Women and Girls with Autism: Mental Health Support

11:00:00

I will call Jessica Toale to move the motion and then call the Minister to respond. I remind other Members that they may make a speech only with prior permission from the Member in charge of the debate and the Minister. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

I beg to move, That this House has considered mental health support for women and girls with autism. It is a pleasure to serve under your chairmanship, Sir Edward. I am grateful to have secured this debate today to discuss a matter of deep importance for one of my Bournemouth West constituents, Lindsey Bridges, as well as the thousands of families across the country affected by the failings in our mental health and autism care system. I rise today not only as a Member of Parliament, but as a voice for Lindsey and her daughter Lauren, known as Lolly to her friends and family, who is no longer here to speak for herself. Lauren was just 16 when she died. She was a bright, compassionate young woman, and a straight A student who dreamed of being a doctor or a paediatric nurse. She was also autistic, and like many girls and young women with autism, she faced serious challenges getting the support she needed. In 2021, Lauren was detained under the Mental Health Act 1983. She was placed in an in-patient unit in Manchester six hours from her home in Bournemouth. As a result, her mental health deteriorated severely. In February 2022, Lauren went into cardiac arrest and died in that unit. Her mother Lindsey had begged for her to be moved closer to home, but her pleas went unheeded. This is not an isolated incident. Like too many others, she was let down by a system that promised care but failed in that promise.

My heart absolutely breaks hearing the story about Lauren—it is awful. Many autistic women and girls are undiagnosed, misdiagnosed or diagnosed late in life due to the outdated belief that autism mainly affects males. As a result, many women receive mental health treatments for conditions they do not have, including treatments that could be ineffective or even harmful. These diagnostic failures can seriously affect mental wellbeing and may explain high rates of depression in that group. Does my hon. Friend agree that the healthcare system must adapt to better identify and support autistic women and girls early on, prevent misdiagnosis and improve mental health outcomes?

Absolutely. There are now more than 2,000 people with learning disabilities and/or autism detained across the UK in in-patient units similar to the one that Lauren was held in. They are often far from home, cut off from their families and placed in highly restrictive environments that frequently do more harm than good. Lauren’s case is heartbreaking, but it must also be a turning point, which is why Lindsey is campaigning for Lolly’s law and why I am bringing this campaign to the House today. Lolly’s law proposes four urgent reforms that could prevent future tragedies. The first is mandatory retraining for psychiatric professionals and support staff so that they have a proper understanding of how autism presents in girls and women. Too often those young women are misdiagnosed with personality disorders or wrongly pathologised.

I commend the hon. Lady for securing this debate. She is absolutely right to highlight the issue. It is very hard to listen to because the particular circumstances are so personal. Numerous studies have shown that girls and women are more likely to internalise the stress and anxieties that come with autism, whereas boys are likely to be more openly tempered or passive-aggressive. That is a statement rather than an observation. Does the hon. Lady agree that we could work more closely with teachers in schools and other individuals to ensure that young girls struggling with autism have support in the educational system to externalise some of their stress?

It is obvious that women tend to mask symptoms of autism more and that they present very differently from men. Our medical system is not set up to properly diagnose it in women. The second proposal of Lolly’s law is a reassessment of personality disorder diagnoses where autism might be missed. There needs to be a national reassessment programme to identify cases of misdiagnosis and provide appropriate support for those affected. The evidence already shows that where female in-patients are diagnosed with emotionally unstable personality disorder and/or eating disorders and are reassessed for autism, 100% of them receive a diagnosis for autism. Thirdly, specialist suicide prevention and self-harm teams must be available in all mental health units for vulnerable young people. These should be multidisciplinary teams trained specifically in females with autism. Finally, anti-ligature doors and safety infrastructure must be mandated across all in-patient mental health facilities. These are basic safeguards that can and do save lives. Lindsey has set up a petition for Lolly’s law, which has already gathered 225,000 signatures—clear proof of the public demand for action. She has also developed a training course for child and adolescent mental health services professionals, solicitors and others involved in mental health decision making, which has been positively received by those who have seen it.

We understand that girls with autism are more likely to be underdiagnosed or misdiagnosed. Without appropriate and tailored support, those girls can face unnecessary distress, particularly in the school setting. Does my hon. Friend agree that we should ensure teachers and other professionals are given the correct training to better understand autism?

Clearly, we need better training across many of our institutional settings. This is in part where Lindsey has put together the training course, which I hope she will be able to discuss with the Minister at some point. Lindsey is also backed by the Children and Young People’s Mental Health Coalition, Emotional Dysregulation Autism, the Abbey clinic and many other respected voices in this space. Let me be frank. The current system is failing young people with autism. The number of people in long-term institutional care remains stubbornly high. It fails to distinguish between autism and other mental health illnesses. It overuses restraint and seclusion and separates children from their families, often for extended periods. It is a system that punishes difference rather than supports it. It is indefensible. Families are exhausted. Parents like Lindsey are forced into campaigning roles they never asked for, because they have been let down so completely by the very institutions meant to protect their children.

