PARLIAMENTARY DEBATE
Eating Disorders - 16 October 2018 (Commons/Westminster Hall)

I congratulate the hon. Lady on securing this debate on such an important issue. Does she agree that one of the ways to tackle the stigma is for people to speak out and then for others to have confidence to speak out as well? That will contribute to more early diagnosis and better treatment and care.

In my constituency, there is an excellent facility, Rharian Fields, run by Navigo, a social enterprise. It is rated as outstanding by the Care Quality Commission, but only accepts patients over the age of 17. If we are to tackle some of the deep-rooted psychological issues, does the hon. Lady agree that we need facilities for young people under the age of 17? Such facilities are incredibly difficult to access around the country.

I congratulate my hon. Friend on securing this important debate. Early intervention is hugely significant. Many eating disorders can be prevented from developing to their full extent with proper preventive care. Is she aware that the Government enable public health bodies in Cumbria to spend only 75p per head for children in the county on preventive treatment? Does she agree that that is a disgrace and that we ought instead to be investing in, for instance, having a mental health worker attached to every single school, to ensure that we prevent people getting to the later stage?

I have a personal interest in this subject. A close member of my family suffered from bulimia. What we found most important was the support provided by the family network. That, above anything else that could be provided, was what carried the family member through to a positive conclusion.

Leading on from that point, my hon. Friend will be aware that in 2016 the Government pledged money for a specific one-to-one eating disorder service for children and young people under the age of 18. Yet two and a half years on, that service does not exist in Cumbria, and people who present with eating disorders often go through the struggles that she has just talked about, because the people that they see are not specialists.

I congratulate the hon. Lady on giving us the opportunity to discuss this very serious issue. Does she agree that, in addition to dealing with the problems that are thrown up by having an eating disorder, the difficulty for people in that position and for their families is access to proper services? That varies from place to place, town to town and city to city. Does she believe that we need a more integrated service that is the same everywhere and that provides an effective service for young people—and older people, for that matter—who are in that situation?

It is a pleasure to serve under your chairmanship, Sir Roger. No one who has been directly affected by any form of eating disorder, or who has been around a relation, colleague or friend who has battled such a disease, will be in any doubt about the devastation that such conditions can bring to a person’s life. Sufferers of eating disorders have the highest mortality rate of people with mental health conditions. About 1.25 million people in the United Kingdom suffer from eating disorders, so I feel strongly that this issue has to be addressed head-on: with strong actions, rather than warm words. Although eating disorders can affect anyone, it would be inappropriate not at least to acknowledge, in an era that emphasises having a positive body image, that the National Institute for Health and Care Excellence estimates that about 90% of people with eating disorders are female.

I welcome the £1.4 billion that the Government have committed to tackle mental health and eating disorders over the next five years, which comes on top of the £150 million they committed in 2014. Although funding is important, having a treatment strategy is even more so. We cannot just throw money at the issue and hope it makes the improvements we need. Hope is not a strategy.

The Government have made important commitments, such as the target to ensure that, by 2020, 95% of those referred with an eating disorder will begin treatment within one month—within one week for cases diagnosed as urgent. We cannot underestimate the benefit of early treatment; to tackle this issue, we must emphasise the need for it. It is reassuring that the Government clearly recognise that. I want to ensure that anyone with an eating disorder who needs helps receives it fast.

Someone close to me visited her doctor because she was having distressing thoughts about ending her life. Her eating disorder had taken over and gone so far that she believed it to be irreversible. She cried in the doctor’s surgery about the pain it caused her and everyone around her. She was offered antidepressants. I welcome Beat’s recommendation to the Scottish Government that GPs need to be informed of the early symptoms so that they are able to refer without delay. We are far too quick to offer patients prescriptions, rather than give them the help they actually need to overcome this deep-rooted issue.

It is incredibly troubling that the picture is so different north of the border in Scotland, compared with England. The Scottish National party-led Government have failed to deal with the problem with the same urgency. Let me make it clear that I am not here to score political points; I am here to address the gaping hole that I, my constituents and many pressure groups see in Scotland, and I want to use this opportunity to put more pressure on the Scottish Government to right that wrong. Although England’s population is 10 times that of Scotland, it has only four times as many hospital admissions for eating disorders. Although that may partly be down to differences in how such admissions are recorded, we cannot ignore the possibility that eating disorders are simply more frequent north of the border due to cultural or dietary differences.

Although the increase in eating disorders is a UK-wide phenomenon, in Scotland the number has increased by two thirds since 2005, compared with just 44% in England. Despite the apparent prevalence of eating disorders in Scotland, the Scottish Government are failing to act. Most worryingly, and with no reasoning behind it, Scotland has no specific waiting time targets for people diagnosed with eating disorders. Such patients are subject to the same 18-week target as patients with any other mental health condition. That timeframe is simply not good enough, and shows a complete failure to understand how urgently this illness needs to be treated. Eighteen weeks—126 days—is not acceptable; it could be the difference between life and death.

