Body Image and Mental Health

Lord Beamish Excerpts

Tuesday 23rd July 2019 Commons Chamber

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

I begin by agreeing totally with the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron): the debate is important. Last week we had a debate on mental health; we have two this week, one here today and one in Westminster Hall on Thursday afternoon on the Mental Health Act 1983. That is good because the more we talk about mental health issues, the more we normalise them. The hon. Lady is right. I have been a Member of the House for more than 18 years, and it has changed. The more we talk, the better. She makes a very good point.

Ministers are going into the twilight zone at the moment; seeing whether they are going to come out of the reshuffle. I add my thanks to the Minister to those of my hon. Friend the Member for Dewsbury (Paula Sherriff). The Minister has been a passionate advocate for mental health and she deeply cares about it. We know when a Minister gets it, and she does. I hope that she survives whatever happens over the next few days. The other thing that is unusual and does not get a great deal of publicity is the fact that she is prepared to work across party and across the House, and to listen to alternative viewpoints. I wish to put that on the record.

I pay tribute to the Mental Health Foundation for its excellent report. I know that the Minister was at the launch. I think it was the first time that body image and mental health had been brought together. The hon. Member for East Kilbride, Strathaven and Lesmahagow talked about eating disorders, and the stark facts that come out of the report should concern us all.

It is important to say that it is not just young people who are affected. As my hon. Friend the Member for Dewsbury said, 20% of the adult population in the UK feel ashamed of their body image and 34% feel down about it. In some cases, that will not lead to mental health problems, but in a lot of them it will. If people have anxiety about their body image, it leads to related conditions.

According to the report, 34% of young people feel upset about their body image and 31% feel ashamed of it. We cannot insulate young people from society—we should not even attempt to do so. Living in society can be difficult and challenging at times, and young people face the added pressure of social media.

[Ruth Jones (Newport West) (Lab)]

I thank my right hon. Friend for making such a positive speech in this important debate. Does he believe that social media and advertising have a significant impact on young people, and does he agree that the Government need to take more vigorous steps to ensure that young people are protected from images that can lead them to form negative views of their own body?

[Mr Kevan Jones]

I completely agree with my hon. Friend. I will go on to speak about the role of advertising because, as she will know, it has changed. When we were growing up, adverts were in magazines or on television. Now, they are accessible to young people 24 hours a day, seven days a week on smartphones and tablets. That has changed the pressure on young people, as is highlighted in the Mental Health Foundation’s excellent report.

Before I come on to advertising, I will touch on the issue of cosmetic surgery, which the Minister raised. Members may want to know why I am interested in the subject. It is down to a force of nature, my constituent Dawn Knight, whom the Minister has met. Unfortunately, several years ago a cosmetic procedure on her eyes led to the horrific situation that she can no longer close her eyelids. As the hon. Member for East Kilbride, Strathaven and Lesmahagow said, such procedures are not easily reversible. It is not like someone changing their hair colour and not liking it. The procedure has had a devastating effect on Dawn’s life. I pay credit to her, because she has been determined to campaign on this issue. I know that she has met the Minister on a number of occasions to highlight the dangers of cosmetic surgery.

The Minister referred to regulation. I have been calling for regulation in this area for five years. I do not think there is a lack of political will, and certainly not from this Minister, but I am told that the Department of Health and Social Care is so scarred by the Health and Social Care Act 2012 that it does not want to bring forward any more health-related legislation. I say to Ministers that they must. This is the wild west because there is no regulation.

The Minister rightly warned people not to go abroad for such procedures, because standards are not high. Sadly, I have to say that they are not very high in this country either. Dawn’s case and the cases of numerous women that Dawn has documented over the years show that surgery that takes place in this country is sold like a commodity. It is not sold as something that could threaten or change people’s lives; it is sold like any other product. I am sorry, but it is not like any other product. Some of these procedures are very dangerous and can result in death.

The problem is the way the industry is structured. There are groups that give the impression that they employ surgeons and that they are hospitals. One that I have spoken about on behalf of Dawn and other victims—that is what I call them—is the Hospital Group. One would think that it is a hospital that employs surgeons and nurses, but it is not. It is a sort of marketing facility company that has a hospital and flies in surgeons from Europe, sometimes on a daily basis. They fly in, operate and fly out again. The aftercare treatment is non-existent in some cases. As Dawn’s case shows, when people try to sue the individual, they find that their indemnity insurance does not cover the resulting legal case.

What we need is a properly regulated system. The fly-in, fly-out surgeons need to be banned. I am sorry, but it is not acceptable. People say, “We have the General Medical Council,” but that is another of my hobby-horses. It is an organisation that is ripe for reform. The Government have promised reform of how the GMC operates, but they have not brought legislation forward. We need legislation to reform it because, as I will say in respect of another organisation in a minute, I am never a great fan of self-regulation. I was one of those who campaigned to take regulation away from the Law Society. Self-regulation has clearly failed. Nearly five years on from her complaint against the doctor, Dawn Knight is still fighting. It is not a user-friendly process for anyone to get redress for their complaint and we need to address that as a matter of urgency.

