My Lords, since this business is time limited, I draw noble Lords’ attention to the fact that the clocks that normally flash are not doing so, so we have reverted back to the older model which will require noble Lords taking part in the debate to exercise the customary discipline in recognising when their time is up.
My Lords, I declare an interest: one of my daughters suffers from anorexia. We have experienced NHS eating disorder services both for children and young people and for adults in the community, and specialist in-patient care, and it is clear to me that while advances have been made, insufficient progress has been made to date in improving the care for people suffering from these life-threatening diseases. Noble Lords should be in no doubt that they are serious mental illnesses. They can cripple lives physically, emotionally, socially and can ultimately take them. Anorexia has the highest mortality rate of any mental illness and, like cancer, if eating disorders are not caught early, they are much harder to treat.
There are waiting-time targets for children and young people to access eating disorder services, but none for adults. The Royal College of Psychiatrists found that people can wait up to 41 months for treatment, with adults waiting up to 30% longer than those under 18 years of age. Those delays to get treatment have devastating and life-threatening results, like the death of Averil Hart aged just 19 from anorexia. Her death and those of two other young women were investigated by the Parliamentary and Health Service Ombudsman in 2017 and followed up by the House of Commons Public Administration and Constitutional Affairs Committee in 2019. Both those inquiries found that it was time to ensure that young people and children’s services were in parity with those provided for adults. I am delighted that the Government are now piloting a waiting time for adults to receive eating disorder services. But when those eight pilots end next year, there is no ring-fenced money in the budget for adult mental health up until 2024 to roll out a national scheme for adults for a waiting time standard. Given that it is now three years since the first inquiry said that this was a matter to be treated with urgency, will the Minister say when the Government think it will be possible to roll out a national waiting time standard for adults with eating disorders?
My Lords, I congratulate the noble Baroness, Lady Parminter, on having secured this debate and introducing it so ably.
I start, somewhat improbably, in China—a part of the world currently in the news for reasons other than what I want to talk about. Only some four decades ago, 40 million people starved to death in the country during Mao’s rule; far greater numbers suffered from pronounced malnutrition. Switch to the present and things look very different indeed. Some 800 million people have been brought out of poverty over that period. Huge urban centres—several far larger than London—have emerged where there was once barren countryside.
I do not know whether noble Lords saw the TV programme on Shenzhen the other night. It was amazing—40 years ago nothing was there but green fields and a river; now, it is a massive high-tech centre, outstripping Silicon Valley. As noble Lords will learn in a moment, I am not in the wrong debate. Nothing like this has ever been accomplished before. Yet not all such change is positive. Some 30% of the population in China today—300 million people—are overweight or obese. An estimated 50 million still suffer from food deprivation, but now as a result of anorexia. A whole spectrum of online “vomit bars” has sprung up in which people encourage each other to vomit after eating.
As China goes, so goes much of the rest the globe. The number of people either overweight or obese in the world now surpasses those who live at near-starvation levels—an amazing, but not wholly positive, turnaround. What a reversal of history this is, and, totally unlike in the past, the vast majority of obese people are not the rich but those in lower income groups. The poor used to be the ones who were undernourished or starved to death. Today, in complete contrast to starvation in the past, anorexia across the world is mostly a pathology of the more affluent.
All this may seem a bit remote from the Question posed by the noble Baroness, Lady Parminter, and indeed from the UK. However, I see it as an essential backdrop. It shows the sheer scale of the issues involved, based on a sort of global reversal of traditional diets and eating habits. It was good to see Health Secretary Matt Hancock taking a similarly macroscopic view in a speech to a recent conference on eating disorders.
My Lords, I cannot claim to be an expert on the subject of this very important debate, for which we are indebted to the noble Baroness, Lady Parminter, who has done so much to help make known the extent of the suffering associated with eating disorders and involved herself so fully in the work of bringing relief to those who suffer, while promoting greater understanding of the causes of this deeply distressing condition.