I wrote to the Scottish Government earlier this year to press them on this matter and to see whether they had any plans to introduce waiting time targets in line with those that the UK Government have outlined. Their response confirmed exactly what I thought: disappointingly, although not surprisingly, they have no such plans. Various groups have submitted freedom of information requests to the Scottish Government to get a true image of the position, but due to the lack of a national framework, the data has not been collated consistently. Why would the Government not implement a system that allows that information to be readily available to ensure easier data collection so solutions can be found? People with this debilitating disease expect more from their Government. I support the work of Beat and other charities that are doing great campaigning to stop the wait in Scotland, and to highlight that eating disorders should not be categorised and treated as though they are the same as other mental health disorders.

I return to my anecdote about the doctor’s surgery to talk briefly to training. Recent research shows that teaching and training in Scotland is, to put it politely, falling short. Four excellent universities in Scotland—Aberdeen, Glasgow, Edinburgh and Dundee—were asked how much time on average is dedicated to eating disorder training during their four-year medical degree. They answered in hours: Aberdeen, three; Dundee, three; Edinburgh, four; and Glasgow, four. They were asked whether eating disorders were covered in the final submissions. It is covered in one question in Dundee and none in the other three. I am not a doctor, but I know that that is not enough.

When a patient with an eating disorder or a similar issue presents themselves, our specialists must have the tools to be alerted to their problem. We know that people with eating disorders have the innate ability to make out that the issues relating to their lack of food are in fact nothing to do with food—I know that, because I have witnessed it first-hand with people around me.

Self-referral is another area where we can try to get help to those who need it. We know that people with eating disorders need significant support to determine whether they need help, but when they self-refer, they should be welcomed and nurtured by our system. Two thirds of NHS trusts in England accept self-referrals from children and young people. However, in Scotland, only Dumfries and Galloway CAMHS accepts self-referrals from children and young people who are suspected of having an eating disorder. I know that all hon. Members are thinking the same as me: why?

We can make progress on this issue only if we have an approach that recognises that eating disorder diagnosis requires urgent action, resulting in specialist treatment. The Scottish Government must act sooner rather than later. I will continue to campaign and put pressure on them to get the improvements we need for my constituents and all those who are suffering in Scotland. The Scottish Government must stop burying their head in the sand and give this issue the dedicated attention it needs. We need to help those affected to get out of the position they find themselves in so they can begin to rebuild their lives and the lives of those around them.

I congratulate the hon. Member for Bath (Wera Hobhouse) on securing the debate and on the compassionate way she introduced it. She clearly cares, and I thank her for that.

I have been involved with this subject with some of my constituents, and I want to talk about two examples. One was not successful, and one was—I use that term loosely. I am my party’s health spokesperson, and I have been directly involved in those two cases. I have knowledge of them, so I want to comment on them.

An estimated 360 adults and 90 children are referred to specialist community eating disorder services each year in Northern Ireland. Those truly monumental and horrendous figures indicate the health problem. The figures for the past five years have increased by 92%, which indicates that we need to focus on this issue through the Department of Health and Social Care. I look to the Minister to make a suitable response that will give us heart.

Does my hon. Friend agree that the startling increase in the past five to 10 years indicates that we need even more research about the underlying reasons for the problem, so we can assess it? We must not have a superficial response to it.

I thank my hon. Friend and colleague for his intervention. He is absolutely right: we do need to raise awareness, and I think this debate will do that. We also need to raise awareness within health services so that they can give the correct diagnoses earlier for such conditions.

I will give some examples, if I may. During my research for the debate, I was distraught to learn that a young lady from Ballynahinch, whose family are from Killyleagh in my constituency, lost her fight against her eating disorder: in March, she died of a heart attack at age 21. She had been struggling with the eating disorder since 2009—that is horrendous. I will share her mum’s interpretation of it, which I read in an article that she wrote for the Belfast Telegraph; it outlined the problems with treatment in Northern Ireland. I know that that is not the Minister’s responsibility, but I just want to show that our problems are similar to those on the mainland—I do not think location matters much; problems are replicated across Northern Ireland, Scotland, Wales and England.

In the Belfast Telegraph article, we read that beautiful Sophie Bridges was 14 when she was referred to the NHS children and adolescent mental health service. The words of her mother are clear:

“Absolutely pathetic. It’s no reflection on anybody who works there, they try their best, but she was discharged on her 16th birthday. She was no better, she was just above the age for their service. She was still too young, though, for the adult service and had nowhere to go.”

That is one of the problems: moving from child to adult services. My examples will illustrate that very clearly.

I am sorry that I came late to this debate. Does my hon. Friend agree that when we talk about early intervention, we are talking about young people? Schools and social media have a responsibility, as they can be such cruel places for young people who feel that they are not perfect and are forced down the route of eating disorders. More needs to be done in that regard.

I thank my hon. Friend for his intervention. He is absolutely right: social media have a lot to answer for in many respects, but especially on this issue.

