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.
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.
Jeremy Corbyn (Islington North) (Lab)
Like all the other Members who have spoken, I welcome the debate. It is important for us to have it, and I hope that it will become an annual event. It is a way of reducing the stigma that is attached to mental illness, increasing understanding of it, and also, quite correctly, holding the Government to account on how their policies develop.
There is still an enormous amount of discrimination against people who have suffered from some kind of mental illness or breakdown, or have spent time in a long-stay institution. Like all discrimination, it is incredibly wasteful of resources, because it means that those people cannot contribute to society in the way that we want, and as a result we all lose out.
I want to raise two points. The first relates to local experiences, and the second to national policies. My borough has an image as being relatively wealthy and high-achieving, and there are certainly some wealthy and high-achieving people in it. Islington council, however, undertook an interesting exercise: it set up a fairness commission to examine the quality of the delivery of public services to everyone in the borough, with the aim of ensuring that the purpose of the council’s policies, including health policies, was to reduce inequality.
According to a briefing that the council gave me before the debate, it is estimated that in my borough
“30,000 adults experience depression or anxiety disorders in any one week…. Mental ill health among 5 to 17 year olds is estimated to be 36% higher…than the national average”.
The briefing states that more than one in eight children are
“experiencing mental health problems at any one time.”
It also states:
“The suicide rate is… 8 per 100,000…second highest in London”,
“similar to the national average”.
Physical ill health is often related to mental health problems. According to the briefing,
“Poor mental health was found in 43% of all Islington patients who died of cardiovascular disease before the age of 75. As people live longer, there are an increasing number of people with dementia, although Islington has a relatively smaller number of older people”—
only 9% of the population. Islington has a 70%—higher than average—rate of diagnosis of dementia. Increasingly, as others have pointed out, people who care for adults with mental health problems are much older people who find it extremely difficult to cope. Those carers need more support, so that they are better able to look after people who are becoming more and more dependent.
Both my local council, in its study, and the Mental Health Trust draw attention to the enormous over-representation of people from black and minority ethnic communities in the context of diagnosis and, in particular, the context of long-stay institutions. We should ask whether there is, in fact, a higher level of prevalence, or whether there is a perception that it is somehow OK to put black and minority ethnic people into long-stay institutions, whereas it would not be OK in the case of other people.
Indeed, I urge Members to visit long-stay institutions and talk to people resident in them. I get the impression some of them have had very difficult lives and very little support, and that they have led very isolated existences. I also get the impression that many of them have very few friends and very little representation, and whereas those who come from a fairly stable family background with a series of understanding relatives are able to get representation and often win their cases where there has been a section order, others do not get the same quality of representation and consequently do not win any tribunal cases.
In an earlier speech, I made an intervention about the role of the voluntary sector in dealing with mental health conditions. As I have pointed out, my borough has considerable problems in dealing with mental health, but we have a number of very good local organisations that often deal with mental health issues in an innovative and supportive way, and are often very successful. Nafsiyat, an intercultural therapy centre based in Finsbury Park which was founded by the late Jafar Kareem, was groundbreaking in its ideas of looking at the cultural background and ensuring culturally appropriate treatment of people with mental illness, for example by making sure there are people who speak the necessary languages and understand something of the specific cultural background. The Maya Centre, which particularly relates to women, does much of the same work, as does ICAP or Immigrant Counselling and Psychotherapy, a counselling and psychotherapy centre originally founded by people in the Irish community that now deals with a much wider community.
We also have a considerable refugee population. A very good group called Room to Heal deals with people who have achieved asylum status in this country. They have often been through the most dreadful experiences of torture, which are frequently dealt with in a community way. People meet regularly and do things together, such as gardening and taking trips. Many of them improve a great deal and get through the terrible traumas they have suffered. I find it very interesting talking to people from different countries all around the world who have all experienced torture in one form or another and who have benefited from these activities. We also have the Refugee Therapy Centre and the Women’s Therapy Centre, which also provide therapy on a culturally sensitive basis. Finally, we have the Holloway Neighbourhood Group stress project.
These are all valuable groups, and they all depend on contracts obtained either from the local health authority or neighbouring health authorities. All of them spend a great deal of time filling in forms in order to gain what are often relatively small sums of money for relatively short-term contracts. Health authorities must value these organisations and look to use them. We should give out the message that we recognise that the voluntary sector has a very important complementary role to play in supporting statutory services in the treatment of mental illness. I do not see them as competitors or rivals; I see them as complementary.
