Obesity Strategy 2020

Wera Hobhouse Excerpts

Thursday 27th May 2021 Commons Chamber

[Jo Churchill]

I understand why my right hon. Friend is calling for milestones but, although the problem is a national one, there are different numbers for the proportion of the population that is overweight or living with obesity in each area. We can set milestones, but a national mile- stone may mask whether we are achieving what we need to achieve in the areas—often the more deprived areas in our communities—where we need to help, encourage, support and educate people to get them further on this journey. I will listen attentively to his contribution, as I always do, and then I may come back to him in my closing speech.

Three out of five children are overweight or obese by the time they leave primary school. We know that there is a direct correlation between the dietary habits picked up early in life and behaviour later on. We are working to create the right health environment to support people, and I will set out briefly some of the actions we are taking, starting with out-of-home calorie labelling. Restrictions laid in the House on 13 May will require large businesses in England with 250 or more employees, including restaurants, cafés and takeaways, to display calorie information for non-pre-packed food and soft drink items that they sell. Many have already gone some way in doing that. These regulations will support customers to make informed, healthier choices when eating out or purchasing a takeaway.

As I said, many businesses have articulated to me that they understand fully the importance of providing information and being proactive in leading the way. They recognise the demand from their customers for more information so that they can pursue a healthier lifestyle. Smaller businesses currently do not fall within the scope of the regulations.

We have also listened carefully throughout the consultation period to individuals and stakeholders who have the challenge of living with eating disorders. We feel we have been careful and sensitive and have put in reasonable adjustments to help that group. We have also exempted schools from the requirement to display calorie information, given the concern about children in school settings. We have included a provision in the regulations allowing business to provide a menu without calorie information on request.

[Wera Hobhouse (Bath) (LD)]

The Minister knows that I have had a number of conversations about calorie counting. What really concerns me is the evidence base for whether this will really reduce the number of people suffering from obesity. As she knows, I am very concerned about the effects on people suffering from an eating disorder, and so far there is no evidence that it will make a significant difference to those who suffer from obesity. Can she provide me with some numbers or assure me that there will be a constant watch on how this is actually affecting those with obesity?

[Jo Churchill]

If the hon. Lady allows, I will go through the rest of my contribution. I hope she will take away that this is about building blocks. As I said, it is a complex situation, and there is no silver bullet. We must look at the antecedents of both conditions, including the link to mental health for those who suffer from anorexia and certain other eating disorders, and at some of the broader challenges when we are looking at those who are overweight or living with obesity. They need to be taken in the round, but one cannot be cancelled out against the other.

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[Wera Hobhouse (Bath) (LD)]

I speak today as the chair of the all-party parliamentary group on eating disorders and I want to highlight the anxiety felt by many of those with an eating disorder about one specific aspect of the obesity strategy: calorie labelling on menus. Obesity causes serious health problems and there is no doubt that far too many people in this country do not have a healthy weight. I add my unequivocal support to the Government’s aim of addressing obesity, but obesity has to be considered as one side of our complex relationship with food. It is a form of disordered eating and therefore cannot be separated from other forms of disordered eating and cannot be dealt with in isolation. Calorie labelling on menus will not only be ineffective in tackling obesity, but will actively damage those with an eating disorder.

Studies show that there is only a small body of low-quality evidence supporting the suggestion that calorie counts on menus lead to a reduction in calories purchased. While there is limited evidence that calorie labelling will support the public in losing weight, there is convincing evidence that it would harm people with an eating disorder. About 1.25 million people in the UK have an eating disorder, and the 2019 health survey found that 16% of all adults aged 16 or over screened positive for a possible eating disorder. Over the pandemic, the charity Beat has reported a 173% increase in demand for eating disorder support, and research shows that individuals with anorexia and bulimia are more likely to order food with significantly fewer calories when presented with a menu including calorie counts. Those with binge eating disorder are more likely to order food with significantly more calories.

Many people with eating disorders also live with obesity. Up to 30% of people seeking weight management services would meet the diagnostic criteria for binge eating disorder. Clearly, a reductionist approach to nutrition means that the obesity strategy risks harming some of the very people it is designed to support.

[Mr Harper]

I am sympathetic to the point the hon. Lady is making, and she will know from my intervention that I think the evidence with respect to calories and out-of-home labelling is quite weak. Is labelling on products purchased in supermarkets also a problem for those with eating disorders? I ask that genuinely; I do not know the answer. Can she furnish that information?

[Wera Hobhouse]

I am particularly concerned about calorie labelling in restaurants. People who suffer from eating disorders are isolated and fearful of contact with others because they are thinking continuously about what they are going to eat or drink. Going out to a restaurant gets them through that step, and it is often a significant step towards recovery. As I say, my particular concern is labelling on restaurant menus.

In response to the survey on calorie labelling conducted by Beat, one respondent said:

“My eating disorder thrives off calorie counting and knowing all the calories in everything. I would feel compelled to look at calorie labels”

in restaurants and

“I would feel embarrassed asking for a different menu. Please don’t do it. Please.”

The Mental Health Minister has been extremely generous with her time, listening to the all-party parliamentary group’s concerns about the plan to mandate calorie labelling on menus. The APPG is grateful for her interest in improving early access to eating disorder treatment. However, I must repeat my plea to the Government to look again at this element of the obesity strategy.

Addressing obesity and tackling eating disorders should not be in competition. We must tackle them together. I look forward to working with the Minister to develop an obesity strategy that successfully addresses the obesity epidemic, but does not harm people with other forms of eating disorder.

