Skin Conditions and Mental Health

I remind Members that Mr Speaker has asked us to wear our masks if at all possible and to maintain social distancing where we can.

I beg to move,

That this House has considered skin conditions and mental health.

I want to start my speech by making a point that I will make at the very end: mind and skin are linked, and we have to take action on both if we are to break the vicious cycle of psychological harm. I suppose, really, I should declare an interest right at the beginning of this debate. It is not a financial interest but a personal interest: I have rosacea, which makes one’s face red and can ultimately deform it, and I take antibiotics every day. There are many more serious conditions—I do not make a great thing of it—but only today, in relation to something else I said on a completely different subject in the House of Commons, I have already received one email accusing me of being a red gammon head and a ruddy-faced buffoon.

I take it very lightly, because I know I am already old and ugly, but for young people this kind of personal abuse about their appearance is deeply upsetting and drives many people into deep psychological harm, because mental health and physical health are intrinsically linked. Knowledge of this link has driven recent advances in NHS service delivery and underpins much of the thinking in the long-term plan. Although that has led to the development of trailblazing and new services for many people with long-term conditions, for some reason people living with skin conditions continue to have dire access to psychological services. Indeed, in 2020 the all-party parliamentary group on skin, which I chair, published a report on the mental health issues faced by people living with skin conditions. It demonstrated that the psychological impact can be severe, in terms of the effect on people’s work, education and healthcare use. We should all worry about this, as 60% of us live with some form of skin condition.

Since the publication of the report, the developing impact of the covid pandemic has inevitably made a bad situation worse. One of my colleagues—who might speak in the debate—said that he was told by his GP only recently that he might have to wait a year for an appointment about a skin condition. With many patients with inflammatory skin diseases now experiencing a 12-month wait for a first appointment with a dermatologist, the stress and anxiety experienced by many individuals has risen significantly. I therefore want to spend this debate outlining the need for commissioners and health leaders to rethink how the NHS provides psychological care for people living with a skin condition.

The APPG’s report on the mental health associated with skin conditions is available on the group’s web pages. The report was based in part on a survey conducted by dermatologists and psychologists of 500 skin patients, with evidence also collected from 100 clinicians and 16 dermatology-related charities. The report was led by experts from the British Association of Dermatologists. The survey part of the report found that 98% of skin disease patients felt that their condition affected their emotional and psychological wellbeing; yet astonishingly, all the patient representative and professional organisations providing evidence stated that the NHS mental health provision for skin was “poor” or “very poor”. In addition, over half the patients surveyed did not even realise that they could ask for help with managing the mental health impact of their skin disease. That clearly demonstrates just how under-resourced services are in this part of the NHS.

Thank you for calling me in this debate, Mr Gray. I also thank the right hon. Member for Gainsborough (Sir Edward Leigh) for bringing this issue to the Floor of the House.

I want to raise the case of one of my constituents who experienced topical steroid withdrawal and the side effects of that as a result of the treatment she received for her eczema. I very much concur with the conclusions of the right hon. Member for Gainsborough on the steps that now need to be taken, not least in instituting mental health support in the care pathway.

Having been prescribed topical corticosteroid medicines over a long time, my constituent experienced a very severe reaction upon withdrawal that caused far worse symptoms than those her eczema preparations were intended to treat. The nerve pain was unbearable and inescapable; the skin split and bled; it was sore and painful. The oedema impacted on her care and was debilitating in itself. Those symptoms, exacerbated by the insomnia she experienced and by not going out—being housebound—therefore had a massive toll on her mental health.

The Medicines and Healthcare products Regulatory Agency and the Commission on Human Medicines have reviewed the impact of withdrawal and the over-prescribing of those preparations, which they often are because people need to treat their skin condition continually. As a result of an investigation under the yellow card system, they identified how poorly managed the condition is and how little known.

It comes back to the need for education around dermatology. At each GP practice, there should be a doctor who not only specialises in dermatology but has a good understanding of topical steroid withdrawal, who can therefore manage the pathway of patients. Patients should regularly see their GP for a review of the application of their medicine. It is even harder to trace what happens because there is no coding for this condition. We need to see coding to help to trace exactly what is happening. However, without proper research and investment in research into dermatological conditions, alternative preparations for the treatment of skin conditions are not being advanced at the pace that they should.

It is a great pleasure to serve under your chairmanship, Mr Gray. I want to talk about mental health support for those with skin conditions, which is something that is often forgotten about by health providers across the UK and beyond. That is surprising, because 60% of British people currently suffer or have suffered from skin conditions at some point in their life. Those figures are comparable with cancer—it is a much bigger problem than we recognise. Some 98% of skin disease patients currently report that their condition affects their emotional and psychological wellbeing, yet only 18% have received any form of psychological support. That is a dichotomy that I want to explore very briefly—notwithstanding my sore voice, for which I am very sorry.

