Eating Disorders Awareness Week

Jim Shannon Excerpts

Thursday 5th March 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Member for Knowsley (Sir George Howarth) for bringing the debate forward. I am pleased to participate in it. I, too, have had constituents who have had eating disorders over the years, so this is an opportunity to highlight those issues and look to the Minister for a positive response—no doubt we will get one. It is good to follow the hon. Member for Broxbourne (Sir Charles Walker), and I thank him for his contribution. Until the right hon. Member for Knowsley told me about it some time ago, I was not aware of the issue of eating disorders among people with diabetes.

It is good to have the opportunity to speak about eating disorders, which are serious mental illnesses that deserve to be dealt with in that vein. My interest in the issue came from sitting with a friend of mine—a father who was at his wits’ end trying to get his daughter, who was suffering from an eating disorder, the help she needed. That was way back when I first came here, between 2010 and 2012. He did not give up. Neither did I—and neither did the Minister responsible for health back in Northern Ireland or the Health Minister here. It was a combination of both that brought about the success that we had hoped for. The Minister in Northern Ireland managed to make changes to how things were approached there. The result of that was that we—not me, but the Minister at the time—made legislative changes and changes to the provision of in-patient care specifically for those suffering from eating disorders.

That story is very poignant. I will not mention any names, but that young lady had severe eating disorders. Unfortunately, she had hidden much of it from her parents, whom I knew extremely well; they both were in an occupation that I had a particular interest in. They had approached the Department of Health back home but had not really got the response they wanted, so I met Edwin Poots, who was Health Minister at that time. Ultimately, through our contact with him and the Health Minister here, we were able to get that young lady over from Northern Ireland, where there did not seem to be anything in place to help, to St Thomas’s Hospital just across the way from where we are now. Ultimately, the medical care it was able to offer saved that young girl’s life. It is as simple, as graphic and as honest as that. I would like to put on the record my thanks to the Minister at that time and to St Thomas’s for giving that family the treatment and help they needed.

The wonderful thing about that story—again, I will mention no names—is that that young girl is now married. She is still one of my constituents, as indeed are her mum and dad, and she has two young children. I had not seen her for a few years, but before the election I knocked her door. She came to the door looking extremely well, and she reminded me of that story. I wanted to tell it today to add to the interactions described by the hon. Member for Broxbourne and the right hon. Member for Knowsley. Things can be changed if the right measures are in place to make that happen.

I asked the Minister back in January how many people were recorded as having had eating disorders over the past five years. The answer was not straightforward. That moves us to the crux of the issue: the differing diagnostic processes. The Minister’s response read:

“The following tables show the number of people referred to specialist secondary mental health services with a primary diagnosis of eating disorders from 2014/15 to 2015/16, and the number of people referred to specialist secondary mental health services with a primary reason for referral of eating disorders from 2016/17 to 2018/19.”

The figure was 4,513 in 2014-15 and 3,895 in 2015-16. The source for those two years is the NHS Digital mental health and learning disabilities dataset. In 2016-17, the figure jumped to 11,207, and in 2017-18 it increased to 18,224. In 2018-19, there was a massive jump of more than 4,000, to 22,336.

The Minister’s answer continued:

“There are two matters to consider when looking at the MHSDS data:

Diagnosis recording is known to be low. Of the people in contact with these services on 31 October 2018, for example, a diagnosis was recorded for only 22.3% of people. Therefore, the number of people with a primary reason for referral of ‘eating disorders’ for 2016/17, 2017/18 and 2018/19 is provided, rather a count of people diagnosed with an eating disorder.”

That probably means that in 2014-15 and 2015-16 a large number of people had similar problems but were not referred. That is what the Minister acknowledged in her response. If we have a problem even counting how many people have a disorder, how on earth do we find them the help they need?

The charities that work with those struggling with their eating are a little clearer about how they work things out. The right hon. Member for Knowsley referred to Beat—I thank both it and the Library for the information they sent us—which estimates that there are some 1.25 million people in the UK with an eating disorder. That is not in any way reflected in the Government’s figure of 22,000. If it is anywhere near the truth, Beat’s figure cannot be ignored.

Beat stated:

“The most common age of onset is 15-25 years old, during a developmentally sensitive time. Anorexia has the highest mortality rate of any mental illness, and the mortality rates of the other eating disorders are also high. People with eating disorders typically develop severe physical health problems and overall quality of life has been estimated to be as low as in symptomatic coronary heart disease or severe depression.”

That demonstrates the magnitude and severity of the issue. Beat continued:

“Without early intervention, many become unable to participate in education or employment.”

Some 1.25 million people in the UK currently live with an eating disorder, while 10% of people affected by an eating disorder suffer from anorexia and 40% suffer from bulimia. The rest of sufferers, including those with binge eating disorders, fall into the “other specified feeding or eating disorders” category. There are some very complex examples of those problems.