Black Maternal Healthcare and Mortality

Wera Hobhouse Excerpts

Monday 19th April 2021 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I am grateful that we are debating this important petition today and pay tribute to the women who have bravely shared their stories, from those involved in the “Dispatches” documentary to the Five X More campaigners to some of my own constituents in Bath.

The disparity in maternal health outcomes between black and Asian women and white women is one of the most frightening elements of systemic racism in today’s society. The statistics revealed in the MBRRACE report should shock and horrify us all. It should go without saying that health outcomes should never be determined by race, but for too many women this is the awful reality when accessing healthcare. One of my constituents said:

“I have two dual heritage daughters. As things stand, they are three times more likely to die during pregnancy and childbirth than my white friends’ daughters.”

Another wrote to me to share her concern that her race affected the way she was treated.

She felt she was not properly informed about the options open to her, her concerns were not taken seriously, and she could not say no when she felt uncomfortable.

Closing the gap between maternal health outcomes for white women and for women of colour must be a priority for the Government. It is not enough merely to recognise the disparity; we need a specific target to dramatically cut the rate of maternal deaths among black women. I urge the Minister to ensure that targets are in place to halve the disparity in the next five years. We need more and properly funded investigations into maternal death, with recommendations that are actioned. We need national accreditation for those who provide language support in maternity care, and we need to look at health outcomes for those new mothers who have no recourse to public funds because of insecure immigration status.

On top of that, if we are serious about eliminating maternal health inequalities, we must tackle the inequalities that exist in all areas of society. We know that the pandemic has made all inequalities much worse. Women from ethnic minority backgrounds made up 56% of all pregnant women having to go to hospital in the early months of the pandemic. Women from ethnic minority backgrounds are more likely to be key workers, giving them an increased risk of contracting the virus. They are more likely to be in insecure employment, which leaves them without basic maternity rights. They are at risk of higher exposure to discrimination and poor treatment at work, affecting their mental health. Once again, I urge the Treasury to look at Maternity Action’s proposals for amending the furlough scheme. It would allow employers to claim 100% of the cost of maternity suspension for women who are over 28 weeks pregnant, or pregnant women with underlying health conditions—we have heard today that underlying health conditions make it much more risky for pregnant women from different ethnic backgrounds.

I hope that the powerful personal stories shared by so many brave women will spur urgent action from the Government. We need to listen to black women, to ensure that pregnancy and childbirth are safe for all.

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[Ms Dorries]

I will go further and explain what we are hoping to do to make a difference. We know that for every woman who dies, 100 women have a severe pregnancy complication or a near miss. That has been mentioned a number of times. When that woman survives, she will often have long-term health problems. Disparities in the number of women experiencing a near miss also exist between women from different ethnic groups. Because near misses are more common than maternal deaths, we can investigate those disparities at local and regional level, to better understand the reasons for disparity, to assess local variation and to identify areas with less disparity and, hence, best practice.

[Wera Hobhouse]

Is it not clear from everything we hear that black women and women from ethnic minorities feel that the health system does not communicate appropriately, so they do not understand all the choices available to them? Is that not a way of getting to the bottom of what is going wrong?

[Ms Dorries]

That is certainly one of the many issues highlighted in the report, but it is not the only one. We have commissioned the policy research unit in maternal and neonatal health and care at the University of Oxford to undertake research into the disparities in the near misses, and to develop an English maternal morbidity outcome indicator. The research will explore whether the indicator is sufficiently sensitive to detect whether the changes made to clinical care are resulting in better health outcomes. Five X More called for that in its list of 10 requests.

We are putting the research in. We have found a way to look at the research in order to make the differences that need to be made. We can do that by examining the near misses. What happened in those cases and in those women’s experiences? What went wrong? Do the women feel that they were not listened to? Was it a matter of treatment? Was it a lack of understanding? We need to understand that by looking at the near misses. The research is being undertaken, but it will take some time. Hopefully, when that is reported, we will be able to make progress on the issue of setting targets.

This Government are no strangers to setting targets. On the very sad issue of baby loss, we set a target to reduce neonatal stillbirth and neonatal mortality rates by 20% by 2020. We have reached almost 25%. We have smashed that target and are still pushing forward to improve that situation even more. We are not afraid of setting targets, but when we are setting them we have to know how to achieve better outcomes. The hon. Member for Battersea (Marsha De Cordova) mentioned continuity of carer. She is absolutely right about those figures. We know that continuity of carer works incredibly well, particularly for black women and women from ethnic minorities. Having the same midwife throughout the process of pregnancy makes a huge difference. That is being rolled out across the country. I am sure that the hon. Lady has spoken to the chief midwifery officer, who is a huge supporter of the policy. We are continuing to roll it out and make progress with it. It has been slightly more difficult during the 12 months of the covid pandemic, particularly because many trusts did not continue with home births.

We are not afraid of setting targets, however. Setting targets in maternity units is what we are about, to make them safer places in which to give birth and in order to reduce both neonatal and maternal mortality rates, but we need to do the research on the near misses, to understand what the problems are. We cannot set targets until we know what we are trying to achieve through those targets and what we need to address. Five X More has asked for that research to be done. It needs to be done, and it will be done.

We are committed to reducing inequalities and to improving outcomes for black women—we work at that daily. I established the maternity inequalities oversight forum to focus on inequalities so that we in Government understand what the problems are. The forum also brings together experts from across the UK—we have met MBRRACE-UK and Maternity Voices—who have done their own research and studied this problem, to hear their findings and recommendations. Professor Jacqueline Dunkley-Bent, the chief midwifery officer for England, is leading the work to understand why mortality rates are higher, to consider the evidence on reducing mortality rates, and to take action to improve the outcomes for mothers and their babies.

