Eating Disorder Awareness Week 2016

– in the Scottish Parliament at on 23 February 2016.

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Photo of Elaine Smith Elaine Smith Labour

The final item of business today is a members’ business debate on motion S4M-15580, in the name of Dennis Robertson, on eating disorder awareness week 2016. The debate will be concluded without any question being put.

Motion debated,

That the Parliament welcomes Eating Disorder Awareness Week 2016 and the progress in mental health services throughout Scotland over the last five years; understands that eating disorders are recognised as mental health conditions but that there is still more to be done to prevent deaths; welcomes the increasingly open dialogue about the complexities of eating disorders and the Scottish Government’s additional mental health spending; understands that early intervention is crucial; notes the dedication and commitment of NHS staff and congratulates the Scottish Eating Disorders Interest Group in its support to professionals and families; believes that the Scottish Government is fully committed to further dialogue and to seeking ways of improving and achieving a qualitative eating disorder service in Scotland, and looks forward to the 2016 Eating Disorders Conference at the Parliament on 26 February 2016.

Photo of Dennis Robertson Dennis Robertson Scottish National Party

I thank all the members who supported the motion and those who have stayed back on this very late evening in the chamber.

This is an historic day for the Parliament, given that we have reached an agreement in principle with the United Kingdom Government on the fiscal settlement for the devolved powers. I am sure that that will take the headlines tomorrow, but I sincerely hope that what I am about to say will at least be reported at some point and will remain on the agenda of the next Scottish Government.

There has been a great deal of movement on eating disorders over the past five years. That is due partly to the debates that we have in the Parliament and partly to the Scottish Government’s commitment to taking eating disorders seriously. Accepting that eating disorders are mental illnesses and looking at them from a different perspective than was the case before now has helped to bring us much further on.

I reflect on where we were and where I was five years ago. Five years ago, on 25 February, my daughter Caroline died because of an eating disorder. I felt the pain then and I feel the pain now, but the pain that I feel now is perhaps slightly different. It is not just grief. I miss Caroline very much, as do Ann and Caroline’s twin sister, Fiona. Of course we miss her, but we continue to try to establish a pathway so that other people do not have to go through the pain and anguish that we have gone through.

We have made significant gains. However, when I look at the various websites on eating disorders, I am confused. When we think about providing the best possible care for people with eating disorders, confusion arises because the statistics and the way that we measure eating disorders are all over the place. For instance, if we look at statistics from Beat or the London School of Economics or various other eating disorder statistics, we have to ask whether one woman in 100 or one in 250 has an eating disorder.

Regardless of the statistics, the fact remains that eating disorders are on the increase. We need to be careful about that and recognise the fact that they are on the increase within our younger population and that we must address that. I am not saying for one moment that anorexia or bulimia are on the increase—they seem to be fairly stable—but eating disorders with a non-specific diagnosis, including binge eating, are certainly on the increase.

We recognise that peer pressure is a factor. I was interested in a phrase on one of the sites that I read, which said that eating disorders seemed to have become a socially transmitted disease. I wondered what that meant and, when I looked into the facts, I found that it was about the fashion industry and body image. It is about how we see ourselves and how other people perceive what we should be. We can probably address that. The Governments in Scotland and in the United Kingdom can look at how that imagery is presented and what influence it has on our young people.

I say to the minister that if we are going to do the best that we possibly can for our young people with eating disorders, we must be clear about what an eating disorder is, we must be able to detect it in the early stages and we must be able to provide the best possible treatment and therapy. The relapse rate for people with eating disorders—regardless of whether they have had therapy—is somewhere between 60 and 70 per cent. That is not good. Young people are still dying, and although the number has stabilised, it is not good.

If we are going to make a difference and do the best that we possibly can, we should think about what we can do. I ask the minister whether we can have a system whereby we record eating disorders and whether we can look at the therapies available. Family-based therapies are available and they are certainly the most effective, but we do not have enough trained specialists. Perhaps some of the money that is coming across for mental health could go towards education, to give people expertise in family-based therapies and the treatment of eating disorders in the community.

I still get emails and correspondence from people who are struggling with eating disorders, or whose children are struggling with them, because they do not know where to turn. We should establish a Government website, for example. The groups that are out there are coming forward. This Friday, I will hold another eating disorder conference in Parliament.

