Skip to main content

Language: English / Gàidhlig

Chamber and committees

Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, March 1, 2022


Eating Disorders Awareness Week 2022

The Deputy Presiding Officer (Liam McArthur)

The final item of business is a members’ business debate on motion S6M-02886, in the name of Emma Harper, on eating disorders awareness week 2022. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that Eating Disorders Awareness Week occurs on 28 February to 6 of March 2022 and this year focuses on the importance of Early Warning Signs in Primary Care; further notes reports that eating disorders affect 1 in 50 people across Scotland and the wider UK; understands that more people lose their lives due to eating disorders than any other mental health condition; further understands that the COVID-19 pandemic has exacerbated the number of persons with eating disorders, with a reported increase of 86% in referrals between 2019 and 2020; notes that the Beat eating disorders charity highlights that less than two hours of medical education leading to a medical degree is focused on eating disorder education; further notes calls from Beat for medical schools across Scotland, and the UK, and the General Medical Council, to ensure that eating disorder education is an important focus of medical degrees, including for those in General Practice training; welcomes the Scottish Government’s reported commitment of £120 million for a mental health recovery and renewal fund, with a focus on additional support for mental health in primary care settings and enhanced community support; notes the May 2021 publication of the Scottish Eating Disorder Services Review, which it understands makes 15 recommendations on how eating disorder support services can be improved; further notes the calls for the Scottish Government to provide an update on current work to implement the recommendations and better support all those impacted by an eating disorder, and thanks all eating disorders interest groups, including Beat and the Scottish Eating Disorders Interest Group (SEDIG), for their work to raise awareness and understanding of eating disorders, as well as to support those impacted by them.


Emma Harper (South Scotland) (SNP)

I welcome the opportunity to lead the debate on eating disorders awareness week 2022, which takes place from 28 February to 6 March. I thank colleagues on all sides of the chamber who have supported my motion, allowing the debate to go ahead.

For many years, this debate was brought to the chamber by the former MSP Dennis Robertson, who lost his daughter Caroline to anorexia nervosa in 2011. In speaking about his members’ business debate in February 2012, he said:

“I want people to be aware of the symptoms and get help as soon as they can. I’m trying to ensure GPs and other medics become more aware of the dangers.”

I agree with Dennis, and I know that the Scottish Government has taken action in that regard—I will expand on that in a wee bit.

Dennis Robertson now chairs the Scottish Government’s lived experience panel on eating disorders, and he has undoubtedly played a part in putting the subject on the political agenda. I thank the eating disorders charity Beat for the excellent work that it continues to do to support those who are at risk of, and those who are living with, an eating disorder. That includes supporting families and friends.

It is great to have folk in the gallery again, Presiding Officer—that is a sign that we are emerging from the pandemic. [Applause.] I welcome the staff and the ambassadors from Beat. I invite members to join us for a photograph at the bottom of the stairs to the public gallery after the debate—everybody is welcome.

Around 1.25 million people across the United Kingdom, and one in 50 people in Scotland, currently live with an eating disorder, and the numbers have increased during the Covid-19 pandemic. The pandemic has exacerbated the situation, with a reported increase of 86 per cent in referrals to specialists between 2019 and 2020.

Types of eating disorders include binge eating disorder; bulimia; anorexia; other specified feeding or eating disorder, or OSFED; and avoidant/restrictive food intake disorder, or ARFID. A very dangerous eating disorder is diabulimia, which occurs when people with type 1 diabetes deliberately omit their insulin in order to control their weight. It is extremely dangerous to do that.

Eating disorders have high mortality rates. Anorexia has the highest mortality rate of any mental illness, and one in six people with binge eating disorder have tried to end their life. People with eating disorders typically develop severe physical health problems, and their overall quality of life has been estimated to be as low as it is for those with symptomatic coronary heart disease or severe depression. Without early intervention, many people become unable to participate in education or employment, but recovery is possible. Access to the right treatment and support is life changing, and early intervention provides the best chance of recovery.

The key symptoms of eating disorders include excessively worrying about weight or body shape; avoiding social situations where food may be involved; frequently visiting the toilet after meals for prolonged periods; and not being up front about the food that you are consuming. It is important for family members, friends and colleagues to be aware of those signs. There is some speculation around what causes eating disorders, but research has shown that there is a link between eating disorders and depression, low confidence and low self-esteem.

One of Beat’s key asks is to ensure that healthcare practitioners are fully aware of eating disorders, and for eating disorder education to be improved across Scotland. I welcome the fact that Beat has had positive engagement with almost all medical schools in Scotland, including those at the universities of Dundee, Glasgow and Aberdeen. Beat continues to engage with the other medical schools; I urge all medical schools to work with it so that our next generation of doctors and healthcare professionals are able to identify eating disorders at an early stage and properly direct people to specialist services.

