Women’s Mental Health

Jeff Smith Excerpts

Thursday 3rd October 2019 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House notes with concern the rise in mental ill health among women, with one in five now experiencing common mental disorders and young women the most at-risk group; recognises that women’s mental health problems are often rooted in experiences of violence and abuse; believes that mental health services often fail to respond to women’s specific needs, including their experiences of trauma; calls on the Government to ensure that the gender- and trauma-informed principles of the Women’s Mental Health Taskforce are adopted by mental health services and that women’s mental health needs, including their experience of violence and abuse, are prioritised and taken seriously in all mental health policy, strategy and delivery.

Constituents often come to us at their lowest point, and we see them going through anxiety, depression and trauma. Poor mental health affects not only the individual, but everybody around them. Women are far more likely to experience serious mental health issues. Young women are at the greatest risk, with one in five having self-harmed and 13% having been diagnosed with post-traumatic stress disorder.

Over the course of this Parliament, there has been a great deal of talk in this House about mental health, which is progress, but the opportunity to discuss women’s specific needs when it comes to mental health services has been limited. Ten months after the publication of the final report of the Women’s Mental Health Taskforce, little has changed. There is a long way to go before our mental health services work for women. There is an obligation on Government to step in and respond to the growing crisis in women’s mental health with a substantive policy.

[Jeff Smith (Manchester, Withington) (Lab)]

I very much welcome the work of the Women’s Mental Health Taskforce, its report, and the principles laid out in it. Does the hon. Lady share my concern that those principles will not be effectively implemented unless there are clear targets and concrete commitments from the Government, and that the next stage needs to be a full strategy on women’s mental health, with those targets and commitments in it?

[Wera Hobhouse]

I could not agree more. We need a strategy. More than half of women who experience mental ill health have a history of abuse, meaning that their conditions are rooted in experiences of gender-based violence. In yesterday’s moving debate, we heard many harrowing examples of that. We have a long way to go if we are to change the whole culture around domestic violence and treat its consequences. When it comes to treatment, we must ensure that frontline mental health services for women are trauma-informed. There is a legal framework that we could use; it is called the Istanbul convention. We signed up to it back in 2012, but so far we have failed to bring it into domestic law.

One consequence is that we do not have enough rape crisis centres across the country. Earlier this year, Fern Champion, a survivor of sexual violence, came forward after being turned away by her local rape crisis centre. She launched a petition asking the Government to ratify the Istanbul convention, which has so far received 171,000 signatures. It is hard to suggest that we can do the groundwork to support women and their mental health challenges effectively when there are fewer than 100 rape crisis centres across England and Wales. This is simply not good enough if we are to support women effectively and prevent them from developing serious mental health problems after suffering abuse. Ratifying the Istanbul convention would mean that the UK was upholding international standards on survivors’ rights.

Earlier this year, I tabled a Bill that would guarantee mothers a health check-up six weeks after giving birth. Depression before, during and after birth is a serious condition that is unrecognised and untreated for nearly half of new mothers who suffer from depression. Statistics suggest that mothers are afraid to speak up, and 47% of new mothers get less than three minutes to discuss their mental health with a healthcare professional. Conversations about the reality of motherhood and perinatal depression are still few and far between. This is a huge problem—and not just for the mother; undiagnosed mental health problems in mothers have serious consequences for the newborn child and their development.

I have been campaigning for better treatment of eating disorders. Eating disorders disproportionately affect women, although they do not discriminate. Women in the LGBTQ community are particularly susceptible.

[Wera Hobhouse]

Absolutely. Post-natal depression is hidden, and the NCT’s “Hidden Half” campaign addresses that. Anyone who has been a parent knows that parenthood is not easy. Probably all mothers go through some form of depression, or feel really down after birth. I keep saying that if anybody had asked me how I felt, I would probably have said, “Oh God, I am not feeling particularly well.” The problem is in not addressing that early on, because these things can develop into something much more serious. That is why it is very important that there be a check-up six weeks after birth for women, not just for the newborn child.

[Jeff Smith]

I thank the hon. Lady for giving way again; she is being very generous. A number of my constituents have been in touch about perinatal check-ups. My constituent Catherine told me of her experience:

“I asked for a 6 week check with a GP—this was, at best, brief. Physical symptoms were looked at, but nothing was checked with regards to my mental health. There needs to be a standard physical and mental health check for ALL new mothers.”

Does the hon. Lady agree that we need to do better?

[Wera Hobhouse]

Yes indeed. I talk to campaigners, who are now looking at the new general practitioner contracts that are going out. That is definitely a way forward, but we also need to ensure adequate training, because people have to ask the right questions. The issue is sort of stigmatised; everybody thinks, “You’re a new mum—you should be on top of the world.” Nobody really wants to admit that motherhood can be very difficult, and that one does not always feel great. We need training, so that when new mums come in, they are asked the right questions.

Going back to eating disorders, they have the highest mortality rate of all mental health conditions. There are about a million sufferers from eating disorders. That is an epidemic of illness that is going undiagnosed and untreated. We must do much better. Our NHS is not well equipped to spot the problem early and treat it. Waiting times for adults have been shooting up over the last few years. Outdated methods, such as the body mass index measurement, are still being used to diagnosis the condition, but that fails to recognise that at the core of an eating disorder is a mental health, not a physical health, problem. Despite increasing public and professional awareness of eating disorders, medical students receive only two hours of training in the condition and its treatment during their entire time in medical school.