Cosmetic surgery is advertised and sold like any other commodity. There used to be two for one offers on Facebook and elsewhere—buy one procedure and get another procedure free. There were time-limited offers. Those should all be banned; they should not be allowed at all, because some of those procedures are very dangerous and people are often not aware of the dangers. I would argue that such a ban is part of the regulation we need. This is not a multimillion-pound industry, but a multibillion-pound industry and it is exploiting people’s poor body image.

Before anyone had any type of cosmetic surgery, I would insist that they had a mental health assessment. Not only should the risks of the surgery be explained, but we should question whether people actually want the procedure.

Advertisers use “Love Island” to promote the idea of young women having procedures to enhance their appearance. That reinforces the image that somehow there is a perfect body to be had, but also the idea that these procedures are risk free. Having spoken to Dawn and other victims of cosmetic surgery, I know that these are not risk-free procedures. In many cases, they lead to mental health problems afterwards during the recovery process.

As the Minister rightly said, the ones who pick up the tab are us—the taxpayers. Not only do we pick up the bill for the correction of the surgery when these organisations fold themselves into new companies and go into bankruptcy, meaning that people cannot get any redress; we also pay for the mental health services for those individuals afterwards.

I say again that we need more regulation of advertising. The Advertising Standards Authority is a toothless tiger. The Mental Health Foundation’s report says that last year the ASA upheld a complaint against the producers of “Love Island” for promoting cosmetic surgery as part of the advertising package around the show. But anyone who has dealt with the ASA will know that it is slow and that it is not proactive. One of the report’s recommendations is that it should be proactive in looking at adverts in advance to ensure that they are pre-screened before they go out. Again, though, that involves self-regulation, and it does not work.

I accept that we have a Government at the moment who do not like regulation and who want to strip it out. We are possibly going to get more of that nonsense over the coming months from the new Prime Minister, but I take the clear view that the state needs to protect people when they are being exploited. On cosmetic surgery, I take the clear view that people who want to have cosmetic surgery have the right to choose what to do with their money, but they should have a fully informed choice rather than being pressured by glossy advertising.

Online advertising and body image have already been raised in the debate. We have heard about the way in which adverts and other images are photoshopped and that this is somehow a positive thing that every young person should look forward to. The Minister also mentioned Botox and fillers. Those procedures are not cosmetic surgery in the sense of people going under the scalpel, but I would argue that they are equally in need of regulation because of the appalling effects when things go wrong. According to some adverts, people can simply go along in their lunch hour and have a Botox or filler treatment and then walk away in the afternoon, but those are medical procedures. They are advertised on social media and elsewhere, but Botox is a prescription drug, and it is interesting that people seem to have access to it even though they have no qualifications at all. No qualifications are needed for injecting someone. Madam Deputy Speaker, I could inject you with Botox this afternoon—not that you need it—without any qualifications or training whatsoever. The Minister was right to say that the problem with the way in which social media algorithms work is that anyone who enters the term “Botox” into a Facebook search, for example, will then be bombarded by adverts not only for Botox and fillers but for training courses on how to administer them. People can actually sign up for those courses in order to earn money.

The only regulation around this is Facebook. Dawn Knight has raised the matter directly with Facebook, but I understand that the only thing anyone can do is to say to Facebook that they no longer want this on their feed and take it down. I have written to Sir Nick Clegg, who has now gone off to live with the beautiful people in California, to ask him why Facebook is carrying those kinds of adverts and bombarding vulnerable people with adverts for Botox and other fillers. Those adverts have no disclaimers about risk, and there is no quality control over the individuals offering the services. As the Minister said, they could be people in hairdressers and other such places. Well, I am sorry, I know Facebook is earning money from those adverts, but it should ban them. I know that the vulnerability of young people is a matter of concern for the Minister, for Dawn Knight and for me. They could be getting access to these procedures without knowing the risks, and they are being targeted by the social media companies. I am waiting to see what response I get from Sir Nick Clegg and the beautiful people in California. Hopefully, they will take some action against this.

This is a serious issue, not just in terms of the way people are personally affected; it costs the taxpayer money when cosmetic surgery goes wrong and when people need mental health support. We also need regulation. We are all focused on Brexit at the moment, and perhaps this is another area that will not be addressed over the next few months. I hope that that is not the case, and I know that the Minister will continue to argue for this reform, as she has already done in Government. I also know that my constituent, Dawn Knight, will not leave this issue alone. I will not do so either, because people are putting themselves at risk and it is the duty of the Government to take action in Parliament to protect individuals when they need it. There is a lot of pressure on young people when it comes to body image. All I would say to those young people today is this: think positively, and be kind to yourself.

[Wera Hobhouse (Bath) (LD)]

It is a real honour to speak in this debate, and I regret that not many people are here to participate in it, but as we know, today is today. Even though I have only recently become a Member of Parliament, I echo the comments about what a pleasure it has been to work with the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), and I hope that she will continue in her post.

