Health: Anorexia

Earl Howe Excerpts

Monday 25th February 2013 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, thank my noble friend Lord Giddens for initiating this debate. As we have heard, the causes of eating disorders are both complex and multifaceted. At times of stress many of us resort to what is euphemistically called comfort eating, and the consequential results impact on self-esteem that can cause a very negative spiral.

Whatever the physical or psychological factors are it does not help that in our modern society we are constantly urged on the one hand to look sleek yet on the other to consume fattening foods. More often than not the food industry through its advertising campaigns manages both in one ad. Why is it that only on television does the person stuffing a bar of chocolate down their mouths appear to be so thin?

The excellent work of the All-Party Parliamentary Group on Body Image has shown that the constant portrayal of the man with the perfect six-pack or a young woman in a bikini does have an impact. It has highlighted the growing evidence that body image dissatisfaction is high, and on the increase. It is associated with a number of damaging consequences for health and well-being. We should contrast this with the way we are encouraged to eat foods packed with calories and made up of saturated fat and simple carbohydrates, the two food types most likely to make us put on weight. I remain concerned that so many so-called low-fat products are packed with sugar and calories.

Eating disorders can stem from a combination of issues, including distorted body image and low self-esteem. As I know from personal experience, someone with an eating disorder is very good at hiding the fact, often using a great deal of deception to fool the person or people to whom they are closest. This partly explains why there is a lack of data on the number of people who suffer from eating disorders. However, as we heard tonight, the numbers are great and the costs to the individual, their family and society can be devastating. Although eating disorders are considered to be a young girl’s disease, they can affect anyone at any stage in life, and up to 20% of sufferers are male.

It is clear that early intervention is vital. However, that relies on greater openness and understanding of the issues on the part of all of us. The excellent campaign launched by the eating disorder charity Beat just two weeks ago used as its theme, “Everybody Knows Somebody”, to flag up the fact that these illnesses are far more common than most people think. The Minister for Women and Equalities, Jo Swinson, in supporting the campaign, highlighted the fact that we are bombarded with all kinds of images, and that we need to equip young girls and boys to be more resilient to these pressures.

The Government’s Body Confidence campaign has worked for the past 18 months to identify non-legislative solutions to tackle the causes of low levels of body confidence. It is a great initiative that includes representatives from the health and fitness, fashion and retail, youth and education, media and advertising, and beauty sectors. That is to be welcomed, but we still have a fashion industry that portrays extremely thin women and girls, and we have also heard that we face a proliferation of websites promoting images of anorexic girls. What assessment has been made of the impact of the Body Confidence campaign? What action will the noble Earl’s Government take against these appalling websites? What action are they taking about the growing number of eating disorders among men?

The NICE guidelines on the treatment of eating disorders, published in 2004, are due for review in 2014. Many excellent services exist—we have heard about them tonight—but what impact will the new commissioning arrangements have on the fragmentation of these services? In my own area there is now a six-month waiting period for the first appointment for someone referred by a GP. Will the Minister ensure that best practice is maintained and that the gap between youth and adult services is addressed? Is it not time for a more coherent government strategy that encourages us all to understand better that what, when and how we eat really matters?

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, perhaps I may begin by thanking the noble Lord, Lord Giddens, for securing this short debate on eating disorders, not least because it affords us a twofold opportunity: first, to let sufferers and their families know that their voices and experience are influencing what we do at the highest levels of government; and, secondly but no less importantly, to give prominence to a range of disorders that so often are hidden.

The noble Baroness, Lady Crawley, described eating disorders as desperately sad. I agree with her. The statistics are grim. Anorexia nervosa has the highest mortality rate of all psychiatric conditions. It disrupts education and quality of life, and in 20% of cases continues to create difficulties in independent living for up to 10 to 20 years after the onset of illness, as a number of speakers said.

Although relatively little research has been done into long-term outcomes for bulimia nervosa, binge-eating disorders and other less well known conditions, anecdotal evidence suggests that these disorders can, for a significant cohort of patients, have equally life-limiting, long-term consequences. These disorders can affect anyone at any time, regardless of gender, but most cruelly the peak age at onset for the majority of sufferers is the mid-teens.

The noble Lord, Lord Giddens, asked what the Government’s policy is in this area. The answer to that has several strands to it. Early intervention is vital, and that is why it is a key national priority for the Government. Our cross-government mental health outcome strategy, No Health Without Mental Health, takes a life course approach, recognising that the foundations for lifelong well-being are already being laid down before birth and that there is much we can do to protect and promote well-being and resilience through the early years, into adulthood and on to a healthy old age.

The strategy’s implementation framework, published last July, sets out that public services intervening early is one of the 10 key changes that will be needed to turn the mental health strategy into reality and the specific actions which local organisations can take to achieve this, including: children and their parents receiving evidence-based health promotion from birth; public services, including GPs, recognising people at risk of mental health problems and taking appropriate timely action; and schools taking a whole school approach to supporting all pupils health and well-being, including both universal approaches and targeted services for those at risk of developing mental health problems.

We are investing £54 million over the four-year period 2011-15 in the Children and Young People’s Improving Access to Psychological Therapies programme to drive service transformation, giving children and young people improved access to the best mental health care by embedding evidence-based practice and making sure that whole services use session-by-session outcome monitoring. In February 2012 the Government announced a further £22 million over three years to the CYP IAPT programme. Some of this money will be used to extend the training offered by CYP IAPT to two further therapies—systemic family therapy and interpersonal psycho therapy. These therapies are invaluable in addressing some of the major mental health problems of adolescence, including eating disorders, as well as providing much needed support for the families of those affected.

