Mental Health Bill [HL]

Baroness Parminter Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Parminter (LD)]

My Lords, it is a pleasure to follow the noble Lord, Lord Adebowale. I will not have quite as many questions for the Minister as he had, but I very much agree with what he says about community treatment orders, which I will return to at the end of my remarks. Like many other Peers, I welcome the Bill, which I hope will improve the treatment of people who are detained when they need to be, for their safety and other people’s, because they are in mental crisis. As others have said, it is a long time coming, and I very much congratulate the Government on bringing it forward so early in their term.

I am not an expert in the field, unlike just about everybody else in this debate, and nor do I have scars on my back from considerations of the legislation in the past. I come to it as someone with lived experience of the impacts of the deadliest of all the mental health conditions, eating disorders, and, in the context of the Bill, as the mother of a daughter who was sectioned aged 17. I know that sectioning is hard. It is hard for the individual: they are separated from their loved ones and the people who care, they cannot do what they want, and they are not where they want to be. It is hard for families and loved ones who are trying to navigate the system. But I know that sectioning works. It saves lives. It saved my daughter’s life when she was in the grips of an extremely vicious eating disorder. She was so malnourished that she could not even allow anyone to feed her by a nasogastric tube, and the state had to step in and save her life. She went to a hospital more than 100 miles away. She was initially restrained and then kept there for five months. We visited her and they kept her safe. At the end of those five months, we were able to bring her home. She was treated in the community by the NHS team, and we are grateful for that care.

I know that detention works, but as the noble Baroness, Lady Watkins, rightly said, we would need less of that detention if there were more provision of community services all around the country so that people could be treated quickly and appropriately. We know that will require more funding, and that was a point that the noble Lord, Lord Adebowale, raised very well. It will require a bigger workforce, and it will require those community services to support people when they need it.

It will also need more specialist beds, and these are particularly needed in the field of eating disorders. At the moment, there are only 251 NHS beds in our country and 198 in the independent sector of specialist adult eating disorder services. The Bill covers England and Wales, but there are no beds at all in Wales. Yet we know that they are absolutely needed. Beat, the leading charity for eating disorders, estimates that about 1.25 million people in this country have an eating disorder. Mental health eating disorder services are absolutely up to the gunnels and beyond, and since 2010 the number of hospital admissions for eating disorders has quadrupled from 7,000 to 28,000—so there is a real pressure point.

When my daughter Rose needed an eating disorder bed, one was not available. She was kept for a month on an adult general ward in the local hospital, where her condition deteriorated to the extent that she had to be sectioned. We need more of these beds. It is no good if we just spend all our time in this Chamber focusing on the particulars of this very small but important part of the Mental Health Bill, on detentions, if the Government do not also grasp the nettle about the need for more beds for people when they really need them.

The other worrying aspect about not having beds is that it stops the mental health law being applied in the first place. The 1983 Act insists that local areas make arrangements for beds in urgent circumstances. I was talking to Dr Ashish Kumar, the chair of the eating disorder faculty at the Royal College of Psychiatrists, who told me that

“even after two medical recommendations, clinicians are not allowed to apply the section because the tier 4 (inpatient unit) services do not offer them a bed. Hence this is a silent crisis—where these seriously unwell patients are not admitted to psychiatry wards or given the opportunity to have a legal provision of the MHAct applied … The whole legal provision is disregarded in a very high number of cases”.

Therefore, I ask the Minister to reassure us—in summing up today and, I am sure, in Committee—that the Government will put equal focus on ensuring that there is community provision for people with eating disorders to minimise the need for people to go into beds, and that there will always be sufficient beds for people with severe eating disorders who really need it.

I agree very much with the comments of the noble Lord, Lord Adebowale, about community treatment orders. It pains me to disagree with the noble Baroness, Lady Browning, for whom I have the highest regard, and with Mind. When we faced Rose being sectioned, the place we turned to for advice to understand the Mental Health Act, as parents literally pushed into it, was Mind and its fantastic website, and I pay tribute to it for that. But I believe that for eating disorders, community treatment orders can be very beneficial.

