Eating Disorders Awareness Week

Lisa Cameron Excerpts

Thursday 5th March 2020 Westminster Hall

[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]

That is incredibly interesting. I had not heard about it, but I am sure that my officials will take note of it. We have an open door for anything that we can identify that helps us in targeting and providing services. We are looking for solutions to the problem. As I said, the money is there. Claire Murdoch, who I mention in almost every debate, and Professor Tim Kendall are rolling out mental health services across the country via NHS England. They have probably heard of it and are probably looking at it, but I am sure that we will take note and check if that is the case.

Although eating disorders are commonly first experienced by people when they are young, they can continue into adulthood. Following a report on how NHS eating disorder services were failing patients, NHS England convened a working group with Health Education England, the Department of Health and Social Care and other partners, which goes to the point that my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made. We are working in collaboration to address the report’s recommendations and to take them into account when planning for improvements to adult eating disorder services. Work is in progress on that.

We are continuing the investment in mental health services through the NHS long-term plan, as I think most people know. The £2.3 billion is with NHS England, which has a long-term plan to deliver on mental health and is moving at incredible pace. Even today, although it is not relevant to the debate, it announced the opening of gambling clinics across the UK. Community services are being rolled out across the UK so that people in mental health crises do not end up in casualty. It is an incredibly impressive roll-out of mental health services across the UK, including for eating disorders.[Official Report, 5 March 2020, Vol. 673, c. 12MC.]

That long-term plan will give an additional 345,000 children access to mental health support; 380,000 adults access to psychological therapies; and 370,000 adults access to better support for severe mental illness by 2023-24. It commits to the delivery of eating disorder waiting time standards, which I have already spoken about, and I hope that we will reach those before the end of next year. The plan has also committed to the design and roll-out of a new integrated model of adult community mental health care.

To increase further the number of people seeking treatment for their eating disorder, the Government recognise that raising awareness and reducing stigma are incredibly important. Here I should come on to a few of the points made by the right hon. Member for Knowsley. I shall go through them backwards, because that will be more positive in terms of affirmative answers. He mentioned social media providers, their role in body image and the impact that they have on young women. My right hon. Friend the Secretary of State for Health and Social Care has already—this happened recently—held a roundtable with social media providers. It was an incredibly positive meeting, but that is something that needs to continue, because when it comes to social media interactors, providers and platforms need to be aware of the impact that their forums have on young women, so we are continuing that dialogue with them and, I hope, are continuing to push that point.

The right hon. Gentleman made a point about the entertainment industry and its relationship and responsibilities with regard to body image. I announced two weeks ago that I am holding a roundtable with the entertainment industry. That was as a result of the death of Caroline Flack, who took her own life. For me, that was a watershed moment. It is time for the entertainment industry to be aware that it does not have a duty of care only to the people who they take on a contract to work with them. This is not just about sudden fame and reputation loss. The industry has a wider responsibility in relation to images that it projects and how it projects them, because young women and, indeed, many people absolutely are influenced by what they see—their perceived role models—through the lens of television or the cinema. The entertainment industry definitely has a responsibility, so in response to the right hon. Gentleman’s question, I can say that I have already put that in train.

In relation to a review of the long-term effectiveness of CBT, I defer to the expertise and knowledge of our friend from the Scottish National party, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who made the point that short-term CBT may not be as effective, in terms of how it is delivered, for such long-term conditions. It may be part of the treatment, but as we know, when it comes to eating disorders, treatment is very prolonged in some cases. I am sure that CBT has a definite role, but it should not be seen in isolation. Management of eating disorders takes the input of physicians and psychologists—people who are expert in managing these conditions and working in this field. Therefore I would say yes, but not in isolation.

[Dr Cameron]

I thank the Minister for making that point. I think that there should very much be a formulation-driven treatment plan whereby all the issues that the person presents with are taken on board, and different aspects may require different parts of treatment. I do not think that often happens currently, particularly where people present to primary care services and perhaps do not get the specialist services that they need, but I hope the work that is being done will streamline that for the majority of people in the future.

[Ms Dorries]

I am sure that Claire Murdoch and Tim Kendall at NHS England are all over that and very aware of that. A streamlining approach to treatment is about getting people seen within the first week. If people are first seen within the first week when they present with their first crisis, that is the time when greater intervention can happen and when that treatment plan can be designed and put in place and there can be that entire care pathway through. I will not say that I think that that would shorten the illness, because I do not know. The hon. Lady probably knows more than I do, but I would think that an effective treatment plan with CBT and everything that is involved in that would provide a better outcome than piecemeal interventions along the way.

The right hon. Gentleman’s first point was careful consideration of Beat and so on. I am a huge admirer of Beat. It provides an incredible service. Its helpline deals with 30,000 people a year, I think, if I am not mistaken—it is a few weeks since I saw Beat. The support service that it provides, particularly to young women who are looking for someone to talk to and advice and help, is second to none. We are absolute supporters of Beat.

Let me just go on to the point made by my hon. Friend the Member for Broxbourne (Sir Charles Walker) about diabulimia. It is also of course the point that the right hon. Member for Knowsley raised repeatedly. We are absolutely committed to ensuring that people with diabulimia receive the treatment that they need. That is why NHS England announced in February 2019 the piloting of services. The services are being piloted on the south coast and in London, and NHS England will evaluate and monitor the pilots and take the learning from them. I will raise what the results show, if the results are through yet from the pilots, and what learning there has been and how it will apply across the UK.[Official Report, 19 March 2020, Vol. 673, c. 13MC.] I am sure that the officials will take a note, and when I have had that meeting, I will report back to the right hon. Gentleman and let him know exactly what the findings are and where we are going on that. The group that we are talking about is very small, but it is at the extreme end and requires very serious consideration.

I think that those are all the points that were raised and that I need to answer.