Eating Disorders Awareness Week

Caroline Nokes Excerpts

Tuesday 28th February 2023 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to serve under your chairmanship, Ms Harris. I congratulate the hon. Member for Bath (Wera Hobhouse) on having secured this important debate and thank the Backbench Business Committee for having agreed to it.

I will not repeat the statistics, because the hon. Member for Bath covered them brilliantly. She highlighted the scale of the problem and the fact that it is growing more among young men; of course, Eating Disorders Awareness Week 2023 particularly highlights the challenge for young men. I will focus on some constituency cases that I have come across recently, and on some areas where we can do better to raise awareness in order to start to tackle the root causes, thereby hopefully helping future generations of young people.

I say young people, and we all know that eating disorders are most likely to impact on 17-year-old girls, but the stark reality is that they can endure into much later life. I remember meeting groups of women in this place who were well into their 40s and still suffering from eating disorders. That is not to paint too negative a picture, because we know that people can recover from eating disorders. With the right support and, crucially, early intervention, eating disorders can be tackled successfully. However, we also know that more and more people are suffering from eating disorders in this country today and that covid exacerbated that. Being locked down in our own homes, confronted with image after image on social media, undoubtedly contributed to the problem.

[Margaret Ferrier]

Social media algorithms will serve to those with eating disorders more and more content that encourages harmful and dangerous behaviours. That is particularly worrying for younger and adolescent sufferers. Does the right hon. Member agree that platforms cannot be allowed to continue to profit from that via advertisements, and that the Online Safety Bill provides the perfect opportunity to address that?

[Caroline Nokes]

That was exactly what I was going to ask the Minister: can we please make sure that the online safety legislation is used as a tool to oblige social media platforms to clean up their acts when it comes to profiting from legal but undoubtedly extremely harmful forms of advertising to people who are already suffering from very serious medical conditions? When it comes to eating disorders—specifically anorexia nervosa, which is the most lethal mental health condition there is—we have to make sure that we do not trivialising or dismiss them, regarding them as something that happens only to young girls and they get over it. The stark reality is that eating disorders kill more people than any other psychiatric illness.

We have seen from the evidence provided to all Members by the Royal College of Psychiatrists the increase in incidence, but we also know that waiting times are up hugely. I return to my initial point: early intervention is crucial. When somebody with an eating disorder asks for help, that is the time to give it to them, not 12, 24 or even more weeks later. We know there is a huge challenge with transfers from children’s to adult services. Too often, sufferers will fall through the cracks and be forced to go back to the beginning of a waiting list.

I want to highlight the case of one of my constituents— I will not give her name—who is currently suffering from a severe eating disorder and has been for years. She had been in children’s services for years but recently turned 18, which brought with it the challenge of finding her appropriate support. She is currently in an adult mental health bed in a secure ward. The stark reality is that she and two other girls in the area covered by the Southern Health NHS Foundation Trust were competing for the one bed available at Leigh House, which is the Hampshire-based specialist support unit for eating disorders. There we have it: an 18-year-old in an adult secure mental health unit, and a real challenge among clinicians to decide whether they will try to treat the physical symptoms of the eating disorder or the mental health conditions, and whether a mental health condition should take precedence over the physical problems.

I then heard from the trust that my constituent was having to be transferred every single day to be force fed with a tube because staff in the mental health unit were not able and did not want to do that. I believe that at just 18 someone is still a child. We know that with eating disorder sufferers development is often slower and young people are more childlike. Yet they are effectively forced to live in an adult mental health ward while suffering from a severe eating disorder and needing specialist help. Furthermore, training is crucial and support for staff who treat people with eating disorders is equally so. It is incredibly gruelling and, in no uncertain terms, a hideous process to have to force feed someone. We cannot imagine the impact that has on staff.

On social media content and algorithms, what does the Minister believe we can do to better protect young people? What can we do to give them the tools they need to be more resilient and to understand, when they are being pushed social media content, what is good and what is not—what is harmful and what is less harmful? I am proud to have stood repeatedly in this Chamber and called for personal, social, health and economic education to be a mandatory part of the curriculum, and proud that a Conservative Government have achieved that, but we also need to ensure that teachers are better equipped to teach PSHE, and I repeat my call for it to be mandatory up to the age of 18. It is not good enough to say that young people have to stay in education—school or college—or training until they are 18 but not to equip them with crucial life skills between 16 and 18. I get that the good colleges will do that, but many will not, so I ask the Minister to work with her colleagues in the Department for Education to ensure that the highest possible quality PSHE is delivered by teachers who feel and, indeed, are equipped to deliver it.

I want to talk briefly about stigma. I am conscious that this Eating Disorders Awareness Week we are highlighting eating disorders in boys and men. Stigma is still a huge challenge and it is undoubtedly worse for men and boys. When we look at the statistics, we see that one in five does not ever even say to anybody else that they think they might be suffering from an eating disorder. How on earth can someone get help if they cannot even talk about it?

It is incredibly difficult for young men to find their way in the world. They are under massive pressures through body dysmorphia or through the images they see, which are wholly unrealistic and unachievable. There are fitness apps on which the proponents will be taking significant amounts of steroids to achieve a physique that is, to be frank, virtually impossible for the ordinary person—the ordinary man—to achieve, and we know that over-exercising is every bit as much a part of eating disorders as not consuming calories. I am particularly aware that we need to find mechanisms to support young men, through the education system, so that they recognise the challenges around over-exercising, the dangers of steroid abuse and, frankly, the wholly unrealistic male body image that is being promoted to them.

