Mental Health

Caroline Nokes Excerpts

Thursday 16th May 2013 Commons Chamber

[Caroline Nokes (Romsey and Southampton North) (Con)]

I add to those of other Members my congratulations to the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this debate, and indeed to the Backbench Business Committee on having agreed the time for it.

I fear I shall stray into what some Members might regard as rather a niche area of mental illness. Some will recall that I led a Westminster Hall debate several months ago on the topic of eating disorders, raising the connection between eating disorders of whatever type and other mental illnesses.

One of the sadnesses I encountered in the run-up to that debate was the trivialisation of eating disorders even by some fellow Members, who made the point that they were not serious conditions but just the afflictions of silly teenage girls who needed to get a grip on their eating patterns. Far from it: in fact, eating disorders are one of the most prevalent mental illnesses. There are thought to be some 1.6 million sufferers in the UK. Anorexia nervosa is the most lethal mental illness: 20% of sufferers eventually die from it and a further 20% never recover.

It is important to recognise that the symptoms of a wide variety of mental illnesses such as low self-esteem, physical abuse and alienation from peers are common traits in a wide range of mental health problems, and are often particularly manifested in eating disorders. As I have said previously, the route map to an eating disorder is not identical for everybody, but similar traits and commons themes can be found. The same route map and traits can be found in schizophrenia and serious personality disorders such as bipolar disorder, for example.

I want to pick up and draw on as a point of contrast the issue of borderline personality disorder. I want to make the point, hopefully as succinctly as I can, that eating disorders are not the poor relation of more serious personality disorders and mental health problems; they are a serious condition of the psyche that should command far greater public awareness and, indeed, greater public spending.

To demonstrate the significant threat posed by eating disorders, one need only make a comparison with a more well-known and recognised mental health problem such as borderline personality disorder. BPD has a higher incidence of occurrence than schizophrenia or bipolar disorder and is thought to be present in about 2% of the general population. It has a phenomenally high rate of suicide and self-harm: 10% of BPD sufferers eventually commit suicide. Those mortality rates are augmented by disorder-related deaths from drug or drink abuse. One of the most well-known cases of undiagnosed BPD was that of the singer Amy Winehouse, who eventually died from alcohol poisoning.

However, anorexia nervosa—like BPD, it is thought to affect roughly 2% of the population—has a 20% mortality rate, which is nearly twice that for BPD. Yet awareness of this shocking statistic is not high; people simply do not know about it. That could be because, unlike BPD, those deaths do not predominantly come from suicide—although that is not uncommon—but happen many years later after the physical effects of anorexia have taken their toll. Many of the deaths occur from multiple organ failure or heart attacks, in addition to the straightforward and more well-known effects of the sufferer having too low a body weight for them to survive.

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the hon. Lady on the persistence with which she has raised this issue and the trenchant way she argues her case. She will be aware that one of my concerns is type 1 diabetics who, by manipulating their insulin intake, can achieve rapid weight loss, which is in itself a form of eating disorder. Does she agree that the major problem confronting these people is falling between two stools? On the one hand they get physical treatment for the physical consequences of their rapid weight loss—organ damage and so forth—while on the other they have difficulty getting access to proper psychological or psychiatric services. Does she agree that the two need to be more integrated?

[Caroline Nokes]

I thank the right hon. Gentleman for that timely intervention. That is one of the key problems. Far too often in eating disorders, the treatment is focused on body-mass index and ensuring that the sufferers are physically well, but without necessarily addressing the underlying cause through therapies and treatments that deal with what triggered the condition. The right hon. Gentleman’s example of diabetics who manipulate their insulin intake is a particularly stark one. Anyone who has done work with diabetics knows that incorrect levels of insulin can lead to horrendous physical complications. Across the whole spectrum of eating disorders, there is far too much focus on physical and too little on mental well-being.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I would not normally intervene, but will my hon. Friend join me in paying tribute to the right hon. Member for Knowsley (Mr Howarth) for the great work he has done to raise with me and my Department this often unheard of, certainly unrecognised and very serious problem of type 1 diabetics with eating disorders? In considering how to tackle it, it is indeed important that we look at the mental conditions and problems my hon. Friend has identified.

[Caroline Nokes]

I certainly join the Minister in paying that tribute. I am delighted to hear her make the point that we must start addressing the underlying mental health conditions, when in too many cases the physical treatments are the sole emphasis.

