Women’s Mental Health

Debate between Lord Beamish and Jackie Doyle-Price

Thursday 3rd October 2019 Commons Chamber

[Jackie Doyle-Price (Thurrock) (Con)]

It is, as usual, a pleasure to follow the right hon. Member for North Durham (Mr Jones), who is always a fixture in these mental health debates, as, indeed, is the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.

I thank the hon. Member for Lewisham West and Penge (Ellie Reeves) for her very honest contribution. It is about time we were honest about the fact that childbirth is hard and that what happens after we have given birth is hard. We could be forgiven for buying into the myth that it is all hearts and flowers, but the reality is very different indeed for many women and their families. It is absolutely fantastic that she made that very honest contribution today. Those of us in this place need to be frank about our own experiences to make the system better.

It is a glib thing to say that it is a man’s world, but, frankly, it is. On so many levels, the health service, in terms of both physical and mental health, does not work well for women. I was therefore pleased to have chaired the women’s mental health taskforce with Katharine Sacks-Jones from Agenda, and I thank her today for her contribution. It is important that we look at women’s mental health, as distinct from that of men. In the same way, we ought to look at mental health through the prism of other things that end up being discriminatory. For example, there is the whole gamut of neurodiverse conditions, autism and attention deficit hyperactivity disorder. There are more mental health issues in people who have those conditions, and, frankly, we are not doing enough for them. That also plays out in further discrimination against women, because they are often diagnosed much later with autism and ADHD, and they are then not equipped with the tools to manage their conditions.

It was absolutely fantastic to get buy-in from people with real experience on the women’s mental health taskforce. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) talked about perinatal, and that was of course a big part of it. It is interesting that we are debating this issue today, just a day after that amazing debate on the Domestic Abuse Bill, because abuse is often a common factor underlying the prevalence of mental ill health in women.

We set up the women’s mental health taskforce because we were seeing an increased prevalence of mental ill health among women between the ages of 16 and 24. There is no doubt in my mind that an underlying cause is abuse, particularly the rise of sexual abuse and violence.

The women’s mental health taskforce concluded that we needed more by way of community services to support women, and one important part of that was improving the support for victims of sexual violence. I completely agree with the right hon. Member for North Durham about the contribution that voluntary services can make in this space. When I was the Minister, one of the messages I always gave to commissioners was not to medicalise everything. Voluntary services, particularly in mental ill health, can give so much additional support to people. That wraparound support can be as important to someone’s recovery or ability to manage their condition as any medical intervention. In welcoming my hon. Friend the Minister to her post, I ask her to continue giving that message to commissioners, not least because, as well as delivering the services well, voluntary services often provide much better value for money. So let us continue to do that.

I was pleased that earlier this year the NHS published its strategy to deal with sexual violence and to provide sexual violence support services. Within it was a commitment to a lifelong package of care for survivors of sexual abuse. The voluntary sector—the hon. Member for Bath mentioned rape crisis centres—has a huge role to play in making sure we continue to support victims of sexual abuse.

Women are often a secondary consideration in the way we deal with many problems, and by definition that becomes discriminatory. We have had a lot of debates in recent months about gangs and the problem of young men carrying knives and stabbing each other and the fact that there are far too many deaths, but another aspect of that gang culture that is not talked about enough is the grooming of girls. It is almost like Rotherham never happened. We must make sure that when we look at gang culture, we do not just talk about young men stabbing each other or the drug trade that goes with it; we must also tackle the grooming of young women, otherwise the incidence of mental ill health among women aged 16 to 24 will only continue to rise.

One thing not yet mentioned in this debate is the review of the Mental Health Act 1983. We must make sure that when we look after women with severe mental ill health we are not doing harm. We need to deal with some of the practices that still exist in our treatment of people with mental ill health. We used to think of people with mental ill health as an inconvenience to be managed. Thankfully, we are becoming much more enlightened, but there is still poor practice that needs to be weeded out. I repeat that abuse is often the underlying trigger that exacerbates a woman’s mental ill health, and when we treat women, we should not compound that harm by handing over the control of someone who has been sectioned to their abusive partner. Under the Act, however, when someone is sanctioned, the next of kin is effectively given control over them, which only compounds the harm. I have heard some incredibly distressing testimony from people who have been through exactly that. As that work continues, we must empower patients, including women who are victims of domestic abuse.

