Women’s Mental Health

Lord Beamish Excerpts

Thursday 3rd October 2019 Commons Chamber

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

My hon. Friend is making a very good point. Does she agree that we need not just to look at GPs and that one visit, but to try to ensure that we embed in health visitors and other professionals who come into contact with new mothers the importance of looking for early signs of mental illness?

[Ellie Reeves]

That is absolutely right. Health visitors have a huge role to play, and we know from our constituency work that they are under a huge amount of strain and often the same issues apply. Health visits are often rushed, not through any fault of the health visitor, but because of the pressures and constraints they are under. The situation for both GPs and health visitors needs to be considered.

The NCT is currently running a campaign that I fully support. It seeks full funding for the six-week maternal post-natal check, so that GPs have time to give every new mother a full appointment. It also seeks to improve guidance for GPs on best practice around maternal health, with dedicated appointments for the six-week maternal check, and to encourage the disclosure of maternal mental health problems. Finally, it wishes the NHS to support GP education in maternal mental health. The consequences of not tackling maternal mental health are far reaching, with around 20 new or expectant mothers taking their own lives ever year. Maternal mental health problems are considered an adverse childhood experience, and urgent action really is needed.

I will end by championing some of the great support that is available to new and expectant mothers in my constituency, and which plays a fundamental role in maternal health and wellbeing. Bromley, Lewisham & Greenwich Mind offers a Mindful Mums course and a volunteer-led maternal befriending service. Our children’s centres offer drop-ins, mindfulness and breastfeeding support. Mytime Active offers a comprehensive pre and post-natal fitness programme in Bromley leisure centres, which I know has been instrumental in me not developing pre-natal depression this time around. Bromley Libraries offers free Baby Bounce and Rhyme and other activity sessions, and there are local NCT groups and baby cafes, to name but a few. I thank the dedicated staff and volunteers, without whom such services would simply not exist.

However, those organisations cannot do it alone, and their budgets are already stretched. Since 2010, 12 children’s centres in Bromley have shut. Bromley library staff have been on strike since June due to cuts to the service, and Mind is operating with waiting lists, such is the demand for its maternal services. Without proper investment in maternal health, and without breaking down the stigma surrounding pre and post-natal depression, women will continue to suffer alone. I hope that the Government are listening, and that this debate will be the start of much needed change.

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[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.

[Mr Kevan Jones]

Will the hon. Gentleman give way?

[Tim Loughton]

I will give way, now that I have set this hare running.

[Mr Jones]

The hon. Gentleman is making the fundamental mistake that Members on the Government Benches often do—the idea that every area in the country is the same. I am sure that there are many more looked-after children in inner cities such as Liverpool, Manchester and others—and even in Durham—than there are in his area. That comes with a cost, and the areas cannot be treated the same.

[Tim Loughton]

That shows a fundamental misunderstanding. I declare an interest because this was my issue. Where children are placed is not necessarily a reflection of how many children are in the care system in that authority. Children in care placed in other authorities, such as Kent, where accommodation is cheaper than in London, are paid for by the placing authorities, and they can cause challenges to the host authorities. That is a wholly different issue. The original point that the hon. Member for Manchester, Withington (Jeff Smith) made was that children’s centres are part of the solution. We need children’s centres with well-trained people offering well-targeted support services to those who need them, but saying that this is purely a numerical issue, because now we have 3,200 children’s centres as opposed to 3,500, is missing the point. It is about the quality of the care offered to those who most need it.

I will wrap up now—as I see you want me to, Madam Deputy Speaker—by touching on a couple of other points affecting older girls. They include the impact of bullying, social media and bullying online, peer pressure relating to body image, the reports by groups such as the Girl Guides and the surveys showing the number of young teenage girls who do not like their appearance and would, if they could, pay for plastic surgery, which is hugely alarming. We have to give young women in particular the confidence to be able to say, “I am who I am. This is who I am, and if you don’t like it—tough.” That is something that we have a major role in getting across in society, and frankly social media need to be part of those positive messages. We still have problems with the internet and social media companies hosting sites that masquerade as sites giving advice to people with eating disorders, but which are in fact malignly encouraging anorexia and things like that.

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

I congratulate the hon. Member for Bath (Wera Hobhouse) on introducing the debate and welcome the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), to her new position.