My participation in this debate stems from my admiration for all that is being done by our remarkable health professionals—often in difficult circumstances, as we have heard from the noble Baroness—and by so many members of staff in our country’s schools to help those afflicted by eating disorders. It is on education that I will concentrate, drawing on the work and great experience of my friend and close colleague, Neil Roskilly, chief executive of the Independent Schools Association, a body that represents the interests of some 550 smaller independent schools, and of which I am president. Our member schools are increasingly sensitive to the needs of children who develop eating disorders or are at risk of doing so. Forming small, closely knit communities, they are only too ready to share the expertise that they are accumulating with state schools in the spirit of partnership that increasingly characterises the relationship between the two sectors of education. The more closely that they can be drawn together, the more our country will gain.
Schools in many parts of the country can now benefit from the excellent work being done by the charity Beat, which was mentioned by the noble Baroness, Lady Parminter, and with which she is closely associated. It is making a major contribution, particularly through its expanding programme of training for schools, and is keen to do more. I shall return to it later in my remarks.
Schools are inevitably in the front line where eating disorders are concerned. Teachers and others in the school community, including of course catering staff, occupy a key position. They can spot the warning signs and so secure early recognition and intervention, which are vital if young people are to gain access to the expert support that they need in the early stages of their difficulties. As we all know, eating disorders are ultimately not about food; rather, they are symptoms of underlying mental health needs that, through training the key people, can be recognised and addressed, so the resources must be adequate to provide the essential training in schools.
My Lords, I will speak a bit more about workforce issues in this very important debate. As the noble Baroness, Lady Parminter, mentioned, nearly one in seven consultant posts in this specialty in England is vacant. I think this reflects the state of the psychiatry workforce across all of its subspecialties. In 2019, the Royal College of Psychiatrists found that around one in 10 consultant psychiatrist posts in England were unfilled. These “missing” psychiatrists in our NHS have an obvious and detrimental effect on patient care in eating disorders and across the rest of psychiatry too.
This also has a secondary and confounding effect on the psychiatric profession itself. A report this year by the BMA found that more than three in five mental health professionals worked in teams with gaps in the rota and that more than half reported feeling too busy to provide the care they wanted to on the last shift they worked. No wonder psychiatry has perennial recruitment problems. I will share an interesting statistic. Of 74 medical subspecialties, 50 are more competitive than general psychiatry and 72 are more competitive than my specialty of the psychiatry of learning disability.
The shortfall in psychiatrists cannot be resolved without addressing the ongoing underresourcing and understaffing of mental health services, especially when people’s lives are at stake. The noble Baroness, Lady Parminter, made a very important point about the high mortality rate in eating disorders compared with, for example, schizophrenia, which people think of as a serious psychiatric disorder. Reversing the workforce shortfall requires a joined-up and concerted effort. Could the Minister comment on the Government’s current plan to improve the recruitment and retention of psychiatrists?
Doctors will choose psychiatry when they feel that mental health is given the same priority and concern as physical health. Although that is now policy, mental health care is still treated as physical health’s poor cousin. In 2019, the OECD estimated that mental ill-health costs the UK £94 billion a year. Contrast this with the £2.3 billion extra pledged by this Government for mental health by 2023-24. It is clear that more needs to be done now; the human and economic costs are far too high. Can the Minister advise the House on what steps the Government are taking to address the shortfall in spending on mental health?
My Lords, I too am grateful to my noble friend Lady Parminter for the debate today. I will speak particularly about anorexia, a killer disease that frequently affects young girls and women between 14 and 25. That is the area I have had most experience of, although, as other noble Lords have said, anorexia also affects adults.