Scotland can perhaps lead the way. There is no magic bullet and we cannot stop people having eating disorders—we will always have that. However, my daughter’s legacy is important to me, and it is important to every person with an eating disorder. We need a quality service that is meaningful to those young people and is there to help the families. Family support is essential and I hope that we can focus on that. I sincerely hope that in the next parliamentary session, the Government will consider having a debate specifically on eating disorders, and perhaps a committee could look at how we best provide services for those with eating disorders.

The Deputy Presiding Officer:

Many thanks. We come to the open debate. Speeches of four minutes, please.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

This is, I believe, the fourth year that I have had cause to thank Dennis Robertson for bringing discussion of eating disorders to the Parliament. It is a subject of profound importance, and this week affords the opportunity to reach out to sufferers, challenge stigma and make a clear statement that this is a mental health problem with serious physical and emotional repercussions.

Many members will know someone who has been drawn into the debilitating and isolating world of eating disorders. An eating disorder often starts as a coping mechanism—a means of exerting control over one’s body or of punishing it until it fits society’s predetermined mould. It chips away at a person’s life day by day, and sometimes it envelops them entirely. We must resolutely challenge any preconception that these conditions are shameful or self-indulgent. An eating disorder is not a phase, and those who suffer have a right to be heard, understood and helped.

Doing that starts with prevention: teaching children about healthy body images from an early age and in schools, and helping them to develop a critical response to media and advertising messages. It also means ensuring that educational psychologists in schools and general practitioners in communities have the resources available to identify children who might be at risk of developing negative coping behaviours.

At the same time, information on finding support for recovery must be widely available, helping individuals find the strength to self-refer to their GP. When they do, they must receive appropriate and accessible treatment within the target time of 18 weeks.

I mentioned the need to provide information and support more widely, and the motion rightly notes the excellent work of the Scottish Eating Disorders Interest Group. It is an invaluable resource that both connects communities of interest with professional advice and services and encourages carers and sufferers to share their own experiences to inform research. The SEDIG website allows sufferers, carers and medical professionals to become members and to use resources such as case studies, useful books and links to relevant websites. It also provides details of services in specific areas and offers advice on steps to take when seeking help with referral and recovery.

I very much look forward to meeting some of SEDIG’s members at the eating disorder awareness week 2016 conference, which is entitled “Scotland’s Journey: Quality Eating Disorder Services” and which Dennis Robertson is hosting. The conference will take place on Friday, 26 February, and will for the first time include a specific discussion on males with eating disorders. We must remember that, while eating disorders are illnesses that predominantly affect women, many young boys and men also find themselves trapped in this seemingly endless cycle and are equally afraid to reach out.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

It is the second year that the conference will look at men and boys, and that is immensely important. Dennis Robertson has done much to bring that issue to light.

I congratulate the charity MBEEDS (Scotland), which is based in Aberdeen, for the work that it has been doing to highlight eating disorders in men and boys.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I thank the member for reinforcing that point.

Finding the right path to recovery starts with an informed and sensitive GP who recognises the real courage that it takes to present as a patient with an eating disorder. That cannot be emphasised enough: recovery starts when a person builds up the courage to speak out. The GP is the vital first step, and can direct the vulnerable person to the correct door.

In September 2015, the see me campaign funded seen but not heard, an advocacy eating disorder project, to produce a GP resource pack about eating disorders called “Living with an eating disorder—what you need to know”. The pack includes a poster for raising awareness in the surgery, a booklet to be available in the waiting room for people with eating disorders and the general public to take away, and an information leaflet for GPs and other members of the primary care team. The GP resource pack was developed by people who have a lived experience of eating disorders to provide crucial information that can help GPs gain a better understanding of how to offer effective and appropriate care and treatment.

In conclusion, this is the fourth—and final—time that I will speak here in support of Dennis Robertson. I do so in solidarity with all those people, young and old alike, who fight a daily battle with food and a daily battle with the unseen dark force that takes control, wears them down and sometimes does not let go.

We must let them know that the battle is not theirs to fight alone. We recognise them, this week and every week, and I thank Dennis Robertson again for ensuring that we never forget them.

I apologise to Dennis Robertson, the Presiding Officer and the minister, because, in two minutes’ time, I have to be at the Devolution (Further Powers) Committee to question David Mundell.

Photo of David Torrance David Torrance Scottish National Party

I join Dennis Robertson in welcoming eating disorder awareness week 2016. His motion highlights that much progress has been made over the last five years, both in raising awareness about eating disorders and in ensuring that all patients have access to the services they need.

