Mental Health

Mark Hendrick Excerpts

Thursday 16th May 2013 Commons Chamber

[Jane Ellison (Battersea) (Con)]

Thank you, Madam Deputy Speaker, for allowing me to speak in this debate. I had not planned to do so, but I realised earlier today that I wanted to address an aspect of female genital mutilation, which I have discussed often in the House. When I listened to the opening speeches, I realised that I have never talked about an issue that many of the campaigners I work with discuss a lot, namely the mental health aspects of both acute and, in particular, chronic FGM.

I just want to put the issue on the record for the Minister to think about; I do not expect any instant answers. As many Members have said, it is hard enough to talk about mental health, but raising the issue of the mental health problems of the victims of a secret, taboo and illegal practice that we have never successfully prosecuted adds several layers of difficulty to an already difficult situation. We know enough, however, for the matter to be put on the record so that somebody at the Department of Health can at least think about it. We should be worried about it.

Female genital mutilation is practised in many countries around the world, but it is predominantly an African practice. In this country, it is practised predominantly by communities from east and sub-Saharan Africa. Most professionals in the field think that the largest diaspora groups in which FGM remains prevalent are probably from Kenya and Somalia; it is certainly heavily practised in those countries.

In the absence of a more up-to-date study, people work on the numbers given in a 2007 study by FORWARD—the Foundation for Women’s Health, Research and Development—which was itself based on the 2001 census. The study established that there are at least 66,000 women with FGM living in England and Wales and that about 21,000 more girls are at risk of becoming victims. Of course, given the substantial migratory trends of people from practising countries to the UK in recent years, the real figure is likely to be higher.

In 2004, the British Medical Association recorded that it believed that there were 9,032 births to women who had had FGM. It should be noted that not all hospitals are required or able to record FGM at birth, and I know that one of the Minister’s ministerial colleagues is looking at trying to get that right. Recent freedom of information requests by the press also show that hundreds of similar women are giving birth every year in hospitals in Leeds, London and elsewhere. We know that this is a problem and that the practice is not being abandoned at anywhere near our desired rate.

During visits to schools in my constituency in recent months, I have asked questions about the issue—other Members may also have done so—but I have not received any satisfactory answers. Most recently, a headmistress who knew about the practice, which is unusual, had been told by a school community worker, “Don’t go there. Let’s not talk about that topic.” This is a problem; do not let anyone believe that it is a myth and that we do not have a problem in the UK.

A study cited by the World Health Organisation in the mid-2000s examined the effects of FGM on the mental health of women. The researchers concluded that FGM is

“likely to cause various emotional disturbances, forging the way to psychiatric disorders,”

especially post-traumatic stress disorder, possible memory dysfunction and other problems associated with trauma.

This issue was brought home to me by a Radio 5 programme I took part in recently after a two-part story on “Casualty”—they were two very powerful episodes—featured the acute health aspects of FGM. The story centred on an older sister who was trying to stop her younger sister being taken abroad to be mutilated, and on the impact of birth on the mother of the family, who had been infibulated.

One of the other guests on the Radio 5 discussion the following morning was a marvellous GP called Dr Abe from Slough, who told me that she sees two or three women a week who have chronic illnesses, some of which are mental-health related, associated with FGM. She asked me—the BMA stresses this and I will cite its guidance in a moment—to imagine the trauma experienced by a small girl who is being held down by people who are usually relatives or people she knows while a brutal procedure is carried out on her without anaesthetic. It is not difficult to imagine that such children will be troubled.

In case anyone thinks that such things do not really happen, let me point out that Dr Abe said that she regularly deals with children and young women whose bodies are contorted with pain and whose limbs are bruised, broken, battered and dislocated as a result of being held down by relatives. Few people who have that done to them by those who purport to be their loved ones will then go on to live with them as a family. I think we can all imagine the special and difficult mental health problem associated with that, and we are only beginning to understand it.

The BMA’s 2011 guidance acknowledged that little is documented about the psycho-sexual and psychological effects of FGM, but it does say:

“Long term consequences might also include behavioural disturbances as a result of the childhood trauma and possible loss of trust and confidence in carers who have permitted, or been involved in, a painful and distressing procedure”

and that

“women may have feelings of incompleteness, anxiety and depression, and suffer chronic irritability, frigidity, marital conflicts, or even psychosis.”

Many of the professionals and campaigners I work with stress the growing problem of anger, particularly among young women who suffered FGM before coming to this country. They are in a conflicted state, because the mentality of those who put them through FGM could not be more different from the mentality that they see around them in Britain. It is considered entirely normal in a sexualised society for magazines to invite young women to express their sexuality and have a fulfilled sex life. If someone has had a procedure carried out on them, the entire aim of which is to stop them wanting to have sex and to be a sexual person, and to restrict them and preserve their virginity—and everything else associated with the centuries-old tradition of FGM—that leads to conflict.