If you are sectioned for an eating disorder, it is because your condition is such that you are at risk. When you come to be released, you are at high risk, even if you have community support, of losing weight quickly and facing an urgent readmission. That is because the complexity and the tyranny of the eating disorder mean that the person cannot, of their own volition, maintain their weight. A community treatment order puts a boundary around the eating disorder in a way that a voluntary agreement could not, in that it makes it clear what will be the result and what will result in an in-patient setting.

Eating disorders are a really complex battle of control. The person with an eating disorder feels that they are completely out of control, but they are desperate for control. A community treatment order gives them control by not keeping them in a hospital, but it also gives them some sense of control through the terms of the order: they know what is going to happen. Let us not forget that it also gives some control to the community treatment team, who do not have to wait for a medical emergency in order to readmit if that is needed.

I contend that if it is done in the right way—in an open and consultative manner, with the intention of supporting that person to live in the community and access their community care—a community treatment order can be uniquely beneficial for people with eating disorders. It has the benefit of keeping that person out of hospital, and the restriction is on the eating disorder and not on the person. In Committee, I hope to carry on making the case for people with eating disorders and their carers, alongside the many other experts in this field, so that we can ensure that this welcome Bill is as good as it needs to be.

NHS Mental Health Patients in Private Hospitals

Baroness Parminter Excerpts

Thursday 28th April 2022 Lords Chamber

[Lord Kamall (Con)]

Can I begin by—if my information is correct—wishing the noble Lord a happy birthday? If it is not his birthday, I have made a fool of myself. I am sure all the House joins me.

Wherever there is a tragedy, we have to learn the lessons. We spoke about this during the Bill, for example with HSSIB and making sure we have a safe space to understand what went wrong and ensure it does not happen again. We have to make sure that, as we move towards different models of care for people suffering from mental health conditions, it is appropriate to their condition. Not all mental health conditions are the same. Some will need in-patient provision and others will need care in the community, but we should make sure they are actually supported in the community.

[Baroness Parminter (LD)]

My Lords, I declare an interest in that I have a daughter currently in a private eating disorder facility out-of-area, which the NHS is paying for—for which I am extremely grateful. Given the increasing numbers of people suffering from eating disorders, both children and young people and adults, what hope can the Minister give families like mine that in future their young people and family members will not be sent far away, when we want to see them? They might be in hospital for four, six or nine months at a time. What hope can the Minister give people that—yes, there are brilliant community services for eating disorders and we need more of them—we will open up more beds in local areas to help families and sufferers of these appalling diseases?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her very personal story. It is important that we understand it is more than stats and figures, which are provided to me by the department. In the community, we understand it is important to make sure that provision is as close to the patient and family as possible. We have to remember that care is not just for the patient; it impacts friends, family and others. We are looking at ways to ensure that care is delivered close to families and those suffering from these conditions.

Eating Disorders

Baroness Parminter Excerpts

Tuesday 1st March 2022 Lords Chamber

Asked by

[Baroness Parminter]

To ask Her Majesty’s Government, further to the report of the Parliamentary and Health Service Ombudsman Ignoring the alarms: How NHS eating disorder services are failing patients, published on 6 December 2017, what steps they are taking to ensure that eating disorders are taught appropriately in medical schools.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, following the Parliamentary and Health Service Ombudsman’s report regarding the tragic death of Averil Hart, the Department of Health and Social Care has been engaging with partners through a delivery group led by NHS England and NHS Improvement to continue to address the recommendations. This includes work with Health Education England to improve training for GPs and with the General Medical Council to ensure that eating disorders are included among outcome measures for newly qualified clinicians.

[Baroness Parminter (LD)]

I thank the Minister for his reply. GPs receive on average less than two hours’ training for eating disorders. Inadequate training was identified by the PHSO report in 2017, as he says, and by numerous coroners’ reports since then, including the latest Prevention of Future Deaths report in Manchester in December following the tragic death of Nichola Lomax. What specifically is the Minister doing to hold the GMC, the Academy of Medical Royal Colleges, Health Education England, NHS England and NHS Improvement to account for their responsibility to ensure that trainee doctors graduate with the skills and the knowledge to be able to identify, safely manage and refer patients with eating disorders?