I understand that eating disorder week is an international initiative to tackle the misconceptions surrounding eating disorders. This year’s focus is on the workplace: how colleagues and employers can support someone’s recovery. That shows how complex eating disorders are.

Eating disorders affect all aspects of a person’s life—relationships with family and friends, ability to perform well in school or at work—and, most importantly, can have a serious long term impact on physical health.

Eating disorders are long-term conditions. Around half of all patients take six years or more to recover. The majority first experience symptoms under the age of 16, and many sufferers wait more than a year before seeking treatment. According to Beat, the eating disorders charity, around 63 per cent of patients relapse, and the Royal College of Psychiatrists reports that anorexia nervosa has the highest mortality rate of all psychiatric disorders.

What are the implications of these facts? As Dr Robert Dennison, an expert in eating disorders, has pointed out, more action needs to be taken to support early intervention and prevent deaths. Without a doubt, early intervention is crucial. Research has shown that the earlier that people with eating disorders seek treatment, the less likely they are to experience relapse and the greater their chance of a full recovery. However, we need to recognise that individuals find it extremely difficult to seek help.

Eating disorders seriously affect mental and physical health; many sufferers also experience depression, personality disorder and substance abuse. That is why support is so crucial. Often such support comes from small, not-for-profit organisations. In my constituency in Fife, the Linda Tremble Foundation organises regular support group meetings for people with eating disorders, as well as their families.

Overall, there have been many positive developments, but more attention needs to be given to supporting individuals with eating disorders. Once diagnosed, more needs to be done to ensure that patients receive effective care in hospital, at home, at university or in any other environment. There is also still a lack of services, especially in more rural areas of Scotland. In Fife, the only anorexia nervosa intensive treatment team, which is part of Stratheden hospital, has limited capacity and can therefore not accept all referrals.

I commend the dedication of all national health service staff, GPs and organisations that support people with eating disorders. The treatment of eating disorders requires the close co-operation of all involved, and new projects are proving to be very promising. In Dumfries and Galloway, a new approach being undertaken by local GPs to ensure that patients receive the right care involves monitoring the physical health of people with eating disorders through biannual training and specific guidance from a resource pack aimed at identifying and treating eating disorders.

Of course, we cannot be oblivious to the fact that such projects require funding, and I am pleased that the Scottish Government is committed to strengthening mental health services. That is important for many reasons. Apart from the human impact, mental health issues are a substantial economic burden. Across the UK, 725,000 people suffer from eating disorders. Many of those affected note a financial loss due to the detrimental effect that the eating disorder has had on their educational development, or, if they are already in the workplace, the time that they need to take off work. As a result, sufferers sometimes become dependent on carers, family members and friends to survive.

Beyond the personal cost, treatment costs the health sector across the UK between £3.9 billion and £4.6 billion. Although that economic burden is only a small part of the many different effects that people with eating disorders suffer over a prolonged period, it is important to acknowledge the cumulative effect of all the factors involved.

As I said, diagnosing, treating and promoting long-term recovery of eating disorders is complex. However, there are many indicators to show that, as service providers for those with eating disorders continue to develop and expand on the range of treatment options available, the increased access to effective treatment will prove beneficial to all those who are most in need. We must continue to support and help both those who suffer from an eating disorder and those who seek to help them.

Photo of Nanette Milne Nanette Milne Conservative

In the five years of this session of Parliament, Dennis Robertson has brought the issue of eating disorders to the chamber on numerous occasions, through debates and questions. I am sure that, should he be re-elected, that will continue. From dealing with the effect on females of mannequins and size 10 models with the “body beautiful”, to the rising problem of eating disorders in young men and boys, we can be proud of continually raising awareness of these conditions, thanks in no small measure to Dennis Robertson’s persistent efforts.

As an international awareness event that stretches across the globe, eating disorders week has become a fixture in many countries’ calendars. The pivotal point of the week is that it helps to bring people together: those affected as individuals, in the medical profession or as carers—as we all know, many carers are family members.

I note that, on Friday, there will be a day-long conference here in Edinburgh organised by the Scottish eating disorder interest group and hosted by Dennis Robertson. Such organisations do so much to raise awareness of eating disorders. It is not only conferences that help, though. There are many fun events, such as live bands, pub nights, cake bakings and so on, all to raise money for various eating disorders charities.