I welcome this debate because it is another opportunity to talk about mental health. As was said earlier, at one time it would not have been spoken about, but our debates, which have in large part been cross-party and consensual, have changed people’s attitudes. That is the real difference that we have made. The hon. Members for Southend West (Sir David Amess) and for East Worthing and Shoreham (Tim Loughton) were right that this is the House at its best—disagreeing politely, but ensuring that issues that frankly are not very popular are debated consensually. I welcome that. These debates have made a real difference in changing people’s attitudes to mental health. I pay tribute to the charities that have recently been involved in various campaigns, because eradicating stigma is a big issue that we still need to work on in our discussions about mental health.

The hon. Member for Bath pointed out in her introduction to the debate that one in five women can at some stage experience a common mental health issue, whether depression or anxiety. Often, they are the ones at greatest risk, especially young women. Although all the evidence suggests that men are more likely to take their own lives, there is an increasing danger among young women of taking their own lives. The statistics have not really budged since 2012, and I think the same is true for the suicide rate among women generally, which at the moment I think is 5.4 per 100,000 of the population. Those rates have remained static for the past 10 years. Some great work has been done on suicide prevention, which led to a slight drop—although I notice that the figures recently went up again—but we need to put more effort into looking in detail at the underlying reason why the suicide rate among women remains static.

The other issue is that women are more likely to suffer from mental illness because of trauma, such as domestic violence and sexual abuse, and issues around body image, which the hon. Member for East Worthing and Shoreham spoke about and which I will come on to.

I welcome the work of the women’s mental health taskforce, which reported in 2018. Let me put on record my thanks to the hon. Member for Thurrock (Jackie Doyle-Price) for the work she did. She was a great champion not only for women’s mental health but for the entire mental health agenda. Not only was she always available to speak to Members, but I know from speaking to charities and others working in the field that her door was always opened. She listened; she made sure she got change; and she can be proud of the work she did.

The taskforce’s report touched on something that is quite self-evident, but which we sometimes forget—namely, the clear link between poverty and socioeconomic conditions and women’s mental health. It found that 29% of women in poverty experience poor mental health. Another issue touched on, which was raised by the hon. Member for Southend West, was prisons. The report highlighted the depressing statistics for women self-harming in prison, which are obviously linked to other issues such as poverty, which has already been mentioned, and substance abuse.

I agree totally with the report’s conclusion that we need to link those issues up and take an holistic approach, but I would go one step further. I have spoken about this before, but we also need to hard-wire mental health and wellbeing into all public policy, whether nationally or locally. We need a system whereby any policy being developed should be tested against a matrix of mental health indicators before implementation, and I would include spending decisions in that. The hon. Member for East Worthing and Shoreham talked about spending cuts, and although we might disagree about their effects on Sure Start centres for instance, making what the Treasury might see as easy cuts leads not only to problems locally but to more expense for the taxpayer in the long term. We should certainly look at that when we are spending money, because while the call is often for more money—which we do need in mental health—we also need to ensure that it is spent correctly and joined up. We could achieve a lot more if we took a joined-up approach.

Let me give two examples of where not having that prerequisite for testing is leading to problems and costing the taxpayer and society more. One is the Department for Work and Pensions and its employment and support allowance assessment. I am clear that people should be encouraged to work, and we all—let us be honest—know that the right type of work is good for people’s mental health. However, we should not have a system that is very blunt in terms of assessment and that takes little account of those living in our communities with long-term mental health problems.

A constituent in her late 50s came to see me a few months ago, having lived with long-term mental health issues in the community. She went for her ESA assessment and got no points. She was then virtually suicidal. I intervened, although, frankly, it should not have taken me to intervene. She then had a mandatory reconsideration, and her payment was reinstated. If we look at that woman’s history, it is clear that she is not going to work, but the process did not take that into account. If that person had then been sectioned, had gone into hospital or had—let us be blunt—taken her life, that would have been a huge cost to society.

[Wera Hobhouse]

I have been an MP for a relatively short time, and I find increasingly that trying to access services or get universal credit throws perfectly healthy people into mental health problems, because it creates anxieties and delays. I am not surprised that a lot of people are being thrown into mental health problems, because our public services are increasingly not responding in a humane way to people’s needs.

[Mr Jones]

I agree, and I will come on to the other example I have in a minute. Those problems then result in a cost to the taxpayer. If we had road-tested the ESA policy in terms of mental wellbeing and assessment when we were developing it, that would have helped the situation.

The other example, which the hon. Lady has just referred to, is universal credit, which is creating huge problems for many of my constituents. They are going up to six weeks without any money. That is having a huge effect on women’s mental health, because the main carers in most of these households are women, who have to juggle budgets. Again, we should have thought beforehand about the cost to society and the taxpayer of the added mental health problems generated through this policy.