Mr Kevan Jones
I agree with what my hon. Friend says about the smaller contracts these organisations get and the bureaucracy they have to deal with. Does he agree that some of them could bid for larger contracts to provide services as well, but the bureaucracy and financial hurdles involved in bids for such contracts make it very difficult for them to do so?
I agree. The bureaucracy involved and the skewing of the contract culture frequently means voluntary organisations that have a tradition of the voluntary provision of services—often in an effective and innovative way, as I have described—are debarred by the contracting process. Instead, very large private sector medical companies come in to privatise those services and run them in a profit-related way, rather than the voluntary sector, which is motivated not by profit, but by the care of the individuals. I urge Ministers to look very carefully at how services are contracted out to the private sector, which is motivated by profit, as opposed to voluntary sector organisations, which often have a very good record in looking after people who need help and support.
We must also recognise that if we are to deal with mental illness problems in any community, there must be a level of understanding that goes wider than just what GPs, hospital doctors and the statutory services do. There is the question of signposting. I pay tribute to local organisations—voluntary groups, churches, mosques —that understand the situation and help signpost people into getting help and support, because many people in our society with some degree of mental illness get no support whatever. This debate may well help us to understand that that is needed.
We must also recognise that there is a cost involved. The cost to health budgets of dealing with mental health is very high. Unfortunately, the policy of community care for the mentally ill has often resulted in lack of care, and in deep isolation and serious problems for the individuals concerned.
I recall a debate in the House in 1986. The Select Committee on Health was looking in an interesting and critical way at the closing down of large asylums and long-stay institutions, such as Friern Barnet and Napsbury, that existed all around London, and, indeed, all around the country. The Committee warned that community care should not be seen as a cheap option, saying it should instead be seen as an opportunity, but as one requiring comprehensive support, support workers and care.
I am sure all MPs have talked at their surgeries with neighbours of those with mental health problems who have come to complain about noise and inappropriate behaviour. Many of them say to me they are sympathetic to the plight of the individual, and recognise there is a lack of support. We should not see community care as the cheap option. It is an option that can be followed, but a great deal of support is also required to carry it through.
Mr Kevan Jones
Does my hon. Friend also agree that under the new NHS structure, local councils will have to do a lot more in terms of understanding the needs of people with mental health conditions?
Absolutely, which is why I referred in my opening remarks to the strategy adopted by my local authority. It has taken the issue very seriously, and has developed a strategy that involves signposting, understanding, support for care in the community and a close relationship with the mental health trust locally. I suspect many local authorities are not particularly well geared up for that role, and they need to address that quickly.
We must recognise that children and young people suffer a great deal of diagnosable mental health conditions. The Mental Health Foundation estimates that one in 10 children suffer from them. One in six young adults aged between 16 and 24 are also suffering from them at any one time. It is very hard for young adults and teenagers to admit they have mental health problems. It is very difficult for them to go to a GP and say they have a mental health problem. Peer group rivalry and peer group abuse—abuse in schools and colleges—is nasty, dangerous, damaging and very hurtful, and can ultimately lead to suicide. The old saying “Sticks and stones can break my bones, but names cannot hurt me” is wrong. Names do hurt. Name calling does hurt. It can lead to young people becoming isolated, and in extreme situations it can lead to suicide.
The all-party group on social mobility has looked at that issue, and we found that one of the major things holding children back from realising their full potential was not necessarily access to the right type of education—further education or higher education—or to funding for such education. Instead, it is their having the social and emotional resilience to be able to bounce back from such problems and take their careers forward.
The hon. Gentleman is absolutely right in what he says. Bouncing back from these things and then getting on in education or any career is very important. I hope that debates such as this one and the remarks made by hon. Members who have been through mental health problems and depression begin to help give a greater understanding in the much wider community.
I wish to make only a couple more points, because I know that other colleagues wish to contribute to this debate. I intervened earlier about the number of suicides that take place in prisons and the number of people in our prisons who are suffering mental illness. Although such people may be there on the basis of a crime, they need mental health support rather than incarceration in a prison. Today’s edition of The Guardian contains a helpful reproduction of a map of suicides in British prisons. Although the number of suicides has reduced, 833 prisoners committed suicide in the decade up to 2011. When a prisoner commits suicide it is traumatic for the prison and for the prison officers concerned, and devastating for the rest of the prison population. We need to look much more seriously at how our prisons operate, the training that is given to prison officers and the mental health issues that need to be assessed much more carefully by the courts and by the prison services. We also need to examine whether it is really necessary or appropriate to put someone who has a mental health condition into a prison, at any level of security, knowing that there is a real danger of their committing suicide. They are not going to become less better because of this approach; they are probably going to get considerably worse.
