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Eating Disorders (Treatment) (PE609)
The first new petition is PE609, from Mrs Gráinne Smith, on behalf of North East Eating Disorders Support (Scotland) and the Scottish Eating Disorders Interest Group. Dee Affleck and Heather Marrison are here to support her. You have three minutes to make an opening statement, after which members of the committee will ask questions.
Nine years ago, my daughter came home from an abusive marriage and developed anorexia, yet she did not recognise how ill she was. It was the beginning of a living nightmare. Anorexia nervosa is an eating disorder. It is a serious illness with terrible physical and emotional effects and a very high death rate from mineral deficiencies, depression and suicide. Up to 20 per cent of sufferers die.
Thanks very much. It is a shocking state of affairs. I open the debate for questions from members of the committee.
Good morning, Mrs Smith. Congratulations on bringing such an important issue to the Parliament. How did you manage to get your daughter through the illness despite the lack of facilities?
I look back and wonder how I did it. I was fortunate in having a sympathetic GP. When I went to my GP in Macduff and asked what I should be doing to help my daughter, I was told that I knew more than my GP did. At that time, I was in a black hole regarding knowledge of the illness. I had a lot of good friends beside me who supported me and my daughter, but it was a living nightmare. That is the experience of all the parents to whom I speak on the helpline and at meetings.
I seem to recall from some women's magazines that I have read that there are some national helpline numbers for eating disorders. Is a national resource available anywhere in the United Kingdom?
There are a lot of fragmented services with a lot of good will. There are some excellent services, but they are fragmented and dependent on personal interest. Some doctors are trying very hard to make a difference, but they lack resources and training. They cannot offer their colleagues training and there is no general provision. There is no co-ordinated approach, which is what has caused the present situation.
What books, leaflets or pamphlets on the matter are available to help people?
The Eating Disorders Association is a very small national charity that is punching way above its weight. If someone gets in touch, it will send them leaflets and information. I have brought one or two such leaflets with me for the committee. I will also give you a copy of my speech, if that will help. However, there is no specialist hospital or co-ordinated national professional resource where people can go and ask for help—it is all voluntary.
How long does it take someone to develop anorexia? Let us start with your daughter's case. You said that she had a bad marriage.
Yes.
Was she anorexic by the time that she came to you, at the end of the marriage?
She came home when she was 21. At that time, there was absolutely no sign of any eating problem. She looked, sounded and was healthy. She said that, when she was married, her husband was away a lot. She was not allowed to go out, so she comfort ate. When she came home, she was unhappy about her weight, although she was not overweight for her height, and she started dieting. Then she began exercising. Most people who go on a diet do not develop an eating disorder, but certain people who have a genetic vulnerability will develop anorexia or bulimia.
How long did it take?
In my daughter's case, she was diagnosed when she was 22. She did not tell me until she was 23. All that time, I saw her losing weight and I thought that she had cancer. If I had been right and she had had cancer, she would have been offered a care plan. It was literally like living a nightmare. I had to watch my daughter become skeletal while she denied that she was ill and I was unable to help.
My second and last question is about self-awareness. Your daughter knew what she was doing to herself by not eating, but did she fully understand what she was doing?
No. It is a sort of compulsion, like a drug addiction or an addiction to alcohol. Unfortunately, people can have a genetic vulnerability to such compulsive behaviour.
Most people—I would say 99.9 per cent of people—develop an eating disorder as a coping strategy for dealing with something that is happening to them psychologically. Therefore, although they may appear very ill and emaciated and in a lot of distress, they will not be aware of that because they are using it as a coping strategy. They may be in denial that there is a problem. That can become a source of conflict for families and carers who witness the situation. The family may be in fear of what might be wrong with the person, because there seems to be no answer to the question that is obviously being posed. Most people develop anorexia, bulimia or any of the other eating disorders as a coping strategy.
They use it as a coping strategy in response to stress.
It is very good of Gráinne Smith to come here today. Being from the north-east, she has made a considerable journey to raise a national issue. Eating disorders are much more common than anyone would assume. I have a young friend of just 18, who is a particularly clever young woman who has been hospitalised for about eight months now because of the condition.