NHS England is working with a range of national partners, led by Jacqueline Dunkley-Bent and the national speciality adviser for obstetrics, to develop an equity strategy that will focus on black, Asian and mixed-race women and their babies, and on those living in the most deprived areas. The Cabinet Office Race Disparity Unit has also supported the Department of Health and Social Care in driving positive actions through a number of interventions on maternity mortality from an equalities perspective. The Royal College of Obstetricians and Gynaecologists has established—

Women’s Health Strategy

Wera Hobhouse Excerpts

Monday 8th March 2021 Commons Chamber

[Ms Dorries]

I would like to reassure my hon. Friend, and I hope that she will do her utmost to make sure that those women she is aware of are aware of the link and will provide us with their evidence. It is the evidence that we need to develop the women’s health strategy, so we need to hear from exactly the women she is talking about. Complex needs are just that: they are very complex. We need to know about these women’s experiences in the healthcare sector—what acts as a barrier to them, where they think they are not heard, where they think their voices are drowned out and where they feel they are not listened to and do not get the services they should get. I will use endometriosis as an example. It can take women seven to eight years to be diagnosed, all the time being told that they may have a mental health condition, that it is something they have to live with and that that level of pain is normal for a woman to experience, when none of those things is true. We want to hear from those women.

I thank my hon. Friend for her question, which is really important. She is right: many women suffer from a number of complex health issues and have difficult lives. That is why we have made responding so simple, via a link on a phone and taking a few minutes. I really hope that those women hear this call and will respond.

[Wera Hobhouse (Bath) (LD) [V]]

I welcome the Minister’s statement on the women’s health strategy. It has already been mentioned this afternoon but, as the chair of the eating disorder all-party parliamentary group, it needs emphasising again: eating disorders have the highest mortality rate of all mental health disorders. While eating disorders do not discriminate, they affect women disproportionately. The longer they go untreated, the longer and more complicated it is to recover. Will the Minister look at the evidence—there is already plenty of it—showing that we urgently need waiting time targets for adult eating disorder services?

[Ms Dorries]

I thank the hon. Lady for her question; I was waiting for it as I knew she would be contributing today. We have had private conversations about this issue, and I want to reassure her. I hope she noticed that some of the £79 million I announced last week will be going towards dealing with eating disorders and the recent surge in referrals to mental health services. She is right to say that there is lots of evidence, and we are aware of what happens with eating disorders and how they develop, and we work with charities, as she well knows. We would still like those women to respond to this call to evidence.

Many women struggle to get anyone to listen or understand that they have an eating disorder. We struggle to identify them early enough or pick up such things. We still need to gather that evidence, because it is at certain points of contact that healthcare professionals do not recognise or realise that they are dealing with an eating disorder. That is the kind of thing that we think we could get fresh evidence about from women by them clicking on the link and letting us know, either via their phone or their laptop. The hon. Lady has a huge number of contacts, so I urge her to inform them and ask them to contribute to the call for evidence.

Covid-19

Wera Hobhouse Excerpts

Tuesday 12th January 2021 Commons Chamber

[Wera Hobhouse (Bath) (LD) [V]]

Covid has created many additional challenges for our country and I want to touch on but a few. Women, particularly pregnant women and new mothers, are more likely to be in insecure jobs. The result is that women have been even more likely to see a loss of income. The Government have finally released guidance for pregnant women in the workplace. It took nine months of campaigning by groups such as Maternity Action to push the Government to release that guidance. I urge Ministers to look at adapting furlough schemes to allow employers to recover the full cost of the maternity suspension of women who are 28 weeks pregnant and beyond.

Many students in my constituency have written to me in the past couple of weeks. They are feeling isolated and let down by the lack of guidance that their universities have received from the Government. In addition to paying full tuition fees, they are also paying thousands of pounds for accommodation they cannot live in. I am calling on the Government for the rapid implementation of a review of this academic year, including recommendations for financial compensation.

I want to add my voice to the calls to prioritise teachers and school staff for vaccination. If the Government are serious about prioritising education, then the profession must come top of the priority list after the most clinically vulnerable and those on the frontline of healthcare. Protecting teachers and school staff from the effects of the virus must be a key part of the plan to get children back into schools. There would be no education for young people without the staff to deliver that education.

The same applies to the staff working in early years settings. The Government must urgently look at the support for early years providers. These remain open despite the fact that staff do not have access to testing and are not prioritised for vaccination. Widcombe Acorns, an outstanding pre-school in Bath, has raised concerns that settings are not able to make their own decisions as to whether they stay open. I urge the Government to confirm what they will do to support early years providers, both in terms of testing and access to vaccines, and on the flexibility to make their own decisions on closures to protect their workforce.

Ockenden Review

Wera Hobhouse Excerpts

Thursday 10th December 2020 Commons Chamber

[Ms Dorries]

My right hon. Friend asked a number of questions that deserve answers, so please bear with me. His first point was about the number of caesarean sections and the thought or belief in the hospital that it was a good thing not to have them, which the report identifies.

The report shows us that there were years when C-sections at Shrewsbury and Telford were running at 11% and the national average was 24%, and at 13% when the national average was 26%. That demonstrates a lack of collegiate working between midwives, doctors and consultants. Most of the report’s recommendations show that, fundamentally, that is the problem: a lack of communication and an unwillingness to work with people—the medics, doctors, obstetricians and midwives. My right hon. Friend is absolutely right about intervention. There is the old saying, “Mother knows best”, but every woman should own her birth plan and be in control of what is happening to her during her delivery.