Another of Beat’s key asks concerns social media, which we know can be a factor that contributes to eating disorders. We need to ensure that people use social media safely, and there are great tips on Beat’s website.

In March 2021, the Scottish Government completed a national eating disorder services review. The “Scottish Eating Disorder Services Review—Summary Recommendations” document includes a total of 15 ambitious recommendations that are focused on ensuring that all those who are affected by eating disorders receive timely and appropriate care and support. The recommendations include better co-ordination of national activity and data collection; national availability of self-help resources, which should be available to everyone in Scotland at any stage of life; and a focus on early diagnosis, with the aim of prevention.

It is welcome that an implementation group has been set up to review timescales for, and the cost of, implementing the recommendations. Three sub-groups—a training group, a standards group and a data group—have been created within that group, although the data group has not yet met. I would be grateful if the Minister for Mental Wellbeing and Social Care could outline when the implementation group is likely to report and when the lived experience panel that is chaired by Dennis Robertson will meet.

This week, I contacted the dietetic team in NHS Dumfries and Galloway. The team has a dietician who works specifically with those who are living with, or are at risk of developing, an eating disorder. I heard from the team that, because of the rurality of Dumfries and Galloway, some people who are at risk of developing an eating disorder may not be picked up as easily, or they may be reluctant to access support because of the travel that is involved in attending appointments. Although the situation has improved with the move to virtual appointments, there is still an issue for people in rural areas who want to access eating disorder support services. That is especially true for face-to-face services, which are required as part of the specialty. Again, I ask the minister to ensure that rural areas are included in the Government’s approach.

I welcome the Scottish Government’s commitment of £120 million for a mental health recovery and renewal fund, with a focus on improving support for mental health in primary care settings and enhanced community support. I also welcome the Scottish Government’s increased investment in Beat.

This Saturday, I will be delivering the keynote address at PosiFest in Edinburgh. PosiFest is a positive psychology festival that aims to support positive health and wellbeing through providing a safe space to explore issues around mental health. There will be performances, music, comedy and a message tree, and everything will be centred on positive approaches to mental health. The event will have a resource hub, with two therapists and information on Beat and eating disorders that can be shared. It will also be live streamed, so people do not have to come to Edinburgh to participate. I congratulate Shalhavit-Simcha Cohen and all the other organisers on putting the event together, and I encourage anyone who is struggling with mental health issues to go along.

In conclusion, I welcome the debate and the work that the Scottish Government has undertaken to improve the outcomes of people who are living with eating disorders in Scotland. I look forward to hearing from my colleagues this evening.

I add my warm welcome to those in the public gallery, but I encourage them not to participate, much as they may be motivated to do so.


Oliver Mundell (Dumfriesshire) (Con)

I, too, along with other members on the Conservative side of the chamber, welcome the fact that we have visitors back in the public gallery. It serves as an important reminder, in this debate in particular, of how important face-to-face and in-person contact is and of the role that discussing such issues in public can play in breaking down barriers and stigma and in bringing what are often very personal and lonely challenges out into the open.

I am grateful to have the opportunity to speak in tonight’s debate and play a small part in our collective effort in the Parliament to break down those barriers and raise awareness. Eating disorders are a complicated area, and the number of conditions and disorders—as Emma Harper set out—along with the range of symptoms highlights how complicated the issue is. It is sometimes easy to forget that.

I will come back to the substance of the debate in a moment, but first I thank Emma Harper for securing the debate and for the work that she does on the issue. That includes much work behind the scenes to highlight eating disorders at meetings of a number of cross-party groups at Holyrood, including the cross-party group on mental health, which we co-convene.

I thank Oliver Mundell for mentioning the cross-party group on mental health which, as he said, we co-convene, as I forgot to mention it.

Oliver Mundell

Not at all. For completeness, I note that Beatrice Wishart co-convenes the group with us.

It is important to mention that the cross-party group on mental health has been looking at eating disorders. That is an issue that many people fail to consider when they talk about mental health, as they do not see it as part of the same remit and do not believe that eating disorders are at the same level of seriousness. We know from hearing about the mortality rates and the lived experience of many people just how wrong that assumption is, and it has to change if the services that support those with eating disorders are to change and fully meet the needs that exist.

Again, I pay tribute to Emma Harper for her persistence on the issue. Given its complexity, it is an area of policy and practice that requires persistence. We see the bravery of people such as Dennis Robertson and others who speak out on the issue, and they deserve champions in the Parliament.

