Eating Disorders Awareness Week

Rachael Maskell Excerpts

Wednesday 27th February 2019 Westminster Hall

[Kirstene Hair]

My hon. Friend is absolutely right. The sufferer of course needs specialist support, but I will go on to speak about how I believe that we also desperately need to support families and, indeed, all those around them. This disease is so complex that it is often difficult to treat and, trapped in the disease, sufferers feel that there is simply no way out. Many believe that if the disease does not take them, they will take their own life, just to rid themselves of it. No matter how strong an individual is, an eating disorder is so all-consuming that once it has taken hold, some people believe that they will never live a normal life again, and many do not: the condition becomes chronic for about 20% of sufferers.

Normally, a series of events has encouraged the person’s mind to think differently about their body image. Perhaps they have decided that they are not good enough: one too many times, people or life events have created a narrative in their mind that they are inferior to those around them, or perhaps life is out of control in many aspects—nothing is going right. They compare themselves with others around them and see only the negatives in their own life and the positives in other lives, but they can take back control of one aspect of their life—control of what they eat. That may well start off as a diet, but not a diet that would be followed by a normal individual, which often fails. It soon becomes a focus and then a more extreme calorie-counting exercise that involves hiding food, burning off every calorie possible and social isolationism. Before they know it, the candle is burning at both ends. Before a sufferer has identified that they need help, the registered impact on their body is always perceived as being caused by some other reason. There is a voice inside a sufferer screaming that too much food is being consumed or not enough exercise is being done—praise when they miss a meal or hear the sound of a rumbling stomach. That voice inside a sufferer will not and cannot go away.

The loved ones around a sufferer see their daughter, son or friend fade into a shadow of their former self; they are helpless in every way. Parents struggle and are in emotional turmoil. They know that if their daughter falls and skins her knee, they can bathe it, put a plaster on it and make it better. If their son is upset because he is struggling at school, they can get him the support that he needs. We have solutions, and it is human nature to want to fix and help those we love. However, when it comes to eating disorders, everyone is helpless and feels hopeless. No one, unless they are trained, can provide support, other than the individual themselves. Many, if not all, sufferers who have managed to recover will say that it was the hardest journey that they have ever taken, but having spoken to some of Beat’s bravest ambassadors, we have seen at first hand the amazing, inspiring individuals they can become—but that is only if we help them.

As a result of the stigma attached to eating disorders, black, Asian and ethnic minority people, lesbian, gay, bisexual and transgender people and people from less affluent backgrounds are less likely to seek and get medical support. Research developed ahead of today’s debate showed that four in 10 people believe that eating disorders were more prevalent in white people than in other ethnicities, yet research shows that they are just as common or more common in the BAME community. Thirty per cent. thought eating disorders were more likely to affect the more affluent; in fact, they evolve at the same rate irrespective of education or income. Sixty per cent. of respondents believed that they affected only young people. That is having a significant impact on adults coming forward for support, and we see men and boys not being referred as soon as girls and females.

The statistics might not be surprising, but we have to challenge them continually. They are preventing certain groups in society from appealing for help, and creating an inequality in support. As a result, people are more ill by the time they are referred, making the recovery process much more difficult and sometimes impossible. We have seen fantastic work by members of the royal family as well as other notable figures, who have raised awareness of mental health disorders and who seek to break down the barriers to people speaking out, but also recognise that it is okay to talk and okay for someone to say that they need help.

When sufferers reach out for help, they have often been suffering for years. They need urgent specialist help immediately. The average cycle of relapse and recovery lasts six years, and there must be constant efforts to reduce that. To undo months and years of torture, specialists need time and resources to allow a patient to open up, to analyse, to find out the root causes, to get under the skin of the issues and to develop the mind to fundamentally change—a long-term approach, but a life-changing one.

Families, too, need guidance and support on how to deal with this troubling time. Many do not know where to go for support. This was one comment from the social media campaign that I ran before the debate:

“When anorexia arrives in a family it is like throwing a grenade into a home and watching it explode...caring for my daughter has impacted on the mental health of all those in my family.”

That is why I agree with my hon. Friend the Member for Henley (John Howell) that family-based therapy would provide a much-needed support base throughout the recovery process.

Without the investment of time, those patients will be back in our GP surgeries and hospitals time and again. We must look beyond weight. This is an issue of the mind, so whether it is a case of referral or recovery, it cannot be determined by the number on the scales. As a result of the digital campaign that I ran, I heard from many people up and down the country, and I thank them for coming forward with their stories. One person, who wished to remain anonymous, said that

“my granddaughter never got so thin but she died nearly 7 years ago at the age of 19 and I feel that if there had been some positive help she would have been alive today.”

She had been disregarded simply because her weight was not low enough. Recent research shows that GPs do not have adequate training for supporting individuals who have an eating disorder, with three in 10 sufferers not being referred when required.

[Rachael Maskell (York Central) (Lab/Co-op)]

rose—

[Mr Adrian Bailey (in the Chair)]

I call Louise Haigh.