I give all thanks to my right hon. Friend, because this report is fundamental in terms of how it is going to inform maternity services across the UK going forward, not least because the NHS is working on an early warning surveillance system. What happened at Shrewsbury and Telford was that it was an outlying trust. As with East Kent and others, including Morecambe Bay, where we have seen issues, there has been an issue culturally; they are outlying, without the same churn of doctors, nurses, training or expertise. The NHS is now developing a system where we can pick up this data and know quickly where failings are happening.

Oxytocin is a drug used in the induction of labour to control the length, quality and frequency of uterine contractions. There are strict National Institute for Health and Care Excellence guidelines on the use of that drug. My right hon. Friend is correct: every trust should follow the guidelines. By highlighting that in this report, we will ensure that trusts are aware of those guidelines and that they are followed in future.

[Wera Hobhouse (Bath) (LD)]

Our heart goes out to all those who have suffered these tragic events and losses; those of us who are parents or grandparents suffer with these families. May I ask the hon. Lady a question as the Minister for Mental Health? The mental health of mothers during and after pregnancy is vital, not just in the tragic circumstance of baby loss or severe injuries during birth. Will she ensure that training in perinatal mental health becomes a strong focus for improving maternity services across the country?

[Ms Dorries]

I hope the hon. Lady will not mind my mentioning it, but I know that she is about to become a grandmother herself soon, so I understand the reason for her questioning. She raises a very important point. I know she is aware, because I believe we have had this conversation, that we are focusing on women in the Department at the moment, and of course the mental health of women is a big part of that. The post-natal depression services that have been rolled out across the UK in the past 18 months are a testament to the fact that we are focusing on mental health. I take her point on board, and she has made it before.

Obesity: Covid-19

Wera Hobhouse Excerpts

Tuesday 10th November 2020 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is a pleasure to take part in this debate with you in the Chair, Mr Davies, and I congratulate the hon. Member for Strangford (Jim Shannon) on introducing this important issue. It is also a pleasure to follow the hon. Members for Vale of Clwyd (Dr Davies) and for South West Bedfordshire (Andrew Selous). The hon. Member for Vale of Clwyd is a GP and the vice-chair of the all-party parliamentary group on obesity, so he speaks with great authority on this subject.

I believe that we have to focus on the social inequalities that are at the very bottom of this issue. Let us tackle it from that perspective. Obesity is, of course, a major problem and can greatly increase a person’s risk of other health conditions. It is absolutely right that supporting people towards a healthier weight is a Government priority, and I fully support it. Any strategy aimed at tackling obesity must recognise that it is a complex condition with many underlying causes, including factors tied to socioeconomic issues. Managing weight is often not simply a matter of just eating less and exercising more. Unless that is recognised, this strategy will not be effective in the long term.

I want to say something about my experience as a councillor. Before I became a Member of Parliament, I was a councillor in one of our most deprived councils, and 10 years ago we tried to ensure that children learned how to eat healthily. If people cook their own food at least they know what is in it, so we tried to ensure that people knew how to cook. We then recognised, going even deeper into that, that a lot of families did not even have the means to cook. Some of the children had never seen water boil.

Those are the issues we face if we are talking about how to teach children early how to eat healthily, cook their own meals and know what is in their own food. Some families are at that level of deprivation: children have not learned to cook and have not seen their parents cook. That is how deeply we need to get into the issue. We need to understand that, without stigmatising families who live like that and without using language that shames people who are overweight. We must understand that, additionally, there are mental health problems and other deeper underlying problems that go with this issue. I urge the Minister to go deeply into that subject and recognise the social inequalities that lie at the bottom of it.

I want to talk about one particular aspect of the strategy that concerns me—calorie labelling in restaurants. There is limited evidence to suggest that that measure has a meaningful impact on tackling obesity. Worse still, it could be harmful for those at risk of living with or recovering from an eating disorder; that is, of course, at the other end of this problem. There is an epidemic of people suffering from eating disorders such as anorexia and bulimia and being underweight. Approximately 1.25 million people suffer from an eating disorder in the UK. It is also true that many people living with an eating disorder also live with obesity. Treatment, therefore, is not as simple as consuming fewer calories. The eating disorder charity Beat is one of many voices sharing concerns about that aspect of the obesity strategy, and I ask the Minister to look carefully into that concern. Calorie counting is well recognised as an unhealthy behaviour: one sufferer described it as an “all-consuming obsession” that “took over my life”. Learning to disregard calorie counts is a large part of recovery from an eating disorder. Having the freedom to go to a restaurant with friends or family—something that many of us take for granted—can be a very big step.

I highlight a quote from one of Beat’s volunteers:

“One of the greatest joys of recovery is being able to go to a restaurant for a meal with friends, and I enjoy going out now with my friends and family, but I really struggle to eat in public once I have noticed the calories. Once I have seen the number, I can’t stop my brain telling me I can only have the food with the lowest amount of calories.”

Research shows that individuals with anorexia or bulimia are more likely to order significantly fewer calories when that information is provided.

Eating disorders and obesity can in many ways be part of our somewhat strange relationship with food. People can go from obesity into bulimia—these things are connected—and it is important that we recognise that. I was extremely grateful to the mental health Minister for meeting me and representatives from Beat a few weeks ago. I appreciate the time she spent listening to our concerns about this element of the strategy, and I know she is committed to supporting those with an eating disorder. As chair of the all-party parliamentary group on eating disorders, I would welcome the opportunity to have another meeting with her and representatives of Beat to talk about that particular, very concerning aspect of the obesity strategy.

Yes, we absolutely need to recognise that obesity is a massive public health issue. We need to tackle it, and I welcome the fact that the Government have made it a priority. But it is important that we make sure that the strategy does not hit people with an eating disorder, such as anorexia or bulimia, in an adverse way.