More than 1 million people of all ages and backgrounds across the UK have an eating disorder. The condition can affect anyone—there is no one whom it cannot affect. We have already heard about the high mortality rates, which are the highest for any mental illness. That in itself should demand action.

Jackson Carlaw (Eastwood) (Con)

I was a member of the Scottish Parliament—although Mr Mundell was not—when Dennis Robertson gave his speech on the issue. It is partly the reason why I am in the chamber today, as it was a profoundly moving occasion for us all—his speech was very courageous and brave.

I was struck by the fact that Ms Harper indicated that that debate took place 10 years ago. With regard to the advance that we have seen in the way in which mental health and its associated stigmas are appreciated, I wonder whether we feel that sufficient progress has been made in the understanding of eating disorders. I note that we are here again, 10 years on, to debate the issue today and, although much has been done, the fundamental issues with regard to an appreciation of eating disorders and their consequences remain broadly similar to what they were when Dennis Robertson spoke in 2012.

I am happy to give you the time back, Mr Mundell.

Oliver Mundell

Thank you, Presiding Officer.

Jackson Carlaw makes a pertinent point. I think that that is one of the reasons why, as part of the awareness campaign this year, there has been a clear call for action through measures such as the “Worth more than 2 hours” campaign, which constituents have been in touch with me about. The campaign is about ensuring not only that front-line general practitioners receive more training and advice so that they can support those who ask for help, but that a future generation of doctors are equipped to identify the signs and symptoms of eating disorders. That will enable them to facilitate the type of early intervention that Emma Harper talked about, secure better outcomes and thereby avoid unnecessary pain and suffering, not just for individuals but—as has been said—for their families too. It is a huge burden for families to carry, in particular when they are struggling to access the level of support that they need.

There are examples of good practice, including at the University of Glasgow. I would be keen to hear from the minister about what has been done to ensure that such practice is replicated across all five Scottish medical schools, because that seems like a straightforward and clear ask. We have to remember that behind every one of the statistics that we hear in the debate, there are real people and families. In the past, they have included members of our own parliamentary community who have experienced the pain of this issue. Eating disorders can happen to anyone, and no one should be left to suffer alone.

I ask the minister whether we can hear more on what the working groups are doing to make real the promises that we make in the chamber. To anyone who is listening to the debate, I simply say: do seek advice, do seek help and do not suffer in silence, as there are a lot of organisations, charities and individuals out there who stand ready to help you.


Jackie Dunbar (Aberdeen Donside) (SNP)

How can I follow the powerful speeches by Oliver Mundell and Emma Harper? I will try.

I am pleased to participate in this members’ business debate, brought to the chamber by my colleague Emma Harper, highlighting eating disorder awareness week. I thank her for bringing this important subject for debate. Like her, I am pleased to welcome the guests in the gallery from Beat. I also take the opportunity to recognise the work that former MSP Dennis Robertson did in initiating the debates on eating disorders, which have been taking place for more than 10 years, and in raising awareness.

Eating disorders are incredibly challenging mental illnesses that affect one person in 50. They include but are not limited to binge eating disorder, bulimia and anorexia. People with eating disorders typically develop severe physical health problems and their quality of life can be severely impacted by those illnesses. Therefore, it is welcome that the Scottish Government is committed to carrying out a national review of eating disorder services to improve the support for people who live with an eating disorder. Recovery is possible with access to the right treatment and support. We politicians must do all that we can to raise awareness of eating disorders to ensure that people do not suffer in silence but are aware of the options that are available to them.

I note that the national review will provide a more complete picture of the current system of support for people with eating disorders and make recommendations about how services and the wider support system should be constructed to ensure that people have access to the right treatments so that support can be provided to all those who are affected by an eating disorder, whether individuals or their wider support network and families.

This year’s theme for eating disorder awareness week is medical training. An average medical student receives less than two hours’ training on eating disorders throughout their degree, with a fifth of medical schools offering no training on the subject. That lack of training for students must be addressed, and I am pleased to see that Beat and other eating disorder charities are engaging with universities to ensure that our medical professionals receive adequate training and have an understanding of the difficulties that face those with eating disorders. However, that training should not just be rolled out to medical students. All healthcare and social service professionals should have an awareness of eating disorders, know how to identify someone affected and know where to signpost them should they wish to receive treatment.

Emma Harper

The training does not have to be complicated. It does not aim to make people specialists. Does Jackie Dunbar agree that we want the simplest approach to raising awareness of trigger signs that would lead to further referral pathways, for instance?

Jackie Dunbar

Absolutely. Everybody should be made aware of the trigger signs and have the information at hand about where to get support so that they can pass it on.