[Lord Kamall (Con)]

The noble Baroness raises a very important point about how we identify the issues and tackle them. It is two-pronged: one way is about the amount of investment into mental health services, including tackling disorders, and the other is training. NHS England and NHS Improvement have been working with Health Education England and other partners to look at training courses that will increase the capacity of the existing workforce to provide evidence-based treatment to more people. We are also working with the GMC and the Academy of Medical Royal Colleges as well as Beat representatives. In addition, Health Education England is looking to increase the exposure of doctors to eating disorders. The GMC’s Outcomes for Graduates states that

“Newly qualified doctors must explain and illustrate”


their understanding of

“the principles for the identification, safe management and referral of patients with mental health conditions”,

including eating disorders.

Eating Disorders

Baroness Parminter Excerpts

Monday 17th January 2022 Lords Chamber

[Lord Kamall (Con)]

First, I pay tribute to the noble Baroness for all the work she has done in this area, making sure that we are all aware of this issue and keeping it on the agenda. In answer to her specific question, the department has invested nearly £110 million in mental health research, including research on eating disorders through the NIHR, as she mentioned. This includes the Eating Disorders Genetics Initiative and a systemic review led by the Evidence for Policy and Practice Information and Co-ordinating Centre. UKRI has announced funding for a £3.8 million study on eating disorders to inform prevention and early prevention in young people. This research is being led by King’s College London and the University of Edinburgh.

[Baroness Parminter (LD)]

My Lords, the latest NHS data shows a continuing increase in the number of people being hospitalised for eating disorders, mainly in the 18 to 39 age group, yet there is still no adult waiting time standard for people with eating disorders. This is despite knowing that access to quality community care can reduce the number of hospitalisations and unnecessary deaths. When are this Government going to introduce an adult waiting time standard for people accessing treatment for serious eating disorders?

[Lord Kamall (Con)]

As noble Lords can imagine, because of the pandemic, sadly, waiting times have gone up, but we are making sure that we are doing as much as we can to address that. Longer term, we are focusing on prevention, not only cure. We are also making sure that we are able to understand the various forms of eating disorder better. It is very simple to lump them all together, but there are different elements and you can distinguish between them. Then we will, I hope, be able to tackle that as much as possible.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Baroness Parminter Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Parminter (LD) [V]]

My Lords, it is a pleasure to follow the noble Lord, Lord Brooke of Alverthorpe, who has done so much in his own way to bring together those of us who speak with the eating disorder community and those who represent those with obesity. I wish the Government would take on his approach of encouraging yet more joint dialogue.

I support the Government’s ambition to make the nation healthier, but these regulations are to be regretted and I therefore wholeheartedly support the amendment in the name of the noble Baroness, Lady Bull. At best, there is weak evidence for their efficacy and there is insufficient attention paid to the impacts on extremely vulnerable people, and the growing number of people suffering from eating disorders.

First, the weak evidence. The Explanatory Memorandum makes it clear that the approach is based on the 2018 Cochrane review, which concluded:

“Findings from a small body of low-quality evidence suggest that … energy information on menus may reduce energy purchased in restaurants.”


It went on to recommend the need for:

“Additional high-quality research in real-world settings”.


So I ask the Minister: did the Government consider trialling this approach first?

Secondly, these regulations will create another place of fear for a vulnerable community of eating disorder sufferers, having the potential to impact on their often-fragile recoveries and shattering the chance of moments of connection with families and friends.

I want to explain what I mean by a “place of fear”. When our daughter, Rose, was in the depths of her eating disorder and was hospitalised, part of her specialist treatment over many months involved taking the eating-disorder patients into cafés and other eating venues to learn how to manage these frightening situations. For those suffering from an eating disorder, the stress of a restaurant is huge: fear of other people watching you eat, fear of people eating less than you and fear of not having safe foods on the menu. It means obsessing about it the day before and restricting food intake beforehand. Going is a known risk, but one that is taken to try to have a moment of joy and celebration, given that food is a way to strengthen all those positive social bonds of connection with family and friends.