In the Belfast Telegraph article, Mrs Bridges went on to say:

“We just had to deal with it at home. We felt there was only a focus on her physical health, there was absolutely no psychological service.”

We need early diagnoses to ensure that we can deal with the physical—yes—but also the psychological, because that is such a key factor. Sophie spent the first half of 2017 as a hospital patient in a mental health unit. Mrs Bridges said:

“They did their best, but the provision just isn’t there. There are just so many different issues in one unit. There are girls like Sophie in the same ward as elderly people with dementia and others with schizophrenia.”

We can see right away where the problems are. Those problems are not unique to Northern Ireland, but are replicated across the United Kingdom. It is clear that we are letting down people who need help and attention that could make a life-saving difference. That was just one example of a young girl who very tragically lost her life, and our thoughts are with her family—her parents, in particular.

Another example is that of one of my other constituents, whose mum and dad I knew quite well. They were both in the police service, and I knew them when I was a councillor and a Member of the Assembly, long before I came to this place in 2010. Their daughter, whose name I will not mention, had anorexia that was so extreme, as I was telling my hon. Friend the Member for East Londonderry (Mr Campbell), that I spoke to Edwin Poots, the then Northern Ireland Minister for Health, and explained the case to him.

We do not have the self-referrals that the hon. Member for Angus (Kirstene Hair) referred to; patients have to be referred by the Department of Health. I asked Edwin to look at the case because the young girl was very close to death. He referred her to St Thomas’ Hospital, just across Westminster bridge, where they were able to help her; I met her and her parents in the House back in 2010 or 2011. The fact of the matter is that the treatment she got—let us give the NHS some credit for its work—saved her life and turned her around. She is now married and has two children. For her, her parents and her family, that is good news.

Despite our best efforts at addressing nutrition in classrooms and through soaps and other TV programmes, the Eating Disorders Association NI said that the eating disorders most commonly seen in young people under 18 are becoming more common among children between the ages of eight and 14. Let us not underestimate just how early eating disorders can start and how that affects people; the hon. Member for Bath mentioned that in her introduction. Eating disorders in children are becoming more common within that age group, and research shows that boys are at as high a risk as girls. I will share some of the figures on that in a moment.

The society that we live in fixates on skinny living, which is a misguided approach to healthy living. At one stage, I weighed almost 18 stone and risked developing diabetes. I turned the situation around by reducing my weight, which I will hopefully keep down. I did that and stopped once my goal had been achieved. What about people who cannot stop?

Comments in programmes such as “Keeping Up with the Kardashians”—I do not watch it and could not say who any of the Kardashians are or where they are from, but my parliamentary aide does watch it, much to her shame, which she will not mind me saying—fixate on looking skinny; in one clip, being called “anorexic” is even a compliment. That must be addressed.

In fairness, the apology from the Kardashians is wonderful, and they should be commended for realising that their comments came across in an unhealthy way, but the words cannot be withdrawn: young women who want to be more like the Kardashians, who seem to have it all, have already been impacted. I am not saying that we should have censorship, but we must have the common sense to address and not worsen our eating disorder problems. My hon. Friend the Member for Upper Bann (David Simpson) referred to social media, which have a lot to answer for. They set trends and create peer pressure. Sometimes, I wonder whether some of society’s problems—not all, but some—are caused by social media.

Many of us have referred to raising awareness, and the health service ombudsman has also recommended measures to increase awareness of eating disorders among healthcare staff, who have to know what the tell-tale signs are to support early diagnosis. Maybe the Minister can give us an indication of what he can do on that.

I look at my own beautiful granddaughters and sincerely believe that they are perfect. The thought of their view of themselves being shaped by others is frightening. They are young girls—only nine and four—but for some eight-year-olds, eating disorders have already taken hold, so let us address the issue at the earliest opportunity. We must take steps to ensure that the difference between skinny and healthy is taught from a young age.

I have some figures here that indicate the magnitude of eating disorders. Some 725,000 people in the UK are affected. At the time I found the figures, 90% of those affected were female, but the latest figures indicate that 25% of those affected are male. While it is very much an issue for young girls—they make up the cases I am aware of in my constituency—we also have to recognise that there are young men out there with the same problems. Young men are becoming as likely as young women to suffer from an eating disorder, and we must ensure that the message is sent that this is not a teenage girls’ disorder. It affects men and women, old and young, rich and poor. The disorder is life-threatening and we must do more to address it. We must provide more help to beat it and keep beating it every day of sufferers’ lives.

I thank you, Sir Roger, and congratulate the hon. Member for Bath (Wera Hobhouse) on securing this important debate. She began, rightly, by saying that eating disorders are about so much more than stigma. It is right that we focus on treatment, because eating disorders—as all of us in the room know—are conditions that are often dismissed initially as girls trying to look like celebrities. They often end with a third of sufferers recovering, but a third of sufferers live with them for the rest of their lives and a third do not make it at all. Those figures are truly shocking and would be shocking for any condition, whether mental or physical.