We have talked about many issues, and I want to pick up on what has been said about the cynicism with which advertising exploits vulnerable people. I will be speaking mostly on eating disorders, and many victims of eating disorders already have a massive problem, even before they go online. If they then order slimming pills online, for example, they will be bombarded by adverts persuading them to buy even more, which they then do. That is nothing short of exploitation, and we need to be alert to that.

We are all ultimately affected by our body image. People might say to me, “Well, you look all right”, but we all think, “Well, this could be better and that could be better.” We all want to please the people around us and ourselves when it comes to what we look like, and that is nothing new. It is only unusual or harmful when it so negatively affects us that it is the only thing that guides our lives. There is a certain intolerance surrounding having to have a particular look, and that is where the real danger lies. People feel they have to look a particular way rather than feeling that it would be fun to look this way or that way and to be playful with what they look like. Instead, they are being shoehorned into a particular image, and anyone who does not fit that image can be badly affected and develop serious mental health problems, including eating disorders. I have been campaigning on the particular issue of eating disorders and mental health.

This debate is important for millions of people across the country, and I hope that we can set an example today by honestly exploring the issues. In fact, I think we already have. In a culture that is obsessed with image, we must talk more openly about the impact that body image scrutiny has on our mental health. It has been said before that we are focusing too much on how we look, rather than on who we actually are as people and what we can bring to the table, whether we are short or tall, male or female. That is one of the obsessions of our society: we are always thinking about what we look like, rather than about who we actually are.

For the past year, I have been campaigning for better treatment for eating disorders. Speaking openly about such conditions is more important than ever, because early identification and intervention are key. Mental health conditions thrive in the shadows and are protected by our ideas about what is and is not appropriate to talk about. Eating disorders have a reputation, and sufferers who do not fit cultural stereotypes are often afraid to speak out or, worse still, are refused help.

[Mr Kevan Jones]

The popular image of eating disorders is that they mainly affect young women, but does the hon. Lady agree that young men and people of all ages are increasingly likely to be affected?

[Wera Hobhouse]

The right hon. Gentleman is absolutely right, and that has been explored in several debates on eating disorders. We are somewhat hemmed in by stereotypes, and I wonder whether our age is particularly prone to that. We think eating disorders are a particular thing, so for a long time they have been a problem for young girls, but they affect people of all ages, and men increasingly. As we have explored today, body image and mental health are not gender-specific, but men suffer in silence more, because they are much less likely to talk about things, and subsequently they seek help a lot later, which can be dangerous. In fact, it is well known that the highest number of suicides is among men between the ages of 18 and 25, because men—this is a cultural stereotype that we can hopefully overcome—just do not talk about their body image, anxieties and mental health as much as women.

Research by the Mental Health Foundation published last March shows how common it is to have body image concerns, and we have heard many other statistics today. One in five UK adults have felt anxious or depressed about their bodies in the past year, and that anxiety can turn into long-term mental health problems, such as eating disorders. Across the country, eating disorders affect 1.25 million people, which is probably a conservative estimate. My work in this area supports that suggestion, and the sufferers I have met come from a range of different backgrounds, but they are united by their dissatisfaction with, and need to control, their body image. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) has already talked powerfully about that.

Of course, eating disorders are far more complex than stress over body image. They are serious conditions that ruin, define and, all too often, end lives. However, the seeds of emergent eating disorders can often be spotted in stress or anxiety about body image. For the more than 1 million people who were identified as having an eating disorder, the outlook is not good. On average, it takes 85 weeks between someone realising they have an eating disorder and that individual receiving treatment. That lost time can be the difference between full recovery and living with a permanent disability or disorder. The Government targets introduced to limit child waiting times for eating disorder treatments were a positive step, but thousands of adults across the UK need the same measures. We need to consider the waiting times for adult sufferers of eating disorders, and I know that the Minister has already looked into that.

Understanding eating disorders better is key to improving treatment. Many sufferers still report being turned away and refused referral, because doctors have told them that they are not thin enough to be treated for an eating disorder—I know that the Minister has talked to Hope Virgo, who has been running the “Dump the Scales” campaign—but an eating disorder is not just about someone’s body mass index. By talking about eating disorders, especially in the context of body image, we can start to grasp how damaging that can be. We must educate everyone, from sufferers’ families to doctors, about the many different forms that such conditions can take and how best to treat them. Eating disorders have the highest mortality rate of any mental health condition, and our mental health policy must reflect that. This is a crisis, but we are not treating it as such.

Early intervention is key. Schools, doctors and support workers must be equipped with the tools to identify when body image concerns are becoming dangerous. Furthermore, we must change the cultural conversation around body image, which can be done on many levels. As we have already heard today, social media companies have a responsibility to police the content on their websites, ensuring that anything that actively incites self-harm is taken down. Eating disorders are on the rise, and many adult sufferers are failing to receive the early intervention they so desperately need. We must do better for those suffering in silence and start having a conversation about body image, mental health and the awful reality of life with an eating disorder.

--- Later in debate ---

[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.