In addition to the work that Beat undertakes to raise awareness of eating disorders, I have been made aware of an excellent support group in my area, North East Eating Disorders Support (Scotland), which is a self-help group that welcomes all adults who are affected by an eating disorder whether as a sufferer, partner, relative or friend. I believe that it continues to meet on the first Monday of every month at 7:30 pm. I will give the group a wee plug. It allows people who are suffering with an eating disorder to interact with others who are in a similar situation, share experiences in a safe and confidential setting and offer support to each other while looking towards recovery.

It is essential that anyone who is, or who believes that they might be, suffering from an eating disorder seeks help and support as soon as possible. I make that absolutely clear. Support is available and I encourage folk to reach out, take that help and begin the journey to recovery.


Carol Mochan (South Scotland) (Lab)

I thank Emma Harper for bringing this important debate to the chamber. Like other parties, Scottish Labour supports the aims and objectives of eating disorder awareness week 2022. I welcome the guests from Beat who are in the gallery—it is so nice to see youse here.

As we have already heard, eating disorders are not uncommon: one in 50 people in Scotland and the wider UK is affected by them. We know that, tragically, their impact can be fatal—more people lose their lives to eating disorders than lose their lives to any other mental health condition. That is shocking, but it acts as a reminder to us all that eating disorders are both prominent and serious. We must raise greater awareness of eating disorders, their treatments, causes and symptoms.

It is important to consider raising awareness from different angles. It is crucial that individuals are aware of the signs of having an eating disorder, so that they can make informed judgments and reach out for support themselves. It is also important—although very difficult—to be able to recognise an eating disorder in someone else, so that support can be offered and a conversation can be had. For the individual who is suffering, talking may be a challenge or even a step too far.

As is highlighted in the motion, the issues around eating disorders are wide ranging. As we have heard from Beat, an organisation that is focused on raising awareness of eating disorders and providing support, the average GP student will receive less than two hours’ training on eating disorders during their entire medical degree. That is less than two hours on a condition that impacts more than a million people across the UK—let us take a moment to take that in. It is of even more concern that, as we have heard from other members, a fifth of UK medical students are not provided with any training on eating disorders. That is simply unacceptable.

I spent many years working in the NHS as a dietician, as part of the allied health professions team, so I know only too well the importance of raising awareness of conditions and disorders, and of training future health professionals. When I speak in the chamber, I like to mention the allied health professions when I can, because they have an important contribution to make. Professionals in that group often discuss the importance of training and how we should ensure that people are aware of the various conditions across the spectrum. I give my full support to Beat, which is calling for more training on eating disorders to be provided during medical training at UK universities.

We also know about the struggles that Scotland’s mental health services face. We know about the non-discriminatory nature of eating disorders. We know that, from children and adolescent mental health services to mental health support in later life, the Scottish Government needs to take more action. Looking to the future, although the 15 recommendations for improving eating disorders awareness and services have been accepted by the Scottish Government, it must also address the calls from the Royal College of Psychiatrists to go that bit further, including outlining how it will evaluate progress towards the delivery of the recommendations and ensuring that research into eating disorders in Scotland addresses our gaps in understanding the impact of such conditions on minority communities. I hope that the minister will give due consideration to those requests.

It is clear from the speeches so far that the research work and contributions made by charities, experts and others are important, but there is more to do. With cross-party support, that work can be done and we can start to address the real concerns of individuals, charities and others across the country.


Siobhian Brown (Ayr) (SNP)

I thank my colleague Emma Harper for bringing this important debate to the Parliament.

Eating disorders remain one of the most taboo topics for discussion. I hope that this debate, in eating disorders week, will shine a light on such illness. The focus of this awareness week is on ensuring that all medical schools provide adequate training on eating disorders and that doctors are equipped with the knowledge and training that will enable them to identify signs and symptoms and intervene, so that we can end the pain, suffering and often deadly consequences that eating disorders cause.

As we heard, eating disorders include anorexia nervosa, bulimia nervosa, restricting food, binge eating and overeating, to name but a few. They are a serious form of mental illness, with serious medical consequences and the highest mortality rate of all mental disorders.

In recent days, I heard the story of Grace, who started dieting at 16 because she was overweight as a result of eating convenience food. Like many teenagers, she wanted to lose weight and started eating healthily at first but then began to cut corners, so that she would be able to eat what she wanted. Her mum spotted the pattern that Grace was falling into and took her to the general practitioner. The doctor put it down to a “thing that girls do” and sent her to a dietician.

That is a familiar story from people who have visited their GP, but what else can we expect when, in medical schools, it is often the case that less than two hours of training is dedicated to eating disorders? Indeed, one in five medical schools offers no training in the illness at all.