I would like to have the answer to that. In the past three years, I have written many letters and approached MSPs. I have also served on the mental health working party on eating disorders, which made recommendations two years ago. I regularly came down from Macduff to Edinburgh for that working party, to which I gave a lot of my time. I have also been on the mental health and well-being support group. Despite all that, I think that the situation is worse now, as the Perth unit has been closed.
Really?
Yes. The small specialist unit in Perth was closed.
Why was that? What possible excuse could have been given for that?
I understand that it was closed for financial reasons.
Is not it always? I think that we also get sick of these working parties, which seem to drag on and give a superficial glow to the matter as if something is being done.
Yes. I can quote a recent case, although obviously I cannot give any names. I know of one young woman who was sent into a general psychiatric unit and was physically attacked by a male patient.
Was it a mixed ward?
I do not think so, but I think that there were mixed facilities such as a common room.
Is it better that such patients should be together? Would it not be better if patients of the same age group were together?
The patients need specialist treatment and help. Heather Marrison is a former sufferer and is also a professional who specialises in dealing with eating disorders. She will say a little about what facilities would be ideal.
We need dieticians and those who can provide psychological help as well as the people who do the practical work of weighing the patient and monitoring the patient's progress. I was very ill and I certainly could not have got through my illness without help. I was lucky in that I am based in Edinburgh, where help is available. In rural areas, people really struggle.
Were you in a good unit with other young people?
I was not actually hospitalised, but the young people's unit in Edinburgh receives many patients who have bulimia and other eating disorders. I attended the Cullen centre, which is an out-patient centre, where I received psychological help. Currently, the waiting list for the Cullen centre is 12 months. It takes a lot of courage for someone to go to their GP and admit the problem. Often, they need help there and then because they can deteriorate rapidly. However, there are no in-patient facilities for adults in Scotland.
If I may just reinforce that point, there are no specialist in-patient beds for people with eating disorders. At the moment, if someone is physically at risk, we try to have them admitted to a general ward. If they are psychologically at risk, they go to a general psychiatric ward, but most people find that very difficult. Indeed, that is difficult both for the sufferer and for the professionals. To pick up on Gráinne Smith's earlier point, those professionals have no specialist training in eating disorders and so find it equally stressful to manage. The situation is difficult all round.
I was 12 when I first went to my GP. He suggested that I should just go home and have a bowl of soup. I was desperately ill and the condition had taken over my life even at the age of 12. I recovered by the age of 21 and I am now 29. It can take a long time.
Very well done.
I have a feeling that the Parliament debated the issue. My colleague David Davidson has a family involvement in the issue, so I know that it can be distressing. One difficulty that I find is in determining to what extent such disorders are medical conditions and to what extent they are mental conditions. Even having heard the comments that have been made today, I am still confused about whether eating disorders are a mental or a medical problem. Will you expand on that?
They are interlinked. When a person's weight drops below a certain level, their thinking becomes distorted. I understand that that happens in all cases of starvation. It is difficult for us to imagine this, but people with anorexia look in the mirror and see a distorted image. Their thinking becomes distorted. That is where the psychological aspect comes in. It starts off as a physical losing of weight that affects minerals and electrolytes, but it then becomes psychological.
In my case, it actually happened the other way round. I was depressed and unhappy. I was in a violent home environment. I did not realise that I was being horrible to myself and abusing myself because that was the way that I had learned to live and learned to treat myself. I had very low self-esteem.
That is helpful.
The fact that someone wants to go on a diet shows unhappiness with self-image. Often, although not always, the unhappiness leads to dieting.
It is not always a question of dieting. People who suffer from anorexia withdraw from life and deny themselves things.
The illness has profound physical and psychological effects. It is a chicken-and-egg syndrome—it is hard to say which comes first. It will depend on the individual.
The Royal College of Psychiatrists recommends that every national health service board area should have a consultant with specialist expertise in eating disorders and the Executive guidance suggests that NHS boards should consider setting up multidisciplinary teams on eating disorders. Those are just paper promises. Are you saying that, in reality, there is nothing out there?