As other noble Lords have said, anorexia has the highest mortality rate of any psychiatric disorder. The death rate associated with anorexia nervosa is 12 times higher than the rate for all other causes of death for females aged 15 to 24. Yet, as other noble Lords have said, there is much to be grateful for in that there can be a recovery, with enough support and treatment. Research suggests that 46% of anorexia patients fully recover, 33% improve and 20% suffer chronically. I am grateful that my daughter was one of the 46% who recovered.
According to Beat, the eating disorders charity, the average duration of the illness is eight years, but it can become severe and enduring, lasting for many years and having a hugely debilitating effect on the sufferer and their family. Thinking about people at the younger end of that age group, we know that the teenage period is a time of such emotional development as well as physical growth. It is a time of intellectual development and moving into the adult world. For sufferers of anorexia, isolated not only in their body but socially, the illness brings this growth and development to a halt. Cognitive development at this age is of huge importance, as it is often much more difficult to catch up afterwards, even if there is a full recovery. Eight years is the average time it takes to recover. Eight years in the life of a 14 year-old is a lifetime, and a huge loss of a key period in anyone's life.
The disease is sometimes considered not so much a disease as a life choice. There is perhaps a lack of awareness that the obsession with weight and body is so compulsive; that there is an overwhelming fear of gaining weight, and a distorted body image. Sufferers will do anything to get thinner, and the thinner they get, the more they think they need to become even thinner.
My Lords, I too am extremely grateful to the noble Baroness, Lady Parminter, for securing this debate, for the great knowledge she has on the topic and for the great campaigning she has done. I am also grateful to the group that she accompanied last week, when we met the head of Public Health England to talk about this issue and some others. We were pressing PHE to perhaps review its approach.
I am also grateful to others who have contributed to this quality debate, and to my noble friend Lord Giddens. We once had a debate in his name on this topic. I looked it up today and way back on 25 February 2013, we identified some issues arising that needed addressing; here we are in 2020, with many of the same problems around. They may be on a bigger scale but call for similar solutions. Back in April 2013, I was one of those who helped create the All-Party Parliamentary Group on Obesity. We had not had one before but it got off the ground then. Look at what has happened between 2013 and 2020: on almost every count, obesity is now worse. There are very few areas in which we can point to progress.
I was at the London School of Economics last night—my noble friend Lord Giddens has strong past connections with it, as he was the head of the LSE. I was there to listen to an address by Professor Richard Layard—my noble friend Lord Layard, one of our colleagues. He was speaking on the publication of his latest book, which is on the topic of happiness. That relates directly to what we are debating this evening. What are we about with health? We seek a better life and happiness. My noble friend has done much work in this area in the past, particularly on mental health, and was closely associated with the introduction of talking therapies under the Blair Government. I think over 20,000 new staff came in to work especially in that area; it was not enough, but it was a major change. We now find many people complaining of having to wait too long before they get assistance on talking therapies, while the length of many courses on talking therapies has been reduced to a point where their impact is perhaps not quite so significant as previously.
My Lords, I think that it was Walling Simpson who famously said that you cannot be too rich or too thin. We never in this House debate being too rich, but we occasionally debate the problems of those who aspire to be too thin. Walling Simpson, famously, ate almost nothing and was probably mildly anorexic.
The noble Baroness, Lady Parminter, has outlined the terrible situation that families find themselves in when they have a child or young person suffering from this terrible disorder, whether or not it is anorexia nervosa, obesity or bulimia—bulimia in particular is very difficult to treat, as is anorexia.
While I was driving down from Norfolk this morning, I listened to an excellent edition of “Woman’s Hour”, on which a young woman called Hannah described her own anorexia and how it felt to her. She had been waiting for treatment in the Greater Manchester area for 18 months, and she was offered just one of a group of services that were available in the area, with no thought as to whether it was appropriate for her. Even then, it was a great time coming. Dr Agnes Ayton, chair of the eating disorders faculty at the Royal College of Psychiatrists, made many of the points, brilliantly and articulately, about the difficulties that people have in accessing services, saying that while we have invested in young people’s and children’s services through child and adolescent mental health services, we have left young adults far behind in their ability to gain access.