I acknowledge all the great work that is being done by Beat, the UK eating disorders charity, and through Scottish Government investment. In a survey conducted by Beat in late 2021, 60 per cent of patients with an eating disorder felt that they received poor care from their GP and 58 per cent felt that their GP did not understand eating disorders. Out of 93 supporters in Scotland who had lived experience, 51 felt that the care that they received from their GP was poor or very poor. That must change. The lack of training is having devastating consequences.

Let me go back to Grace. As she waited to be seen by a dietician, she found herself sitting in a waiting room with four other girls she knew. That is a sign of how common eating disorders can be. Grace recalls sitting with the dietician and feeling that the appointment was just a tick-box exercise in which she was asked questions such as, “What is wrong and why aren’t you eating?” “How do you feel when you eat?” She was put on a diet plan and asked to write a food diary, but she lied and no one ever checked up on her. When she talked to the other girls, they all said that they had done the same thing: they lied on the forms, and not one medical professional ever checked or questioned them about that. Eventually, Grace stopped going to the service and fell off the radar.

Grace grew from a teenager into an adult, taking the eating disorder with her. At 23, she made a breakthrough with a doctor in Ayr. The young female doctor understood her, listened to her and wanted to help. What would have happened if her first doctor had been like that? Unfortunately, the doctor in Ayr did not remain at the practice for long, and Grace went back to square 1.

The Scottish eating disorder services review in 2021 recommended that there should be appropriate training for all professionals and that there should be a particular focus on early intervention, medical aspects of care, and support. It recommended that training should range from undergraduate healthcare training to specialist training.

There is good news: the University of Glasgow medical school has been an early trailblazer in delivering the new training package. We must lead the way by ensuring that all five medical schools and the foundation programme in Scotland deliver such training.

Does Siobhian Brown recognise that the Scottish Government has an important role to play in ensuring that there is best practice across all five medical schools?

Siobhian Brown

Yes, I agree with Oliver Mundell. There is dedicated funding at the University of Glasgow, and the Scottish Government absolutely is aware that the approach needs to be rolled out in all five medical schools.

Let us fast forward from Grace at 23. She is now 29 and she talks quite openly about the struggle that she faced. Although the mental effects have subsided, the physical effects have not. She knows that she has caused herself damage, but the answer from the doctor is more pills and a diagnosis of irritable bowel syndrome. No one will listen.

We need to listen to people with lived experience. Recovery is possible—we need only look at Grace. The plea from people like Grace is that eating disorder is not just a thing that teenagers do but a serious mental illness with grave consequences. As such, it deserves to have money and resources ploughed into it, with funding for research.

The Scottish Government needs to ensure full implementation of the Scottish eating disorder services review recommendations, including on the allocation of sufficient funding, and workforce and staff training. We know that the pandemic has compounded the issue, made it worse for those who are battling the illness and affected others for the first time.

I will finish by repeating what my colleagues have already said: help is out there. People should take down this number: 0808 801 0432. It is for Beat, whose trained advisers can offer one-to-one help. If talking is too hard, people can email [email protected]. Please seek help.


Gillian Mackay (Central Scotland) (Green)

I, too, will start by welcoming those in the gallery and by thanking Emma Harper for securing this important debate.

My thoughts are with everyone who is affected by an eating disorder. Lockdown was a lonely and distressing time for many people, and I cannot imagine how difficult it was for people with eating disorders who may have had to cope without access to their usual support systems. Research by the eating disorder charity Beat suggests that 61 per cent of adults who received care for their eating disorder had less contact with services as a result of the pandemic. As we recover from the pandemic, it is vital that that support is restored.

We must also tackle stigma. There are many misconceptions about eating disorders, one of which is that someone must be extremely thin or underweight to suffer from disordered eating. We are learning more all the time about the different ways in which eating disorders manifest, and awareness of less common eating disorders, such as avoidant/restrictive food intake disorder and orthorexia, is increasing.

Stephen Kerr (Central Scotland) (Con)

I wonder whether Gillian Mackay shares my concern about the distorting effect of social media, particularly on young men and young women, who see unreal images that are filtered or photoshopped. Does she agree that influencers and celebrities have a special responsibility to be truthful in the way that they portray image in social media and on social media platforms? Does she agree that it would be a good idea if social media companies labelled images as filtered or unfiltered or photoshopped or unphotoshopped, so that people can know what is real and what is not real?

I am happy to give Gillian Mackay her time back for that intervention.

Gillian Mackay

Thank you, Presiding Officer.