Recently I spoke to a young woman whose doctor had referred her to the specialist eating disorder unit in Aberdeen. The waiting list for that unit is several months. In the meantime, the GP, who was very worried about his patient, referred her to a general psychiatrist. When she saw the general psychiatrist, he said, "I don't know why you're here—I don't do eating disorders."
So not every NHS board in Scotland has a consultant who has expert knowledge of eating disorders.
That has certainly not come through in anything that I have heard or know about.
You mentioned that you were part of the mental health and well-being support group. Is not it that group's job to ensure that the recommendations are implemented?
I think that the group is trying very hard to do that. Questions about what is happening are asked on every visit. Things are improving, but the process is very slow. So far, improvements have not fed through in any real way on the ground, for example, in meetings with parents or on the helpline.
Do you think that some kind of initiative has to come from the top?
Yes, definitely. Although every general psychiatrist is trained in schizophrenia and there is a set of clinical standards for schizophrenia, there is nothing like that on eating disorders. Provision seems to be very haphazard and completely dependent on personal interest. There are excellent people who do their best in the face of lack of resources and so on, but there is a lack of specialist training and a lack of sufficient opportunities.
Are there any other questions? Do any of the witnesses wish to make any other points that we have not asked about?
It is important to stress that, if intervention is taken early on, eating disorders can be prevented. The longer the condition goes on, the stronger the hold that it has on the individual and the more difficult it becomes to treat it.
We need to have an infrastructure of services to provide that early intervention. Without such an infrastructure, early intervention does not happen.
On current resources, the waiting lists are massive.
I have brought with me a leaflet from the Eating Disorders Association, entitled "The hidden cost of eating disorders", which outlines the social costs as well as the costs to families. I can leave it with the committee. I have also brought a copy of what I have said, which includes the statistics.
It would be useful if you could leave that information with the clerks. We will ensure that the members get it, so that it can influence them.
Thank you very much for giving me the opportunity to appear before the committee.
That is what we exist for.
When we write, could we include a copy of the leaflet to which Gráinne Smith referred and of the statistics, which show how serious the situation is?
We could do that. It is also suggested that we draw to the attention of those to whom we write the necessity of early intervention as a means of preventing the development of eating disorders.
I want to pick up on the point that Mrs Smith made about Professor Scholtz of Germany. Perhaps we could ask the Scottish Executive whether it would consider examining the feasibility of some kind of trans-European exchange of best practice between Germany and Scotland. It seems that Professor Scholtz might have something to offer us. I am interested in the issue. We could ask the Scottish Executive whether that would be practicable.
We could do that.
The situation is shocking. The issue of eating disorders seems to have fallen out of the loop in the Parliament. Many people assumed that something was being done. We should never assume.
When we write to the Executive, we will ask for details of waiting times for access to the clinics in Edinburgh, Aberdeen and any others.
Perth.
We will also ask for information on why the Perth centre is closing.
We could ask for that information from the Scottish Parliament information centre, because it tends to give better answers than the minister.
The ministers are supposed to be in the know. They should know what they are doing.
Renewable Energy Projects (Funding) (PE615)
The second new petition today is from Mr Peter Hodgson, on the funding of renewable energy projects. Mr Hodgson asks the Scottish Executive to reconsider the funding of renewable energy projects to encourage the development of sustainable sources that contribute to the Kyoto agreement.
My inclination is to be greener than Greenpeace and friendlier than Friends of the Earth. I fully support renewable and reusable everything, but not when it fails to yield environmental benefits.
As one who goes to Orkney regularly, I suggest that the windmills there are a tourist attraction.
Hydro is genuinely green, because it thoroughly replaces carbon-produced energy. Unfortunately, with intermittent or unpredictable sources, such as wave power, the national grid does not know from minute to minute what power it has available. It is essential that the national grid has that information because if there is too little power, we get power cuts, and if there is too much power, we get brownouts, which are even worse. The national grid is performing a balancing act.
Is that the way in which Denmark deals with the situation?
Denmark is withdrawing subsidies because of that problem. It has carried out calculations that have shown that, even with the existing penetration of wind farms, Denmark has saved only 0.1 per cent of emissions. The Danish say that wind farms are not environmentally viable.