On women in prison, it saddens me a little that the Government have now taken up the “lock them up and throw the key away” agenda in the criminal system. We need to reduce the number of people who are actually in prison, and especially women. If we look at the evidence and at the reason why women are in prison, we see that it is linked to domestic violence, mental health problems and substance abuse.

In County Durham, I pay tribute to Durham police and the crime commissioner Ron Hogg, who introduced Checkpoint in 2011. He did that because he was sick and tired of putting women shoplifters through the criminal justice system when what they really needed was help. If we look at the statistics and at the changes that the programme has made, we see that it is cutting reoffending rates. It is addressing the real issue, which, in most cases, is domestic abuse and mental health issues.

In addition, we need clear pathways. The report says we need joined-up local services. That is not just about the acute sector and GPs; it is about the voluntary sector as well, and we need to ensure that it is part of that joined-up local system. Certainly, in my experience, it is delivering local services and good value for money very effectively for local communities. In my constituency, I have a fantastic project called Just for Women, which deals with women who have faced domestic violence and mental health problems and who have been in probation. The project staff do one simple thing: they allow time, and they talk to people. They use crafts and other things to get women’s confidence back. If we sit and talk to the women in that project, we find that most of them have been through every programme possible—they have gone through systems and systems. We need to ensure that we put in place a system that works.

Finally, I want to touch on body image. I welcome this year’s report by the Mental Health Foundation, which focused on the link between body image and the nation’s mental health. In the report, one in five UK adults said they felt ashamed of their body image and 43% of women had low self-esteem when it came to their body image. That does lead to psychological effects.

I agreed with the hon. Member for East Worthing and Shoreham when he talked about the internet companies. They have a huge responsibility in ensuring that the messages they put out do not perpetuate the myth of the perfect body image. That is leading not only to psychological problems but to people having unnecessary cosmetic surgery and interventions, which are harmful to them.

I have challenged Facebook, for example, to ask why it continues to carry adverts for Botox, which is a prescription drug. Just try to take one down; my constituent Dawn Knight, who has been campaigning on this, tried to take one down, but it cannot be done. These companies should take a proactive approach to blocking these adverts, because they are not only perpetuating the image of the perfect body, but are, in some cases, I think, actually breaking the law. If social media companies such as Facebook will not change, there needs to be legislation.

In conclusion, I welcome the debate, because we are talking again about mental health. Is this about money? Yes, it is. We do need investment in mental health services. However, we also need to ensure that we have that joined-up approach to not only services but methods and processes. That can reduce people’s mental illness and ensure not only that we have a society that is content with itself but that, when people do get into crisis, there is a service and support there for them.

[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.

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[Ms Dorries]

My hon. Friend is absolutely right: it is about breaking down the stigma in mental health. When somebody breaks their leg, they wear a plaster cast and we can see that they have broken their leg. We cannot always see when someone is suffering from a mental health issue, so it needs to be destigmatised. It also needs to be given the same consideration as physical illness, and I think it is.

Obviously, my speech has now been dumped, because so many points were raised in the debate and I feel that I have to answer them. I shall start with the hon. Member for Bath, who raised so many points when introducing the debate. I want to answer some of her questions. One of her first points was about rape crisis centres; this year, we will spend £35 million and fund 47 sexual assault referral centres, to ensure that when sexual violence occurs, there is the best possible response for victims. The centres are available to all victims—male and female, adults, children, and current and non-current victims of rape and abuse.

I want to mention the approach the Government have taken to mental health. I took up this post just as we announced £2.3 billion of expenditure on mental health. Let me put that into perspective: my hon. Friend the Member for Cheltenham (Alex Chalk) informed me that that is more than half the entire yearly prisons budget; that demonstrates how much money we are investing in mental health. The money is going into many areas, but in almost all areas it will have an impact on women and young girls— and this debate is all about women’s mental health. It is important that women are at the centre of all mental health policy. They should be not just be siloed off into their own particular areas; they should be at the centre of everything.

[Mr Kevan Jones]

I understand what the Minister says about the increase in budgets, but does she not also realise that cuts in other areas are actually adding to the problems? Therefore, it does not matter how much money we pour into mental health services. Public health funding, for example, which is devolved to local authorities such as Durham, has had a 40% cut, which means that existing services, such as those for substance abuse, have had to be cut. Putting money in one way and taking it out in another does not solve the problem.

[Ms Dorries]

The NHS budget is not bottomless, but the mental health budget is growing faster than the overall health budget, and the budget for children and young people is growing even faster than that. One Member—I think it was the hon. Member for Lewisham West and Penge (Ellie Reeves)—said that more people are presenting with mental health issues now than ever before. In fact, GPs agree with that, and say that a lot more people are presenting with those issues at their surgeries. That is due to many, many reasons. One Member raised the issues of the postings on Facebook and Instagram, of body image and of dieting. There are many reasons why people are suffering from mental health issues, and it is not just to do with service cuts, which are being addressed.