As someone who grew up in the early to mid-2000s, when diet culture was probably at its peak and pictures of very thin celebrities were rife, I think that it is incumbent on everybody to take stock of the fact that what they are portraying influences those around them. It is important that social media organisations look at how their content affects everybody around them. We probably need more research and more of a look into that to assess some of the impacts that social media organisations are having, particularly on teenagers and young adults.

It is important to note that symptoms may not fall into neat categories such as “anorexic” or “bulimic” but may overlap and be classified as “other specified eating disorder”. A friend was kind enough to share her story with me. She did not menstruate for years because she was restricting to the extent that she was underweight, but her GP told her that she was fine because her body mass index was borderline. There is an argument to be made for greater inclusion of eating disorders in medical training. In this eating disorder awareness week, Beat has highlighted that, on average, UK medical students receive less than two hours of teaching on eating disorders in their entire medical degree course and that a fifth of medical schools do not include eating disorders at all in their teaching. Beat has argued that eating disorders are highly complex mental illnesses that cannot be adequately covered in two hours. I have a lot of sympathy with that view.

Like many others, I have received numerous emails from constituents this week who have asked me to write to the Minister for Mental Wellbeing and Social Care to bring that issue to his attention and to find out what is being done at the national level to ensure that all future doctors are equipped to identify the early signs and symptoms of an eating disorder. I would be grateful if the minister addressed that in his closing speech.

I am sure that everyone in the chamber would agree that eating disorders should form part of medical education. In its briefing for today, the Royal College of Psychiatrists highlighted that anorexia nervosa is prevalent among 1 per cent of women and 0.5 per cent of men and that it has the highest mortality rate for any type of severe mental illness. Women are likelier to present with an eating disorder, as are LGBT people.

I have raised the need for improved data on mental health in the chamber previously, and I will continue to do so. The Royal College of Psychiatrists has said that there are real gaps in our knowledge as to the impact of eating disorders on our ethnically diverse and LGBT communities, in particular. I would be grateful to hear from the minister what action is being taken to improve the situation and whether we have data on how people from minority ethnic backgrounds are affected by eating disorders, given that data on the mental health of minority ethnic communities is often inadequate.

As well as putting in place training for future medical staff, we need to ensure that time is made for current staff to improve their awareness and learn from new research. The “Scottish Eating Disorder Services Review” found that,

“Services ... have seen increased numbers of referrals of people with eating disorders since the start of the pandemic”


“are seeing people present later and significantly more physically unwell.”

The review also said:

“Child and Adolescent Mental Health Services (CAMHS) eating disorder leads have reported an unprecedented increase in the number and severity of children and young people presenting with eating disorders.”

Those findings are extremely worrying. It is vital that we receive regular reports on what action is being taken to improve eating disorder services and help them to meet growing demand.

The Royal College of Psychiatrists has highlighted that, nearly a year on from the publication of the “Scottish Eating Disorder Services Review”, we need to know what progress is being made towards delivering on the recommendations that the review document set out. The RCP has called on the Scottish Government to outline how it will evaluate progress towards delivering on those recommendations, and I ask the minister to address that in his closing speech as well. I appreciate that there is a lot in there.


Gillian Martin (Aberdeenshire East) (SNP)

I thank Emma Harper for securing the debate. She has led these debates for quite a few years now and she consistently brings up the subject of eating disorders in the chamber and—I know this first hand—makes sure that it is factored in where appropriate and possible in her committee work. Oliver Mundell also mentioned the work that she does through the CPG on mental health.

Emma Harper highlighted the increased incidence of people suffering from eating disorders during the pandemic and the problems that they have experienced. The Health, Social Care and Sport Committee recently did some work on young people’s mental health, and Emma was quick to ensure that that issue was factored in, for which I commend her. She follows, as I do, in the footsteps of our friend and colleague Dennis Robertson, who many members have rightly mentioned. We cannot overestimate the impact that Dennis’s work has had, and continues to have, in raising awareness, all of which he does in the name of his daughter Caroline, who tragically lost her life.

We talk about many difficult and complex issues in the chamber; I see that as our job. Eating disorders are such an issue, and so is suicide, which we find difficult to talk about. I do not think that there is an awareness out there among the public of the impact that eating disorders can have in terms of suicidal ideation, in particular among young women.

When we talk about mortality rates for eating disorders, many people think first of the tragic deaths resulting solely from complications due to deteriorating physical health. Of course, that is a factor, but I was taken aback to find out just how many of those suffering from the mental health conditions of binge eating, anorexia nervosa and bulimia attempt or complete suicide.