Having re-read the debate instigated by the noble Lord, Lord Giddens, back in 2013, it strikes me that we have repeated this evening exactly what was said during that debate: that there has been very little improvement—and, of course, the numbers have gone up. As to why the numbers have gone up, the noble Lord’s own specialty has told us: they have perhaps been rising since the 1960s. We are very keen to say that it is not a lifestyle choice, but it is lifestyle factors that have made people want to go down this route in the first place. Biological triggers turn a normal seeking of a slim, elegant, beautiful figure into something much more pathological. That is the thing that we really do not understand.
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It is not just about having access to early treatment. It also about ensuring that when people go to their GP there are medics who know how to identify, manage and safely refer those patients. Research in 2018 by Dr Agnes Ayton showed that on average there is less than two hours of medical training on eating disorders, with one in five medical schools offering no training whatever. Ellen Macpherson, a final-year medical student in Manchester, says:
“I’ve had around 10 hours of teaching on schizophrenia, which affects one-fifth of the numbers affected by an eating disorder and has half the mortality rate.”
A survey of medical schools by the General Medical Council echoed Dr Ayton’s research. It concluded that doctors are not sufficiently prepared to manage patients with eating disorders. Recent initiatives by the GMC are welcome, but progress is painfully slow. When she responds, will the Minister tell us how the Government are ensuring that the GMC, medical schools and the royal colleges are undertaking their responsibility to ensure that medical professionals are teaching people properly about these life-threatening diseases?
There is also a need for more research. There are excellent examples of clinic-based treatment here in the UK. When I recently visited the South London and Maudsley NHS Foundation Trust I heard about FREED—first episode and rapid early intervention for eating disorders—and I was told about how early intervention and evidence-based treatments can work, but we still do not have a full understanding of, or know how best to treat, eating disorders.
Research levels for mental health are woefully low. Analysis from the charity MQ recently identified that just 96p per person affected is spent on eating disorder research, whereas a physical health condition which affects twice the number of people receives £228 per person affected. When will the Government review the level of funding given to mental health research? Only by looking at funding as well as services will we deliver the parity of esteem for mental health enshrined in legislation by the coalition Government, and the Government have made welcome signs that they are still committed to that.
Recruiting and retaining staff is also a real challenge, given the pressures, especially in adult services. The Royal College of Psychiatrists survey showed that vacancy rates for psychiatrists have more than doubled in the past six years and eating disorder services are among the most seriously affected services. In England, there are only 81 psychiatric posts in eating disorder services, and last year 12 of them were vacant. This directly impacts on the time people wait for treatment. While NHS England and NHS Improvement have been tasked with ensuring that local plans are drawn up to meet staffing requirements for mental health, they will not be able to deliver them unless some of the underlying reasons causing those shortfalls are addressed. This may be an issue that the noble Baroness, Lady Hollins, will touch on, so I shall not say much more: only two things. First, increasing the pipeline of medics by creating more psychiatric foundation training places with direct experience of eating disorders would help and, secondly, better resourcing eating disorder services would allow workloads to be managed better and stop people leaving as they are overworked and carrying risks that are too high.
Those risks are exacerbated by dangerously low in-patient capacity. As some Members of the House will know, 19,000 people needed hospitalisation in England last year for eating disorders. That figure has doubled in 10 years but no extra beds have been provided. There are only 649 beds in England. That means that patients with BMIs of under 12 are sent to units while they wait for hospital beds to become available and that patients, who are often children, are sent hundreds of miles away from their families for months on end. When our daughter needed specialist in-patient care there were no beds available anywhere in the country. She was kept alive by the local hospital for a month until a bed became available 144 miles away. She received excellent care, for which I am truly grateful, but I am in no doubt that the distances that people have to suffer at these very difficult times often make it an unbearable situation.