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[Wera Hobhouse]

The hon. Lady is focusing on the number of takeaways in those communities. They are there because people cannot cook for themselves. It is important that the Government look at how many families have the ability to cook for themselves. I recognise the temptation to order a takeaway, but it is the result of the problem of people not being able to cook.

[Jo Gideon]

I thank the hon. Lady and absolutely agree. There are other factors as well, including income, housing, access to green space and exposure to junk food advertising.

On the extra factors, I discussed the issues around exercise with Stephanie Moran, the executive principal of the Esprit Multi Academy Trust, and visited the Grove Academy in Hanley to see first hand the challenges of organising outdoor exercise in a covid-safe way. This Victorian-built junior school, which was built for 100 people in a busy, dense residential area, has no green space and an inadequate playground area for what are now up to 480 pupils to exercise daily. We must include the right to exercise as a vital element of tackling obesity as well as looking at nutrition, and ensure that schools such as Grove Academy have access to green space.

Recently, I spoke to consultants at the Royal Stoke University Hospital, who shared their concerns about the increasing number of children with type 2 diabetes whom they had to refer as a consequence of poor diets and unhealthy lifestyles.

The Government started to address the challenge of poor diet in 2018 with the soft drinks industry levy, which has led to a significant reduction in the sugar content of drinks. This July, I wholeheartedly welcomed the Government’s Better Health campaign, which looked to address some of the issues through measures such as a ban on the TV and online advertising of fatty foods before 9 pm, and an end to all “buy one get one free” deals on unhealthy foods.

However, successive Governments have adopted different approaches to tackling obesity and, until now, they have neglected to address the structural inequalities that are so strongly linked to levels of obesity. The national food strategy and the Government’s obesity strategy are intended to be long-term approaches with comprehensive and holistic solutions.

I was delighted with the announcement from the Department for Work and Pensions earlier this week. It confirmed that, as of April next year, the Government will increase the amount of financial support made available to pregnant women or those with children under the age of four, to help them buy fruit and vegetables. The recommendation is to increase the rate of the Healthy Start payments from £3.10 to £4.25—just one of the core recommendations in part 1 of the national food strategy. It is a decisive step in the right direction, and I look forward to working with the Government, through my chairmanship of the all-party parliamentary group on the national food strategy, to see future recommendations implemented as part of their strategy for tackling obesity and malnutrition in the UK.

I say this to the Minister: although obesity is perceived as a health issue, for the reasons we have discussed today, it very much also goes to the heart of levelling up, so I believe that the solution can only be found in a cross-departmental way.

As we slowly but surely emerge from this pandemic, it is important we do everything in our power to capitalise on the momentum and shifting public perception within our attitudes towards tackling adult and childhood obesity. By addressing the structural, economic and social inequalities that exist in parts of the UK and by implementing the long-term and holistic solutions that will emerge from a national food strategy, we will be in the unique position to turn the tide on obesity once and for all, and ensure that everyone has access to healthy food and opportunities to exercise in every community across our country.

Covid-19

Wera Hobhouse Excerpts

Tuesday 12th May 2020 Commons Chamber

[Wera Hobhouse (Bath) (LD) [V]]

I wish to put on record my warmest thanks to all our doctors, nurses and care workers here in Bath, to the police and emergency services, key workers and council workers, and to everybody else who has helped us keep going during lockdown.

The covid pandemic has forced us all to change our lives in ways we would not have imagined only a few months ago. In all of the hardship and tragedy of this time, one of the brightest points has been the improvement in our air quality, because many fewer cars are on the road. As we have adjusted to lockdown, many people have commented that they have thought about the benefits of talking a walk or going for a bike ride, because it is much more relaxing and there is more time to reflect. Walking and cycling contribute greatly to our wellbeing. We have talked at length about social distancing measures and the space we need to give each other when we are socially distancing. In this country, safety has always been a barrier to cycling, but now, as our towns and cities are less congested, cycling has become a much safer option. Of course, we want to restart the economy as soon as it is safe to do so, but when we do we have a once-in-a-lifetime opportunity to look at our streets with fresh eyes. We need to think about what did and did not work before lockdown, and at what we want to achieve as we put in place the conditions for a new normal.

For decades we have been overdependent on cars, and that must change. I have also spoken before about the need to tackle emissions from surface transport. We have been having these discussions in my city of Bath, which has suffered from severe air pollution, for many months now. As we slowly emerge from lockdown, we need to look at ways to avoid a dramatic resurgence in car use, particularly as many people may be nervous about using public transport. Other countries are already looking at ways to rebalance the priority given to cars over cyclists and pedestrians in urban areas, through segregated cycle lanes, speed reduction zones or new and widened pavements. I welcome the Transport Secretary’s new guidance to local authorities. Early action will be crucial, in order to embed changes in behaviour This is a great moment for change, and we must ensure that our economic recovery is focused on the need to get to net zero.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I now call the shadow Secretary of State to wind up for the Opposition and ask that he speaks for no more than eight minutes.

Women’s Mental Health

Wera Hobhouse Excerpts

Thursday 3rd October 2019 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House notes with concern the rise in mental ill health among women, with one in five now experiencing common mental disorders and young women the most at-risk group; recognises that women’s mental health problems are often rooted in experiences of violence and abuse; believes that mental health services often fail to respond to women’s specific needs, including their experiences of trauma; calls on the Government to ensure that the gender- and trauma-informed principles of the Women’s Mental Health Taskforce are adopted by mental health services and that women’s mental health needs, including their experience of violence and abuse, are prioritised and taken seriously in all mental health policy, strategy and delivery.

Constituents often come to us at their lowest point, and we see them going through anxiety, depression and trauma. Poor mental health affects not only the individual, but everybody around them. Women are far more likely to experience serious mental health issues. Young women are at the greatest risk, with one in five having self-harmed and 13% having been diagnosed with post-traumatic stress disorder.