The noble Lord, Lord Giddens, mentioned the tragic case of Laura Willmott. I, too, saw that coverage. I know that transition can be a huge issue, often pitching sufferers and their families into crisis at a critical time. Sudden changes in treatment and services can be bewildering and dangerous for patients and their families, and parents can find themselves excluded from decisions about care. I was very struck by the powerful remarks of the noble Countess, Lady Mar, on this theme. Charities such as Beat and Anorexia & Bulimia Care, which do so much to raise awareness as well as provide support and advocacy in action, are working with experts in the field on the feasibility of improvements to the care system, with a specific focus on introducing the option for students to receive care wherever they are.

It is this kind of grass-roots action that will make the difference the Government envisage when we have freed up health and social care services from micromanagement, empowering localities to make vital decisions that are tailored to meet the needs of their communities.

My noble friend Lord Carlile referred to the variation in services. I recognise his concern. New arrangements for the commissioning of services for eating disorders should also result in better planning and co-ordination of specialised services, greater equity of access, care and outcomes for patients, and a more proactive and systemic approach to service development, research and innovation. The child and adult specialised eating disorder services will be commissioned by the NHS Commissioning Board from April this year.

Within the board there will be a central team that will have a clear focus on specialised services organised around programmes of care. The team will develop a national service specification for each service while at the same time ensuring that it is sensitive to local needs. Work on eating disorders services has been underpinned by expert clinical reference groups on eating disorders and child and adolescent mental health services. The groups have explicitly recognised that targeted work is needed on the issue of transition.

However good our intentions, beneficial change does not always keep pace with the urgent desire of patients and families to feel the impact of those changes, but there are areas where direct action can yield swift dividends. The Time to Change programme, England’s most ambitious programme to end mental health stigma and discrimination, now has the potential, with funding from the Department of Health and the Comic Relief fund, to reach 29 million members of the public with its vital messages on mental health. As is so often the case, it is the courage of individuals as evidenced recently in a debate in Westminster Hall in which Mr Brooks Newmark spoke. Events like that do much to challenge stigma and secrecy, and I think the honourable Member is to be commended for shining the light on an underreported aspect of eating disorders. The fact is that they are not simply the preserve of teenage girls. Male sufferers are growing in number, and I shall have something more to say about that in a moment.

The noble Baroness, Lady Gale, asked what we are doing to work with the fashion industry, a question echoed by the noble Lord, Lord Collins, and the noble Baroness, Lady Crawley. I commend the assiduous work of the All-Party Parliamentary Group on Body Image under the expert chairmanship of Caroline Nokes. The Government’s own Body Confidence campaign has made great strides over the past two years in encouraging a more open and public conversation about body image. Working with a range of representatives from health and fitness, fashion and retail, youth and education, media and advertising, and the beauty sectors, we have been active in a number of areas: research, parent education, resources for teachers, industry awards and promoting public debate.

The noble Lord, Lord Giddens, my noble friend Lord Carlile and the noble Baroness, Lady Gale, spoke powerfully on the theme of websites. I am aware of the growing evidence of pro-eating disorder websites. They attract impressionable young people and intensify weight/shape anxiety as well as, disturbingly, introducing users to new methods of losing weight, as the noble Baroness, Lady Gale, told us so graphically. What can the Government do about this? Legislation is not the answer. Many of these websites are set up by young people with an eating disorder and we would not want to criminalise an already vulnerable group, while other websites are hosted overseas. However, we are committed to joint working with charities and the internet industry to speed up the reporting of damaging web-based content and the blocking of harmful websites. In January, my honourable friend Norman Lamb hosted a round table with key stakeholders on this very issue where, encouragingly, the development of a concordat was discussed. The Government will support this joint endeavour in whatever way we can.

The noble Lord, Lord Giddens, asked whether we recognise the link between these disorders and obesity, while the noble Lord, Lord Brooke, also spoke on that theme. The answer is that we do recognise it and we are doing a whole host of things to combat obesity, some of which I have referred to in your Lordships’ House before. Weight management funding will in future be addressed through the new public health system, but most data on eating disorders come from charities such as Beat, particularly in its report on the costs of eating disorders in England, as well as surveys and reports from the royal colleges and other professional bodies. The Health and Social Care Information Centre published its annual mental health bulletin last Tuesday. It provides information on eating disorders for the first time, and I commend it to noble Lords as a reference point.

The mandate to the commissioning board makes it clear that the NHS should measure and publish outcome data for all major services by 2015, broken down by local clinical commissioning groups. To support that, the Government will strengthen quality accounts, which all providers are legally required to publish.

I have a great deal more material, but signals are being sent to me that my time is running out. I would like to address all these issues in letters to noble Lords, particularly those concerning men with eating disorders; my noble friend Lord Alderdice’s question on research that we are helping to fund; and the role of schools, which my noble friend Lord Carlile and the noble Baroness, Lady Gale, asked me about.

In my own researches in this area, I have been much struck how many of those affected talk about how worthless and disempowered they feel. I think it is appropriate for me to use this opportunity to send a clear message to them: you are valued, you are not invisible, and with the right, targeted support, recovery is not only possible but probable.