and young people growing up in a world where body image seems to become so significant, with the explosion of social media platforms. Living with a skin condition or any form of disfigurement impacts on an individual’s everyday life. At best, they might have to put up with strangers staring or pointing fingers, but for many it is a steady stream of teasing, harassment or bullying, which has a detrimental effect on self-esteem and subsequently on psychological wellbeing.

Almost one in five people across the UK self-identify as having a visible difference—a mark, a scar or a skin condition. We know that at least 1.3 million people are living with a significant disfigurement, which includes 569,000 with facial disfigurements. Although many dermatological clinics can provide support and advice on the physical challenges and treatments, fewer than 5% of them offer any level of specialist mental health support for young people.

I have talked before in this place about the fantastic charity Changing Faces, which provides unique and life-changing counselling and emotional and psychological wellbeing support for those with visible differences and their families. It does an amazing job and relies on voluntary funding and grants that stretch only so far, which means that it can reach only a tiny percentage of the people who need its help. Its mission is to challenge prejudice and discrimination and to change attitudes towards people living with skin conditions and scarring. Its “Pledge to be seen” campaign was launched to ensure that people with a visible difference that affects their appearance are seen and heard across mainstream culture and in workplaces.

I was absolutely delighted last year when the Welsh Government signed the pledge and became the first UK public body to make the commitment to represent and support those with skin conditions or disfigurements. I certainly encourage businesses and brands to do the same and to help to make society more inclusive. Research carried out by Changing Faces showed that people with visible differences are often vulnerable to isolation, loneliness and social anxiety, which is something we would have seen intensify over the last two years of covid.

As we start to emerge from the pandemic, our NHS services across all areas are stretched to full, beyond capacity, and we risk a looming mental health crisis. Something has to be done to tackle the growing gap in specialist mental health support for people with skin conditions. These people are not different; they simply have a visible difference. By seeing them represented in job adverts, brand marketing and campaigns, we will start to reduce the stigma, and I hope, in turn, some of the ridicule and bullying that they currently encounter.

I encourage colleagues from across the House to promote the “Pledge to be seen” campaign, and ask the Government to follow the lead of the Welsh Government by signing the pledge themselves. We all acknowledge the need for better mental health care, but alongside that it is up to us to demonstrate our commitment to reducing intolerance and prejudice, and to promoting opportunity and inclusivity.

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee 5:30 pm, 25th January 2022

It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to the APPG, and to my right hon. Friend Sir Edward Leigh for securing this important debate. I will try to keep my comments brief, but the challenge is that there is so much to talk about.

I, like Carolyn Harris, pay tribute to Changing Faces, which has done incredible work to promote the cause of those with visible difference, who too often in our lives face discrimination and bullying. We know that 55% of young people will be bullied about their appearance. With the skin the largest organ of the body, it is almost inevitable that those who have a visible difference, such as eczema, cystic acne, scars or burns, will face some horrendous bullying at school—the sort of bullying that means that they do not take part in the ordinary activities that other children do. When I say “ordinary activities”, I mean that they do not want to take part in PE or put their hand up in class in case attention is drawn to them. Is it any surprise that children who have conditions that require medical treatment also need psychological help to overcome all of that?

I pay particular tribute to the most amazing man in Southampton, Professor Keith Godfrey—a dermatologist at Southampton General Hospital who runs the paediatric dermatology service.

Nobody likes talking about acne. I have been in this Chamber when I have heard Members say to me, “Nobody died of a few spots.” But actually, we heard my right hon. Friend the Member for Gainsborough highlight acts of self-harm in young people who feel so bullied and pressured because of the state of their skin that they do not leave their bedrooms and do not want to take part in school activities. Tragically, some do take their lives; they lose their lives because of “a few spots”. That is why it is so important that they are given the psychological help they need to get through their conditions.

Sometimes this is terribly controversial and upsets people, but I want to pay particular attention to the drug Roaccutane, which in itself can cause low mood. It is therefore important that young people who are prescribed it get the support they need when under prescription. We are terribly good at ensuring that young girls who are taking that drug go on the pregnancy prevention programme, but terribly bad at ensuring that the young men who take it get the support they need to get through low mood swings and the depression that some—I am quick to emphasise, not all—feel.