Over the course of this Parliament, there has been a great deal of talk in this House about mental health, which is progress, but the opportunity to discuss women’s specific needs when it comes to mental health services has been limited. Ten months after the publication of the final report of the Women’s Mental Health Taskforce, little has changed. There is a long way to go before our mental health services work for women. There is an obligation on Government to step in and respond to the growing crisis in women’s mental health with a substantive policy.

[Jeff Smith (Manchester, Withington) (Lab)]

I very much welcome the work of the Women’s Mental Health Taskforce, its report, and the principles laid out in it. Does the hon. Lady share my concern that those principles will not be effectively implemented unless there are clear targets and concrete commitments from the Government, and that the next stage needs to be a full strategy on women’s mental health, with those targets and commitments in it?

[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.

[Jeff Smith]

I thank the hon. Lady for giving way again; she is being very generous. A number of my constituents have been in touch about perinatal check-ups. My constituent Catherine told me of her experience:

“I asked for a 6 week check with a GP—this was, at best, brief. Physical symptoms were looked at, but nothing was checked with regards to my mental health. There needs to be a standard physical and mental health check for ALL new mothers.”

Does the hon. Lady agree that we need to do better?

[Wera Hobhouse]

Yes indeed. I talk to campaigners, who are now looking at the new general practitioner contracts that are going out. That is definitely a way forward, but we also need to ensure adequate training, because people have to ask the right questions. The issue is sort of stigmatised; everybody thinks, “You’re a new mum—you should be on top of the world.” Nobody really wants to admit that motherhood can be very difficult, and that one does not always feel great. We need training, so that when new mums come in, they are asked the right questions.

Going back to eating disorders, they have the highest mortality rate of all mental health conditions. There are about a million sufferers from eating disorders. That is an epidemic of illness that is going undiagnosed and untreated. We must do much better. Our NHS is not well equipped to spot the problem early and treat it. Waiting times for adults have been shooting up over the last few years. Outdated methods, such as the body mass index measurement, are still being used to diagnosis the condition, but that fails to recognise that at the core of an eating disorder is a mental health, not a physical health, problem. Despite increasing public and professional awareness of eating disorders, medical students receive only two hours of training in the condition and its treatment during their entire time in medical school.

Those are just a few examples of where our NHS does not work for women’s mental health. We need a strategy. The Women’s Mental Health Taskforce did some extremely important work, but its recommendations have been left on the shelf. A Government strategy would help individual trusts to make the changes required to implement the recommendations. The Liberal Democrats have championed the fight for better mental health care for many years, and we believe that mental and physical health should be supported equally by our services. I have highlighted a few areas where women’s mental health provision could be improved, and I am looking forward to the debate and to the Minister’s response.

[Sir David Amess (Southend West) (Con)]

As a man, I make no apology for contributing to this debate, Madam Deputy Speaker, because I come from a household in which four of my five children are women. My late mother had a big role in my life and, of course, I do have a wife. I am prepared to say that I think women are the fairer sex but, by and large, they do have the tougher deal in life. I certainly would never fancy giving birth to a baby, and there are so many other things that women face that men do not.

I congratulate the hon. Member for Bath (Wera Hobhouse) on allowing us to debate this subject. I agree with all her points, and I just want to pick out a few other subjects that colleagues may not talk about later in the debate. With World Mental Health Day just one week away, I am pleased that the hon. Lady has secured this debate because, as she said, reports indicate that one in six people has experienced a common mental health problem in the past week—truly shocking. With a population of roughly 65 million in the UK, almost 11 million people need to access publicly funded support. The prevalence of mental health issues is similar for men and women in the UK but, as I have said already, women have to deal with different challenges. The House of Commons Library’s superb briefing on this topic makes it clear that the greater caring responsibilities and a high risk of domestic violence are contributing factors to the challenges that we are discussing today.

I was not in the Chamber yesterday for the Second Reading of the Domestic Abuse Bill—I was in my House of Commons office—but I was dumbfounded by the speeches. The hon. Member for Dewsbury (Paula Sherriff) may sit on the Opposition Benches, but she is a thoroughly wonderful colleague in every respect. She has had some terrible issues to deal with over the past few months and beyond, and I think of her struggle and hope that colleagues are rallying round to support her. We then heard the speech from the hon. Member for Canterbury (Rosie Duffield) the likes of which I have never heard before. It was so brave and truly shocking, but she was prepared to share that with colleagues. The hon. Member for Bradford West (Naz Shah) then told us about her life and I just could not believe it. It must have taken enormous guts and courage to speak publicly about it, knowing that all sorts of people on social media are going to pick up on the issue while not necessarily being sympathetic. It was a wonderful debate, and I absolutely agree with Mr Speaker that the tone used yesterday and today is far better than that used in recent months.

Women are more likely than men to experience anxiety, depression, post-traumatic stress disorder and eating disorders, as the hon. Member for Bath said. We need to recalibrate entirely how the media put ideas into young women’s minds about how they should look and how they live their lives. There is so much pressure on them to have the perfect figure or the perfect look, which is unreasonable and definitely adds to mental health issues. The suicide rate for young women has more than doubled in the past 10 years, which is shocking. Such facts are easy to speak about, but it is for the House of Commons to try to come together to think of some solutions.

