Women’s Mental Health

Tim Loughton Excerpts

Thursday 3rd October 2019 Commons Chamber

[Wera Hobhouse]

I could not agree more. We need a strategy. More than half of women who experience mental ill health have a history of abuse, meaning that their conditions are rooted in experiences of gender-based violence. In yesterday’s moving debate, we heard many harrowing examples of that. We have a long way to go if we are to change the whole culture around domestic violence and treat its consequences. When it comes to treatment, we must ensure that frontline mental health services for women are trauma-informed. There is a legal framework that we could use; it is called the Istanbul convention. We signed up to it back in 2012, but so far we have failed to bring it into domestic law.

One consequence is that we do not have enough rape crisis centres across the country. Earlier this year, Fern Champion, a survivor of sexual violence, came forward after being turned away by her local rape crisis centre. She launched a petition asking the Government to ratify the Istanbul convention, which has so far received 171,000 signatures. It is hard to suggest that we can do the groundwork to support women and their mental health challenges effectively when there are fewer than 100 rape crisis centres across England and Wales. This is simply not good enough if we are to support women effectively and prevent them from developing serious mental health problems after suffering abuse. Ratifying the Istanbul convention would mean that the UK was upholding international standards on survivors’ rights.

Earlier this year, I tabled a Bill that would guarantee mothers a health check-up six weeks after giving birth. Depression before, during and after birth is a serious condition that is unrecognised and untreated for nearly half of new mothers who suffer from depression. Statistics suggest that mothers are afraid to speak up, and 47% of new mothers get less than three minutes to discuss their mental health with a healthcare professional. Conversations about the reality of motherhood and perinatal depression are still few and far between. This is a huge problem—and not just for the mother; undiagnosed mental health problems in mothers have serious consequences for the newborn child and their development.

I have been campaigning for better treatment of eating disorders. Eating disorders disproportionately affect women, although they do not discriminate. Women in the LGBTQ community are particularly susceptible.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I am absolutely in accord with the hon. Lady. Before she gets off the subject of perinatal illness, she will agree, I am sure, that it is a shocking statistic that in the UK, suicide is the leading cause of direct maternal deaths occurring within a year of the end of pregnancy. Perinatal mental illness can actually lead to a loss of life among mothers. We need to do so much better for them in those early mental health checks.

[Wera Hobhouse]

Absolutely. Post-natal depression is hidden, and the NCT’s “Hidden Half” campaign addresses that. Anyone who has been a parent knows that parenthood is not easy. Probably all mothers go through some form of depression, or feel really down after birth. I keep saying that if anybody had asked me how I felt, I would probably have said, “Oh God, I am not feeling particularly well.” The problem is in not addressing that early on, because these things can develop into something much more serious. That is why it is very important that there be a check-up six weeks after birth for women, not just for the newborn child.

--- Later in debate ---

[Tim Loughton (East Worthing and Shoreham) (Con)]

I concur with every word of your comments, Madam Deputy Speaker, and the response to this debate, and the one we held yesterday on domestic abuse, has shown this Chamber in a much better light than that of a week or so ago. These are things we can agree on and that are of acute, everyday importance to our constituents.

As I have said previously, I have been in this House for 22 years and we never used to debate subjects such as this, and rarely held debates on children’s issues or many social issues. It is absolutely right that we hold such debates much more regularly these days, and they are enhanced by the personal, often emotional, harrowing and brave testimonies of hon. Members who bring such experience and richness to the debate. They show that we do have some understanding of the complex, complicated and challenging issues that face so many of our constituents every day.

I had not intended to speak in this debate, but I was moved by the contributions from my hon. Friend the Member for Southend West (Sir David Amess) and the hon. Member for Lewisham West and Penge (Ellie Reeves). I have a long-standing interest in this issue, and I declare an interest as chair of the all-party group for conception to age two—first 1001 days. That issue has growing traction and importance, and it should be mainstreamed. I also chair the charity Parent Infant Partnership, PIP UK, and co-chair the all-party group on mindfulness. If any hon. Members present have not attended a mindfulness course, I reiterate that they are available on Tuesday afternoons, usually at 5 o’clock in Committee Room 7. Given the stress of recent weeks, attendance has been noticeably higher and perhaps of more benefit than usual.