What makes it, frankly, shocking is that commissioning decisions about how many beds and services we have are being made without the NHS having even basic data on the number of people suffering from eating disorders in the UK. You cannot manage what you do not measure. I call on the Government to institute a review of eating disorder services, informed by accurate prevalence data.
While there is much more to do to improve the lives of sufferers of these diseases, there is much to be thankful for: the staff who care and battle on despite the workforce shortages and resource limitations; voluntary organisations, such as Beat and TasteLife; the families and carers who may rage in private but refuse to give up on their loved ones; campaigners, such as Hope Virgo and others, who use their lived experiences to offer much-needed hope of a better tomorrow; and—if I may say so—the Minister, whose willingness to listen is genuinely appreciated.
With the help of this Government, we can take the actions necessary to improve the lives of people suffering from these dreadfully cruel diseases. They deserve nothing less.
The term “eating disorder” is usually reserved for those suffering from anorexia and/or bulimia. Yet the only genetic factor involved in these conditions is dispositional, not causative, which is exactly the same in the case of obesity. The health implications are far-reaching indeed. Two-thirds of adults in the UK are classified as overweight or obese, with a full third in the second of these categories. Anorexia and obesity used to be thought of as two distinct populations; to some degree this is true, since the former is more often linked to high levels of distress and malfunction. However, the incidence of anorexia is much lower. Recent research indicates that those at the more extreme levels of obesity show comparable levels of anxiety, stress and depression to those with anorexia, particularly in the case of female sufferers.
I welcome the Government’s initiatives for raising consciousness in schools about eating disorders and their parallel reforms to provide early treatment within the NHS. More than one report in the Commons has warned about the serious lack of training on eating disorders for doctors. Just as important is ensuring that GPs are up to date with the most recent research in a field that has a strong medical pathology yet is closely embedded in lifestyle.
Since the Minister has strong Oxford connections—and speaking as an academic myself—I should like to ask her views on the avant-garde research into anorectic disorders being carried out by the Department of Psychiatry at Oxford University. The interest of this work is the attempt to link the biological, emotional and somatic processes involved in anorexia. There is a shortage of evidence-based treatments for anorexia and eating disorders more generally. The Oxford Centre for Human Brain Activity—a really interesting research organisation—is working together with psychiatrists and social scientists on this.
We need further long-term studies of eating disorders, in the wide sense in which I am using the term. A study carried out at Harvard University showed that fewer than half of adults in the US achieve recovery from anorexia or bulimia nervosa over the long term. It is good to see that this research explores the links between those apparent opposites—anorexia and obesity—which I am saying are part of a connected syndrome. The common link is a compulsive relationship to food coupled with distorted but powerful body imagery. Some of the underlying neural mechanisms seem to be the same. One piece of research in the US describes anorexia and obesity as—going back to Chinese—the yin and yang of bodily weight control.
“Go on a diet!” That is the common-sense response to obesity. However, both anorexia and obesity stem from the fact that we live in a world where we are all on a diet. For the first time in history, an almost endless array of foods is available on a daily basis. Every day, consciously or not, we have to decide what to eat in relation to how to be. Even noble Lords have to take these decisions since there are so many cafés on site here; I never quite know which one to go to at a particular time.
I have a couple of questions for the Minister in concluding, as one is supposed to. First, what procedures have the Government established to track and assimilate cutting-edge research on the diagnosis and treatment of eating disorders? By that I mean international research, not simply research in this country; as I am trying to stress, this is an amazing global reversal in human beings’ relationship to food and the body, so the research needs to be transnational. Secondly, and in conclusion, will the UK follow the lead of other countries in recognising the need to explore the aetiological parallels between anorexia and obesity?