Research suggests that the earlier treatment is sought, the better the sufferer’s chance of recovery. That is the case with almost every disease: early diagnosis always helps to address something early, solve problems and raise awareness. Some 50% of eating disorder sufferers go on to recover. That is encouraging, but it tells us that 50% continue to have problems. Only 30% improve, and 20% remain in a chronic condition; many continue to suffer way beyond their alarming early conditions. Those high figures highlight the serious issues with the availability of holistic treatment.

I wholeheartedly support the Dump the Scales campaign, which would bin the GP regulations enforcing a minimum weight or BMI before a diagnosis can be given. Indeed, I support calls for GP retraining on this issue. I am very respectful of our GPs, who are wonderful people. They do great work, but sometimes we need a better understanding of eating disorders. We should not insist on certain categories in relation to eating disorders or insist that people get on the scales. I think it is important to address that.

I am a type 2 diabetic. Whenever I go down to the doctor, he weighs me and refers to my BMI, and he tells me whether I am on the right or wrong side of it. Thank goodness, this last while I have been on the right side of it. I try to keep careful control of what I eat and how much I eat.

When a parent, a carer or a sufferer themselves realises that all is not okay with their mindset towards food, palming them off with a little leaflet or a referral—I mean this respectfully—to yoga classes, as sometimes happens, is not enough. I am not saying that yoga is not good to do—I have never done it and have no knowledge of it—but to say that that is a way to solve someone’s eating disorder is a wee bit crass, to say the least. We must get on with early diagnosis and intervention, rather than effectively saying to people, “You aren’t skinny enough yet to merit help,” because they are.

The starting point must be the first realisation that there is a problem. When the parents of the young girl I mentioned earlier realised that their daughter had a problem, they addressed it early on. A doctor has never asked me to be tired for six months before checking the iron in my blood. He carries out a test to ensure that nothing is wrong. We start at the beginning and do not waste six months to see what it is. Why must we wait until someone is dangerously underweight before we offer them help when, in some cases, that is just too late?

I am fortunate to have two granddaughters who are extremely beautiful, not like their grandfather—and they will be glad to hear that; they have their grandmother’s and mother’s good looks—but never do I want them not to see what I see when I look at them. If, God forbid, there was a problem, I would want to know that the NHS had not simply the finance but, more importantly, the understanding of how and when to intervene. That is not simply when the scales show the correct small number.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank the right hon. Member for Knowsley (Sir George Howarth) for introducing the debate, particularly in Eating Disorders Awareness Week, on such an important issue that is often overlooked because it is hidden. He was fastidious in detailing so many of the crucial aspects of eating disorders and how our popular culture impacts on so many. I think it will go on to affect more young people as it grows under the social media stresses and pressures put on them.

I was thinking back to when I first started to think about appearances, which was probably when I was in my mid-teens, but my daughter, aged 11, is already looking on Instagram and so aware of how she looks and how many friends she has on social media. Those are not what I would call actual friendships, but these days it is all about social perception, and the pressures and stresses we put on young people through social media, which remains largely unregulated, are astronomical. We are creating a mental health catastrophe that is coming down the line for our young people. It will impact on men, who are not immune, but it impacts significantly on young women. I see that in young children of primary school age: my daughter and her friends very much relate to pictures of one another online and how they look. A societal image of perfectionism is being created that is very unhealthy for people’s mental health.

Eating Disorders Awareness Week is running this month, raising awareness of a disorder that, as has been said, affects 1.25 million people across the UK. When I worked as a psychologist in mental health services, I was aware how even then it was not a key focus in our training. Mental health professionals could benefit from much more in-depth training in eating disorders. When I was at Glasgow University, we benefited from the psychologist who came to train us having a specialist interest in the area. He is long retired and I do not know if anyone has taken his place, but training was very much dependent on individuals who had developed specialist expertise coming and lending that expertise, because those in training may not meet or have clinical experience of treating people with eating disorders unless they go on to do a specialist placement. Many of the professionals we are bringing through across the United Kingdom will not necessarily feel that they have sufficient expertise to treat eating disorders. We need to address that, particularly because, as has been said, it is not the kind of difficulty where people often come forward and say, “I have an eating disorder.” Clinicians, trying to form a picture on presentation of someone who might come with a diagnosis of depression or trauma, may notice a larger clinical picture not in the referral, but they require that expertise to pick up those symptoms early on. We know that earlier intervention creates a much better outcome for those with these conditions.

The other important issue I want to bring up is the Dump the Scales campaign, which I looked at while other hon. Members were talking. There may be more obvious signs of weight loss in individuals who present with anorexia, but those with bulimia are often bingeing and then purging, so there may not be noticeable weight loss. Such disorders can become extremely chronic before anyone picks up the symptoms. Certainly, one symptom of the disorders is denial and attributing difficulties elsewhere.