We have heard reference to eating disorders. We have actually made considerable progress in improving eating disorder services, but we need to do much more for adults. The health service needs to empower women, not just tell them to run along. Many Members will be aware of the campaign by Hope Virgo, the Dump the Scales campaign, but the really telling thing about Hope’s testimony is this: she has been through anorexia, she understands her condition, and she can see when she needs help, but when she goes to her GP, she is weighed and told she does not have a problem. That shows a fundamental misunderstanding about how eating disorders play out and how they should be managed. Members have discussed the need to make sure GPs behave better. One reason GPs do not behave as well as they should when dealing with mental health is that they are not adequately trained. I encourage the Minister to have that conversation with the royal colleges to make sure mental health training is a mandatory part of doctors’ training. The earlier we identify someone who needs help, the more effective that support can be.

I want to finish by picking up on an issue raised by several colleagues, including my hon. Friend the Member for Southend West (Sir David Amess): that of people in prison. We all know that prison should be a place where people go when they have done bad things, but anyone who visits a prison wanders around thinking, “A lot of these people shouldn’t be here at all.” They are people who have fallen out of society and been failed by the state. That is particularly the case for women. The more we can do to get that early intervention the better. We should not be allowing people to fall out of the care of society and then dealing with them only when they become a nuisance. That applies to people who have been through the care system and been victims of abuse.

[Mr Kevan Jones]

Does the hon. Lady agree that one of the problems that pertains particularly to women prisoners is that of short sentences, which do not give enough time for rehabilitation and over time disengage people from services outside and, in a lot of cases, from families and other support networks?

[Jackie Doyle-Price]

The right hon. Gentleman puts it very well. In those instances, we are just doing harm. We should be able to identify when somebody needs help. Just taking them away and putting them in prison without any programme of support only puts them on a conveyor belt to more offending. We need to make sure we are picking people up. There are some fantastic tales of how people do that. I once met a lady who had been convicted of drink driving after she reported herself. She had gone through a period of grief. What good would it have done to make her serve a prison sentence? It would have compounded her grief; she would have been away from her family; and she would have lost her job and probably her home—if she was renting—which would only have put her on a conveyor belt to disaster. We must be much more enlightened and make sure that our prisons are for people who are going to harm society, not people who are harming themselves.

I could say so much more, Madam Deputy Speaker, but time is limited, so I will finish there.

Body Image and Mental Health

Debate between Lord Beamish and Jackie Doyle-Price

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

I shall not detain the House for too long, because I think it has heard enough from me for one day. I thank Members for their generous comments, even if they might be career-limiting.

In this debate, however, there is consensus across the House. We all fully recognise the problems that we face and the need for decisive action to tackle them. I will certainly continue to work with all Members to do exactly that, because this is too important and—I make this observation—the people out there expect us to work together more often than not. Such subjects should not be a political football, and it is too important to ensure that we are tackling harms.

The hon. Member for Dewsbury (Paula Sherriff) made the observation that the debate might not be as well attended as previous ones, but to be fair we have had many such debates in this space. Many Members, even if not present this afternoon, clearly have a keen interest. I am utterly at one with her when she expressed her concern about a context in which we have normalised unrealistic body image. Such images have become so normalised that it will take a lot of effort to address it. She also referred to the incident of the lady who, sadly, died as a result of accessing a Brazilian butt lift from a surgeon in Turkey. Unfortunately, she is not the only such person from this country. It is the most dangerous cosmetic procedure that can be undertaken and, as a consequence, is banned in this country. None the less, despite the ban, people are still bombarded with images and with adverts for where they can seek the procedure. That brings home the fact that we need to do much more to make people aware of the risks.

Many Members referred to the influence of advertising, and I am afraid that those organisations that profit from hosting advertising ought to have a duty of care and ensure that the material they carry does not expose people to harm. I therefore welcome the engagement that the right hon. Member for North Durham (Mr Jones) is undertaking with Facebook on exactly that. It is not good enough for social media providers to retreat to the defence of, “Well, we are a liberated platform, regulated by our users.” Where they become a vehicle for things that will cause harm, those social media providers have a duty of care to the people who use their platforms. We must all continue to challenge them on that issue.

We have had lots of references to “Love Island”. Collectively, perhaps we ought to challenge use of the term “reality TV”, because it is not reality TV; it is fantasy TV. [Hon. Members: “Hear, hear.”] So that might be the outcome of today’s debate—let us all talk about fantasy TV from now on, because such programmes promote lifestyles that are not normal or achievable. Let us do that.

[Mr Kevan Jones]

Will the Minister challenge the producers of a show such as “Love Island” to produce a series with real people in it, rather than one with the image that they are trying to portray now?

