I congratulate the hon. Members for Romsey and Southampton North (Caroline Nokes), for Enfield, Southgate (Mr Burrowes), and for North Tyneside (Mrs Glindon) on recognising the importance of eating disorders awareness week 2013. As we have heard, more than 1.6 million people in the UK are affected by eating disorders; they are young, middle aged and older. They are every age from eight to 80, and they are women and men. This serious mental illness has the highest mortality rate of any mental illness.
Over the past 25 years, the incidence of eating disorders has increased enormously. There are many possible contributory factors. I observe the tiny size of models, actors and actresses, and screen, tabloid and magazine heroines and heroes; the cult of celebrity; the obsession with gyms and exercise; the constant barrage of advertising through every medium; the pressure on us to diet and to eat low-fat, low-calorie food; the ranges of “light” foods on sale and the so-called “healthy eating” regimes. There is bullying and name calling in the playground, in the workplace and during our leisure, and pressure to remove what is called excess weight and achieve someone else’s idea of a perfect body shape. We have life on the run. Eating on the go is now more common. There is an absence of what I used to have: formal lunchtime at school, at which a teacher sat at my table and watched me eat—even the semolina. If a child takes in a packed lunch, they can give it away or bin it, and no one has any control or sight of what they are eating.
[Mr Charles Walker in the Chair]
I also observe that things are different from when I was young, which was quite a long while ago. Young women are often physically mature at a very early age. It is confusing for an eight, nine or 10-year-old to find out that they are much larger than their friends; they will not necessarily understand that their body is getting ready for full maturity.
We can even look to an escalating divorce rate, which means that many of us are single. There is huge social pressure to have a partner, and there is the implication that in order to count, we must be gorgeous, attractive or at least half of a couple, rather than an individual, with our own rights and responsibilities. I recognise that I am saying this on Valentine’s day. My list, of course, is not exhaustive, but feeling inadequate, worthless and lacking in self-esteem are common factors, and the list starts to provide some clues to the settings in which eating disorders can be triggered, and how they are sustained. That constant pressure has contributed to the suffering of those 1.6 million people, and their families and carers.
So often, eating disorders are evident when a patient perceives that choosing whether they eat or not is the only area of his or her life where he or she can exert complete control. Anorexia and bulimia are serious mental illnesses, and need recognition and the appropriate responses from our national health service. In the next few minutes, I will refer to anorexia, but I want it to be noted that my concerns also relate to bulimia and eating disorders generally.
Most patients with an eating disorder in this country struggle to find effective treatment. They may find that a GP looks at the figures, and not what is in front of them—the patient. I refer to cases where patients are told that they are “not ill enough”, and that their body mass index would need to be lower for them to qualify for referral for help or treatment. When they do qualify, in many cases patients are admitted to medical wards in hospitals where the nurses unfortunately know little about psychiatric problems, and even less about nutrition. Patients are given little or no family therapy or individual therapy.
Others go to psychiatric units, where they are offered psychological support, but where their physical problems and need for weight gain are severely neglected. The few good dedicated units, which combine re-feeding with therapy and education, are mostly privately run. However, at £700 a night, these units are often out of the reach of most families, unless their primary care trust or its replacement NHS organisation funds the treatment.
I want to concentrate particularly on the problems facing children and young people with anorexia and bulimia. In hospitals all over the country, there are children and young people—some as young as seven or eight—who are being treated by doctors and nurses who have very little training in dealing with eating disorders, and who often have no knowledge of how to set a safe target weight. Sometimes, they weigh patients who still have their clothes on, or who have their pockets filled with kitchen weights, or who have their stomachs filled with three or four litres of water. Families are not given the support they need, or clear-cut advice. Patients see a different doctor or specialist at each appointment, and the appointments are too far apart. Little heed is paid to the patient’s physical condition. I have heard about children attending out-patient clinics because of their weight loss, but having neither their pulse nor their blood pressure taken. Monitoring pulse and blood pressure is vital if we are to prevent a child from collapsing, and if we are to know when a child needs hospital admission.
There are very few doctors who specialise in the treatment of children with eating disorders, so the waiting lists for children who need to access those doctors are often dangerously long. Eating disorders must be a condition that students are taught about in medical school, and awareness of them must be included in the postgraduate training of GPs, psychiatrists and paediatricians. If children were seen early in their illness by professionals working as part of a multidisciplinary team, so that parents were given the consistent, sensible advice they needed on how to re-feed their child, and if patients were seen by a family therapist and an individual therapist, as well as having a medical doctor who understood the long and short-term risks, and who could make a referral to an in-patient unit before the patient became irreversibly damaged, we would have fewer chronically ill adults in later life.