Dump the Scales is important, because my understanding is that BMI has to be at a certain level for a referral. We need to move on from that in clinical practice and look much more widely. I have just looked up the criteria in ICD-10 and, while they may have moved on, there are a number of symptoms and BMI is one of them. That needs to be considered, because, as I said, the person is not likely to come with a presentation of eating disorders in the first place and then, if some of the clinical symptoms are so stark that they cannot be referred on to appropriate services so quickly, that creates another barrier to getting the treatment they so desperately need.

Family support is another matter that we often overlook but need to focus on. We really need to get family members on board in order to have holistic treatment, particularly for young people’s mental health. It would be helpful to know more about what is being done in relation to family systems therapy and family therapy.

I was trained in the cognitive behavioural therapy model when I was practising, but it was very much a formulation-based model. I do not think eight sessions of CBT would necessarily be effective for people who have a long-standing chronic illness or perhaps other underlying issues such as trauma that need to be resolved. We need a flexible system to ensure that a person’s care pathway is at the level of service they need for the chronicity of their difficulties.

It has not passed me by that it is International Women’s Day this week, so it is apt to have this debate on eating disorders awareness, which an issue that is likely to affect so many young people—overwhelmingly women, but also men—who face this social pressure.

I will finish with a few things that the Scottish Government are trying to do. This is an area where we should share best practice and have much collaboration across the UK, and I would like to see that and be part of it. It is excellent for the way forward that an all-party parliamentary group has been reconstituted.

Last year, the Scottish Government created an online peer support tool specifically for this issue to allow young people to pair with a trained volunteer, who had themselves recovered from an eating disorder. That is important because peer-to-peer support can be extremely helpful, particularly for young people. At certain stages in life we may speak to our parents more or less readily, depending upon our stage of development, and for adolescents, among whom a higher percentage of eating disorders initially develop, peer-to-peer support will provide an excellent starting point for treatment.

The website caredscotland.co.uk is an information platform for parents and carers. We must ensure that parents and carers, who are, most often, going to be the ones who pick up the initial signs, have awareness, as well as the support they need. It is vital that parents and carers have that support because dealing with an eating disorder can take an enormous emotional toll upon an entire family. We need to look at people’s mental health in a holistic manner.

We need to do much more, right across the United Kingdom, in relation to access to treatment for those who have eating disorders. We have come some way, but we need to raise more awareness at different levels within the system. GP training has been mentioned. We also need a public awareness campaign, because often peers or families pick up the initial symptoms, and medical training for psychiatrists and those working in mental health. From my own training, I do not think those professionals have the level of training necessary to treat people in primary mental health care, which is often where an eating disorder might be picked up initially before it is referred on to secondary community mental health teams.

[Jim Shannon]

I am thinking about the dangers of social media and how it affects children and young people. Could the dangers of social media be made clear at an early stage, perhaps at school? The perfect body, clothes, hair and everything become things everyone wants, whereas the reality of getting them is quite different. For instance, in some photographs, models’ six packs or their weight are actually changed digitally. Social media has a lot to answer for.

[Dr Cameron]

The hon. Gentleman is entirely correct. Social media often creates a false world that none of us can ever live up to. That is why I welcome the Government’s work on social media, which is looking at potential regulation and other issues in relation to the impact on mental health.

This is an excellent pivotal debate, but it is not the finishing point. It is most definitely the starting point for taking these issues forward on a cross-party basis. I look forward to working with everyone who has an interest in this field, to support progress for those who have eating disorders across the United Kingdom.

--- Later in debate ---

[Ms Dorries]

My right hon. Friend makes an important point. That is why we invested £2.3 billion in mental health services, which, as I always say, is more than half the entire prison estate budget. We are focusing on young people and young women in this debate, but funding for mental health services is growing faster than the overall NHS budget. That funding and the development of community services is there to pick up exactly the cases she cites.

No mental health service, other than the very extreme, is better delivered in a hospital than in the community, whether for children, young people or adults. Despite that investment in community mental health services, our challenge is unprecedented, and our challenge is about workforce—it is about attracting people to work in this arena and to help us develop the community services that we need to provide treatment for adults and young people. That is the challenge we have taken on, and it is a challenge that we are meeting and moving forward with. It is our ambition and my absolute hope that children, young people and adults, regardless of their age—this illness is severe, whether in adults or children and young people—receive the treatment they require, when they require it.

[Jim Shannon]

These plans will require a close working relationship between the Department of Health and Social Care and the Department for Education. I am sure that that is what the Minister refers to, but will she confirm that that is the case?

[Ms Dorries]

Absolutely, and the Green Paper, which I am sure the hon. Gentleman will be aware of, references the mental health of young people in schools. However, it is also about the trailblazer schemes, peer support workers and other people who go into schools who specialise in how to identify this and pick it up. Teachers have a huge job, and I think if we were to say that they needed to pick up when someone is suffering from an eating disorder, they would probably throw their hands up, because it requires specialised training. It is a skill, and it takes careful handling when identifying someone who is suffering from an eating disorder. So yes, of course we work across Departments, but it is those specialised and trained mental health workers in schools who will pick this up.