Those in recovery—and to be clear, recovery is not a linear process for sufferers; many get dragged back down time and again—will be at greater risk once this measure is introduced. Seeing calories on a menu will be one more way, once they are seated at the table, of stacking the cards against them as they battle the demons in their head telling them exactly what they are allowed to eat. In short, it turns what might have been a manageable situation—a moment of all too brief happiness for a family eating out—into one that descends into a paralysing stand-off.

There is no logic in eating disorders, only triggers to letting the illness claim control of your loved one. Victoria, another eating disorder sufferer, described it to me like this:

“During my recovery, I found calorie labelling highly triggering as it held me back from rebuilding my relationship with food and my understanding of how to feed myself in a healthy way without being controlled by numbers ... Eating disorder recovery is very fragile and I am daunted by the prospect that calorie counts will be harder now to avoid”.


This is the reality of these regulations for eating disorder sufferers.

The Explanatory Memorandum refers to the concession that menus without calories will be permitted—but, when I asked about the guidance that businesses were being offered, the department confirmed that there will be no obligation to produce such menus. So there is no guarantee of one being available and no sanction if the restaurant just turns around and says no. Why does the guidance for businesses not at least strongly recommend that such menus are available on request?

So the noble Baroness, Lady Bull, is right. We must review the impacts of this legislation within 12 months of its introduction, including assessing fully the impacts on eating disorder sufferers. We all want to encourage more healthy eating, but interventions should be evidenced-based and consider the implications for other vulnerable communities.

Eating Disorder Services: Referrals

Baroness Parminter Excerpts

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, my noble friend puts it extremely well. Young people have been under huge pressure during the pandemic. It is a huge tribute to the young people of Britain that they have borne it so well. I do not have to hand the statistics on waiting lists that she asked for, but I would be glad to write to her with the details. We are recruiting right across the NHS at the moment; it has been an extremely successful recruitment round, and those kinds of recruits will go to services such as those dealing with eating disorders.

[Baroness Parminter (LD) [V]]

My Lords, to return to calorie labelling on menus in restaurants, as raised by the noble Baroness, Lady Bull, there is limited evidence for its efficacy in reducing levels of obesity, but there is clear evidence from the Royal College of Psychiatrists eating disorders faculty—and anecdotal evidence from my daughter and others—that it can be responsible for triggering those with eating disorders. Can the Minister respond to what the noble Baroness, Lady Bull, asked for and confirm that, should the Government introduce this labelling on menus, they will review its impacts not just on reducing levels of obesity but on those suffering from eating disorders?

[Lord Bethell (Con)]

My Lords, the eating habits of the nation have changed considerably in recent years. The amount of food that people eat that has been prepared by others has risen dramatically, and many people have no idea what is in the food they are eating. That is why we have moved to bring in calorie labelling on food that is delivered and in restaurants. I am acutely aware of the concerns of the noble Baronesses, Lady Parminter and Lady Bull. We are committed to engaging with eating disorder charities, Beat and other key stakeholders, and to listening very carefully to their concerns on this.

Body Mass Index

Baroness Parminter Excerpts

Thursday 22nd April 2021 Grand Committee

[Baroness Parminter (LD) [V]]

My Lords, I thank the noble Lord, Lord Addington, for his passionate introduction to this debate.

I applaud the Women and Equalities Committee’s work highlighting the impacts of the use of BMI on eating disorders and people’s mental health by disrupting their body image. Eating disorders are not niche. The 2019 NHS health survey found that

“16% of adults … screened positive for a possible eating disorder”.

Covid has increased the pressure on eating disorder services hugely, with referrals across the country increasing by 75% on average.

There is still an overreliance on BMI by GPs when diagnosing eating disorders to determine who is unwell enough to access treatment. Hope Virgo’s “Dump the Scales” campaign has literally hundreds of people, mainly young women, sharing how damaging it was to be told that they were not thin enough for treatment. It drives them deeper into this pernicious illness, which I know about from our family’s experience. Indeed, the evidence shows that early intervention is far better and offers the best hope of recovery.