Those are just a few examples of where our NHS does not work for women’s mental health. We need a strategy. The Women’s Mental Health Taskforce did some extremely important work, but its recommendations have been left on the shelf. A Government strategy would help individual trusts to make the changes required to implement the recommendations. The Liberal Democrats have championed the fight for better mental health care for many years, and we believe that mental and physical health should be supported equally by our services. I have highlighted a few areas where women’s mental health provision could be improved, and I am looking forward to the debate and to the Minister’s response.

--- Later in debate ---

[Tim Loughton]

We need both. The health checks are NICE-recommended, but alas not mandatorily funded or instituted across the country. Frankly, all GPs need better training on mental health and mental illness prevention generally, and especially on perinatal mental health.

It was a huge success of the coalition Government that we recruited almost the 4,200 target for health visitors that was set back in 2010. We have lost as many as 30% of those now, since the responsibility for health visitors went from the NHS to local authorities. I am not saying whether that was the right move or not, but, given the cash constraints on local authorities, health visitors have turned out to be a soft target. That is a hugely false economy and certainly needs to be revisited as a priority by the health team.

The lifelong importance of early attachment should not be underestimated. It has been judged that for a 15 or 16-year-old suffering from depression—an all too common problem among teenage children in schools—there is around a 99% likelihood that his or her mother was suffering from depression or some other form of mental illness during or soon after pregnancy. The correlation is as close as that. Not getting it right during the conception to age two period will have an impact on many children for their childhood years and, for too many, continuing into their adult years too. Maternal mental health is very important, not just for the mother herself but for her children and the surrounding family.

Let us not underestimate the impact this has on fathers as well. I will be ruled out of order if I go too much into the subject of male mental health—although I hope we have a debate on male mental health too—but the impact of poor attachment between a mother and baby has significant impacts on fathers. It is important that they are also given every help and support to have that attachment to their children. Too often, children’s centres and other support mechanisms are mum-centric and we overlook the role of the father. The father has an important role to play in the life of the child and an important support role to play in the physical and mental health of his partner, the mother.

The Government have done an awful lot in recent years to raise the profile of the importance of mental health and flag up how we need to do much more. Importantly, they are also investing much more in mental health. We talk about the parity of esteem between mental health and physical health, and we all agree that that is necessary. Much has been done to reduce the stigma that was attached to mental illness just 20 years ago. It is good that so much more money is going into the area. We have a shortage of mental health practitioners and we need to make sure that we prioritise recruiting, training and getting them in service as soon as possible.

The criticism I have is that last year’s Green Paper on mental health included a lot about school-age children, which is important, but virtually nothing on pre-school-age children and perinatal mental health. Shifting the age profile forward and making it more about prevention and early detection—rather than dealing with the symptoms of a child who may already be damaged because their mother was damaged in their early years—is the way we have to go. We have to do much more in schools, but we need to do so much more before children get to school, by working with their mothers and fathers at an early stage.

[Jeff Smith]

The hon. Gentleman made an important point about the reduction in funding for local authorities. When it comes to trying to provide holistic support to the family and mother, does he share my regret at the closure of so many hundreds of Sure Start centres since 2010?

[Tim Loughton]

I do not want to make this a partisan issue. We can have a debate on this subject, and there have been some cuts to support services that have obviously not been helpful and will have some of the long-term impact that I have mentioned. I have visited, and even opened in my time as Minister, several children’s centres, and many of them do a fantastic job. But many were not doing a fantastic job and were failing to do a job of work for the 15% of the most deprived communities for whom they were originally most intended.

The failure to comprehend the importance of children’s centres is to put too much trust in bricks and mortar. Many of the outreach services that went with children centres were more important, and they were not getting out enough. We have children’s centres that have worked really well in my constituency, and we have not closed any in West Sussex, largely because we put them in the right places and turned them into what I call a Piccadilly Circus of services. They have district nurses, health visitors, mental health nurses and social workers hot-desking and sharing information about various families, especially vulnerable children and others, to give a wrap-around, comprehensive support mechanism. The challenge so often for children’s centres is getting the parents—particularly dads—to come across the threshold. Some children’s centres do that really well, but many do not. I know about the importance of children’s centres, but I also know some of their weaknesses. It is the services they offer and the outcomes they achieve that are so much more important than the amount of bricks and mortar that exist to provide them.

[Jeff Smith]

The hon. Gentleman is making an important point, but, with the greatest respect, West Sussex did not have the kind of cuts to its local authority funding that many more impoverished areas such as Manchester and other big northern cities did. He is right that it is not just about bricks and mortar: it is the support services that were also cut that have had the greatest impact on young families in those areas.

[Tim Loughton]

Nice try. West Sussex was the least funded shire county in the whole of England. Do not try and tell me that supposedly affluent areas such as West Sussex have not faced financial challenges. I do not know about the hon. Gentleman’s constituency, but the gap between the per capita funding that children get in my constituency and many of the London and other municipal boroughs is substantial. It is a question of how that funding is used and prioritised.