One of the toughest challenges that autistic women and girls face is misdiagnosis and late diagnosis, so girls’ problems go unnoticed. Parents in my constituency frequently tell me how frustrating and exhausting it is for them and their families to try to get the support and diagnosis that their daughters need. Does my hon. Friend agree that too often young women get a late diagnosis and are left wondering how life could have been so much different if they had got that support earlier?

I absolutely agree with my hon. Friend. There are far too many families across the country left fighting for their children and, like Lindsey, having to take up campaigning roles, which are clearly exhausting. Will the Minister and the Government back Lolly’s law and commit to a formal review of autism diagnosis pathways for girls and women, with particular attention paid to those currently diagnosed with personality disorders? Will the Department of Health and Social Care mandate anti-ligature safety standards across all NHS and private health in-patient units, and develop specialist suicide and self-harm prevention teams in children’s in-patient care? If not, will the Minister consider piloting some of those schemes? Will she agree to meet Lindsey Bridges, hear her proposals directly and consider supporting the formal introduction of Lolly’s law as part of a broader strategy to transform in-patient care? Finally, will the Government review the current use of out-of-area placements and set targets for their reduction? Lolly’s law is not radical; it is responsible. It is about safeguarding and justice for those families. It is about listening, learning and delivering reform, so that nobody is failed again like this and no more lives are lost. It is within our power to build a system where care means connection, not containment, and one that understands autism rather than punishes or isolates those living with it. It would be a system where families are partners in care, not visitors trying to navigate a maze of red tape, and where features such as anti-ligature doors are not considered nice to have but essential. Lindsey’s courage in the face of unimaginable loss is truly moving. I am here to stand beside her in calls for change. Lauren should still be here and we owe it to her and every young person like her to build a system that sees, supports and safeguards every child, not just in words but in actions.

11:10:00

It is a pleasure to serve under your chairmanship, Sir Edward. I am grateful to my hon. Friend the Member for Bournemouth West (Jessica Toale) for securing this debate and raising this extremely important topic. We know that, sadly, autistic people are at the wrong end of statistics on a range of mental health conditions: 70% to 80% of autistic people will experience mental health problems during their lives, and tragically many are more likely to die by suicide. We have heard the devastating impact that can have on individuals and families. I pass my heartfelt condolences to my hon. Friend’s constituent, Ms Bridges, on the loss of her daughter. My hon. Friend spoke of the campaign for Lolly’s law, and I commend her for her tireless work to ensure that autistic people get the mental health support and treatment they deserve. As my hon. Friend said, that is exhausting, and too many parents are forced into campaigning roles. As she rightly said, Lauren should still be here. It is clear that the number of autistic people and those with a learning disability who are in mental health hospitals is unacceptable. There are still too many people being detained who could be supported to live well in their communities. We want to ensure that people get the support they need in the community, improving care and keeping people out of hospital. The Mental Health Bill, currently before Parliament, would limit the scope to detain autistic people and those with a learning disability, so that they can be detained under part 2 section 3 only if they have a co-occurring mental disorder that requires hospital treatment. The Bill would also introduce a package of measures to improve community support for autistic people and those with a learning disability. It is also critical, however, that when autistic people do need to be admitted to mental health in-patient settings, due to a co-occurring mental health condition, they receive the right care and support.

My constituent, Annabel, who is a teenager, has parallel experiences to Lolly, as set out by the hon. Member for Bournemouth West (Jessica Toale). She also had a terrible experience being detained in a secure unit, which her parents did not think was safe. Does the Minister agree that when teenagers—children—are detained in secure units, more needs to be done to ensure that they are safe and fit for purpose to protect those children’s welfare?

The hon. Lady raises another terrible case concerning a teenager on behalf of her constituent. We must of course be mindful of that provision for children and young people. My hon. Friend the Member for Bournemouth West spoke of her constituent’s campaign to retrain mental health staff, to improve understanding and acceptance of autistic women and girls. As we have heard, we know there can be differences in how autism presents in males and females, which can make autism harder to identify in girls.

I am grateful to my hon. Friend the Member for Bournemouth West (Jessica Toale) for securing the debate. Will the Minister ensure that mental health trusts and integrated care boards do not put people waiting for an autism assessment through a process of filling in a pro forma, only to be left languishing on a list, perhaps never having an assessment? We know the predominance of young women on those lists, yet the right support in the right way never comes. Will the Minister ensure that that process is brought to a conclusion?

I will come on to talk about what we expect local providers to do, but obviously no one should languish on a list as she describes.