The stigma arising from eating disorders is not solely about looking slim. It is about the pervasive effect of that eating disorder. It is a condition that quickly stops people being able to function in the way that they would wish to function. It a condition that stops people leaving the house. People end up being stigmatised because they are not behaving as they would like to, not able to fulfil a function within society and, often, not even able to work or go out. The stigma arises because of the condition, and it is the condition on which, clearly, we should focus.

I commend the work that charities such as Beat have done to raise awareness of eating disorders and to ensure that people are not stigmatised; that GPs in particular do not greet people who show up suggesting that they are worried about their attitude to food by saying that it is not a problem and that they might just allow themselves to go away and get better. We need to focus on NHS training but also to acknowledge, as my hon. Friend the Member for Angus (Kirstene Hair) did, that there has been some progress in England, if not sufficient in Scotland yet. However, this is not a party political matter.

We have seen not only some positive work by the NHS and charities, but some of the damaging effects of social media, as the hon. Member for Strangford (Jim Shannon) said. Social media presents a huge opportunity to promote the positive body image that we would all like to see of what being healthy in the 21st century looks like. In reality, at this stage on this front social media does far more harm than good. It is far too easy to scratch the surface of the internet to find images that reinforce deeply negative perceptions of body image, reinforcing behaviours that are profoundly harmful. If social media companies can do a huge amount to take down child abuse images and other images that we as a society decide are profoundly harmful, it is reasonable to ask what more could be done automatically or more rapidly to take down images that all too often end up with people losing or taking their own life.

My hon. Friend is making a powerful point about social media, but perhaps he needs to go one stage further, to look at the role of the advertising industry and the images that it puts forward, which encourage young people to achieve a fantasy position for themselves and their body image.

I absolutely agree with my hon. Friend and, in fact, that was the point that I was coming on to make next. Clearly, not only do some sites encourage profoundly self-harming behaviour, but the advertising industry puts forward exactly that pervasive image to which he referred. We should look to regulators and Government for action to tackle that in a sensible way that promotes a genuinely healthy lifestyle without promoting unhealthy or unreasonable expectations, but we should not pretend that it is anything other than very difficult. Tackling such issues should not bleed over into not being positive about people who struggle with their weight, who would often like to see a more positive image of people who are larger. None of us wants to see an advertising regulator that ends up prescribing an ideal weight, although we need to prescribe a greater sense of health.

I agree absolutely with what the hon. Member for Bath said about no sensible and properly trained doctor in the modern NHS using BMI alone to assess whether a person has an eating disorder. However, too often it does become the single defining characteristic. Too many doctors have not been provided with all the tools and do not have the services to which they might refer their patients. Too often BMI becomes the measurement of last resort, and it is right for the NHS to seek to tackle that and for this House to do all we can to encourage the Minister and the NHS itself.

The hon. Lady mentioned family therapy. My understanding is that family therapy, in particular for young people and adolescents, is the only clinically proven therapy. It has been shown to make a real difference. It is incredibly intensive in resources and in the pressure on the family and patient, but it works. We should do more to reduce the stigma—to come back to the point of the debate—so that families accept that they might have someone in their midst who needs help not just from the NHS but from them—their family and friends.

As the hon. Lady said, however, it remains the case that eating disorders do not stop when someone is 17 or 18. In all too many cases, triggered by stress, they can emerge or return when a patient gets older. With that in mind, we should commend the work of places such as the Maudsley, which have tried to push family therapy beyond the point where everyone is expected to live at home and to say, for example, that the university setting could be a kind of family that encourages people to get better. What happens when people are older? As I said at the start of my speech, there are of course a number of functioning older adults who need all the help with which we can provide them, and that is about more than antidepressants.

If the Government could do two things, the first would be to encourage social media companies to look more closely at what can be done to tackle those images that go beyond the kind of advertising that my hon. Friend the Member for Henley (John Howell) said we need to look at and go way into a territory that is not healthy for anyone. My second ask, when it comes to funding research and spending some of that £1.4 billion that we are allocating to eating disorders over the coming years, is for the extension of family therapy—the one method that we know works. With the help of science and innovation, we should be looking at whether we can go further with that therapy. The stigma around the condition is a hugely important issue, but we must focus on tackling the illness itself.

It is a pleasure to serve under your chairship, Sir Roger, and I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this important debate.

A sad reflection of our times is that the explosion of social media in the past decade has spawned an obsession with looking good and showing off the body. If people want to be in with the right crowd, they need to post images of themselves looking happy with their beautiful body. Sadly, sometimes the impression given on social media does not match the reality, and cases have been reported of people who have not been able to keep up with the facade of being permanently happy, and striving for the perfect body has resulted in their suicide.

Eating disorders are part of that obsession with body image, and hashtags such as #thinspiration are associated with images of mainly young people showing off their thin bodies and limbs. Unfortunately, the way in which social media works nowadays means that if they click on the internet links about being thin or having a beautiful body, and thanks to the algorithms that are part and parcel of social media, people will more than likely receive online advertisements about dieting or weight loss.