The Government and the NICE guidelines are clear: BMI should not be used on its own as an arbiter of whether to offer treatment, yet GPs are still doing this. Why? First, there is inadequate training for GPs and other health professionals about eating disorders. The issue was identified by the Parliamentary and Health Service Ombudsman in his report on eating disorder services in 2017, in the follow-up report by the Public Administration and Constitutional Affairs Committee in 2019, and in the Cambridgeshire and Peterborough coroner’s prevention of future deaths report last month, to which the Secretary of State has to respond formally by next Wednesday. Will the Government now lead a strategy to improve eating disorder education in the medical profession, including embedding it in the curriculum? For GPs already in surgeries, a screening tool should be produced to ensure that, instead of relying on BMI, they ask the right questions of patients, with clear guidance on the language to use.

Secondly, GPs are using BMI to ration access to services as demand hugely outstrips supply. I welcome the Government’s recent investments in mental health funding, but it is mainly for children and young people, and only one in six eating disorder patients is under 18. Given the rise in demand, significantly exacerbated by Covid, without ring-fenced funding BMI will continue to be used to limit access to eating-disorder services, resulting in further unnecessary deaths.

Health: Eating Disorders

Baroness Parminter Excerpts

Tuesday 19th January 2021 Lords Chamber

Asked by

[Baroness Parminter]

To ask Her Majesty’s Government, further to The Health Survey for England 2019, published on 15 December 2020, and the finding that 19 per cent of women aged 16 and over screened positive for a possible eating disorder, what steps they are taking to support those with eating disorders.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, eating disorders are serious, life-threatening conditions, and we are committed to ensuring that people have access to the right support when they need it. We are growing our investment in community healthcare for adults year on year—almost £1 billion extra by 2023—with specific funding to transform adult eating disorder care and, for young people aged 16 to 25, to accelerate provision beyond existing growth and to transform plans.

[Baroness Parminter (LD) [V]]

The NHS health survey suggests that the prevalence of eating disorders is significantly higher than previously assumed, so will the Government commission a national, population-based study to accurately identify the number of people with eating disorders, as the Public Administration and Constitutional Affairs Committee recommended, to inform research and service-level provision?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right: the statistics on eating disorders are shocking. The Mental Health of Children and Young People in England Survey identified 0.4% of 5 to 19-year-olds and 1.6% of girls aged 17 to 19. The NHS Digital Adult Psychiatric Morbidity Survey showed 6.4% of adults displaying signs of an eating disorder. There is the survey by Beat, and I could go on. I do not think it is an issue of surveys; we have to address the underlying statistics with measures that make a difference.

Mental Health Services: Young People

Baroness Parminter Excerpts

Thursday 24th September 2020 Lords Chamber

[Lord Bethell (Con)]

We are deeply concerned about suicide; any suicide is too many. The noble Lord will be aware that the increased numbers recently are in part due to the recategorisation of suicide among the coroners’ courts. Nonetheless, we take this issue very seriously. The programme to help people identify those who show the markers of suicidal thinking has provided a very important impact on this issue. We are deeply concerned about Covid, and we continue to support suicide charities.

[Baroness Parminter (LD) [V]]

My Lords, calls to the eating disorder charity Beat’s helpline nearly doubled during lockdown, and at the same time fewer children and young people started treatment for eating disorders compared to the previous year. What are the Government doing to ensure sufficient funding for children and young people’s eating disorder services so that young people can access the help they need?

Anti-obesity Strategies

Baroness Parminter Excerpts

Monday 14th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely endorse my noble friend’s views. When it comes to mental health challenges and connections between obesity and mental health, the resources need to be put in place and the sensitivity she speaks of applied. I return to my earlier comments: 87% of the country is involved in this. Not all have mental health issues; some simply need to take responsibility for their weight.

[Baroness Parminter (LD) [V]]

The National Audit Office’s report last week on tackling obesity confirmed that there is limited evidence that calorie labelling in restaurants reduces total calories consumed. How will the success or otherwise of the Government’s proposed calorie labelling in restaurants be evaluated? Will it take into account the potential harm caused, given that the ability to track calories can be highly triggering for those with or vulnerable to developing an eating disorder?

[Lord Bethell (Con)]

My Lords, we are tracking the success of this obesity strategy, although it should be understood that this is generations in the making and may well take a while to work through. I come back to my previous comments: calorie labelling is a very important element of people’s education about the content of their food and often their drinks, including alcoholic drinks. We support that measure as an important part of our strategy.