The Women and Equalities Committee last year conducted our inquiry into body image and the pressures that young people face. Of the evidence that we took, particularly from witnesses put forward by Changing Faces, two stick out in my mind. Tatyana, who was a burns victim when she was a very small child—she was at primary school when she was disfigured—gave us the most incredible evidence, in which she spoke about the importance of being open and talking about her skin condition.

Tatyana also spoke about the importance of role models. Pretty much everybody we see on social media today—those influencers of young people—is seen through a filter, so they look perfect at all times, yet young people look in the mirror and do not see that same perfection. Tatyana drew attention to Katie Piper, who she said was the only person she saw in public with visible burns who she could hold up as a role model. She said that she talks about it because she wants that young boy or young girl in their bedroom to see somebody who looks like them who is prepared to speak up publicly and ensure that other people have the courage to take part in everyday life.

I conclude with a plea from Changing Faces, which provides a brilliant, charity-run service that includes its skin camouflage clinic and one-to-one counselling support. Changing Faces would love to work with the Government. My plea to the Minister is: please, go and talk to the people there, listen to the lessons that they have learnt and the support that they can give, and work out how we can bring them into the NHS and help clinical commissioning to ensure that the psychological support is available for those who need it.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 5:34 pm, 25th January 2022

I congratulate Sir Edward Leigh on securing this debate. I want to focus on that issue of major importance to which he referred: mental health. As my party’s health spokesperson, I am keen that these issues are addressed. Skin is always completely visual. For young people in particular, looks can seem like the most important thing, which is why it is crucial that we recognise skin conditions that are normal and those that are not. We have 4,000 skin cancer deaths annually in the UK.

The reason I am interested in this subject is that my second son was born with psoriasis. He had to have cream three times a day. The doctor told us that although he would grow out of the psoriasis—and he did—he would then develop asthma. He did develop asthma, but he is now married to Ashleigh, and they have two boys, Austin and Max—life has changed for him. I remember that when he was at school it was terrible for him; all over his skin was a rash. My wife was the person who looked after him, but that is what happened.

In Northern Ireland, in my constituency alone, we have 2,713 people who suffer from inflammatory skin disease. It is really important that the issues are taken onboard. Some 4,351 people develop skin cancer each year, and around 300 of those cases involve malignant melanomas. It is crucial that there is special psychological care to deal with the impact of skin problems, to help people to cope and to ensure that the condition does not worsen. The right hon. Member for Gainsborough referred to the fact that 18% of people suffering with skin conditions have received some form of psychological support—that is really important. They have to learn how to live with it, as well as learning how to deal with it. As I have said before, young people are growing up in a world where looks seem like everything, and we must do more for them.

Photo of Steven Bonnar Steven Bonnar Shadow SNP Spokesperson (DEFRA Team Member) 5:36 pm, 25th January 2022

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate Sir Edward Leigh on securing this debate on such an important matter, and for informing us all so much through his excellent contribution. Millions of people across Scotland and the UK suffer from skin conditions, which can have a devastating impact on a person’s mental health. The skin is the most noticeable part of our body that could be impacted by psychological factors, yet very few psychologists are researching it. It is classic health psychology, just in a different area. It may seem purely aesthetic to the unaffected, yet the impact goes much deeper, as we have heard.

Skin conditions can be extremely distressing. They can affect all aspects of people’s lives, from schooling, relationships, self-esteem and career prospects to social and leisure activities. Unlike hypertension, diabetes or other health problems, skin problems are usually obvious to any onlookers. That can lead to feelings of isolation, embarrassment, depression or anxiety. People may have psychological reactions that seem out of proportion to their actual skin complaint. Around a quarter of the UK population consult a GP every year for a skin complaint, the most common being for stress caused by the complaint. Despair and other psychological issues can exacerbate the skin problem, creating a vicious spiral.

Acne, psoriasis, eczema and hives are just a few of the dermatological conditions that have been scientifically proven to be exacerbated by stress. Psychodermatology treatment is becoming more accepted among dermatologists, and psychologists are becoming more involved in assisting dermatology patients. Dermatologists and other skin experts are still researching the role of stress and other psychological factors on skin conditions. They are also working on therapies to help dermatology patients deal with the mental health difficulties associated with their conditions.