In the new training regimen, can we please ensure that parents are believed? Young women and young girls often mask very well in schools where all the professionals are, but then at home they can explode and have meltdowns. Some parents are not believed at that stage. Will that also be included in the new training guidelines?

My hon. Friend makes an excellent point about carers. We should address that. She made an excellent point about support for parents wanting to support their own children. With regards to training, we are taking action to increase awareness and understanding of autism in health and adult social care services. Under the Health and Care Act 2022, providers registered with the Care Quality Commission are required to ensure that their staff receive specific training on learning disability and autism appropriate to their role. To support that, we have been rolling out the Oliver McGowan mandatory training on learning disability and autism to the health and adult social care workforce. The first part of the training has now been completed by more than 3 million people. NHS England has also rolled out additional training across mental health services, and 5,000 trainers have been trained as part of the national autism trainer programme. That training covers autism representation in women and girls, as well as exploring misdiagnoses, including of personality disorders, for example. These trainers will cascade their training to teams across mental health services. NHS England also commissioned the Royal College of Psychiatrists to deliver the national autism training programme for psychiatrists, with over 300 psychiatrists having been trained in the past three years. My hon. Friend the Member for Bournemouth West spoke about her constituent’s campaign on suicide prevention. We have committed as a Government to tackling suicide through the suicide prevention strategy for England. It identifies autistic people as one of a number of groups for tailored or targeted action at a national level. To support that, the Department, through the National Institute for Health and Care Research, has commissioned a review to understand what is known about the effectiveness, cost-effectiveness and experience of interventions to reduce suicide among autistic people. More broadly, we also know that autistic people can face challenges in accessing mental health services. While it is the responsibility of local NHS bodies to ensure services meet the needs of their local populations, we are taking actions to support them to address the challenges that autistic people face. In addition to the training I have outlined, NHS England has published guidance on how to improve the quality, accessibility and acceptability of care and support for autistic adults to meet their mental health needs, as well as taking guidance on adaptation of NHS talking therapies for autistic people. NHS England has also developed a reasonable adjustment digital flag, which enables the recording of key information about a patient and their reasonable adjustment needs to ensure that health support can be tailored appropriately. We are taking action to support early intervention and improve access to mental health services more broadly. Through the 10-year health plan, we will continue to roll out mental health support teams in schools and colleges to reach full national coverage by ’29-30. We will also ensure that support for the mental health of children and young people is embedded in the new young futures hubs, alongside a wellbeing offer to ensure that there is no wrong front door for young people seeking help.

Clearly, there are issues on the school side. Without tailored support, accessible information and properly funded SEND pathways, too many girls are being left behind, often resulting in mental health difficulties and poor educational outcomes. Does the Minister agree that urgent investment in SEND support in schools is needed, alongside reforms that recognise the different ways that autism presents in girls?

I understand that the previous debate was on SEND; I am sure my hon. Friend will pick up that point with the relevant Minister. As I have said, we are rolling out more support into schools, so that should join up to support those young people. We are also transforming mental health services through the 24/7 neighbourhood mental health centres, to support our ambition to shift care from hospitals to communities. People will also get better direct access to mental health support and advice 24 hours a day, seven days a week through the NHS app, without needing a GP appointment. Our ambition is that, through improving access to mental health support in the community, we will prevent the escalation of mental health needs for all people, including autistic people. My hon. Friend the Member for Bournemouth West asked a number of questions that I hope I have largely addressed. Regarding anti-ligature doors and specialist suicide prevention for in-patient units, I know that she has received a letter from the Department. I will make sure that officials provide a more thorough answer on the issues outlined in that request. She also raised the issue of the transformation programme, and support for and work with families. We have committed to developing a new national autism strategy to help support the direction of local systems to include families. I will ask officials to consider the specific issues that my hon. Friend raised, and make sure that she gets an answer. I also assure my hon. Friend that, on out-of-area placements, ICBs have published plans to localise in-patient care under the national in-patient commissioning framework. To support that, we have allocated £75 million in this financial year to help stop mental health patients being sent far away for treatment. I know from my own constituency work that that is an issue of great concern. We will make sure that we are focused on it. I am happy to request that the Minister responsible for this policy area, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), meet my hon. Friend the Member for Bournemouth West and her constituent. I know that he wanted to attend this debate, but could not do so for family reasons. We will get that meeting in train. I again thank my hon. Friend for raising such an important issue, and recognise the tireless efforts of her and her constituent to raise awareness of mental health needs, and the need for support for autistic women and girls. I also thank all hon. Members in this debate who raised issues on behalf of their constituents. This is a really important issue for many of us, and I hope that my comments have gone some way to assure people that we take it very seriously, and are committed to working with them to make life better for people. Question put and agreed to.

11:21:00