I want to touch briefly on the significant impact eating disorders can have on future career opportunities and in the workplace. As I said earlier, eating disorders are often trivialised and generalised as being conditions affecting teenage girls. That is far from the truth, as the highest rate of increase is among male sufferers. In addition, many eating disorder sufferers are managing their conditions over many years or even decades. I am the first to emphasise that sufferers can be of any age and of either gender, although I acknowledge that the age at which an eating disorder is most likely to manifest itself is 17, and that it is most likely to do so in girls. It often occurs in academically high-achieving individuals who put themselves under immense pressure to be absolutely perfect in every way they can. That frequently manifests itself in a control of food intake. Those determined to put themselves under significant academic pressure also put themselves under massive physical pressure and wish to conform to a body ideal that is actually far from healthy.

I want to pay tribute to the work of April House in Southampton—a specialist unit that focuses on eating disorders in the city. I paid a very enlightening visit to the centre just over 12 months ago and met a number of sufferers, several of whom came from my constituency. Although April House serves the wider Southampton area, three of them were Romsey residents. They have kept in touch with me since my visit, and have emphasised that they have not only benefited from the work done at April House, but have undertaken other therapies.

I am very aware of the work of an organisation in Southampton called tastelife, which was set up by the families of people suffering from eating disorders. The aim was to move the focus away from the physical, and, through self-help groups, to encourage sufferers to talk about their issues, work through them with other people and concentrate on not just physical but mental wellness.

I pay tribute to the hon. Member for North Durham (Mr Jones), who drew attention to the stigma experienced not only by those who suffer from mental health problems, but by their families. Before the Westminster Hall debate, I was contacted by many parents, husbands and, indeed, wives of people with eating disorders, who told me that not just their relatives but they themselves suffered that stigma. A number of them believed that they must be in some way to blame for the fact that their relative, perhaps their child, suffered from an eating disorder. Many were suffering from massive levels of guilt and introspection because they felt they must have somehow caused it.

I have tried to emphasise during discussions of this topic that it is not possible to identify a single trigger, and that a parent cannot do anything to prevent the descent of a child into a form of mental illness, but what that parent can do is help. I was pleased to hear various Members stress the importance of having a parent or other relative as an advocate. In the case of eating disorders, it is almost inevitably the parent who will know the young sufferer best. I think it very important that we be prepared to talk openly about the subject and to move away from the stigma.

Many of those who attended the Westminster Hall debate will remember my hon. Friend the Member for Braintree (Mr Newmark) talking about a pea. He described how he had suffered at school from anorexia nervosa, and had decided to address his condition by seeking to tackle it one step at a time. The first step involved a single green pea on a plate, which he pushed around endlessly, trying to summon up the ability to eat it. His was a moving and interesting account, which gave those of us who had by then been debating the issue for some hours something on which we could really focus: that vision of a plain white plate with a single green pea on it.

Unfortunately the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), is no longer in the Chamber. I am sure the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), will do an admirable job in responding to the debate, but the point I am about to raise is one that I raised with the Minister of State after it was raised with me by an organisation called Anorexia and Bulimia Care.

Once a young person suffering from an eating disorder has turned 16, they can choose to accept or refuse treatment and their parents no longer have a say. In order for them to be force-fed, they must be sectioned. That brings me back to what I said earlier about teenagers who are in the middle of academic exams and approaching A-levels. Being sectioned could have a significant impact on their future career choices.

I am not necessarily suggesting that we should insist that the parents must be in charge until a child reaches the age of 18. The Children’s Minister explained to me carefully and clearly about previous rulings in this place and in the courts which have granted people Gillick competence at an earlier age. I am not saying we should insist that that right be taken away from eating disorder sufferers. I think it important for us to work with health care professionals, and with mental health experts in particular, to find a solution to what I regard as a very knotty problem.

Among the sufferers to whom I have spoken during various meetings at April House and elsewhere, one sticks especially keenly in my mind. She was a lady my own age, and, although she was not one of my constituents, she came from Hampshire. She had suffered from anorexia for decades, and was incredibly frail. When I mentioned April House she shuddered visibly, because she regarded it as a place where she had been effectively force-fed. She had not come through the treatment successfully; here she was, 20 years on, still suffering from anorexia nervosa.

I always find myself—with good reason, I believe—on the side of the sufferer or the patient, and I am therefore not suggesting to the Minister that when it comes to the debate about whether parents should have the right to insist on force-feeding young people until they reach the age of 18, we should enter the fray. I recognise it is a very difficult area. However, I want to leave that thought with the Minister. I have raised the issue with her colleague the Minister of State, and no doubt I will raise it again over the coming months and years.