My hon. Friend the Member for North Durham (Mr Jones) made an important point about people’s availability for work interviews undertaken by Atos on behalf of the Department for Work and Pensions. I am sure that every hon. Member has had people come to their constituency surgery who have been through the misery of an Atos interview when they are suffering from a mental health condition. Whether on a good day or a bad day, nearly all of them get assessed as being capable of work. They therefore start losing benefits and then go through an appeal. Usually, these people eventually win the appeal, but the trauma caused during that process has led to suicides, to deep depression and to deep fear among them.
When I intervened on my hon. Friend, I suggested that instead of automatically calling those with mental health conditions in for an interview, just as every other person with a disability is called in, medical records should be looked at first and a much more sympathetic and appropriate way forward should be taken. Where someone is able to work and an employer is able to take them on, as there is a job, that is clearly good—we want and welcome that—but we should not force them into it. We should not force people to try to hide mental health conditions. Instead, we should be supportive and sympathetic towards them. I hope that the message we can send from the debate is that that is the direction in which we want to go.
This is a valuable and timely debate on an issue that can affect any of us at any time. We all know people who are affected by mental health conditions and as a society we should stop the name calling, stop the abuse and start understanding this as a condition that we can all suffer from and that we can also, generally speaking, always get over.
Dr Sarah Wollaston (Totnes) (Con)
It is a pleasure to follow the hon. Member for Islington North (Jeremy Corbyn), who made some powerful points. Perhaps I might add to what he said about the appalling difference in respect of the use of compulsory detention under the Mental Health Act 1983 for those from black and ethnic minorities. We heard in evidence that the fear of this among some communities is acting as a deterrent to seeking early help. We must address that, making sure that people do have that access and that that fear is removed from communities in order to improve health for everybody.
I wish to begin by stating for the record that I am married to a consultant NHS psychiatrist who is also chair of the Westminster liaison committee for the Royal College of Psychiatrists, which provides impartial advice to all political parties on psychiatry. He is also now a clinical director of NHS England’s mental health and dementia network in the south-west.
The corresponding debate last year focused importantly on the issue of stigma in mental health, and I congratulate the ongoing work of Time to Change in reducing stigma. The other issue that was raised, which many Members have focused on today, was parity of esteem. It is wonderful that that important principle is established within the Health and Social Care Act 2012, but we now need to ensure that that translates into action and practice on the ground. As we have heard, 23% of the overall disease burden lies in mental health, but we all recognise from stories that we hear in our constituency surgeries, and from clear evidence, that that does not translate into either funding or our constituents’ experiences of services. How are we going to see that translated into action? We need to look at the evidence of what works and to focus on the outcomes.
We know that 30% to 65% of hospital in-patients have a mental health condition and that mental health and physical health are inextricably linked. Not only is someone more likely to suffer from a mental illness if they have a chronic long-term condition, but someone who has a mental illness will find that there is an impact on their physical health. We have heard again about the scandal that the life expectancy of people with a serious mental illness will be shortened by between 20 and 25 years.
My hon. Friend is picking up on the point made by the hon. Member for Islington North (Jeremy Corbyn) about there being a real link between public health issues such as smoking and alcohol, and mental health issues. Does my hon. Friend agree that we can do great work in this area at a local level, especially under the new arrangements whereby public health is devolved back down to local authorities, where it used to be and always should have been?
I am grateful to the Minister for that intervention. There has been a consistent tendency to ignore physical health problems in those who have severe mental health illness. She is right to say that putting in primary prevention work locally is important, but the Government could perhaps do more on primary prevention, through having a relentless focus. I am grateful to her for the personal support she has given to addressing issues such as alcohol pricing and the availability of ultra-cheap alcohol. Such issues are very important, and the Government need to deal with them to support the work that is being done. Minimum pricing is, of course, not a magic bullet, but unless we address the issue of ultra-cheap alcohol all the other measures that public health directors wish to take within local communities risk being undermined.
Does my hon. Friend agree that we can do great work on the minimum pricing of alcohol at local level? I urge her to examine the work being done in Newcastle and, in particular, in Ipswich, where all the agencies are coming together. We have seen supermarkets and many off licences agreeing not to sell cheap beer and lager. Does she agree that such an approach has the potential to be a better way—I think it is one—of dealing with this issue than minimum unit pricing?