Impact of skin disease on mental health report

All Party Parliamentary Group (APPG) on Skin: Parliamentary report reveals worrying lack of mental health support for skin disease patients

New mental health funding promised to Clinical Commissioning Groups (CCGs)* must urgently be used to invest in and improve mental health services that are dedicated to dermatology patients, according to a report published today by the All Party Parliamentary Group on Skin (APPGS).

The call is prompted by survey data revealing that 98 per cent of skin disease patients feel their condition affects their emotional and psychological wellbeing, and five per cent have suicidal thoughts, yet only 18 per cent have received some form of psychological support. Over half of the patients surveyed for the report did not realise specialised support was available for people with skin conditions, in the form of psychodermatology.

The APPGS raises concerns that access to specialist mental health support for people with skin disease is limited throughout the UK, despite a growing need for such services. This is particularly worrying since the COVID-19 pandemic has exacerbated mental health distress in a skin community that was known already to experience significant appearance-related distress.

Evidence was collected in March and April 2020 from over 500 UK patients with a range of skin conditions, a hundred clinicians, and 16 organisations operating in the field of dermatology. Of the 16 skin organisations contributing to the report, all said that they felt NHS service provision in this area is either ‘poor’ (80 per cent) or ‘very poor’ (20 per cent).

The aim of the report was to gain insight into the state of mental health services available to patients with skin conditions in the UK and the psychological impact of these conditions.

Mandatory psychodermatology training, an increase in dermatology training numbers, and comprehensive dedicated psychodermatology services in each region of the UK were all identified as key recommendations for improving services. In addition, the report found that there is a need for all dermatology units to have named, dedicated staff either to manage patients with skin and mental health disease or refer patients to a nearby regional service. The density of dermatology units able to offer these services needs to reflect the UK population and needs to include all devolved nations, as currently there are no services in Wales and few in Scotland and Northern Ireland.

Another major issue identified by the report is the lack of paediatric psychodermatology clinics – currently there is only one in the UK. All too often, children are not offered support services, which has a profound impact on their long-term mental health, life course and wellbeing into adulthood. Therefore, a key recommendation of the report is that, at a minimum, there should be access to regional paediatric psychodermatology clinics.

Psychological burdens are extremely common in people with skin conditions. The impact can be debilitating and seen across all aspects of patients’ lives. The APPGS survey of people with skin conditions found:

• 93% of people with skin disease reported a negative impact on their self-esteem
• 87% of people with skin disease reported a negative impact on their social life or leisure and sporting activity
• 83% of people with skin disease reported a negative impact on their sleep
• 73% of people with skin disease reported a negative impact on intimate relationships
• 69% of people with skin disease reported a negative impact on their work or education
• 5% of people with skin disease reported having suicidal thoughts
• 100% of the 27 children who responded to the survey indicated that their skin condition affected their psychological wellbeing, and 85% felt they had low self-esteem
• Of the children with low self-esteem, 85% reported this being particularly in relation to engaging with peers at school

Sir Edward Leigh MP, Chair of the All-Party Parliamentary Group on Skin and Member of Parliament for Gainsborough, said:

“This timely report comes out during a period of unpresented psychological distress for many people living with a skin condition. The COVID-19 pandemic has exacerbated anxiety and stress amongst those already known to experience significant appearance-related distress.

I know from direct experience the impact skin conditions can have on your mental health. I have rosacea, which is an incurable condition causing red and visible blood vessels on the skin. On almost a daily basis I am mocked on social media for the noticeable visible difference caused by my rosacea. It is clear, from the powerful and moving testimony we received from skin patients, that many others experience similar episodes of discrimination, rejection and negative reactions. This can be alienating and deeply distressing.

People living with a skin condition deserve the right to be provided with excellent and appropriate psychological support to manage their condition. However, I was alarmed by the lack of psychological support that is available to people with a skin condition. Therefore, the NHS must urgently invest in, and expand, specialist mental health support for people with a skin condition.

The APPG on Skin will be discussing the findings and recommendations from our report with Government and key policy-makers within the NHS to ensure that vital improvements are made to services.”

Dr Tony Bewley, Consultant Dermatologist and Chair of the All Parliamentary Group on Skin’s Expert Committee, said:

“Skin conditions are extremely common, and it has been shown time and again that they often have a significant impact on peoples’ mental health. Despite this, the availability of specialised mental health services for people with skin conditions remains poor, and in some regions non-existent.

“As this vital report illustrates, children and young people, who can be particularly vulnerable to mental health issues and bullying related to their skin health and appearance, have been particularly let down in this area. As it stands there is only one paediatric psychodermatology clinic in the UK, which is clearly inadequate.

“Evidence is increasingly showing that providing comprehensive dedicated services for patients with skin and mental health disease is both cost and clinically efficient. We are keen to urge commissioners to recognise the evidence highlighted in this report which shows that investment in specialised mental health services for people with skin conditions is cost effective compared to the alternatives.”

Notes to Editors:
*NHS Mental Health Implementation Plan 2019/20 – 2023/24 – The funding available to CCGs for mental health services is set to increase from £596 million in 2019/20 to an indicative figure of £1,921 million in 2023/24.

This is a summary of the full report, which is available online here: http://www.appgs.co.uk/wp-content/uploads/2020/09/Mental_Health_and_Skin_Disease2020.pdf

The report contains further information about the surveys and data collection, as well as a list of participating organisations.

More than a dozen leading doctors, specialising in dermatology and mental health led the report, as well as the dermatology specialist groups, the British Association of Dermatologists, the Primary Care Dermatology Society, and the British Dermatological Nursing Group. Patient organisations involved in the membership of the Working Group which led the inquiry include:

• Ichthyosis Support Group
• British Association of Dermatologists
• British Skin Foundation
• Changing Faces
• Psoriasis Association
• British Dermatological Nursing Group
• National Eczema Society
• Vitiligo Society
• Primary Care Dermatology Society

For more information contact the media team on: comms@bad.org.uk

Psychodermatology is a discipline and sub-speciality of dermatology that recognises the link between the skin and the mind. Psychological interventions, either alone or adjunctive to conventional dermatology treatments, can be helpful in both coping with and treating many skin conditions.

About the All Party Parliamentary Group on Skin

The All Party Parliamentary Group on Skin (APPGS) is a group comprising members from all political parties, health professionals and patients which aims to increase understanding of skin care issues and improve treatment.

The All Party Parliamentary Group on Skin was established in 1994 with an aim to increase understanding about skincare issues in Parliament, and to achieve improvements in the treatment and management of patients with skin disease in England. It also provides an unbiased means of responding to threats to dermatology services and acts as a forum for partners in skincare to engage with politicians with an interest in the issue.

The APPGS has a large and active membership that includes MPs from all political parties, members of the House of Lords, health professionals, patient groups and industry representatives. The APPGS benefits from clinical input from its Advisory Panel. The activities of the Advisory Panel are subject to the approval of the Group’s parliamentary Officers and, in particular, the Group’s parliamentary Chairman, Sir Edward Leigh MP.