Public discussion and debate are essential too in helping sufferers overcome the shame and the need for secrecy that they often feel. Weight loss is only one of the possible symptoms. No less important can be indicators such as mood and behaviour. Irritability, restlessness and difficulty in concentrating in class can all too easily be explained away if school staff have not received the training that is needed to probe the real difficulties successfully, so equipping school staff with the skills to encourage children in the most sensitive way to talk openly about their feelings must be a central part of any training.
It is so very important to combat the stigma that still attaches to eating disorders, the stigma that treats them as a sign of vanity or a means of gaining attention. The Government’s recognition that more needs to be done in training schools to banish stigma and identify the early signs of trouble is to be warmly welcomed. The funding announced last year for the national mental health programme, working with the NHS, is an important start, although the target of training a senior member of staff to lead on mental health issues in all schools over the next four years is not perhaps as ambitious as many hoped.
More thought needs to be given to the long-term improvement of clinical referral services for children. With more teachers trained to lead on mental health issues in schools, demand for early access to expert NHS clinical support will increase. At the moment services vary far too much in quality and extent across the country. Instances of children being turned away by the NHS because their condition has not become life-threatening are a cause for grave concern.
A mentally ill child faces an almost insurmountable barrier to learning. In view of the need for early intervention, and the large potential cost to the NHS and families of the growing number of severe cases, the vital work of charities such as Beat in schools should be recognised and supported.
Working in co-operation and in partnership with the Government, charities can help achieve the progress we all want to see accomplished. Beat’s Spotting the Signs training for schools is now available widely in the north and in some other parts of our country. It will be extended as further resources allow. Beat is also working with organisations such as the Independent Schools Association, which I mentioned at the outset, to make more teachers aware that a child’s mental health is just as important as their physical health. That surely is an absolutely fundamental point.
It is in schools that part—a significant part—of the answer to the urgent problems at the centre of this important debate can be found. I end by thanking the noble Baroness, Lady Parminter, again for initiating it.
It is not just the medical workforce which has suffered over the last 10 years. Since 2009, the mental health workforce has also lost 7,000 nurses and 6,000 clinical support staff, and more than one in 10 clinical psychology posts is vacant. The sorry state of the workforce is only one part of the story. The noble Baroness, Lady Parminter, emphasised that early intervention is key to success in the treatment of eating disorders and spoke clearly about the need to introduce waiting-list standards for adult services. However, early identification of eating disorders has to happen before anybody can intervene. That means that all doctors need basic knowledge about how to recognise them. The noble Baroness notes that one in five UK medical schools seems to teach very little about eating disorders, although I understand that the GMC has specified that all medical schools should teach this. It is crucial that staff across the health service, including in primary care and general hospitals, have a basic working knowledge of eating disorders and other common mental health presentations. It is not something to leave just to specialists in psychiatric services.
On 10 February, I will be asking the Minister about the Government’s plans for mandatory training for health and social care staff in learning disability and autism. There is a relationship between eating disorders and learning disability and autism. As many as 90% of children diagnosed with autism have some form of disordered eating, and some estimates suggest that up to one in five women with anorexia has autism. The situation is complex when multiple mental health conditions coincide; there is no substitute for better trained and supervised staff.
There are many possible responses to the issue of training. The House of Commons Public Administration and Constitutional Affairs Committee recommended last year that all newly qualified doctors should work in psychiatry in one of their six foundation placements and gain some experience of eating disorders. This request has been made many times before by the Royal College of Psychiatrists and others, including when I was president earlier this century. The Government’s response to the committee’s recommendations in August 2019 stated that
“the GMC will host a roundtable with HEE, NHS England and NHS Improvement, key bodies within the Devolved Administrations, the AoMRC and individual royal colleges, the Medical Schools Council and other key bodies.”
Could the Minister provide an update on the status of these discussions?
I will end by commenting on the importance of generalism. A suggestion is gaining ground that all subspecialists should be generalists as well, with the aim of minimising the gaps that can arise between specialisms—whether the specialism is eating disorders, learning disabilities, autism or anything else. Is it time to consider additional postgraduate qualifications for generalists, while ensuring that all general psychiatrists have training in these conditions?