I sympathise with your view on hydro power, given that I was the manager of two major hydro complexes in Scotland, in Galloway and Lanark. That said, I searched the whole of south-west Scotland for additional sources of water that would add to our 109MW output, but there was nothing of significance to add. From where would you get your additional hydro power?
I mentioned hydro only as a source of genuine renewable energy. There are others, such as tidal, barrage—which might be environmentally unfriendly to wildlife—and biofuels. There are all sorts of other energies, but because wind farms are so quick to get up and running, there is a rush to use them when there ought not to be. We should consider the issue properly and gently and do the job once and for all.
I have some sympathy with you but perhaps you will have no sympathy with my view that nuclear energy is the best way of cutting emissions and the cleanest way of generating electricity, if we have to have it.
I could not agree more, and that is one of the reasons why I brought the petition. We need to look at the broader picture.
On your point about home insulation, my knowledge of the situation goes back to the early 1980s. Since then, we have had programme after programme on house insulation in the UK. By now, has not everyone been insulated?
I do not think that that is true, with all due respect. There has not been the incentive, either through the level of grants or through legislation, which would probably be the best way, as building regulations could be strengthened to make it essential for new houses to be built to a much higher standard than exists at present. I am talking about five layers of double glazing—not only two—and about houses being dug into the ground to tap into the inertial heat within the ground. Those would be major changes.
You said that, in your opinion, renewables such as wind, wave and tidal were unpredictable—to say the least—and that a constant volume of generation could not be guaranteed. Which of the three is the most appropriate? We have a constant tidal flow around the coast, and tidal generation might be more predictable than wind generation.
Yes. I would not say that tidal generation is an unpredictable source; it is highly predictable. If there were generators on the west coast and the east coast, one could predict that they would produce the same amount of electricity minute by minute and hour by hour. I have figures that show that with some of the intermittent sources there can be as much as a 15 per cent fluctuation over half an hour. We must bear it in mind that the output of wind turbines is proportional not to the wind speed but to the cube of the wind speed. If the wind speed doubles, the output goes up eight times and if the wind speed doubles again, the output goes up 64 times. One has only to stand on a hill to feel the fluctuations in the wind; some of that is ironed out by the inertia, but not over a half-hour period. That is what the grid cannot cope with.
You make the point that generation is not constant or predictable and that therefore it is difficult to control. The reverse of that position is that the same thing happens now with existing generation systems, whether nuclear or oil, but particularly nuclear. There is a demand on generation at certain times of the day, and because of the time that it takes to shut down generation, there is a surplus of energy that must be dissipated.
Nuclear power currently provides what is called the base load, which, as I understand it—I am not an expert—is the highly predictable, year-in, year-out minimum load. On top of that are various other stages in the make-up of electricity input. At the top of the pile are generators that generate a little bit of steam. Those generators are not connected to the grid but are slowly turning round. There is a whole stack of generators at that level going up and down.
What is also predictable about nuclear energy is the impossibility of getting rid of the waste that it produces, which is not very green.
I do not want to get into an argument about the nuclear industry, because that is not what I am here for.
It is not the subject of your petition.
It is a problem, but I do not know the answer. We may be forced into having more nuclear power because of the lack of foresight in the current approach.
The way that the system operates is that certificates under the Renewables Obligation (Scotland) Order 2002—ROS—are issued to electricity suppliers, which must provide so much green electricity. You suggest that the easiest thing for the suppliers to do is to put up wind farms because that is quick, cheap and will hit the target of 40 per cent by 2020. However, you also suggest that that approach will in itself cause problems, so we should take a much more studied approach that uses hydro, solar and tidal energy, biomass and energy savings, which are all less quick answers to the problem. You think that there has been a rush to wind farms and that that should be stopped.
That is correct.
There are no more questions. Do you want to make any other points?
No, thank you.
You are free to listen to our discussion about what to do with the petition.
Military Action in Iraq (Legality) (PE619)
A further new petition was received too late to be issued with the committee papers, but I thought that we had better deal with it. I think that members have all received it.
We have a law officer of our own; can we not also ask him?