Both Efua Dorkenoo, who wrote the WHO guidelines, and campaigners such as Nimco Ali of Daughters of Eve talk about a growing pool of angry young women who are caught between those two very different worlds. It is also difficult for them to talk about it, because the subject is already taboo. Some Members may have read a recent article in The Sunday Times, which reported that Nimco Ali, who has been very bold in speaking out, has been threatened by people telling her that she should stop speaking out.

[Mark Hendrick (Preston) (Lab/Co-op)]

Is the hon. Lady saying that FGM is taking place in this country, or are parents taking their children abroad to have it done before coming back?

[Jane Ellison]

That does not relate strictly to the debate topic, but I will answer. We do not strictly know, but a growing body of evidence suggests that FGM does happen here. The girls I meet through some of the groups I work with will say off the record that it is happening here, but it is more difficult to get people to say so on the record and to point the police in the right direction. For example, women are re-presenting having being re-infibulated in hospital, which is also illegal. I think there is enough evidence now to suggest that FGM is happening here, but I think that the predominant view, and that of the police and the Crown Prosecution Service, is that girls being taken overseas is still the biggest problem. Since 2004, when a private Member’s Bill closed a loophole in the Prohibition of Female Circumcision Act 1985, such girls have also been covered by British law. The extraterritorial aspect of the law means that it is against the law to take a British resident or citizen abroad to perform FGM on them. Either way, that is covered. I think it is happening here, but we do not know.

[Mark Hendrick]

Have there been any prosecutions?

[Jane Ellison]

No; to the eternal shame of this country, in 25 years of this being an illegal act, there have been no prosecutions.

In recent times—I will return to the mental health aspects in a moment, Mr Deputy Speaker—we have had encouragement because Keir Starmer, the Director of Public Prosecutions, has been really good on this issue. He has a new action plan for the Crown Prosecution Service. It has reopened several old cases and is going through them with the police to see whether a prosecution is possible. It is also looking more imaginatively at prosecuting the aiders and the abetters, such as the people who set up the travel and those who supply the strong pain killers. If we wait for a seven-year-old girl to walk into a police station and report her parents, we will have a long wait. That is one reason why there have been no prosecutions. However, I am more optimistic now than ever that the police and the CPS are taking the matter seriously.

To return to the mental health aspects, a recent survey by the National Society for the Prevention of Cruelty to Children showed that 83% of teachers either do not know about FGM or have had no training on it. From memory, 16% of teachers thought that condemning FGM was culturally insensitive. That is extremely disturbing, given that it is an illegal act.

--- Later in debate ---

[Ms Abbott]

My hon. Friend’s points are well made.

Let me consider the future for mental health and set out for the House how important the role of local authorities can be in addressing the social determinants of mental ill health. Public health has become the responsibility of local authorities. They have a ring-fenced public health budget, and despite all their pressures and difficulties—which I do not seek to minimise—there is an opportunity for local authorities to do important and interesting work, bringing together education and housing with health care to address mental health problems and intervene in them early.

I was shocked to hear of a social housing project near King’s Cross that, presumably to make its tenants more manageable, did not want to give tenancies either to people who had a history of rent arrears or to people who had a history of mental health problems. Such things need to be highlighted and addressed. Sitting responsibility for public health with local authorities could address mental health, particularly in respect of early intervention and preventive work with children in schools.

I gave a speech this morning on the crisis in masculinity. We need to focus on the mental health challenges that face men. Whether it is because they are unwilling to come forward or because of stress in society, we know that, during a recession or economic downturn, suicide rates among men increase. Suicide is currently the biggest cause of death among under 35s. In planning services nationally and locally, we need to pay particular attention to that issue among others.

The hon. Member for Totnes made an important point. She said that, in our desire to reduce health tourism—a desire supported by the Opposition—there is a notion that people will need their passport when they turn up to see their GP. That runs the risk of making it harder for the socially excluded to access health care—many simply do not have a passport or such documentation.

I will not speak at this point about the merits or otherwise of the welfare reforms, but there is a lot of anecdotal evidence that they are having an effect on the mental health of some who are caught up in the system. There is a lot of anecdotal evidence that Atos, as it is currently configured and as it currently operates, does not meet the needs or seem to understand the problems of people with mental health challenges.

[Mark Hendrick]

I am sure that my hon. Friend, like many other hon. Members, has come across many constituents attending surgeries who are developing serious mental health problems purely and simply because of the pressures caused by the reforms to the benefits system. I am finding that people who are mentally ill and do not know it are getting worse—they are under pressure from the benefit changes that have been made and those that will take place in future.

[Ms Abbott]

I am afraid that there is increasing evidence that worry about the changes and about the threat of the changes is causing a lot of stress for people with mental health issues. Social services and health authorities must be mindful of that.