In considering the mortality rate for those with eating disorders, it is sometimes hard to contemplate the issue of suicide, in particular when we think about families who are terrified that one of their own is struggling with an eating disorder. I can only imagine how difficult it is to hear that one in six people with an eating disorder will try to end their own life; that makes what is an already frightening concept for parents and families even more frightening.

Nevertheless, people can and do get better, and I point to the massively improved child and adolescent mental health services in Aberdeen as a model for how access to mental health services can be made much better and more appropriate for young people who are at risk. We now have a modern and appropriate setting for those services in the city of Aberdeen.

I am grateful to Beat for its briefing today, and for the work that it does on the importance of early intervention and support for families. As I said, there are frightened families who fear that the worst may happen, and also fear that there is little that they can do. I have had conversations with Dennis Robertson about the fear that he and his wife Anne felt when Caroline was suffering—fear that they might do the wrong thing, and that there was no support out there for them.

Families need expert advice, and Beat absolutely provides pathways to that. Parents and guardians worry that it might not be enough to get their young person through the door, and that the medical professional they see might not have the expertise—Siobhian Brown mentioned a situation where that was the case. They fear that the waiting list might be too long, and they do not know what they can do in the meantime. As always when I speak on this issue, I will put a link to Beat’s excellent website on my social media, along with its phone number.

I will not echo much of what has been said by others about the training of medical professionals, except to say that it is a very important theme. Indeed, it is not just medical professionals who can benefit from training and awareness, and I want to discuss what training might be helpful to parents, young people and teachers on the earliest interventions and on the potentially negative influence of social media. When I was a teenager, that debate was around images in women’s magazines, but those came out only monthly or bi-monthly. Now, there is a constant stream of images of so-called perfection on tap on TikTok and Instagram, and there are websites with tips on how to starve yourself hitting the top of Google searches—pro-ana and thinspiration websites, for instance. There has been some progress on them being called out, but they are still out there, and I do not think that the social media companies are doing enough to bring them down. I would also point out that body-shaming clickbait in tabloids and online exacerbates the mental health issues that young women might face.

Will the member give way on that point?

If I have time.

The member is just winding up. It needs to be a very brief intervention.

The member has mentioned young women, and it is important to put it on the record that young men are also impacted by those images.

Gillian Martin

Forgive me—young men are of course impacted as well. I do not forget that but, as a woman, I think about the situation of women a lot, as that is my lived experience.

Given the many aspects of the impact on the mental health of women in particular—and on that of men, as Stephen Kerr has mentioned—I urge social media companies and media companies in general to do far more than they are doing at the moment. They are making staggering profits from our reliance on them, with their psycho-technical tactics in having us glued to their content. It is time for them to be far more responsible for the content that they share that can harm young people.

I call on the minister to wind up the debate. You have around seven minutes, minister.


The Minister for Mental Wellbeing and Social Care (Kevin Stewart)

Thank you, Presiding Officer. Seven minutes does not seem long enough to answer all the questions.

First, I will welcome some folks to the gallery: Emma Broadhurst, Beat’s national officer for Scotland, and the Beat ambassadors. It is great to see you here today.

I welcome this debate to mark eating disorders awareness week 2022. It allows us to raise awareness about eating disorders and the terrible impact that they can have on those who are diagnosed and on their family and friends, too. I thank Emma Harper for lodging the motion this year and for focusing our minds on how significant this subject is. I am pleased that our minds are focused on it at least once a year, but I see it as part of my job not just to keep that focus on the once-a-year debate that Dennis Robertson instituted but to get folk speaking about the issue more.

Jackson Carlaw rightly asked what has changed. I think that a lot has changed. For a start, the communication about eating disorders is much less taboo than it was when Dennis Robertson first stood up in the chamber to speak about the subject 10 years ago. That means that more folk are seeking the help that they need.

As a Government, we are making significant investments in our mental health services. We know that the pandemic has had a huge impact on people’s mental health, and we are aiming to encourage recovery and renewal as we emerge from the pandemic. That includes dedicated actions to improve support for those with an eating disorder and their families and carers, which I will touch on later in my response.

I also extend my thanks and appreciation to all those across the country who work day in, day out to support the recovery of those with an eating disorder and their families.

As has been mentioned, the theme of this year’s awareness week is to encourage our medical schools in Scotland to ensure that they provide eating disorder training to medical students. That will ensure that our future workforce is equipped with the skills and confidence that they need to provide the support that people across our country require. I am pleased that our medical schools in Scotland are all in discussions with Beat to deliver eating disorder training, or are already delivering it. In particular, I want to mention the University of Glasgow, which was the first in the UK to adopt Beat’s training. The folks from Beat have called Glasgow the trailblazers, and that is the case. However, we need all our other medical schools in Scotland to follow suit, and I am sure that they will do so.