One thing that is desperately needed is greater understanding of the mental health aspect of eating disorders and the addictive nature of many of the conditions, including body dysmorphia. I have a constituent who has been struggling with anorexia for a number of years. He had difficulty in living on his own and, for his own wellbeing, had to move back in with his parents, because of the support that they were able to give him at home. He desperately needed mental health services from the local clinical commissioning group and, although it was a battle, we were successful in getting him the help that he needed.

Eating disorders are serious mental illnesses that can have severe psychological, physical and social consequences. Typically, they involve disordered eating behaviour, which might mean restricting food intake, binge eating, purging, fasting, excessive exercise or some combination of those behaviours. Recently, I was made aware of orthorexia, which is an obsession with or addiction to eating healthy food—a gateway to other eating disorders. Many of the eating disorders are associated with negative perceptions of body image, as I mentioned. A negative perception such as that, coupled with an obsession with posting pictures on social media, exacerbates the problem and leads to more stress, pushing those who are suffering closer to the edge. In its clinical guidelines on eating disorders, the National Institute for Health and Care Excellence states:

“The emotional and physical consequences of these beliefs and behaviours maintain the disorder and result in a high mortality rate from malnutrition, suicide and physical issues,”

such as electrolyte imbalances, osteoporosis and anxiety disorders.

Using figures for UK hospital admissions from 2012 to 2013, the eating disorders charity Beat estimates that there are 725,000 people with an eating disorder in the UK, approximately 90% of whom are female. Every disorder is closely associated with poor quality of life and social isolation, and each one has a substantial impact on family members and carers. Eating disorders are long-lasting conditions if they are not treated.

In The Guardian in October last year, Dave Chawner described his experiences as a boy with an eating disorder. He wrote:

“Before I was anorexic I’d always assumed people with mental illness knew they weren’t well. But on reflection that’s ridiculous. My Dad has diabetes. He had it for years before anyone realised and no one expected him to innately know. Sometimes you’re too close to your own life to gain perspective; it’s like trying to make sense of a painting if you’re only inches from it.

It’s really hard to find the words to describe my anorexia—it was more of a feeling, a lacking, an awareness I wasn’t really coping…I wanted to talk but I didn’t know what to say. I was waiting for something to happen so I could classify myself as ill. I was worried people wouldn’t take me seriously, that if I didn’t explain myself properly people would think I was attention-seeking or pathetic.”

He concluded:

“So I understand why more people don’t just talk, because sometimes finding the words can seem impossible. Not all the silence on mental illness is to do with stigma. It’s also about finding the right words.”

We have to get rid of the stigma around eating disorders to help the thousands of people like Dave who are suffering.

Thousands of people with eating disorders are turned away from treatment and support every day. The NICE guidelines for access to treatment are correct, but they are not implemented in the right way.

That is a real issue with Vale of York CCG, where only 12.9% of people start treatment within four weeks. The CCG spent only £68,000 of the £161,000 it had to spend on eating disorders. Beat identified it as the worst CCG in the country. Does my hon. Friend agree that far more robust accountability is needed for the delivery of services for eating disorders?

My hon. Friend makes an excellent point. Yes, much more funding and accountability is needed to tackle eating disorders. I will come to that shortly.

A person’s BMI should not prevent them from getting the support that they need. Action is also needed to tackle irresponsible social media companies, which give platforms to those who glorify eating disorders and negative body images. Failure to tackle eating disorders costs lives and results in heartbreak, anguish and despair for people with such disorders and for their families. It ends up costing the NHS more, because of the increased need when someone hits crisis. Much more funding is needed for mental health services, including child and adolescent mental health services. More early intervention is needed to address eating disorders.

Eating disorders are serious and potentially life-threatening conditions. Unless proper support and more mental health funding are made available to tackle them, we will all pay the price.

I congratulate the hon. Member for Bath (Wera Hobhouse) on bringing this vital debate to the House. I pay tribute to everyone who is watching the debate, whether they are in the House or at home. I know that eating disorders—bulimia nervosa, anorexia nervosa, body dysmorphia and others— are secretive and private illnesses that people battle, and that it is difficult for those individuals to speak out because of their fear of being judged.

Many Members touched on the immense pressure that people are under to look thin, healthy or muscular. When I was a teenager, my big role models were Arnold Schwarzenegger and Sylvester Stallone. Every time their films came out, I wanted to look like them. It got to the point where I worked out twice a day. I lifted weights constantly and followed a diet. I suffered from all the causes of body dysmorphia. I never looked good enough. But wanting to look like big Arnie was not the trigger; the trigger was that my parents were going through a divorce and I was about to sit my exams. It was a high-stress situation, and the only way out of it was to look like Schwarzenegger or Stallone. Luckily—or unluckily—I injured my arms and could not lift weights any more, and that feeling went away. But for so many people, it does not go away.

