I posted on instagram yesterday about a debate led by MP Sir Edward Leigh in Westminster Hall, to discuss the link between skin conditions and mental health. He is a member of the APPGS (All Party Parliamentary Group on Skin) who aim to increase understanding about skin care issues in Parliament and achieve improvements in the treatment and management of patients with skin disease. This debate referenced their recent reports and surveys on this topic, inviting other MPs to discuss both their own experiences of skin conditions, as well as sharing stories from their constituents and praising charities and specific services they thought were leading the way in this field.
You can read the minutes yourself HERE, but I’ve summarised the main points below.
As Edward Leigh pointed out in his speech, “the psychological impact [of skin conditions] 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. [There is a] need for commissioners and health leaders to rethink how the NHS provides psychological care for people living with a skin condition.”
These debates are a way for MPs to bring attention to matters of importance and suggest ways in which the government can move forward with changes. Essentially, they have to convince the relevant people that it’s 1) necessary 2) urgent and 3) realistic and possible. Slightly depressingly, this MP has actually had this debate twice before, first in 2003 and then again in 2013, which doesn’t fill me with confidence. However, he points out that he is bringing the topic to be debated for the third time because – not only has the situation not improved, but – what was already a dire situation has been made much worse by the impact of the pandemic, partly because of the logistical strain on the NHS but also because of the mental health impact of the last 2 years. “Our most recent report shows that, despite a general recognition of the need for better care in this area—and leaving aside the more recent impact of the pandemic—most of the recommendations of the previous reports have, I am afraid, not been acted on by Government. That seems to me to be an indictment of those responsible for the planning and commissioning of these essential services.”
He closed his speech with the following words, which stress “the urgent clinical need for healthcare professionals to be equipped with the necessary skills and resources to provide the holistic care that patients need. This must include patient assessments and care that treats the mind and skin together; otherwise, we will not break the vicious cycle whereby problems create psychological problems that in turn exacerbate the skin condition. We ultimately hope that through the publication of this report and debate, the need for action will be made clear to policy makers and service commissioners working in Government and the NHS.”
OTHER KEY POINTS OF INTEREST FROM THE DEBATE:
- 98%* of skin disease patients felt that their condition affected their emotional and psychological wellbeing; yet all the patient representative and professional organisations providing evidence stated that the NHS mental health provision for skin was “poor” or “very poor”.
- Over half the patients surveyed did not realise that they could ask for help with managing the mental health impact of their skin disease.
- 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.
- There were some examples of HCPs who were providing great care: “the specialist IAPT service in Sheffield and the well-established psycho-dermatology services in some London hospitals. Psychological interventions are also being tested, and approaches involving cognitive behavioural therapy, merged with mindfulness and self-compassion, are showing great promise.”
- Changing Faces was mentioned multiple times as an example of a wonderful charity doing great work in this area.
SUGGESTED NEXT STEPS FROM THE APPGS:
- All NHS dermatology units must have regional access to psychodermatology services, with clear pathways for patients to be referred to for appropriate psychological intervention or support.
- A stepped care pathway that starts with good quality screening and enables patients to speedily access the most economic and effective psychological services that they require and deserve.
- Increased staffing in dermatology services and improved dermatology and psychological training of all NHS staff who have regular contact with patients with skin conditions. That includes training for trainees, primary care clinicians and secondary care specialists.
- Research funding for psychodermatology should be prioritised. It should focus on the development, evaluation and implementation of a range of psychological and educational interventions for patients with skin conditions. The inclusion of patient support organisations in service development is critical to amplify the patient voice and to ensure that patients have clear access to some of the excellent services available in the community. NHS mental health funding provided to local commissioners must urgently be used to invest in and improve mental health services.
- [There is an] urgent clinical need for healthcare professionals to be equipped with the necessary skills and resources to provide the holistic care that patients need. This must include patient assessments and care that treats the mind and skin together.
OFFICIAL RESPONSE FROM THE DEBATE LEADER:
In closing the debate, the Minister for Care and Mental Health, Gillian Keegan responded: “We are committed to achieving parity between mental and physical health services, and to reducing mental health disparities. We know that we are not there yet, but we are committed to that… [to ongoing] investment and expansion of mental health services. To deliver on our commitments, we need to ensure we have the workforce available. That is important but it takes time to deliver and that impedes our progress. It is vital that we have the right skilled workforce in place; we have improved that and we will continue to improve it.” (this is a partial quote for brevity, please see transcript for full response).
On a personal note, I believe that the larger scale changes to policy are unlikely to be implemented. We all know that the NHS was struggling before the pandemic and is now buckling under the weight of the impact. Unfortunately, as with many conditions, until you have suffered yourself it is hard to understand the repercussions a skin condition can have on your everyday life. Funding, staffing, and policy changes take time and need strong, ongoing commitments (both financial and practical). In lieu of the – in my opinion! – achievable but unlikely changes requested by the APPGS, I believe there should be a push for what I would consider to be the bare minimum in assistance when a patient approaches their GP with a skin complaint. Your appointment should include (as standard) a section where they enquire about your mental health and the impact your skin condition is having. If you are found to be struggling in that area, you should either be referred to a trained colleague internally or a specialist external service. If this kind of referral isn’t possible, the patient should be made aware of services available for self-referral. All HCPs should have access to a database of resources that they can recommend to patients, whether that’s skin-condition-specific charities, online support groups, or information portals.
I will be keeping an eye on the ongoing discussion and will, of course, keep you updated. Although I’m not convinced the big changes we need will be forthcoming, I do find it comforting to know that these conversations are being had, as it can often feel like skin conditions are at the bottom of the pile when it comes to health priorities. I would love to hear your thoughts on this debate and what you think the most impactful next steps would be.
*Survey results from APPGS Mental Health and Skin Disease Report (2020)