[Jackie Doyle-Price]

I could give that challenge, but the sad thing is that I do not think that any of us would watch that—although I do not think that many of us watch it now. Frankly, I like my dramas gritty and real. Ultimately, ITV broadcasts “Love Island” because it attracts many viewers—many of them among the most vulnerable group we are talking about. Again, ITV should be much more responsible, although the show is one of its biggest earners. I just regret the fact that we have become such a nation of voyeurs, and we all need to reflect on that point.

It is interesting that, because the people in these so-called reality TV shows are not known to us—they are not celebrities—we do not really see what we are doing to them in these circumstances. I do not know whether any hon. Members used to watch “Big Brother”, but there was an occasion when a contestant on “Celebrity Big Brother” effectively had a meltdown on TV. The public reaction then was very different; I think it seemed more real to people because it was a celebrity and the public were invested in them. That illustrates just how pernicious these so-called reality TV shows are, with their anonymous celebrities. These people suddenly become very exposed, and we have seen the outcome for some people’s mental health when they re-enter the real world. I know that ITV has reflected on some of those risks, but there is much more to do. As I said, let us start calling them fantasy shows.

The hon. Member for Dewsbury also mentioned the whole issue of body-shaming online. We have accepted as normal some really unpleasant behaviour online. I always use the example of drinking and driving. It did not matter that drinking and driving was made illegal; it was only when it became socially unacceptable that people really stopped doing it. We need to get to that stage when it comes to how people behave online. Again, this happens because people do not see others as real people online. When people make abusive comments online, it is because they feel that they are able to. That has got to stop and we need to lead the way.

The hon. Lady also asked what it takes to make the social media companies actually do something about this. In the context of suicide content, it took a death—and it should not take a death. With regards to other content, I suspect that it will also take deaths to get these companies to do something. That really is not good enough. I pay tribute to those who are brave enough to share their experiences of self-harm and suicide as a result of what they have seen online, because they are really helping us to drag the social media companies to where they need to be.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I never pronounce it right—articulated the fact that this area is an artificial world that becomes more and more intense. When we start using the internet and looking at things on social media, we do find ourselves dragged into a deeper and deeper world of “like” content, and it is easy to cease to be objective in those circumstances. We have certainly seen that with regard to self-harm and anorexia sites; it is just constant. The journeys that some people have been through are akin to grooming. People can find themselves being groomed by online content by sheer accident. Given that context and given how we use devices these days, it is not difficult to see why people are becoming much more exposed to such risks. Safe ways of using the internet—using iPads and so on to access content—has to be central to any education we give children about looking after themselves because that level of intensity clearly causes harm.

The hon. Members for East Kilbride, Strathaven and Lesmahagow and for Bath (Wera Hobhouse) talked about eating disorders, the clinical pathways available and out-of-area places, all of which are issues that really bother me. It has to be said that we have done well on children’s access to help with eating disorders—and I think it was right to do so because if we can tackle these issues early with children, we are tackling eating disorders—but it has highlighted the risks that exist when children cease to be children and become adults. The level of service is not as good when people enter adulthood, particularly through the whole period of transition, and that in itself can cause harm. We have heard about Hope Virgo’s #DumpTheScales campaign and the fact that different clinical standards are being applied for children and adults. That is clearly something that we really need to fix and it is a key priority for me.

I also fully recognise the danger of out-of-area placements for people with eating disorders. Part of people’s recovery has to be the relationships that they have with family and friends. I have seen that very clearly with children and young people. Generally, we need to reduce the number of out-of-area placements for people with acute mental health issues, including eating disorders, but I will not be satisfied until we have no out-of-area placements at all. Having people long term in beds in hospitals is not good for their mental health. Clearly, there are cases where there is a need for intensive treatment and we need to do that, but over time, out-of-area placements really should not be a thing.

The right hon. Member for North Durham, as usual, brought to the debate his very well-informed knowledge of this subject. I join him in paying tribute to Dawn Knight and all the campaigning she has done. She has not been shy about sharing the devastating impact of what she did, telling her story of how she just wanted to enhance her appearance and the result has been absolute hell. Neither is she shy about sharing exactly what the impact will be on the NHS as a consequence of the treatment she has had to have to put it right.