We heard Rachael Maskell speak about her constituent’s issue, as well as about women’s health more broadly. My hon. Friend James Sunderland spoke about the number of people impacted by mental health issues compounded by their skin condition, such as eczema or psoriasis. Despite all that, there is still a gap in services available for people experiencing distress. A report released in September 2020 by the all-party parliamentary group on skin, undertook some fantastic research and found that many primary healthcare professionals lacked access to dermatological training—even fewer are trained to support patients with the psychological effects of these conditions. We may miss critical signs of distress if primary healthcare providers lack the expertise to conduct a psychological evaluation.

According to the British Skin Foundation, 70% of people across the UK have noticeable skin disorders or scarring that will lower their self-esteem. For example, psoriasis is an illness that primarily affects the skin, and occasionally the joints through psoriatic arthritis. It presently affects between 2% and 3% of the UK population, which is over 2 million people. Psoriasis can have a significant and sometimes catastrophic psychological impact, causing anxiety and depression. Despite that, there is a lack of resources to help persons with inflammatory skin feel less stigmatised. I am myself a psoriasis sufferer, and fully understand the implications of the condition and the effect it can have on a person’s self-confidence. I developed psoriasis in my teens: it is a genetic, hereditary disease, passed on to me from my mother. In fact, my granddad, my mum, my auntie Anne, and now myself have all been long-term sufferers.

The damage that this condition can cause does not simply arise from the impacts on a person’s skin, many though they can be. I am maybe fortunate that my psoriasis manifests mainly on my scalp and head: I often jest that as long as I keep hold of my hair, I should be okay. However, I have also seen first hand the impacts of severe and extreme breakouts resulting in hospitalisation, and have touched on the stress and anxiety of sufferers, none more so—in my opinion—than that of the parent watching their child growing, hoping against hope that they will not have unwillingly passed their condition on to their children. My 13-year-old has so far been unaffected, but that seems to be by the grace of God.

I put on record my thanks to NHS Scotland for its continued work in this field, which has been made possible by the Scottish Government boosting mental health spending by over 65% in the past year alone. I am sure that Members will agree that the mental health consequences of skin diseases are vast, and that as a morally responsible society, we must do more to combat those effects.

Photo of Karin Smyth Karin Smyth Shadow Minister (Health and Social Care) 5:41 pm, 25th January 2022

It is a pleasure to serve under your chairmanship, Mr Gray, and I commend Sir Edward Leigh both on having secured this debate and on his ongoing work in, and commitment to, this area. He introduced his comments by saying that yet again, he had had more ridicule through an email, which is appalling. He stands up for people, and I am sure that that is well appreciated by fellow sufferers.

The APPG’s report is very powerful. It is very sobering that, despite similar reports in 2003 and 2013, so little has changed for people suffering from these conditions, both from childhood and among adults and people who are older. The link between skin conditions and deterioration of emotional and psychological wellbeing are well documented, and have been for some time. As we have heard said so eloquently this afternoon, people with skin conditions report that they have experienced social isolation, stigmatism, depression, anxiety and in some cases suicidal thoughts and, indeed, action. There is also strong evidence to suggest that, although people with skin conditions have much higher rates of common mental health conditions, they struggle to access psychological support. Members have given some very good examples from among their constituents. This is particularly prevalent in children, as James Sunderland discussed. The APPG’s survey found 98% of respondents stating that their condition impacts their mental health, and only 18% saying that they could access support.

The rise of social media has exacerbated these problems. As my hon. Friend Carolyn Harris has said, children and young people with these conditions are particularly reporting bullying and being mocked on social media, all of which we obviously condemn. We cannot disagree with all the evidence that has been presented today—the reports and recommendations on what is needed to support people. It is very clear, Minister: we need to improve access to specialist support, improve training and awareness through the health service, commission more psychodermatology services, improve staffing, support further research, and encourage further integration between psychology, psychiatry and dermatology. The Government need to do much more to support these people, particularly those who are battling through the primary and secondary care interface—I am particularly thinking about parents who are trying to do so. The IAPT service, with which I have worked in my previous career with the health service, offers a route through. However, as all of us know from our constituencies, IAPT is heavily over-subscribed and really struggling with current caseloads.