In this case, he would probably refer the matter to the Attorney General because, within the Cabinet, it was the Attorney General's decision.
Should we refer the petition to Westminster, given that this is primarily a matter for the Westminster Parliament? The decision should be made by the Westminster Parliament.
The petition asks the Scottish Parliament to take a view. Before we could do so, we would have to hear from the Attorney General, who claims that the war is legal. The minimum that we should do is ask the Attorney General for his arguments in response to the petition.
The Scottish Parliament has taken a view on the issue—there is nothing in the petition that has not been debated in the Parliament. The Parliament was obliged to consider the Attorney General's opinion and it accepted that opinion. A major concern for all members who took part in the parliamentary debate was that our troops should not act illegally when they are sent abroad. The Scottish Parliament received an assurance on that point from Mr McConnell. Given that our servicemen are in military action in the middle east, we should do nothing to upset the apple-cart.
There is a good case for passing the petition to the Justice 1 Committee. Scottish troops have been sent in and, tragically, some have died. The Parliament has as much right to a voice as Westminster or the representatives of any other part of these islands have. Rather than refer the petition to the appropriate law officer, we should send it to the Justice 1 Committee. We do not know what will happen in the next few weeks or months or how the legality of the action will be viewed, even in the medium term.
There is no point in passing the petition to the Justice 1 Committee because it will not have any more meetings.
I meant the successor justice committee.
We would first have to reach a view on the petition, but we cannot possibly do so at this stage because we are not qualified to do that. I suggest that we write to the Attorney General so that our successor committee can consider his response and take a decision in its own right. That action would not be taking a view on the petition, whereas if we decided to rule out the petition, we would be taking a view on it. I suggest that we do not take a view, but do what we would normally do, which is seek the views of the Attorney General and leave the matter to the successor to the Public Petitions Committee.
We should not rule out the petition.
We should seek the view of the Attorney General, although I support almost everything that Phil Gallie said. I also refer members to some of the speeches that were made by Scottish members during last week's debate in the House of Lords. I ask the clerks to examine that debate so that they can inform our successor committee about the comments that were made about so-called legal expertise and the Attorney General's contradiction of those comments.
If you tell the clerks to which part of the debate and which lords you refer, I am sure that that can be done.
You were right to do so, convener.
I feel strongly about the matter and I recognise that others also have strong feelings. However, I have only one interest, which is the uncertainty that would be raised in the minds of our armed forces if a parliamentary body questioned the legality of their actions. We have sought and received assurances from the highest politicians and legal minds in the land that our servicemen are acting legally. Any challenge to that opinion at this time would be folly and I would not be prepared to support it. I ask members to put themselves into the minds of servicemen and to imagine the query in their minds if they wondered whether, at the end of the day, they could be brought before the International Criminal Court. The people who are responsible are our politicians and law officers—we should leave the matter at that at the moment.
One could argue the same about Hitler's Germany. Mr Gallie takes the dangerous line that we have a right to stifle free speech—we should not take such a line.
The petition has been properly framed and brought before the committee and we must deal with it. We should not pass judgment on the petition by supporting or opposing it; we should simply facilitate our successor committee's handling of it. My suggestion is not that we should take a view on the petition but that, as always, we should allow the authorities to respond to the issues in the petition. We have a responsibility to the petitioners to try to facilitate the serious consideration of their petition. We will not deal with the petition this morning because we are not sufficiently informed to do so, but we should seek information to allow our successor committee to reach a conclusion.
The final paragraph in the recommended action on the petition would suffice. We should seek the comments of the Attorney General, after which the matter will be up to our successor committee in the new Parliament.
Yes. We cannot make a decision on the petition because, if we did so, we would be taking a position on it. I suggest that we do not take a position on the petition because we cannot respond to it until we have received comments from others. By seeking comments, we will not in any sense undermine British forces or anyone else—we will simply facilitate our successor committee's dealings with the matter. Is my suggestion agreed to?
I would like to have a five-minute suspension at this point, because the BBC wants to do a piece about the final meeting of the Public Petitions Committee. If that is okay, we will reconvene at 11.10.
Meeting suspended.
On resuming—
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