This whole area of cosmetic surgery is growing very quickly, and people are quite naive in thinking that perhaps the more money they spend on a procedure, the better it is going to be. Nothing could be further from the truth, because there are the least virtuous of people in this space. As the right hon. Gentleman says, this is the wild west. These people are profiteers. Part and parcel of enabling people to protect themselves in this environment is to really talk about the risks. There are some absolute cowboys out there. The story that Dawn tells about trying to sue the practitioner who undertook her procedure shows that that is frankly impossible. When people want to become engaged in activity that is borderline criminal, they find ways of making sure that they cannot be held to account for it. Whatever our instinctive view about people’s choice, self-regulation and so on, where there is clear evidence of harm, the Government should act. We really must look at this more seriously. I am happy to continue speaking to Dawn and to the right hon. Gentleman about that.

Clearly, we need to look at the whole issue of dermal fillers. It is classed as a medical device and therefore is not on prescription, but ultimately something is being injected into the face, so we need to make sure that we are doing something about regulation. The right hon. Gentleman mentioned the role of the GMC. As he says, Botox is a prescription drug, but it is clearly being administered by people who are not practitioners. Both the GMC and the Nursing and Midwifery Council have an obligation to uphold their regulatory standards. If someone is using their prescribing power irresponsibly and not being present when the product is administered, then action should be taken, and I shall expect those bodies to do that.

[Mr Kevan Jones]

I agree with what the Minister says, but if we look at some of the adverts—for example, on Facebook—there is no way that people who are signing these prescriptions can actually be present. Her Department should look at this area, because there are clearly people signing prescriptions and then either selling them on for a profit or giving them to people to make money out of these procedures.

[Jackie Doyle-Price]

I am grateful to the right hon. Gentleman for amplifying that point, because we must do that. We give very clear indications that we expect the NMC and the GMC to deal with this. However, we must also send a message to people out there that people will get these adverts about how to become a dispenser of dermal fillers and think that that is all they need to do, having no idea that they are committing a criminal offence. We need to educate them as well.

I will end there, because, as I say, I feel like I have been the Government at the Dispatch Box today. I look forward to continuing discussions with all Members present, who I know care very deeply about this. It is something that we really must tackle as a matter of urgency.

Question put and agreed to.

Resolved,

That this House has considered body image and mental health.

Mental Health First Aid in the Workplace

Debate between Lord Beamish and Jackie Doyle-Price

Thursday 17th January 2019 Commons Chamber

[Jackie Doyle-Price]

I can say that we are making progress, but I would prefer to write to the right hon. Gentleman with more details, if I may. I have seen some of that individual placement and support in operation, and it is hugely inspiring. In those mental health trusts that are giving one-to-one support, people are finding that the reward and discipline of going to work really does aid their recovery, even in some of the most challenging cases. I will write to the right hon. Gentleman with more information on that.

[Mr Kevan Jones]

Will the Minister liaise with colleagues in the Department for Work and Pensions? As I said to the right hon. Member for North Norfolk (Norman Lamb), voluntary work is a helpful access point for people who want to get back into work, and the current limitations on people being allowed to do certain voluntary work hinder some who want to take that route into work.

Mental Health Act: CQC Report

Debate between Lord Beamish and Jackie Doyle-Price

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend reached the nub of the issue in that final point. Commissioning is a matter for local commissioning groups. However, through the CQC report, the work that we are doing through the mental health investment standard and the scrutiny applied by NHS England, we are trying to ensure that there is a consistent application of good-quality services around the country. We find some centres of excellence and some areas in which the service is less patchy, but when it is less good it obviously leads to worse outcomes. We are determined to do our best to promote the best possible services throughout the country.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome the Government’s outlawing of the use of police cells for those experiencing a mental health crisis, and I do not question the Minister’s commitment to improving the service, but the system is fragmented. There have been local authority cuts, including cuts in community services. The Health and Social Care Act 2012 leaves local commissioners to decide where the money goes, which has led to a confusing local picture and fragmentation. Do we not need to give people clear pathways out of hospital, and to ensure not only that the money goes to the right places, but that individuals know their rights and that local agencies know their responsibilities?

[Jackie Doyle-Price]

The hon. Gentleman’s point about people knowing their rights and providers and commissioners knowing their responsibilities is crucial to the whole issue, and I think it probably underlies the lack of parity of esteem hitherto. When it comes to the role of central Government, we want to continue to rely on local provision and local commissioning, but we also need to be clear about the standards of performance that people should be able to expect. We are being more transparent about where services are being delivered well and where they are being delivered less well, but I think the work that Sir Simon Wessely is doing will shine a light on exactly that, and will enable us to engage in a much more meaningful debate about what is appropriate.