Obviously, universities are independent institutions, but does the minister hope that, by this time next year, all universities will have moved forward and will offer that vital training?

Kevin Stewart

They are independent institutions, as Mr Mundell rightly says, but they have all engaged with Beat, which is a good sign. We will do all we can to persuade them all to move forward on that.

It is vital that our GPs and those who work in our primary care services feel confident about spotting the early signs of an eating disorder and understanding the complexities of this type of illness. They are key players in ensuring that, when someone comes forward for support, they are directed to the right treatment. We do not want any more situations such as the one that Grace had to deal with in Ayr.

As I have mentioned, in the past two years, we have taken significant actions to ensure that those who require support for an eating disorder can receive timely access to appropriate treatment. Our transition and recovery plan, which was published in October 2020, is backed by the £120 million recovery and renewal fund, which will help to transform services, with a renewed focus on prevention and early intervention.

In June last year, I was pleased to announce £5 million to implement the recommendations of the national eating disorders review. The majority of the funding is being provided to NHS boards to support them to respond to the increase in eating disorder referrals. Early feedback highlights that boards have used the funding to ensure that their staff have access to the right training, to expand clinician time and to recruit additional staff.

In that regard, I refer to Gillian Martin’s point about the changes that were made to child and adolescent mental health services in Grampian, which made a real difference in modernising services and getting things right. We need to export that best practice right across Scotland, which has not quite happened yet. The reason why we have put our CAMHS specifications in place is to ensure that it happens.

Stephen Kerr rose—

I will take a brief intervention from Mr Kerr.

Does the minister also agree with Gillian Martin’s comments about the need for social media companies to take more responsibility for the content that is published on their platforms?

Minister, I am happy to give you the latitude that I have given every other speaker: you have a generous seven minutes.

Kevin Stewart

I will come on to Mr Kerr’s point towards the end of my speech, but I will definitely address that issue.

We have had additional recruitment of staff in our NHS, and we have also provided more than £400,000 to Beat, the UK’s eating disorder charity, to provide a wide range of support options to families and carers as well as support for children, young people and adults who are impacted by an eating disorder. Feedback from those services highlights just how important different types of support can be, with one user reporting:

“For the first time I was with a group of people who totally understood what I was going through. It is so reassuring to hear others’ experiences with eating disorders and to know you are not alone”.

It was because of that feedback that I commissioned additional services from Beat to be rolled out nationally across Scotland, beginning in April.

We have awarded Beat more than £300,000 to provide expanded helpline support until midnight seven days a week, improved carer support through NHS board referrals, specific binge eating disorder support services and beyond the symptoms training for GPs and other healthcare professionals to support them to identify when a patient has an eating disorder and to confidently intervene early. From a conversation that I had earlier today with Beat, I believe that we will be the first part of the United Kingdom to have it deliver all its suite of services in our country. I am glad that Scotland is leading the way on that.

I am also pleased to provide an update on the eating disorders implementation group that was established last year to take forward the recommendations from the national review. I will attend the group’s next meeting.

There are specific questions from the debate that I must answer with regard to that work. Emma Harper asked when we would publish the specification for the lived experience panel. It will be published shortly. She also asked about the data working group. It plans to meet in the next two weeks.

Gillian Mackay and others brought up the subject of data. We do not yet have the right data. That is one of the reasons why we have established the data working group. We need to do better on that front and, with the group’s help, we will no doubt do so.

We need to get over the subject being taboo, as Siobhian Brown described it. The more that we speak about, and encourage others to speak about, eating disorders and some of the other difficult subjects that come with mental ill health, such as self-harm and suicide, which Gillian Martin mentioned, the more impact we can have on getting it right for people.

Mr Kerr talked about the online aspect. We do not have powers in this Parliament to deal with the social media and internet providers, but I hope that every member will engage with the bill that is proposed and going through the House of Commons on the issue, not just in relation to eating disorders and the things that the so-called influencers do but in relation to every other aspect of mental health, because I do not think that that proposed legislation goes far enough. In some regards, it does not really matter what I think because the third sector organisations—the folk at the front line—including the Samaritans, do not think that it goes far enough. Perhaps we could get some cross-chamber agreement to get cross-border agreement to beef that legislation up somewhat and get rid of some of the nonsenses that exist on social media channels.

I thank Emma Harper for lodging the motion for the debate. I reiterate my support for and thanks to the staff who have worked tirelessly throughout the pandemic to support people with an eating disorder and their families. I assure them and Beat that they have the Government’s full support.

Meeting closed at 18:13.