I am slightly daunted by speaking in this debate. Yesterday I said that I was daunted by speaking in the fantastic debate on domestic abuse, on the basis, first, that I am a man, and, secondly, that I am not from Wales. Today I am daunted, first because I am not a woman, and secondly because I am not from Essex, which seems to have a dominant geographical impact on the contributions that we have heard and will hear.

Next week we will celebrate Mental Health Awareness Week, and we will also relaunch the charity PIP UK. I have just written a letter to the Minister, and I very much welcome her and the huge amount of experience that she brings to her role from her health background. I am glad that perinatal mental health featured in the remarks of the hon. Members for Bath (Wera Hobhouse) and for Lewisham West and Penge, because that is where I think we can have the biggest impact on the mental health of future generations.

A few years ago, the Maternal Mental Health Alliance produced a valuable piece of work that estimated that perinatal mental health issues affect at least one in six women. Too often that happens in silence, which is why it is so important that the hon. Member for Lewisham West and Penge recounted how it happened to her—why would it not happen to somebody just because they happen to be an MP? The cost to the nation of perinatal mental health issues was estimated at £8.1 billion every year, which is probably an underestimate. We can add to that the cost of child neglect in this country, which is estimated at £15 billion and is often born out of problems with attachment in those early years, even before the child is born, and particularly if a woman is facing huge stresses and challenges, or domestic violence and so on. The statistic that I gave yesterday, which I still find hard to believe, is that a third of domestic violence cases start during pregnancy. The cost of getting this issue wrong is more than £23 billion a year. That is so much more than the more modest investment we could make to get this issue right and prevent those problems and the huge issues they create, financially but also socially—problems that are often lifelong for future generations.

We need better attached children, and attachment dysfunction has gone under the radar for so long. It is therefore essential—I am glad that the hon. Members for Bath and for Lewisham West and Penge mentioned this—that the vital six-week checks on new babies should also include the physical and mental health of new mums, particularly first-time mums. I make no apology for repeating that health visitors have been an important component in helping with those checks, and one great achievement of the coalition Government—I was also part of the shadow health team when we worked on this—was the substantial increase in health visitors. That was based on the Kraamzorg programme in Holland, which we went to see. It showed that if we work intensively with new parents in those early stages, we can prevent many problems from happening later on. Health visitors are such a good investment to ensure happy, healthy, stable new parents who are able to interact in a sensible, robust, proper and healthy way with their children, and that is in the best interests of kids and their parents.

[Wera Hobhouse]

The health visitors in the early weeks when I was first a mother, and subsequently, were wonderful and a real lifeline. We do need to continue with that, but the problem is that it is not systematic enough. Making sure that a mandatory six-week health check is done by a GP and a health professional is the way forward. Currently, the system is too haphazard and we need to have a much more watertight system to get help to every woman who needs it.

[Tim Loughton]

We need both. The health checks are NICE-recommended, but alas not mandatorily funded or instituted across the country. Frankly, all GPs need better training on mental health and mental illness prevention generally, and especially on perinatal mental health.

It was a huge success of the coalition Government that we recruited almost the 4,200 target for health visitors that was set back in 2010. We have lost as many as 30% of those now, since the responsibility for health visitors went from the NHS to local authorities. I am not saying whether that was the right move or not, but, given the cash constraints on local authorities, health visitors have turned out to be a soft target. That is a hugely false economy and certainly needs to be revisited as a priority by the health team.

The lifelong importance of early attachment should not be underestimated. It has been judged that for a 15 or 16-year-old suffering from depression—an all too common problem among teenage children in schools—there is around a 99% likelihood that his or her mother was suffering from depression or some other form of mental illness during or soon after pregnancy. The correlation is as close as that. Not getting it right during the conception to age two period will have an impact on many children for their childhood years and, for too many, continuing into their adult years too. Maternal mental health is very important, not just for the mother herself but for her children and the surrounding family.