No one should die from an eating disorder. At present, however, there are more deaths from eating disorders than from any other mental illness, and it is estimated that 10% of all sufferers of eating disorders die as a result of their condition. For adults, the courts always support an application for nasogastric feeding, but tragically the request for a court order is often made too late, or not at all. However, working with children with eating disorders reveals another serious problem, one that interferes with the ability to help them. That problem is the implications of the Children Act 1989, which deems children of 16 capable of making their own decisions about treatment. However, anorexic patients rarely want to eat voluntarily. Although many of them are crying out for help, the guilt wrapped around food and eating means that they need someone to help them to eat, and not someone to ask their permission as to whether they would like to eat.
Despite an excellent ruling a few years ago, which in summary states that anyone who seeks to starve themselves to death is not competent to make decisions, we nevertheless require 16-year-olds to give written consent before they can be admitted to a medical unit. There are some units where, in order to protect themselves and their staff, this permission is sought from 14 and 15-year-olds. Once children are in the unit, if they refuse to eat, no staff member would dare use a nasogastric tube for fear of being sued. Until the passage of the Children Act 1989, units treated anyone under the age of 18 and fed them if and when necessary, requiring only parental consent. What a ridiculous situation we are now in. The reality of the current situation leaves parents feeling completely ineffectual and frustrated. It also leaves the child feeling quietly victorious, as they go on their way home with medical permission not to eat.
Today we find ourselves in the ludicrous situation whereby staff have to tell parents of often very ill children who will not consent to eat that they must wait until their daughter or son loses another x number of kilos, whereupon that young person can be sectioned under the Mental Health Acts and treated compulsorily. That puts lives at increased risk, and being sectioned is an overly serious response to the problem. We should seek a more appropriate solution. Being sectioned jeopardises any hopes that that child in recovery might have of joining the armed forces, for example, or becoming a doctor or nurse, which is particularly sad, because when they have recovered, many of these children are attracted to working in the caring professions, such as
health care. The Children Act might need to be amended, so that we are able to treat children who are damaging their health through starvation before they become so ill that their lives are in danger.
The hon. Members for Romsey and Southampton North, and for Enfield, Southgate, and I have met the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who is the Minister with responsibility for children, to explore the legal situation regarding the Mental Health Acts. I am very glad that the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) is here today. I am grateful to him for agreeing to meet us to explore whether practical solutions are available, or inventable, to allow those who care for young people with eating disorders to trigger some action short of using sentencing as a route to treatment and help.
I particularly want to recognise the work of two charities. One is the Somerset and Wessex Eating Disorders Association, or SWEDA, which is a user-led registered charity based in Wells in Somerset, in my constituency. It works on the principle of self-help, and its phone number is 07511 499 494. It has an online “health unlocked” community, and people can seek support and advice about self-help through that group.
The second charity is, of course, Anorexia and Bulimia Care, or ABC, which is a national registered charity that also happens to be based in my constituency. It is doing an amazing job. ABC was founded and is governed, run and supported by people whose lives have been touched by eating disorders. It offers kindness and compassion to sufferers at a time when they are desperate and alone. It has staff, professional advisers and a national network of volunteers, all of whom are carers or recovered sufferers. It provides positive, practical advice by telephone, by e-mail and via its website. It also offers a befriending service, and a range of literature and training advice. Lastly, it has a young people’s blog, called “To be honest”. ABC’s work is fantastic and its telephone number is 03000 11 12 13. That number will lead to a parent helpline, a sufferer helpline and a self-harm helpline.
We need a fairer system. Every child who develops an eating disorder should have access to first-class treatment, rather than the somewhat cobbled-together, inadequate provision that most have to accept. It is time that this life-threatening and debilitating illness was taken more seriously, and I truly hope that the Minister will consider what changes might be made to ensure that fewer lives are lost, recovery comes more quickly and families do not suffer the terrible consequences that often come with loving a patient with an eating disorder.
Lastly, I appeal to all those who suffer from this challenging mental illness: there is hope, and there is help out there for you. Our responsibility is to make sure it is better and easier for you to accept treatment and help.
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