I have two former Ministers behind me—my hon. Friends the Members for Thurrock (Jackie Doyle-Price) and for East Worthing and Shoreham (Tim Loughton)— who have more expertise in this subject than me and who did great work. I really am glad that this subject has at long last reached the top of the political agenda. I sat on the Select Committee on Health for 10 years and although we held inquiries into abuse in institutions in which people with mental health issues were detained, we never really tackled what lay behind those issues, so I am glad that we are highlighting them today. Since 2010, Back Benchers have come together to put pressure on Governments of different persuasions to set up the Women’s Mental Health Taskforce, which was a clear indication of the Conservative party’s commitment to understand and address problems with current women’s mental health support. It was also announced at the party conference in Manchester that funding will be made available for 1,000 extra staff in community mental health services.

I congratulate the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), on her appointment, and I wish her well. However, my hon. Friend and parliamentary neighbour, the hon. Member for Thurrock, spent two days at the Dispatch Box just before we—how can I put it delicately?—formed a new Government responding to points about mental health issues. She was a first-class Minister, and I thank her very much for her work highlighting the mental health challenges that women face. I am glad to see her here today, and I shall enjoy listening to her speech.

My hon. Friend used to be the Parliamentary Under-Secretary of State for Mental Health, Inequalities and Suicide Prevention and was kind enough to meet me together with my constituent Kelly Swain and her team at N.O.W Is The Time For Change. Kelly works tirelessly to provide alternative therapies and wellbeing classes to people of all ages. Before my hon. Friend left office, she seemed to have a magic wand, because I find that Kelly Swain is now pushing at open doors in trying to spread her message throughout Essex, so I thank my hon. Friend for that. The all-women leadership team led by Kelly Swain works so well together, and I am glad that local organisations, along with the clinical commissioning groups, are now considering how they can integrate and support the ideas that Kelly has promoted.

Another trailblazing constituent is Carla Cressy. I look to the hon. Member for Dewsbury at this point, because she was present at a meeting with Carla and my hon. Friend the Member for Thurrock. Again, it may seem strange to have a chap as the chairman of the all-party parliamentary group on endometriosis, but it was decided that I should chair it, and I am very proud of that. I now understand the damaging effect that the condition can have on women’s mental health, and I salute my constituents. Carla’s charity is called Women with Endometriosis, which seeks to provide comprehensive mental health support to any woman facing that uphill battle, and I will continue to support her work in any way that I can.

Something that both those charities have in common, other than the brilliance of the two founders, is a commitment to pulling down barriers and removing any stigma around mental health. As the hon. Member for Bath so rightly said, it is difficult to talk about these topics, and people can be branded very unfairly. We must do something to change people’s perception of women who have mental health issues, and there are still more barriers to be brought down. I have been in this place for 36 years—some people might say that that is too long, but I still have a bit more that I want to do—and there are still issues to tackle, and my two constituents have brought the challenges home for me in very different ways. Both their organisations provide tailored support to individuals, and they are always ready to listen without judgment. That is a basic requirement for mental healthcare at any level, and it would be a great asset to our nation if we could provide that service to every person who required it.

As the hon. Member for Bath rightly pointed out, mental health issues are probably the most difficult healthcare issues to deal with. When I first became a Member of Parliament, I did not see many people with mental health issues at my surgeries, but now that is a regular occurrence. Of course, people with mental health issues need our time, but Members of Parliament are not necessarily equipped with the expertise to give advice and support; we try to signpost people in the right direction. I am sure all Members would say that, although they are very grateful for their local mental health services, we could all do better. That is where the real investment needs to be made.

[Wera Hobhouse]

I go to many schools. Mental health problems often start early, when people are teenagers, so does the hon. Gentleman agree that it is important that mental health services are also provided through schools? That is where we are falling very short.

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[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.

--- Later in debate ---

[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.

--- Later in debate ---

[Wera Hobhouse]

I thank the Backbench Business Committee for granting this debate, everybody who has made vital contributions this afternoon and the Minister for her responses. If I could take one thing out of this afternoon it would be for the Government to take seriously my request for the Women’s Mental Health Taskforce recommendations to be put into a full strategy in order to bring everything together.

Question put and agreed to.

Resolved,

That this House notes with concern the rise in mental ill health among women, with one in five now experiencing common mental disorders and young women the most at-risk group; recognises that women’s mental health problems are often rooted in experiences of violence and abuse; believes that mental health services often fail to respond to women’s specific needs, including their experiences of trauma; calls on the Government to ensure that the gender- and trauma-informed principles of the Women’s Mental Health Taskforce are adopted by mental health services and that women’s mental health needs, including their experience of violence and abuse, are prioritised and taken seriously in all mental health policy, strategy and delivery.

Body Image and Mental Health

Wera Hobhouse Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

It is a real honour to speak in this debate, and I regret that not many people are here to participate in it, but as we know, today is today. Even though I have only recently become a Member of Parliament, I echo the comments about what a pleasure it has been to work with the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), and I hope that she will continue in her post.

We have talked about many issues, and I want to pick up on what has been said about the cynicism with which advertising exploits vulnerable people. I will be speaking mostly on eating disorders, and many victims of eating disorders already have a massive problem, even before they go online. If they then order slimming pills online, for example, they will be bombarded by adverts persuading them to buy even more, which they then do. That is nothing short of exploitation, and we need to be alert to that.

We are all ultimately affected by our body image. People might say to me, “Well, you look all right”, but we all think, “Well, this could be better and that could be better.” We all want to please the people around us and ourselves when it comes to what we look like, and that is nothing new. It is only unusual or harmful when it so negatively affects us that it is the only thing that guides our lives. There is a certain intolerance surrounding having to have a particular look, and that is where the real danger lies. People feel they have to look a particular way rather than feeling that it would be fun to look this way or that way and to be playful with what they look like. Instead, they are being shoehorned into a particular image, and anyone who does not fit that image can be badly affected and develop serious mental health problems, including eating disorders. I have been campaigning on the particular issue of eating disorders and mental health.