Let us not underestimate the impact this has on fathers as well. I will be ruled out of order if I go too much into the subject of male mental health—although I hope we have a debate on male mental health too—but the impact of poor attachment between a mother and baby has significant impacts on fathers. It is important that they are also given every help and support to have that attachment to their children. Too often, children’s centres and other support mechanisms are mum-centric and we overlook the role of the father. The father has an important role to play in the life of the child and an important support role to play in the physical and mental health of his partner, the mother.

The Government have done an awful lot in recent years to raise the profile of the importance of mental health and flag up how we need to do much more. Importantly, they are also investing much more in mental health. We talk about the parity of esteem between mental health and physical health, and we all agree that that is necessary. Much has been done to reduce the stigma that was attached to mental illness just 20 years ago. It is good that so much more money is going into the area. We have a shortage of mental health practitioners and we need to make sure that we prioritise recruiting, training and getting them in service as soon as possible.

The criticism I have is that last year’s Green Paper on mental health included a lot about school-age children, which is important, but virtually nothing on pre-school-age children and perinatal mental health. Shifting the age profile forward and making it more about prevention and early detection—rather than dealing with the symptoms of a child who may already be damaged because their mother was damaged in their early years—is the way we have to go. We have to do much more in schools, but we need to do so much more before children get to school, by working with their mothers and fathers at an early stage.

[Jeff Smith]

The hon. Gentleman made an important point about the reduction in funding for local authorities. When it comes to trying to provide holistic support to the family and mother, does he share my regret at the closure of so many hundreds of Sure Start centres since 2010?

[Tim Loughton]

I do not want to make this a partisan issue. We can have a debate on this subject, and there have been some cuts to support services that have obviously not been helpful and will have some of the long-term impact that I have mentioned. I have visited, and even opened in my time as Minister, several children’s centres, and many of them do a fantastic job. But many were not doing a fantastic job and were failing to do a job of work for the 15% of the most deprived communities for whom they were originally most intended.

The failure to comprehend the importance of children’s centres is to put too much trust in bricks and mortar. Many of the outreach services that went with children centres were more important, and they were not getting out enough. We have children’s centres that have worked really well in my constituency, and we have not closed any in West Sussex, largely because we put them in the right places and turned them into what I call a Piccadilly Circus of services. They have district nurses, health visitors, mental health nurses and social workers hot-desking and sharing information about various families, especially vulnerable children and others, to give a wrap-around, comprehensive support mechanism. The challenge so often for children’s centres is getting the parents—particularly dads—to come across the threshold. Some children’s centres do that really well, but many do not. I know about the importance of children’s centres, but I also know some of their weaknesses. It is the services they offer and the outcomes they achieve that are so much more important than the amount of bricks and mortar that exist to provide them.

[Jeff Smith]

The hon. Gentleman is making an important point, but, with the greatest respect, West Sussex did not have the kind of cuts to its local authority funding that many more impoverished areas such as Manchester and other big northern cities did. He is right that it is not just about bricks and mortar: it is the support services that were also cut that have had the greatest impact on young families in those areas.

[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.

[Mark Tami (Alyn and Deeside) (Lab)]

Does the hon. Gentleman agree that social media companies that hide behind the claim that they are just platforms and are not responsible for the content need to take a serious look at themselves?

[Tim Loughton]

The hon. Gentleman is absolutely right, and I am glad that the Government are doing that with proposals, which are currently being consulted on, to fine social media companies that do not take down harmful comment. I am not just talking about hate crime or terrorism; this is about how it can undermine impressionable young people in particular. There are laws in places such as France about such sites, and Germany has introduced heavy fines that can be imposed on social media companies.

This is a big problem. Mental illness is a particular problem for women who might be affected by relationship breakdown, domestic violence, homelessness, housing difficulties, missed education opportunities, unemployment, financial difficulties, debt, ill health, substance misuse and interaction with the criminal justice system. Mental illness takes different guises and different forms, but the earlier we act, and with the most appropriate support, the more likely we will be to do the best job for future generations, and that starts at conception.