I visited April House in Southampton, a specialist over-18 eating disorder unit, years ago now. That is to my shame: I should go back and say hello again. What was striking was that in a room of women, there was one man, and his particular problem was running. Every single day, he was running a marathon, and he could not rest mentally unless he had run those 26 miles every single day. Let us all just imagine what that was doing to his body and how incredibly weak and damaged he was by it. If we do nothing else today, let us encourage more men to speak up, encourage people to be braver, and ensure that we speak with a united voice from this Chamber. This is not a party political issue; it is absolutely a cross-party issue that we have to do more to support eating disorder sufferers.

--- Later in debate ---

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a genuine pleasure to serve under your guidance this morning, Ms Harris. I congratulate my hon. Friend the Member for Bath (Wera Hobhouse) on securing this debate, which she has led very well. It has been a helpful debate, and I associate myself with the comments that everyone has made. I also add my thanks to Beat, Hope Virgo and all the others leading the campaign to increase awareness and improve provision for people suffering with eating disorders.

Eating disorders are, of course, a range of mental health conditions that have a physical consequence, with maybe two thirds of those suffering from them having a physical illness as a consequence of their mental health condition. It is a privilege, and deeply moving, to work alongside, support and serve sufferers and their families in my communities in Cumbria. I feel deeply affected by not just their struggle with their condition but, sometimes, their struggle to access the services they need.

As has been mentioned, covid has had an impact on the prevalence of eating disorders, with something like a 55% increase in referrals during that period, and an increase of more than 80% in the number of hospital admissions, and I want to remark on what we do in response to those admissions. In our communities in Westmorland, anybody needing tier 4 hospitalisation for an eating disorder will be placed in a bed in Manchester, Edinburgh or Darlington if they are lucky and there are sufficient beds in those places. In many cases, as the hon. Member for Sheffield, Hallam (Olivia Blake) mentioned, people—often young people—end up hospitalised on the wrong kind of wards, where they are supported by lovely, wonderful people who are just not trained to support them. Therefore, the experience not just of that person in their suffering, but of the people caring for them and the other people—often young people—on those wards, is harrowing, deeply distressing and inappropriate.

As has also been noted, it is worth mentioning that the use of BMI as a measure to decide whether someone can access services is dangerous and foolish. We would not say to a person with cancer, “Come back when you have more cancer”—we would treat them.

[Caroline Nokes]

This will be a very brief intervention. The hon. Gentleman is absolutely right about BMI—we really have to move away from it. It gives a misleading impression of wellbeing. Can we please remember that it is designed for a Caucasian male’s body type? We know that the majority of sufferers of eating disorders are women.

[Tim Farron]

I am grateful to the right hon. Lady for a helpful intervention. That is absolutely true. We would not say to a person who presented with cancer, “Come back when your tumours have spread.” If someone is presenting with an eating disorder, we need to believe them and allow them to access the right support immediately. That needs to be changed urgently.

At the other end of the spectrum, at tier 1, and particularly for young people, what are we doing to build resilience so that people do not develop eating disorders in the first place? In Cumbria, there is nearly nothing in terms of provision for adults, while we spend a grand total, through our public health, of 75p per child and young person on tier 1 resilience support, and that is for all mental health conditions, not just eating disorders. We need to prevent people from getting into these circumstances in the first place—for their sake and for everyone else’s.

Let us be positive: it is important to welcome the access waiting time standards. They are a good thing. However, they are mostly not being met. In north Cumbria, 26% of routine referrals of young people and 11% of urgent referrals of young people are not being treated in that timescale. In south Cumbria, 23% of routine referrals are not being seen within the four-week standard. While there is better news for those meeting the standards for urgent referrals, the total declared for Morecambe Bay hospitals trust is 12 individuals with an urgent eating disorder need. That is baloney. I personally know more people than that who are struggling, which tells us either that the data is faulty or that it is hard to get into the system because BMI is used as a gateway to access those services.

More generally, this speaks of a lack of parity when it comes to care, treatment and taking seriously issues relating to mental health, particularly where young people and eating disorders are concerned. If one of our young people were to break their leg on a football pitch on a Saturday afternoon, they would be straight into hospital and the healing process would begin that day. If something invisible in them breaks, it could be weeks or months before they get support, or it could never come. It may come dangerously, or even fatally, too late, and that is wrong.

What are our collective asks? We need increased awareness. It is right that we focus on men, who are less likely to come forward and yet make up a huge proportion of those in need, but help should be there for everyone, and I urge people to come forward and access it. We also need more support for families, who are massively hit by the consequences of eating disorders for their loved ones.

We mentioned the waiting time standards for young people and children—I am glad we have them, although I wish we met them—but there are no standards for adults, and it is about time that there were. Research funding needs to be increased so that we can understand the causes and cures and tackle this range of diseases head on. We need to be utterly intolerant of dangerous images and things that lead people into this dangerous area and cause such ill health.

Medical training needs to be improved so that we can refer our referred accurately. We need to tackle the BMI gateway. When tackling obesity, for example, we need to remember that there is a danger of things such as like calorie references being well-intentioned but counter- productive. We need to ensure that money allocated to integrated care boards for eating disorder support is actually spent on that. Finally, services must be commissioned adequately and close to home.