This debate is important for millions of people across the country, and I hope that we can set an example today by honestly exploring the issues. In fact, I think we already have. In a culture that is obsessed with image, we must talk more openly about the impact that body image scrutiny has on our mental health. It has been said before that we are focusing too much on how we look, rather than on who we actually are as people and what we can bring to the table, whether we are short or tall, male or female. That is one of the obsessions of our society: we are always thinking about what we look like, rather than about who we actually are.

For the past year, I have been campaigning for better treatment for eating disorders. Speaking openly about such conditions is more important than ever, because early identification and intervention are key. Mental health conditions thrive in the shadows and are protected by our ideas about what is and is not appropriate to talk about. Eating disorders have a reputation, and sufferers who do not fit cultural stereotypes are often afraid to speak out or, worse still, are refused help.

[Mr Kevan Jones]

The popular image of eating disorders is that they mainly affect young women, but does the hon. Lady agree that young men and people of all ages are increasingly likely to be affected?

[Wera Hobhouse]

The right hon. Gentleman is absolutely right, and that has been explored in several debates on eating disorders. We are somewhat hemmed in by stereotypes, and I wonder whether our age is particularly prone to that. We think eating disorders are a particular thing, so for a long time they have been a problem for young girls, but they affect people of all ages, and men increasingly. As we have explored today, body image and mental health are not gender-specific, but men suffer in silence more, because they are much less likely to talk about things, and subsequently they seek help a lot later, which can be dangerous. In fact, it is well known that the highest number of suicides is among men between the ages of 18 and 25, because men—this is a cultural stereotype that we can hopefully overcome—just do not talk about their body image, anxieties and mental health as much as women.

Research by the Mental Health Foundation published last March shows how common it is to have body image concerns, and we have heard many other statistics today. One in five UK adults have felt anxious or depressed about their bodies in the past year, and that anxiety can turn into long-term mental health problems, such as eating disorders. Across the country, eating disorders affect 1.25 million people, which is probably a conservative estimate. My work in this area supports that suggestion, and the sufferers I have met come from a range of different backgrounds, but they are united by their dissatisfaction with, and need to control, their body image. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) has already talked powerfully about that.

Of course, eating disorders are far more complex than stress over body image. They are serious conditions that ruin, define and, all too often, end lives. However, the seeds of emergent eating disorders can often be spotted in stress or anxiety about body image. For the more than 1 million people who were identified as having an eating disorder, the outlook is not good. On average, it takes 85 weeks between someone realising they have an eating disorder and that individual receiving treatment. That lost time can be the difference between full recovery and living with a permanent disability or disorder. The Government targets introduced to limit child waiting times for eating disorder treatments were a positive step, but thousands of adults across the UK need the same measures. We need to consider the waiting times for adult sufferers of eating disorders, and I know that the Minister has already looked into that.

Understanding eating disorders better is key to improving treatment. Many sufferers still report being turned away and refused referral, because doctors have told them that they are not thin enough to be treated for an eating disorder—I know that the Minister has talked to Hope Virgo, who has been running the “Dump the Scales” campaign—but an eating disorder is not just about someone’s body mass index. By talking about eating disorders, especially in the context of body image, we can start to grasp how damaging that can be. We must educate everyone, from sufferers’ families to doctors, about the many different forms that such conditions can take and how best to treat them. Eating disorders have the highest mortality rate of any mental health condition, and our mental health policy must reflect that. This is a crisis, but we are not treating it as such.

Early intervention is key. Schools, doctors and support workers must be equipped with the tools to identify when body image concerns are becoming dangerous. Furthermore, we must change the cultural conversation around body image, which can be done on many levels. As we have already heard today, social media companies have a responsibility to police the content on their websites, ensuring that anything that actively incites self-harm is taken down. Eating disorders are on the rise, and many adult sufferers are failing to receive the early intervention they so desperately need. We must do better for those suffering in silence and start having a conversation about body image, mental health and the awful reality of life with an eating disorder.

Services for People with Autism

Wera Hobhouse Excerpts

Thursday 21st March 2019 Commons Chamber

[Huw Merriman]

The hon. Gentleman has put it beautifully. As he probably knows, a recent survey showed that 50% of autistic individuals and families were scared to go out, and did not go out, because they were worried about how they would be judged. That isolation is a huge challenge for us.

[Wera Hobhouse (Bath) (LD)]

rose—

[Dr David Drew (Stroud) (Lab/Co-op)]

rose—

[Huw Merriman]

I will take two more brief interventions, and then I will make some progress.

[Wera Hobhouse]

I am pleased that the debate is taking place in the main Chamber. We had a very moving debate some months ago in Westminster Hall, but this is such an important issue that it needed to be raised here. Unfortunately I shall have to leave soon. The debate was meant to start about an hour ago, according to my diary. I am so sorry not to be able to stay, but I am so pleased that the hon. Gentleman is raising the issue now.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. I do not know who told the hon. Lady that the debate would start at that time. Someone must have misled her, because there was no set time for it to start.

[Wera Hobhouse]

In that case, Mr Deputy Speaker, I apologise.

My local authorities have some excellent care providers and support services, including Parent Carers Voice. Does the hon. Gentleman agree that services for children with autism should be financed through council budgets rather than the responsibility being pushed on to struggling families?

[Huw Merriman]

I think that we all face a real challenge. At a time when local authorities are themselves having to watch their budgets, it is the altruistic services—the support services—that tend to go. The challenge I face is that as authorities look just at their statutory obligations, they may end up spending more money to deliver those than they spent on some of the support services beforehand. I have every sympathy with the point that the hon. Lady has made.