[Rachael Maskell]

The hon. Lady is making an excellent speech. I am troubled by the fact that, a year on, services in York are still completely inadequate. On Friday, I spoke to GPs who are trying to manage individuals with eating disorders. They have been instructed to take patients’ blood, to monitor the electrolytes, and to weigh them frequently, without the psychological support and clinical competencies that are necessary. Is it not absolutely essential that GPs receive the training that they need, so that we can put in place the holistic services that patients need?

[Kirstene Hair]

The hon. Lady is absolutely correct. I will come on to speak about that in detail. I hope the Minister will give further detail on how she is approaching that with other Departments.

In any five-year medical degree at UK medical schools the average amount of training in eating disorders was 1.8 hours, and one in five gave no training at all. The concern is not confined to one part of the United Kingdom; it is a widespread issue across all nations. That seems absolutely extraordinary, given that this is one of the most fatal mental health disorders, affecting 1.25 million people. GPs must be able to tell the difference between a healthy exercise routine and a compulsive one, low body-mass index and lack of nutrition, and going through a diet phase and the beginning of an eating disorder. They must recognise the clear indicators and how eating disorders manifest in order to deliver the right treatment plan, but to do that they need training.

I would like to see further encouragement of self-referrals and more work with schools, where many members of staff may be able to identify unusual behaviour. I warmly welcome the approach taken by my secondary school, Brechin High School, which has appointed a member of staff to lead on mental health who has a support base within the school and is linked up with the local primary schools, so that at the end of primary school, when an eating disorder—or any mental health disorder—may begin to develop, that support is monitored and continued as pupils enter secondary school and progress their education. I am keen to hear from the Minister how the training aspect can be addressed. I would like to hear from the Scottish National party spokesperson how the Scottish Government could do more to include training within university tuition, and how they will address the role that schools can play in early intervention.

When help is needed, how long do we have to wait? Waiting time targets have been a focal part of the campaigns run by many charities for years. In England and Wales, by 2021, 95% of eating disorder referrals for those under-19 are due to reach a specialist within four weeks, and within one week for urgent cases. Will the Minister confirm that the Government are on track to deliver that target, which is already making a huge impact? Along with the charities, I warmly welcome the ambition shown by this Government.

This is not a political debate and I do not wish to make it one. However, once again, when I wrote to the Scottish Government asking why they refused to equalise that target for young people, no substantive reason was given. I have also asked the Scottish Minister for Mental Health about that, and I look forward to her response. The UK Government have stepped up to treat under-19s. I encourage work so that those targets continue to be ambitious. We know that the sooner patients are seen, the higher the chance of recovery and the lower the long-term cost to the NHS. The current 18-week target in Scotland simply has to be addressed. When sufferers determine they need help, their illness is more likely to be treatable, but by the time they may be seen, the likely outcome is much more negative and potentially fatal. I want my constituents to have the same opportunity for early intervention as people south of the border. I want the Scottish Government urgently to address this needless inequality.

As we know, those with an eating disorder often take up to three years to identify that they have such a disorder. Sufferers must do two things: realise something is wrong and wish to make themselves better. When a sufferer comes forward, given their scepticism about all those trying to help them, we have a moral responsibility to grasp their ask for help and support them as a matter of urgency. That requires step-by-step help, to nurture these fragile but wonderful people and not let any of them fall out of the system.

I want to conclude with a point about social media, which is a force for good in many ways, but a stain on the life of many families, which recognise it as the tool that tore them apart. All age groups regularly browse online to determine what everyone else is up to or to catch up on the news, but they normally see only positive news. I have not seen one Instagram image of anyone in this room getting up in the morning, doing mundane things, such as washing the dishes, or having a bad day at work, because we submit only positive images. However, if we also put out negative images, things might feel slightly more normal.

Social media is a platform for showcasing the positive aspect of our lives, with no balance of the negative aspect that we encounter every day. For someone with an eating disorder, or any mental health disorder, that only accentuates their problems. Recent cases have made us all stop and think. There is so much pro-ana and pro-mia material promoting a harmful mindset, which forms or heightens an eating disorder. We must not forget that this material is often put up by sufferers themselves, so we must push supportive materials towards those who promote such images and material.

I do not believe that that is above any of the social media companies. The Secretary of State for Digital, Culture, Media and Sport made a hugely positive step forward in that respect earlier this month. Will the Minister explain the conversations that her Department has had with the Department for Digital, Culture, Media and Sport? Social media platforms cannot take all the positives of social media, but refuse to take responsibility for some of the damage it causes.

In summary, I would like to thank all hon. Members for supporting this debate. I know that it is close to the hearts of many in this place. I hope that the Minister will show those who have suffered, those who are suffering and those who do not yet know that they will suffer that this Government are on their side. I hope the Minister will show that we will never rest on our laurels, but will continue to address the flaws and increase our ambition, reduce waiting times, develop support and facilities for all who need it, wherever they live in the country, intervene early and offer the right support throughout the whole process, expel the postcode lottery of support, encourage our world-class universities to improve teaching programmes, so that they are in line with the impact this disease has on so many, and ensure that social media companies play their part in bucking this trend. We have to help those who are, through no fault of their own, helpless about their own aid. For many it will be the first time in their lives, because that is what Government is here to do: help you when you cannot help yourself.