Eating Disorders

Lisa Cameron Excerpts

Tuesday 16th October 2018 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is an absolute pleasure to serve under your chairmanship, Sir Roger, in an extremely important debate that reaches out to those across the United Kingdom who are struggling with eating disorders, and their families. I very much commend the hon. Member for Bath (Wera Hobhouse) on bringing the debate to the House and on her extremely poignant and sensitive speech about the day-to-day issues that people living with eating disorders face and their difficulties in accessing services across the United Kingdom, and specifically in her constituency.

Let me put it on the record that I have worked as a psychologist in the NHS in Scotland, including with people who have eating disorders. I want to spend a few minutes discussing the issues I had while working with people and how services can be taken forward. First, I thank all hon. Members who have spoken; the hon. Member for Strangford (Jim Shannon) spoke consensually, as always, about the issues in Northern Ireland and how difficult it can be for people to come forward and seek treatment. I also thank the hon. Member for Angus (Kirstene Hair), who spoke about her difficulties in accessing treatment in her locality; that is a difficulty indeed, which is reflective of the service difficulties across the United Kingdom. I would like to sit down and discuss my own experience with her, if she were willing to do that.

 The Scottish Government have put money into mental health services, including eating disorder services. An extra £250 million for mental health has been placed at the heart of the strategy. The Scottish Government’s mental health strategy is a long-term strategy from 2017 to 2027.

The issues raised by hon. Members about body image are extremely important. Body image has come to the fore with the advent of social media. People struggle with it, particularly young people, and I think it contributes to the difficulties that people face. It is possible that there is a greater propensity for eating disorders to develop as a result of those issues. I particularly thank the hon. Member for Islwyn (Chris Evans) for raising the issue of body image, particularly for young men, because often that is overlooked. It is extremely important and will become much more relevant as time goes on, because social media has such an impact on people, as do advertisers. It certainly contributes to the difficulties that people experience, through the sense of perfectionism. Young men are not excluded from that—in fact, idealistic images are portrayed to young men and young women that are particularly unhealthy to psychological and physical development, particularly in relation to people’s adjustment and mental health in particular.

The hon. Member for Enfield, Southgate (Bambos Charalambous) also spoke about body image, social media and the difficulties of accessing treatment and services in his constituency. He often makes fantastic contributions and I am always pleased to be in debates alongside him. The hon. Member for Boston and Skegness (Matt Warman) made an extremely well-informed speech, about some of the difficulties in coming forward and GP training, primary care and people’s pathway through services. I thank everyone who has taken part in the debate.

The Royal College of Psychiatrists in Scotland produced a briefing paper that states that

“Scotland has seen striking improvements in the provision of specialist eating disorder services over the past decade.”

They include specialist units in Aberdeen and West Lothian, and beds in Glasgow. It continues:

“Services have been developed to provide alternatives to hospital admission, or shorter admissions.”

There are anorexia intensive treatment services in Lothian and Fife, day programmes in Aberdeen and specialist teams in Glasgow. On training, the 2010 Eating Disorders Education and Training Scotland programme was set up to bring training to professionals across Scotland and to train experts in practice. But despite all those issues and progress made, there is still so much more to be done.

From my own experience, I agree with the majority of Members who have spoken that services remain quite patchy. There is still a postcode lottery across the United Kingdom. I do not set Scotland out as different or having different difficulties in that regard, but Governments across the United Kingdom are trying to grapple with and make progress with these issues. It would be helpful if the Minister could address service provision in rural areas, what might that look like and how people could access services. I know that having to travel long distances to services can be a particular difficulty for patients when they come forward, and that is not always helpful for family involvement, yet we have heard that therapy and family involvement can be extremely important for the prognosis.

On CAMHS, it is an objective of the Scottish Government to put counselling services in every school. From the work I have been doing on the Health Committee, I know that the UK Government are also looking at those issues. However, it is difficult because when young people have an eating disorder it perhaps does not initially present as that—it might present as depression, anxiety or another symptom. Often the eating disorder is not acknowledged by the person suffering from it or does not come to the attention of those around them for some time later.

Those who work with young people should have appropriate training to look below the surface for the symptoms of eating disorders, which might present in different ways in young people, so that people do not fall through the net so often. It can be difficult, and misdiagnosis in the initial stages is quite common, because one of the symptoms is denial. Perhaps the person does not want to seek treatment, or they present themselves in a way that suggests that they have a different mental health difficulty. Perhaps their family wish them to seek treatment but they are resistant. Those are all the issues that services have to grapple with. Therefore, the care pathway must be improved.

Denial is extremely important. Hon. Members spoke about early intervention, but it is extremely difficult to intervene early when often people do not accept their own difficulties and do not wish to come forward for treatment. Often, we look for other types of difficulties at presentations in primary care at GP level. GP training will have to be extremely sensitive and more hours will have to be devoted to understanding the different ways eating disorders present.

One of the difficulties I experienced was referring from primary care to specialist eating disorder services. The person had to go through three services to get where they needed to be. By that point, we are talking months down the line because only a community mental health team can refer to the eating disorder service. I suggest that that is not necessary, because psychologists and psychiatrists working in primary care are perfectly capable of diagnosing eating difficulties and referring straight on to specialist services. That should be addressed.

Weight restrictions are a particular issue for those with bulimia. If a service uses weight restrictions and makes body mass index a key criterion, those with bulimia will fall through the net. My quick ask of the Minister is for services to be more flexible and accept referrals to specialist services from those in primary care; for specialist training for a member in every CAMHS team to pick up eating disorders in young people; to have a discussion with advertisers about the contribution to mental health of unrealistic body image expectations; and to pick up the issue of rural services.