On my way to the Chamber, I went to the newsagent and looked at the magazines. This week’s Men’s Health says, “Lose belly fat in 30 days.” GQ has pictures of people with six-packs. Gary Barlow, who is promoting a new book, said, “I was so unhappy when I was 17 stone, but look at me now—I’m 12 stone. I lost 5 stone.” People are under immense pressure. Mark Wahlberg, who led the band Marky Mark and has starred in various films, said recently that his daily regime begins with him getting up at half-past 2 in the morning and working out twice before half-past 7, when he plays golf and goes off to work. Nobody in the media condemned him—everyone complimented him on his discipline. That is madness.

What message are we sending to young people—that it is good to look like someone from “Love Island”? When I am on the beach in Porthcawl, no one looks like they are on “Love Island”. This weekend, my wife and I decided to clear out some old books. Most of them were by Atkins or had titles like 30 Days to a New You or Body for Life—“12 weeks to your new body!” There was even one about the Dukan diet. All those diets sell a perfect way of life. If someone suffers from self-esteem issues and thinks they are not good enough, like I did many years ago, those books feed into that. It is not just social media that we have to come down on.

Let me say this about social media. I read in the paper that a young girl who got through to the final of “The X Factor” said she had been plagued by trolls about her size. As someone said earlier, if we force social media to take down illegal things, we should do the same with trolls. The Government could go further with the diet industry. The Advertising Standards Authority needs real teeth so that when it sees those things happen, it can come down on magazines and advertisers like a ton of bricks. Equally, we have introduced health warnings for things such as cigarettes and alcohol, and we should do exactly the same for eating disorders.

Eating disorders manifest themselves in different ways. For me, it was body dysmorphia and my constant desire to train. Other people experience other things. When I was about 10 or 11, an extremely skinny young woman lived at the top of our street. My mother, who said that the woman had anorexia, befriended her. That young woman said that every morning, she would wake up and eat a quarter of a red pepper. My mother asked why, and she said, “Because when that comes up, I know I’m empty.” She could not get the help she required. She could not get a referral to a psychiatrist.

It is all very well saying that that was 30 years ago, but it still happens. The National Audit Office reported the other day that a quarter of young people, who make up most of those affected by eating disorders, cannot get an appointment with a psychiatrist. When they do, it is often not with a specialist. The picture is patchy across the country.

Let me end as I began—by paying tribute to everyone who suffers from an eating disorder. I say to them: “Talk to someone. Seek out the help you need. It does not have to be from a professional—it just has to be from someone you trust. If you come forward, you will find that people do not judge you but try to help you if they can.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It is a pleasure to serve under your chairmanship, Sir Roger. Like others, I thank the hon. Member for Bath (Wera Hobhouse) for securing this important debate and for speaking so passionately.

As we have heard from many colleagues, eating disorders manifest in many different ways. They are mental illnesses that involve disordered eating behaviour, with types including anorexia, binge eating disorder, bulimia, purging disorder and avoidant or restrictive food intake disorder—that list is clearly not exhaustive. Their severity and complexity should never be underestimated. Sufferers will commonly go to extreme lengths to hide their symptoms and behaviours even from those closest to them.

It is thought that the majority of people with eating disorders are young women aged 12 to 20, but it is harmful to stereotype; the possibility that someone can develop such a disorder should never be ruled out. The number of boys and young men developing them is rising, and the numbers could be higher than we think, mainly due to stigmatisation and fear of speaking out. Indeed, when I visited the Navigo eating disorder service, which my hon. Friend the Member for Great Grimsby (Melanie Onn) spoke about, I met four service users of whom two were women over 40 and another was a young man in his late teens. That shows that we must not stereotype.

Eating disorders have the highest mortality rates among psychiatric disorders, with anorexia having the highest mortality rate of any psychiatric disorder. Of those who survive, 50% recover, whereas 30% improve and 20% remain chronically ill. It is estimated that 40% of sufferers will also self-harm. Given those startling statistics, it is clear that more needs to be done to help sufferers with their recovery and that access to treatments must be greatly improved. Someone with an eating disorder will currently wait an average of 3.5 years before receiving treatment. As we have heard, it is worse for adults, who statistics show have to wait twice as long as children before accessing treatment.

In 2015, clinical commissioning groups were given extra money to help children and adolescents suffering with eating disorders. Unfortunately, in the CCGs’ bid to balance the books in these times of severe NHS funding cuts, much of that money never found its way to the frontline and, of what did, little was actually used for eating disorder services. We heard from the hon. Members for Bath and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) about how services are patchy. There does appear to be a postcode lottery and disparate availability of services. However, we do recognise that some fabulous work is going on, including the service run by Navigo in Grimsby.

Much more needs to be done to raise awareness and to remove stigmas. Common misconceptions include that people with eating disorders are more responsible for their symptoms and that they would be more likely to use their disorder to gain attention than those suffering from other mental illnesses. Such misconceptions must be dispelled and greater awareness must be raised. The popular TV series “Hollyoaks” is currently running a story highlighting a young woman’s struggle with her eating disorder. Well-researched storylines such as that are an important way of educating people and dispelling myths, but there is still much work to be done.