I need to race on with my speech because I have just three minutes left. On the maternal six-week check, we hope to ensure that that happens in all our GP contracts going forward.[Official Report, 7 October 2019, Vol. 664, c. 11MC.] The hon. Member for Bath mentioned the Istanbul convention. The Government signed the Istanbul convention in 2012 to reaffirm our strong commitment to tackling violence against women and girls. She also talked about eating disorders—I know that she has brought forward other debates on this issue. She also mentioned body mass index. We want all GPs to adhere to the NICE guidelines, which means that they must take a holistic approach to young women who are presenting with potential eating disorders. I am talking about taking a look at dental records, considering whether those women are still living a full life and still working, whether they are seen to be eating or whether they are absenting themselves after a meal. We need to look at everything in the round. Nobody should be referred for having an eating disorder based on their BMI alone. That is in the guidelines. We are raising awareness of that, and introducing more training for GPs, so that they are aware of this, too. The hon. Lady may be aware that I wrote an article on this subject recently, emphasising that point.

Perinatal mental health, as we discussed, is also important. According to one study published in 2014, a shocking 10% to 20% of women develop a mental health illness during pregnancy, or within the first year of having a baby. From April 2019, new and expectant mums have been able to access specialist perinatal mental health community services in every part of the country.

The NHS long-term plan, which I referred to earlier, commits to ensuring that an additional 24,000 women will have access to specialist perinatal mental healthcare, with more support for fathers and partners. I am pleased to see that NHS England has expanded the capacity of in-patient mother and baby units, which are in-patient services that support women with serious mental health issues, keeping them together with their babies, which is so important.

My hon. Friend the Member for Southend West (Sir David Amess) talked about female offenders. I know that women in prison often have a disproportionately high level of mental health problems, and there are also worrying levels of self-harm. We have recently published standards for healthcare for women in prison and are looking at improving care for pregnant women in prison.

The hon. Member for Lewisham West and Penge talked about health visitors. Earlier this year the Prime Minister announced our commitment to modernise the healthy child programme to reflect the latest evidence on how health visitors and other professionals can support perinatal mental health.

My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) talked about the closure of children’s centres. We are investing £84 million over the next five years to support up to 20 local authorities that are seeing high demand for children’s social care. This will help to support the most vulnerable families, and I am sure that that is welcomed by everyone. It is up to local councils to decide how to organise and pay for services in their areas, as they are best placed to understand local needs.

The right hon. Member for North Durham (Mr Jones) talked about social media and about his constituent trying to get Facebook to take down an advert. I actually congratulated Facebook and Instagram recently on removing all the diet advertisements for miracle cures and diet teas that simply do not work. That is a step in the right direction. I also thank all the women in my constituency who have emailed me on that the issue and others.

[Mr Kevan Jones]

rose—

[Ms Dorries]

I do not have any time; I have only 30 seconds left.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke about poverty. Many of us in this place understand the impact of poverty and have experienced poverty ourselves, and we know that it can cause anxiety not only for women, but for young girls. We absolutely understand those issues.

Let me say to the shadow Minister that our £2 million programme Standing Together Against Domestic Violence looks at how the whole health system can better respond to domestic abuse. Like her, I was delighted that the Domestic Abuse Bill passed its Second Reading yesterday. On carers and increased access, the carers action plan published in 2018 sets out a range of ways that we will improve support for carers. We published a progress review in July this year to ensure that we focus on delivering the plan.

The shadow Minister also spoke about the use of restraint, which is abhorrent. The Government fully supported the Mental Health Units (Use of Force) Bill—a private Member’s Bill that became an Act of Parliament on 1 November 2018. The Act imposes requirements regarding the use of force, the publication of data, and how and when physical, mechanical and chemical force is used, as well as requirements for improved staff training. We want to end restraint. We know that it continues to be a routine occurrence on many wards, affecting women and girls disproportionately. That has to end.[Official Report, 7 October 2019, Vol. 664, c. 12MC.]

I will conclude by stating again that we are putting £2.3 billion into mental health, and that will benefit women and young girls. Never before have any Government ever considered mental health in such a way—with regard to policy, and finance to drive that policy and back it up. I thank the hon. Member for Bath for raising this very important issue. We are making progress, and I am determined that we will make more. I recognise that there is more to do and we will certainly be working on that.