A key reason why support for these conditions is so important is that recent studies have proven that there has been an increase in psychological distress, and in the last two years in particular. That applies in particular to adults over 18 and children aged between six and 16. For over-18-year-olds, there has been an increase of distress from 20.8% in 2019 to 24.4% in March 2021. That in my view is a reflection of the pandemic, from which we have all suffered.

A study of adults over 18 also found that 26.1% of respondents reported self-harm thoughts at least once between March 2020 and May 2021. That is a hidden danger that we must all be aware of. It is even worse for those who are a bit younger. Among children aged six to 16, 39.2% have experienced some kind of deterioration in mental health since 2017—no doubt as a result of schools being closed and the isolation we all suffered from during the pandemic. For me, this debate is about the hidden dangers of the pandemic and the mental health cost on individuals.

That is made worse as young people emerge from the pandemic and their hibernation. How do they look? How do they feel? How low or high is their confidence? What about not having been in the sun for the last couple of years for those living in high-rise blocks in London and inner cities? What about skin conditions, such as acne? What about not going to school at that key age as a teenager? What about the lack of confidence that comes from having a skin condition? I want to raise these questions today. We can easily acknowledge the problem, but the solution is much more difficult.

Having discussed mental health, I want to move on to dermatology. The number of eczema sufferers in the UK has been steadily rising for the last 10 years. It stands currently at 1.3 million people. Interestingly, eczema is diagnosed much earlier. In around 90% of cases, it is children below the age of five. Psoriasis is much more of a problem for people that are slightly older. The prevalence of psoriasis in the UK today is a similar figure, at about 1 million to 1.3 million people. I am very familiar with it myself. Psoriasis is a problem that can affect how people look, and it is just one of many skin conditions, as we heard earlier from my right hon. Friend the Member for Gainsborough (Sir Edward Leigh). It is part of the whole panoply of skin issues that affect people so badly.

The hon. Gentleman is giving an excellent speech. I, too, pay tribute the right hon. Member for Gainsborough (Sir Edward Leigh). This is such an important issue. I have been contacted by a constituent of mine called Margaret who is a lifelong sufferer of psoriasis. To judge from his opening speech, I think that much of what she said in her email to me would be very familiar to the right hon. Member for Gainsborough. Does the hon. Member for Bracknell (James Sunderland) agree with me about the importance of first contact with the doctor and how important it is that sufferers of all kinds of skin conditions can feel confident about reaching out to their doctor? As the hon. Gentleman says, face-to-face contact is so important. I also want to emphasise to anyone, anywhere, who might be suffering from a skin condition that help is available and they should not hesitate to seek it.

I thank the hon. Lady for her intervention; I could not agree more. The simple answer is that doctors cannot see anything on a Zoom call. Also, people need to be able to see a doctor to get a prescription. If someone has a skin condition, they cannot just go to the chemist to get a prescription. They have to get an appointment first in order to get the prescription, and that is where face-to-face appointments come into it.

My third point is that we need to increase the range of psychological support for all those who need it. That is part of the panoply of health support that we need. A 2014 study showed that 94% of the patients who had completed psychodermatology treatment reported reduced stress, 92% reported increased confidence, and 90% reported that their skin condition was better understood. Wow. Those figures are amazing, but if someone asks for that treatment at this point in time, it takes up to a year for a referral, which is worrying.

I want to commend the excellent services locally in my constituency. The Frimley integrated care system is one of the best in the country, if not the best. The treatment that I have had personally has been pretty good, notwithstanding the delay that we are all suffering form. Lastly, I ask the Minister to reinvest accordingly in this very important area so that young people and adults are not suffering.

This debate can continue until 6.07 pm. However, the House will know that there is very probably a vote at 6 pm. Coming back for five minutes seems odd, so it would be helpful if we can conclude by 6 pm. We have three further Back-Bench speeches and 15 minutes to conclude them in, so four or five minutes each will be helpful.

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the right hon. Member for Gainsborough (Sir Edward Leigh) on securing this debate.

As co-chair of the all-party parliamentary group on beauty, aesthetics and wellbeing, I am deeply concerned about the impact on mental health of having a visible difference, particularly for our children and young people growing up in a world where body image seems to become so significant, with the explosion of social media platforms. Living with a skin condition or any form of disfigurement impacts on an individual’s everyday life. At best, they might have to put up with strangers staring or pointing fingers, but for many it is a steady stream of teasing, harassment or bullying, which has a detrimental effect on self-esteem and subsequently on psychological wellbeing.

Almost one in five people across the UK self-identify as having a visible difference—a mark, a scar or a skin condition. We know that at least 1.3 million people are living with a significant disfigurement, which includes 569,000 with facial disfigurements. Although many dermatological clinics can provide support and advice on the physical challenges and treatments, fewer than 5% of them offer any level of specialist mental health support for young people.