My hon. Friend the Member for Islwyn (Chris Evans), who made a passionate speech, spoke about how the media controls much of the narrative. I remember looking at women’s magazines—I tend not to buy them so much anymore—and constantly seeing frighteningly thin models; plus-size models are rarely seen, even though being bigger than a size 10 does not necessarily mean that someone is unhealthy. Equally, social media plays a big part. Role models also have a responsibility. I remember a supermodel famously saying that nothing tastes as good as thin feels. Children and adolescents in particular look up to those people, who must recognise that they are role models in society.

Data on access, quality, workforce and investment in adult eating disorders services, which is key to the evaluation of whether services are effective, is not routinely collected and published. That would not be acceptable for physical health conditions, so why is it for a mental health condition? Furthermore, we have heard that there are no waiting time targets in place for over-18s. It would be great if the Minister responded on that.

In December 2017, the Parliamentary and Health Service Ombudsman published its findings after investigating the death of 19-year-old Averil Hart from anorexia. Its investigation “Ignoring the alarms: How NHS eating disorder services are failing patients” found that there had been inadequate co-ordination and planning of Averil’s care and that, tragically, Averil’s death could have been prevented had the NHS provided appropriate care and treatment.

The Parliamentary and Health Service Ombudsman and Beat, which I also thank—it does fabulous work and lobbies Members of Parliament to ensure that this issue is firmly on the agenda—have recommended that the General Medical Council conduct a review of training for all junior doctors on eating disorders to improve understanding of complex mental illnesses. As we have heard, although eating disorders affect an estimated 1.25 million people in the UK, training on it is limited to just a few hours over several years of training.

GPs, who are often the first port of call for people with eating disorders, must be provided with the training they need to identify the illness and to know what steps to take next. Blame is attached not to NHS staff but to how the service is run. The problems in the NHS have not come about overnight; the Government knew they would happen. Junior doctors have protested against the situation.

Much more needs to be done to aid the early stages of diagnosing and treating eating disorders because, as with much else, early intervention is crucial. A constituent of mine who was suffering from an eating disorder was praised on her weight gain during a consultation—such comments are enough to set recovery back for months. Health professionals should be given training on acceptable basic language when dealing with these sensitive issues. I am interested to explore family therapy further, because when I have met sufferers of eating disorders and their families, its great impact on the whole family has been clear. Family therapy is therefore a positive way forward.

I am conscious that I am running short of time, so I will try to summarise the remainder of my speech. NICE guidance for eating disorders states that children and young people with suspected eating disorders should start treatment within four weeks. However, a 2017 survey by Beat found that only 14% are referred within four weeks of their first GP visit. The average wait for referral is more than 11 weeks, and those aged 19 and over wait significantly longer. The situation is worse for men and boys, who make up between 10% and 20% of people with anorexia or bulimia.

We know—it has been said before—that mental health services are the poor relation in a cash-starved NHS. Some 40% of NHS mental health trusts are having their budgets cut, and we appear to be moving further and further away from parity of esteem. When I recently questioned the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), it emerged that an average of 2,000 mental health staff are leaving their posts in the NHS every month. At the end of June this year, one in 10 mental health posts was vacant, despite promises by the then Health Secretary, the right hon. Member for South West Surrey (Mr Hunt), that he would increase the mental health workforce by 21,000.

As Labour’s shadow mental health Minister, I am passionate about seeing improvements across all our mental health services—as I know everyone in the Chamber is. I am committed to delivering on Labour’s promise to have a counsellor in every high school, as early intervention is the key to preventing serious mental health issues. We would also ensure that budgets for mental health services are ring-fenced and ensure parity of esteem, providing a properly funded NHS with properly funded mental health services.

I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this incredibly important debate on a topic that is a key priority for the Government and for the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who unfortunately cannot be here; that is why I am responding to the debate.

It is clear from the testimony we have heard today that having an eating disorder can be devastating. The hon. Lady is absolutely right that people should have the correct mental health support—in the right place, at the right time and, most importantly, without the fear of stigma.

Eating disorders are serious, life-threatening conditions with the highest mortality rates of any mental health disorder. They can have severe psychological, physical and social consequences and they often start and are prevalent when people are young. We know that early intervention is absolutely vital, as noted by the hon. Member for Dewsbury (Paula Sherriff), and we recognise how important it is that everyone with an eating disorder can access quick, specialist help when necessary. That is why we set up the first waiting times, in order to improve access to eating disorder services for children and young people, so that by 2020-21 some 95% of children with an eating disorder will receive treatment within one week in urgent cases and within four weeks in routine cases.

Latest available waiting time figures for children and young people with an eating disorder indicate that NHS England is on track to meet that standard by 2020-21. First quarter data showed that 74.7% of all patients started urgent treatment within one week and over 81% of patients started routine treatment within four weeks. The number of people who are seeking treatment is rising and it is greatly encouraging to see a commensurate increase in patients getting the care they need, as well as a significant reduction in waiting times compared with last year.