I congratulate the noble Baroness, Lady Parminter, on securing this important debate, on speaking so frankly, honestly and powerfully about the subject, and on allowing me to speak about some broader, related issues in the mental health workforce.
Sufferers also change personality. If somebody in your house is suffering from anorexia, you will find that your cheerful, open teenager can become aggressive, abusive, deceitful and manipulative, and an expert in inflicting pain on their loved ones. It is very hard for anyone who has not had first-hand experience of this debilitating and vicious disease to imagine what it is like to have to keep up surveillance and constant care just to keep your precious child alive. It is a deadly disease but, as the noble Lord, Lord Lexden, said, it is often seen as an extension of vanity—the obsession with image and appearance. It is far more complex than that, as other noble Lords have said in the debate.
It is alarming that the January NHS figures show that hospital admissions for eating disorders have risen by 37% across all age groups in the last two years. Hospital admissions are only for those who have to be prevented from starving themselves to death, so this is just the tip of the iceberg. It is a huge issue, and sufferers need intensive support and early intervention. As other noble Lords have said, the sooner they get the treatment they need, the more likely they are to make a full recovery. Prompt access to high-quality treatment and support can prevent people getting to the point where hospital admission is the only course of action that will keep them alive.
I agree with what has already been said: research has been starved of funding. My experience was quite some time ago, but there was very much a feeling that this was not really an illness but the teenage behaviour of adolescent girls, and a failure to recognise the results that could occur when people did not get the care that they needed.
I was interested to hear that research has proposed the idea that there may be a hereditary aspect, for example, and also that people are now looking into a metabolic dimension. As has been said, the relation to obesity is something that appears to be being looked into more. Certain individuals may be much more likely to suffer from anorexia when they experience stress, bullying or very severe pressure. I feel that we need to raise awareness of this as a disease that kills people, not a lifestyle choice, affectation or folly of teenage girls.
I hope that treatment and support will be made available consistently across the country. Whether you survive this disease should not be a matter for a postcode lottery. In my opinion, eating disorders have for many years been a Cinderella service within mental health, which is itself a Cinderella service. I hope, from the information we have had, that the Minister will reassure us that this will not continue to be the case. If not, there will be more and more tragic and unnecessary deaths, as sufferers’ lives continue to be at risk. Again, families and carers live with that risk of death every day. I hope that we are to get assurances from the Minister, as more and more families will be torn apart if there is not very prompt and urgent action to provide support and treatment for people suffering from all eating disorders. However, I make a special plea for anorexia.
I will not repeat all the points that my friend, the noble Baroness, Lady Hollins, made but we have a grave shortage, right across the board. We have shortages in addiction generally; in psychiatrists; in doctors, nurses and staff at many levels right across the mental health field. We look forward to having some comforting response, I am sure, from the Minister on how we are going to see improvements in those areas. They are sorely needed because we seem to have a shift from physical health into mental health, and the caseload is growing all the time.
I spent many years working on addictive issues. I have a personal history of problems with alcohol and drugs. I was on my knees and had to find a way forward, and I did that nearly 40 years ago. Since then, I have spent much of my life working with people with addictions—not just in alcohol and drugs but food, too, and at both ends of the spectrum with food. My dismay is that we have a divide between the approach on obesity and that often taken on eating disorders, when in fact there is so much commonality between them. As others have said, it is time that we started trying to bring some of these elements together, and to work closely in a more overarching way than in the past.
I am pleased that the Government have announced that they are to introduce a cross-departmental approach on a number of addictive issues. Can the Minister say why the subject we are talking about and obesity have not, so far as I can see, been specifically included? They are not being addressed within that approach. When will the work get under way? Can she give us a little more information about its timescale and who will be involved with it? What does she expect to come out from the new review that is being established? But overall, I welcome that development.