In previous debates, I have referred to the number of celebrities and those in public life who have come forward to talk of their condition. Although I do not watch “Emmerdale”, I read about the show’s actress Gemma Oaten, who has spoken movingly about her own battle with anorexia. She said that she was doing that ahead of eating disorders awareness week not only to highlight the bullying that she had endured but to demonstrate that eating disorders can affect people from all backgrounds and walks of life.

Gemma Oaten also referred to anorexia as a recognised mental health condition. We cannot reiterate that enough. Sadly, a stigma remains not only in relation to mental health issues but in relation to eating disorders as mental health conditions. That stigma is largely brought about through misunderstanding and ignorance, and there remains a significant number of people who believe that conditions such as anorexia and bulimia are largely about individuals with faddy eating habits. That is clearly not the case, and those who suffer from those disorders should be referred promptly for the psychological support and psychiatric help that they and their families need.

An issue that requires closer scrutiny is the recognition of eating disorders outwith teenagers and young adults. It is telling that Beat, which is the UK’s leading eating disorders charity, has chosen as its theme this year eating disorders in the workplace. That will concentrate on the impact that those disorders can have in the workplace and highlight what individuals, colleagues and employers can do to support someone’s recovery at work.

The motion mentions

“the Scottish Government’s additional mental health spending”.

I recognise that there has been significant investment, which will cover the next four years. Additionally, in January this year, the Prime Minister pledged

“a revolution in mental health treatment”, with a commitment from 2018 that all teenagers who suffer with eating disorders will be seen within a month of being referred, or within a week for urgent cases. Additional resources and funding will also be made available. The motion rightly refers to the Scottish Government’s commitment to seek improvements in the treatment of people who live with eating disorders, but I hope that the minister and members will also appreciate the similar commitment that the UK Government has given, because there has to be greater co-operation north and south of the border to tackle a condition that for too long has not been taken seriously enough by society and its elected representatives.

If I got right what Dennis Robertson said, he hinted at the need for a managed clinical network across Scotland to deal with the various issues that are associated with eating disorders. I would be very supportive of such a scheme, which would help to ensure equity in accessing treatment for those affected and their families.

Finally, as this will undoubtedly be my last speech in the chamber about eating disorders, I thank all members who have worked together over the years to improve the lives of the individuals involved with what can often be tragic circumstances. I wish them well and look forward to hearing about the progress that they make in continuing to raise awareness of those conditions in the next session.

Photo of Jamie Hepburn Jamie Hepburn Scottish National Party

I join other members in congratulating Dennis Robertson on securing this debate. As Nanette Milne said, it continues his long-standing interest in bringing these matters to the chamber, and I thank him for bringing it to us.

I also thank Dennis Robertson for speaking very movingly about his family’s experience. I know that doing so could not have been easy for him, and none of us could fail to be moved by his doing so. It is always very important to hear about such experiences. That reflects the point that Nanette Milne made about others who have spoken publicly about their challenges and struggles with eating disorders. I recognise that it is never easy for individuals to come forward and talk about their own challenges—not necessarily just eating disorder challenges, but any form of mental health challenges. Those who do so do us a great service, as that helps us to challenge the tremendous stigmatisation issues that we know still exist and pervade.

Dennis Robertson and Malcolm Chisholm mentioned the conference that will take place this Friday. I am sorry that I will be unable to attend it, but I look forward to hearing about its outcomes.

I am very pleased to be able to respond to the debate on behalf of the Scottish Government. Doing so gives me the opportunity to join others in marking eating disorder awareness week this year and to recognise the efforts of all the people and organisations across the country who are working to raise awareness of eating disorders, including the Scottish eating disorder interest group.

I very much associate myself with Malcolm Chisholm’s remarks about the nature and impact of eating disorders as a serious mental health problem. This may be the last opportunity I have to pay tribute to his work on and the interest that he has shown in mental health over the years, so I should take it. I know that he is standing down at the election. Similarly, I may not get the opportunity between now and dissolution to pay tribute to the work that Nanette Milne has undertaken in the time that she has been an elected representative.

I listened carefully to the range of comments that were made and the issues that were raised during the debate, and I assure members of the Scottish Government’s commitment to doing all that it can to tackle eating disorders and further improve care services and support.