However, there is further to go. Beat, the eating disorder charity referred to this morning, which does fantastic work, reports that on average it takes people over a year to seek help after first recognising the symptoms of an eating disorder. We recognise the importance of raising awareness and reducing stigma so that more people feel able to talk about their eating disorder and to seek treatment.

In January 2017, the Prime Minister committed to making mental health first aid training available to all secondary schools, aiming to have trained at least one teacher in every secondary school by 2020. In the first two years of the programme, over 2,000 school staff have received training, helping to reduce stigma in school environments. The Government have also committed to equip 1 million people to be better informed about looking after their own mental health. Public Health England is leading the development of a £15 million national mental health campaign called “Every Mind Matters”. The first pilot began earlier this month in the midlands, ahead of a national launch next spring.

I move on to community services for children. In-patient treatment should be seen as a last resort wherever possible, which is why the Government announced in 2014 that they would invest £150 million to expand and improve eating disorder community-based care. We are making good on this promise and as a result 70 dedicated new or extended community services are now either open or in development. This has led to swift access to effective eating disorder treatment in the community, with the number of children and young people accessing treatment increasing from 5,243 in 2016-17 to 6,867 in 2017-18.

The services are designed to give young people with eating disorders and self-harm issues early access to services in their communities, provided by properly trained expert teams that deliver evidence-based psychological and medical intervention, aiming to avoid the need for hospital stays. By improving care in the community, we can improve outcomes and recovery, reduce rates of relapse or prevent eating disorders continuing into adulthood and, if admission is required as a very last resort, reduce lengths of stay.

I will now address some of the issues raised by hon. Members in the debate. The hon. Member for Bath made a series of incredibly important points, particularly about training for GPs. Early identification is crucial and it is vital that professionals look out for potential signs that indicate an eating disorder. GPs are trained to identify symptoms and help patients discuss the issues, but in response to the recommendations in the Parliamentary and Health Service Ombudsman report on the tragic death of Averil Hart, as referenced by the hon. Member for Dewsbury, Health Education England is reviewing its current education and training offer and, crucially, identifying any gaps. It is working with eating disorder experts to scope existing evidence-based practice, to inform any new education and training resources.

The hon. Member for Dewsbury was right to mention that being under weight and body mass index are not good criteria for treatment. The NICE guidance is clear: rejection for treatment on the grounds of weight and BMI is not in line with any of the published guidance and should not occur. The hon. Lady also mentioned travelling too far for treatment, as did the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). We are committed to ensuring that everyone with an eating disorder has access to timely treatment, as close to home as possible. That is why we are seeing a shift to community services, to try to reduce, wherever possible, out-of-area placements. The hon. Lady talked about ring-fencing funding for these services. This is important too, as local areas need to fund services based on local needs. That is why I was alarmed to hear the figures from the hon. Member for York Central (Rachael Maskell). I will ensure I take this up with our local clinical commissioning group. As the hon. Member for Bath said, funding must reach the frontline. We already have in place the 70 community services, designed to give young people with eating disorders early access to services in their communities.

My hon. Friend the Member for Angus (Kirstene Hair) talked about having the confidence to speak out. She is right and we welcome Beat’s work in helping to improve awareness. I am delighted that the hon. Member for East Kilbride, Strathaven and Lesmahagow will be meeting my hon. Friend the Member for Angus, following her powerful speech. The hon. Member for Islwyn (Chris Evans) brought up an awful case concerning a constituent. I can assure the hon. Gentleman that my officials have heard what he said and, with his permission, we will follow up and make sure the Department of Health and Social Care comes back to him about that case. The hon. Member for East Kilbride, Strathaven and Lesmahagow was correct to mention service provision in rural areas.

Several hon. Members raised the issue of social media, including my hon. Friend the Member for Boston and Skegness (Matt Warman), the hon. Member for Enfield, Southgate (Bambos Charalambous) and, not least, the hon. Member for Strangford (Jim Shannon). It would be very unwise of me to attempt to keep up with the Shannons, but I can tell the hon. Gentleman that the Government recognise the impact that social media can have on mental health. Increasing evidence is showing that excessive social media use may have a detrimental effect on young people’s mental health.

The hon. Members for East Kilbride, Strathaven and Lesmahagow and for Enfield, Southgate also raised body image, as did the hon. Member for Islwyn in his incredibly powerful and moving speech. Those promoting the perfect body image should be forced to watch this debate, to listen to the testimony we have heard and to be made to think about what they publish and the devastating impact it can have.

To conclude, I extend my thanks again to the hon. Member for Bath for securing the debate and all hon. Members here today for their powerful speeches. I am proud of the work the Government are doing to improve eating disorder services. We have a long way to go. I am also proud of the incredibly brave young people who have come here today to listen to the debate and who have been mentioned in the speeches. I hope I have been able to provide some reassurance that we are absolutely committed to reducing the stigma associated with all mental health conditions, including eating disorders.