Having examined some different types of addiction, my experience is that in many areas they seem to have common themes running through them. Look at how we address it within Public Health England; it is interesting that it has separate units dealing with drugs, alcohol and the problems arising with food. We should look at the structures within that major organisation to see whether it is properly set up for prevention, given that the Government have now decided that they need a cross-departmental approach on reviewing addiction.
It is not easy to find solutions, particularly on anorexia. Among the addictions I have looked at, it is one that hits quickly and is very difficult to reverse. It also has quite dramatic impacts on families, relatives and other people around them. In looking for solutions we should not limit ourselves to dealing with the individual; families should be involved, too. We should look to have the widest possible participation, not just from professionals—we are short of them and need more—but more across the voluntary sectors. We should look at what alternatives may be available.
I am quite open in saying that I believe that there is a requirement for a spiritual approach. That is not something that we frequently talk about in the Chamber, but I have certainly seen many people whose lives have been written off yet who have found by one means or another, using the 12-step recovery programme, their way to a better, fruitful life. I am pleased to report that, in March, we will set up for the first time an all-party parliamentary group on this topic. The inaugural meeting will look at the 12-step recovery programme on addictions to see how it might be applied over the widest possible area to help people who have problems which seem difficult to resolve and who may find an answer in it. I would like to hear whether the Minister welcomes that development.
As the noble Baroness, Lady Parminter, said, the report by the NHS ombudsman on how patients are failed was truly shocking. Since then, we have had much better guidance in commissioning, but those documents are often ambitious, noble but pie in the sky and are not widely taken up, for all the reasons which have been articulated. Eating disorders are more common than people realise. Some 80% of people who have them never go to a doctor, and many episodes are managed in families with no access to specialist services. Such services may not be needed, because, within a few weeks or months, the child or young woman has tackled the disorder themselves and has been able to get to grips with what has become a pathological desire to be thin without flipping over into something that does not get better. It is important to remember that, because those who are referred are therefore often in great need of specialist care, and that is the thing that is so difficult.
Eating disorders are of course prevalent in young men as well, particularly those with a gender disorder of some kind or who are troubled by their sexuality. I have treated at least two young men with anorexia nervosa and found them quite as difficult as young women to reach and help through their disorder. It is also common—and getting commoner—in older people. My Aunt Florence never recovered, and died when she was in her 90s. She was slim, but healthily so, all her life until she was in her 80s, when she started to adopt strategies identical to those of a much younger woman. This was similarly pathological, and she starved herself almost to death. Elderly people who get these disorders are often inappropriately investigated, because of the link between physical ill-health in old age and loss of appetite. Perhaps “inappropriately investigated” is not fair, but these things are much commoner in later life than one might imagine.
We have had the commissioning help after the ombudsman’s report and we got the extra £30 million put into young people’s services, but it has simply not touched adult services. Other noble Lords have already mentioned the mortality rate, so I will not stress that.
Historically, such disorders were a lot commoner than we think. There is a description of an illness suffered by Mary Queen of Scots which is a classic eating disorder. There are explicit medical descriptions from about 1670. In the 19th century an awful lot of young women had a condition called chlorosis. People turned slightly green because they had iron deficiency, but it is also thought that this was largely caused by anorexia. There were pressures on young women then which they too addressed in that way.
Treatment is extremely difficult. Evidence-based treatments are few and far between. What we try to do is keep people alive and at a healthy weight long enough for them to get a grip on it and recover for themselves. That is true not just for anorexia nervosa but for many other mental health disorders, for which we do not have the specific treatments we have for psychoses. People need a lot of help, support and psychotherapeutic approaches. The ones that are good for some people may not be for others. The commissioning document makes it clear how important it is for people to be given choices.
My time is up. I stress that we need more investment in a choice of services which are readily accessible for people locally, so that they do not have to just accept what their local service provides. That is the major thing the Government should be doing. What are they intending to do?