Both Dennis Robertson and Nanette Milne mentioned the impact of the fashion industry. Beat, which is the UK-wide eating disorder charity, acknowledges that influences are wide ranging, and although the media and the fashion industry do not necessarily directly cause eating disorders, I think that we all agree that their influence cannot be ignored. The see me programme, which the Scottish Government helps, funds work to promote mental health and wellbeing, including positive body image, through the benefits of healthy lifestyles and diet. That work is under way, but I make it clear that I accept that more can always be done. I call on all those who are responsible, including retailers and the fashion industry, to play their part in tackling unhelpful or unrealistic ideals, which can contribute to unhealthy lifestyles.

I turn to some of the work that is under way. Our improvement agenda has been driven forward over the past few years through delivery of the national mental health and suicide prevention strategies, and we will publish a new three-year mental health strategy later this year. I met Dennis Robertson last year to discuss the important issue of eating disorders as part of the engagement process around that strategy. No decisions have yet been made on the content of the strategy, but in maintaining continuity with the work that has already been progressed in recent years, some priorities naturally emerge.

I expect the new strategy to focus on encouraging the development of new models for managing mental health problems in primary care. I anticipate a focus on child and adolescent mental health and better responses to distress, and there will also be a focus on developing and measuring outcomes for improved mental health. Those are our broad priorities at present, and there are clear links with eating disorder care.

We will develop the detail over the coming months as the new mental health strategy is finalised, and there are opportunities for Dennis Robertson and indeed any member of this Parliament and those whom Mr Robertson works with on eating disorders to contribute to the process. That could include any conclusions from the conference on Friday, and I would be very happy to receive such contributions.

It is important to look forward but also to look back at some of the successes that we have had. In July last year, I was able to visit—at Mr Robertson’s invitation—both the adult and young people’s eating disorder services in NHS Grampian. I spoke to staff who work on the front line, families and those who use the services and I saw at first hand the impressive care and support that is delivered day in, day out. I saw the royal college’s MARSIPAN—management of really sick patients with anorexia nervosa—guidance being used to better manage patients and I heard about the wide range of treatments that are available and the benefits of improved access to therapies, including increased availability of family therapy. It is clear that great work is taking place in the north-east and I thank Dennis Robertson for arranging for me to visit.

Members talked about some of the funding decisions that we have made. Part of the significant additional investment of £150 million that the Scottish Government announced recently for improving mental health and wellbeing will contribute directly to the aim of working closely with NHS Scotland and its partners to ensure that we offer the best quality of life and opportunities for all people with mental health problems, including those who are living with an eating disorder. The First Minister announced in January that part of that funding—£54.1 million—will go towards directly improving access to mental health services for adults and children.

Part of the funding that the First Minister announced directly relates to the point that David Torrance made—and which has been made as part of eating disorder awareness week—about the need for a responsive workforce. We need to ensure that the workforce has the requisite skill set, and some of the funding that the First Minister announced will be used to improve workforce supply and train existing staff to better deliver services for children and young people, as well as psychological therapies for people of all ages.

Malcolm Chisholm talked about the importance of primary care and general practitioners. Again, over the next three years £10 million will go directly towards improving mental health support in primary care. I absolutely agree that we need a better response to the challenges of dealing with poor mental health in primary care settings.

The bulk of the additional investment will be invested from next year. It will take time to deliver results, but I think that the funding will make a difference to how we support people with poor mental health, including those who present with eating disorders. Dennis Robertson requested that we utilise some of the remainder of the funding specifically to help people with eating disorders. We have not decided how the entirety of the funding will be used, so I will be happy to talk to Dennis Robertson about that and consider any proposition.

I hope that what I have said demonstrates that partners across all sectors are undertaking a great deal of work to tackle eating disorders and wider mental health problems. Dennis Robertson expressed a hope that eating disorders will retain political prominence after the Scottish Parliament elections. I am confident that that will be the case. As I think Nanette Milne said, this is not a partisan political issue but a shared concern, and I am sure that it will remain high on the political agenda.

It is right that we recognise eating disorder awareness week and I reaffirm our commitment to deliver on our ambitions for improved outcomes and quality of life for everyone who lives with an eating disorder. I thank Dennis Robertson for providing us with the opportunity to do that.

The Deputy Presiding Officer:

That concludes the debate. I thank members who participated, particularly those who will not speak again on the subject in the Parliament.

Meeting closed at 19:16.