I have talked before in this place about the fantastic charity Changing Faces, which provides unique and life-changing counselling and emotional and psychological wellbeing support for those with visible differences and their families. It does an amazing job and relies on voluntary funding and grants that stretch only so far, which means that it can reach only a tiny percentage of the people who need its help. Its mission is to challenge prejudice and discrimination and to change attitudes towards people living with skin conditions and scarring. Its “Pledge to be seen” campaign was launched to ensure that people with a visible difference that affects their appearance are seen and heard across mainstream culture and in workplaces.

It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to the APPG, and to my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) for securing this important debate. I will try to keep my comments brief, but the challenge is that there is so much to talk about.

I, like the hon. Member for Swansea East (Carolyn Harris), pay tribute to Changing Faces, which has done incredible work to promote the cause of those with visible difference, who too often in our lives face discrimination and bullying. We know that 55% of young people will be bullied about their appearance. With the skin the largest organ of the body, it is almost inevitable that those who have a visible difference, such as eczema, cystic acne, scars or burns, will face some horrendous bullying at school—the sort of bullying that means that they do not take part in the ordinary activities that other children do. When I say “ordinary activities”, I mean that they do not want to take part in PE or put their hand up in class in case attention is drawn to them. Is it any surprise that children who have conditions that require medical treatment also need psychological help to overcome all of that?

I pay particular tribute to the most amazing man in Southampton, Professor Keith Godfrey—a dermatologist at Southampton General Hospital who runs the paediatric dermatology service.

Nobody likes talking about acne. I have been in this Chamber when I have heard Members say to me, “Nobody died of a few spots.” But actually, we heard my right hon. Friend the Member for Gainsborough highlight acts of self-harm in young people who feel so bullied and pressured because of the state of their skin that they do not leave their bedrooms and do not want to take part in school activities. Tragically, some do take their lives; they lose their lives because of “a few spots”. That is why it is so important that they are given the psychological help they need to get through their conditions.

I congratulate the right hon. Member for Gainsborough (Sir Edward Leigh) on securing this debate. I want to focus on that issue of major importance to which he referred: mental health. As my party’s health spokesperson, I am keen that these issues are addressed. Skin is always completely visual. For young people in particular, looks can seem like the most important thing, which is why it is crucial that we recognise skin conditions that are normal and those that are not. We have 4,000 skin cancer deaths annually in the UK.

The reason I am interested in this subject is that my second son was born with psoriasis. He had to have cream three times a day. The doctor told us that although he would grow out of the psoriasis—and he did—he would then develop asthma. He did develop asthma, but he is now married to Ashleigh, and they have two boys, Austin and Max—life has changed for him. I remember that when he was at school it was terrible for him; all over his skin was a rash. My wife was the person who looked after him, but that is what happened.

In Northern Ireland, in my constituency alone, we have 2,713 people who suffer from inflammatory skin disease. It is really important that the issues are taken onboard. Some 4,351 people develop skin cancer each year, and around 300 of those cases involve malignant melanomas. It is crucial that there is special psychological care to deal with the impact of skin problems, to help people to cope and to ensure that the condition does not worsen. The right hon. Member for Gainsborough referred to the fact that 18% of people suffering with skin conditions have received some form of psychological support—that is really important. They have to learn how to live with it, as well as learning how to deal with it. As I have said before, young people are growing up in a world where looks seem like everything, and we must do more for them.

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the right hon. Member for Gainsborough (Sir Edward Leigh) on securing this debate on such an important matter, and for informing us all so much through his excellent contribution. Millions of people across Scotland and the UK suffer from skin conditions, which can have a devastating impact on a person’s mental health. The skin is the most noticeable part of our body that could be impacted by psychological factors, yet very few psychologists are researching it. It is classic health psychology, just in a different area. It may seem purely aesthetic to the unaffected, yet the impact goes much deeper, as we have heard.

Skin conditions can be extremely distressing. They can affect all aspects of people’s lives, from schooling, relationships, self-esteem and career prospects to social and leisure activities. Unlike hypertension, diabetes or other health problems, skin problems are usually obvious to any onlookers. That can lead to feelings of isolation, embarrassment, depression or anxiety. People may have psychological reactions that seem out of proportion to their actual skin complaint. Around a quarter of the UK population consult a GP every year for a skin complaint, the most common being for stress caused by the complaint. Despair and other psychological issues can exacerbate the skin problem, creating a vicious spiral.

Acne, psoriasis, eczema and hives are just a few of the dermatological conditions that have been scientifically proven to be exacerbated by stress. Psychodermatology treatment is becoming more accepted among dermatologists, and psychologists are becoming more involved in assisting dermatology patients. Dermatologists and other skin experts are still researching the role of stress and other psychological factors on skin conditions. They are also working on therapies to help dermatology patients deal with the mental health difficulties associated with their conditions.