In the final few moments of my speech, I will pick up on the issue of teledermatology. Although people over the past 20 years might not have experienced much difference in services, the world has changed quite considerably in those 20 years. A decade ago, I was a commissioner for a primary care trust—now they are CCGs—of a teledermatology service, encouraging GPs to use that service as a way of supporting them, providing better link-in to secondary specialist care, and ultimately providing a better, quicker, more responsive service to local people, particularly for parents who can sit with children and avoid trips into hospital. It was clinically led, working with the private sector, new technology and willing GPs, and it was innovative. It was incredibly hard to achieve: at some point, I may share my stories of trying to implement a new service in the NHS. It is not easy, because new practice is always hard to achieve and savings and effectiveness are hard to demonstrate.

Although as we have heard, covid has made the situation much worse for many people, the pandemic has provided a catalyst for some rethinking of how we deliver services. Though I heed the warning in the report —also made by hon. Members today—about the loss of face-to-face services and about how important those are, I think that we can learn some lessons. With waiting lists at 6 million people and rising rapidly, I wonder how the Government will make developments in this area, as well as in many others, without thinking about more radical approaches, while clearly bringing people with them. Technology and digital access provide some of the solutions.

I have a number of questions for the Minister. Given the clarity of the evidence, will she outline how she would support embedding innovation and the lessons of the pandemic to create a more responsive, faster and better service? Will she outline how she will work with her counterparts in the Department for Digital, Culture, Media and Sport to deal with online bullying about skin conditions, which we have also talked about today? It would be helpful to understand the Government’s strategy on employing and training more psychodermatologists and, indeed, how the Minister will support GP training so that GPs understand the effect on people’s mental health of skin conditions, again as has been so eloquently outlined over the past two decades.

What plans does the Department have to invest in further research into psychodermatology and the wider mental health implications of skin-related diseases, as the right hon. Member for Gainsborough mentioned? I sincerely hope that we are not all here in another decade’s time, with another report from the APPG saying the same things. I am sure that we would all like to see some progress for people suffering from the mental trauma of their poor skin conditions.

Photo of Gillian Keegan Gillian Keegan Minister of State (Department of Health and Social Care) 5:46 pm, 25th January 2022

It is a great pleasure to serve under your chairmanship, Mr Gray.

I add my thanks to my right hon. Friend Sir Edward Leigh for securing the debate. The subject is clearly important to many people in the House and to many people across the country who have skin conditions and are concerned about their mental health. I also thank my right hon. Friend for championing this cause for so many years. I am relatively new to my role, but I look forward to working with him. I thank him for sharing his story, which I am sure will have given a great deal of comfort, as well as having resonance in this debate. It is real that people suffer bullying. I was very interested to hear about Changing Faces, the visible signs and the pledge, and I am happy to hear more from Carolyn Harris.

Skin conditions, such as acne, psoriasis—we heard the personal story about psoriasis of Steven Bonnar—the rosacea we heard about from my right hon. Friend the Member for Gainsborough and eczema can be complex and affect people of all ages. Many young people are affected by acne and one in 50 of us will develop psoriasis. Eczema is also very common, affecting one in five children, including me when I was younger. It can also start later in life.

Some of those conditions can be relatively minor, as in my case, and will clear up over time, but others are much more serious, causing pain and scarring and being for the long term, perhaps lifelong. Clearly, that can and will have a negative impact on a person’s life, often causing stigma, discrimination and bullying. It can seriously affect their self-confidence, self-esteem and overall mental health. I understand that. I assure the Chamber that the Government are committed to supporting people with all dermatological conditions.

I note the report on “Mental Health and Skin Disease” by the all-party parliamentary group. I will be happy to attend the group on occasion. I acknowledge that the need for specialist mental health support for people suffering with often debilitating long-term skin conditions was raised as a particular issue, as has been discussed. As my right hon. Friend the Member for Gainsborough stated, the mental health issues faced by people living with skin conditions can be severe, in particular when people are not getting the treatment they need—or waiting for more than a year, as he outlined. Obviously, the longer someone waits, the worse the condition often gets. I reassure my right hon. Friend that mental health and ensuring that people get the treatment that they need will continue to be a priority for the Government.

We are committed to achieving parity between mental and physical health services, and to reducing mental health disparities. We know that we are not there yet, but we are committed to that. We are making good progress, however, with investment in NHS mental health services continuing to increase each year from almost £11 billion in 2015-18 to more than £14 billion in 2020-21. We are investing at least £2.3 billion of extra funding a year in expanding and transforming our mental health services by 2023-24.

Some people with dermatological conditions will be on a long-term condition pathway, due to the nature of their illness, such as cancer, including skin cancer. In these cases, the team responsible for the patient’s physical health should discuss and review the patient’s emotional and psychological status regularly and support them, through access to information and services for their mental health if needed.

Commissioners are encouraged to ensure that local pathways include assessment and ongoing support of patients’ mental and psychological wellbeing and cognitive status. They should also ensure that health practitioners have ongoing training—a number of Members mentioned that—to understand the emotional, cognitive and psychological needs of patients. We have continued to expand our flagship talking therapies programme—a number of hon. Members welcomed that. The improving access to psychological therapies—IAPT—programme for all adults with common mental health problems has been accessed by more than 1 million people in 2020 and 2021. We have expanded the programme to help people with their mental health and long-term conditions, including dermatological conditions.

A person’s mental and physical health are intrinsically linked—they are in one place, in one person. People with long-term physical health conditions, such as dermatological ones, may also need emotional and psychological support. Conversely, two thirds of people with anxiety and depression have a long-term physical health problem—the two go hand in hand. Integrating psychological therapies with physical health services can provide better support to this group of people and achieve better outcomes. That is something we discuss regularly when talking about integration and the new integrated care systems, as one of the benefits of taking that approach. It is also why we have expanded our IAPT programme to include an integrated approach for people with mental health as well as long-term conditions.

All clinical commissioning groups are expected to commission IAPT services, integrated into physical care pathways, as part of their IAPT expansion plans locally. That should bring together mental and physical health providers so they can work in a co-ordinated way to achieve the best outcomes for all people irrespective of their diagnosis. While there is some excellent practice of services offering talking therapies for people with dermatological conditions, such as those in Southampton mentioned by my right hon. Friend Caroline Nokes, I acknowledge that that may not be the case in every area, but IAPT services are continuing to grow and develop all over the country.

I would like to take the opportunity to remind people that IAPT services are accessible to all adults in England. I fear there is low awareness of the understanding that people can self-refer to IAPT. They do not have to wait for a GP, although that is one route, and can self-refer to IAPT. We have also launched a “Help!” campaign, accompanied by The Beatles music, which is raising awareness so people know they can access those services. They can be referred by a range of practitioners in the community or by primary care, but they can also refer themselves. They will receive a person-centred assessment that covers the person’s mental health problems and acknowledges the impact of their long-term condition. Clear pathways and processes should be in place to enable a person to progress between those services and existing pathways.

As mentioned by my hon. Friend James Sunderland, I acknowledge the impact of the covid pandemic and the excellent work going on in mental health services to respond to the pandemic. The past two years have been really tough. There has been a lot of innovation, as Karin Smyth said. We need to take that innovation and embed it in the services. There has been unprecedented demand on mental health; it was growing anyway, but the pandemic has accelerated demand. They are doing their utmost to make sure that services are there for everyone who needs them—for patients and our NHS colleagues who have been on the frontline— but services have been strained and it is harder for people to get an appointment at times. That is why, in addition to our long-term plan commitments, as part of the Government’s commitment to build back better, we have published our mental health recovery action plan, backed by an additional £500 million for this financial year, to ensure we have the right support in place and that we embed that innovation to access more people.

The plan aims to respond to the impact of the pandemic on the mental health of the public, specifically targeting groups who have most been affected—young people and children, clearly, are in that group. That investment and expansion of mental health services will help to address the needs of those people with long-term conditions, as well as other people in need of support. To deliver on our commitments, we need to ensure we have the workforce available. That is important but it takes time to deliver and that impedes our progress. It is vital that we have the right skilled workforce in place; we have improved that and we will continue to improve it.

Question put and agreed to.

Resolved,

That this House
has considered skin conditions and mental health.

Sitting adjourned.