The final item of business is a members’ business debate on motion S4M-12192, in the name of Dennis Robertson, on eating disorders awareness week 2015. The debate will be concluded without any question being put.
Motion debated,
That the Parliament observes that 23 to 27 February marks Eating Disorders Awareness Week 2015; notes that the most recent figures from NHS Information Services Division estimate that, in Scotland, around 2,000 patients in a single year sought treatment for an eating disorder; believes that the real figure is impossible to know due to the great number of people who do not seeking help from a GP; understands that eating disorders are recognised as mental health conditions; acknowledges what it considers the serious conditions that can be associated with such disorders, including other mental health conditions, osteoporosis, type 1 diabetes, anaemia, low blood pressure and organ failure; notes with sadness that people are still dying from these disorders; believes that there can still be imperfections in the communication between clinicians and families; commends the organisations in Aberdeenshire West and throughout the country that are playing a part in raising awareness and providing support to people with eating disorders, and welcomes what it considers the continued engagement and support from the Scottish Government.
17:34
I thank all the members who supported the motion in order for me to secure the debate. I welcome to the gallery members of Diabetics with Eating Disorders who will participate in an event in committee room 4 after the debate.
Prior to the debate, I asked myself why—why am I doing this? The answer is really quite simple. We need to continue raising awareness within the medical profession of people with eating disorders. It was once said to me that things only change death by death. I am hoping to take a much more positive view of this. I am hoping that things will change by raising awareness—awareness by awareness.
This is the third time that I have come to the chamber to raise awareness. I believe that, as I have done so, we have made significant changes. For instance, last year we had the first ever eating disorders conference held in the Parliament. It was well attended. We brought together clinicians, families and patients, people from the media, colleges, universities and the fashion industry. They all had one aim in mind, which was to look at how best we serve those with eating disorders—how best we can make changes in their lives and how best we can resolve some of the problems that those with eating disorders face.
In the past, I have focused on anorexia, for very personal reasons. Perhaps I can come back to that later. However, I want to look at the whole spectrum—well, maybe not the whole spectrum, but there is a wide spectrum of eating disorders. Those with bulimia nervosa have huge problems in coming to terms with their eating disorder. Quite often, it goes undetected and people cope secretly with their condition. Thankfully, many more seek medical attention, but often much harm has been done to their bodies before they do that. The condition affects their fertility system, it can weaken their heart, it can damage their kidneys and it erodes the enamel from their teeth. It is a dreadful eating disorder.
There are also non-specific eating disorders, one of which is perhaps that related to those with diabetes. I had no idea when I first came into the Parliament, or when I first became aware of eating disorders, that mortality is five times more prevalent among those with diabetes and eating disorders than it is among those with anorexia nervosa. That is a shocking statistic to me.
It would appear that those with diabetes and eating disorders still do not have a recognised diagnosis. There is no medical name attached to this condition, as far as I am aware. I hope that, in raising awareness by bringing the subject to the chamber for debate, having an event here, listening to the clinicians and having the minister attend, we will make some strides forward in listening to those people’s stories.
The Parliament is well aware of my story, and it is with sadness that I recall the fact that Caroline died four years ago—four years ago tomorrow, in fact. When this anniversary comes around, I ask myself why, and I think I know the answer. It happened because it happened. It is as simple as that. It was not because there was no intervention. It was because there was perhaps the wrong intervention. It happened because, maybe, we were ill informed as parents, as Caroline’s main carers. This is still too often the problem—communication between the clinicians and the parents and carers is still not at a level at which we can have confidence that young people and others with eating disorders are getting the care and treatment that they need.
NHS Grampian has had bad press recently, but let me give the Parliament a good story from NHS Grampian. It has, probably, an exemplary service for eating disorders at the moment—exemplary, but with a condition. It has a fantastic transition from the young person’s eating disorder unit to adult services. Why? Because it learned a lesson. It learned a difficult and tragic lesson, but in saying that, I note that it did learn a lesson. That lesson needs to be replicated in other health boards throughout Scotland.
There is good practice. The management of really sick patients with anorexia nervosa—MARSIPAN—code of practice should be picked up and implemented throughout all eating disorder services. Young people who are going to medical services are not being appropriately cared for. They are not getting the appropriate treatment when they go to hospital. Why? Because the people who give that treatment are not aware of the full implications of the eating disorder. Help is available. That just needs to be recognised.
We have got better. The general practitioner referral rate is better and I believe that psychiatric services are coming to terms with eating disorders, although resources are few. Let us look, however, at the economic implication of eating disorders. It is estimated that, in the United Kingdom, somewhere between £7 billion and £8 billion is lost due to eating disorders. That is the cost to the NHS, the cost of people who lack employment or those who require care. I do not think that those with eating disorders are asking for too much.
I said that the NHS Grampian service would be an exemplar. It would, if it had the community services to support the hospital service. I say to the minister that, with the integration of health and social care, let us look at the intensive therapy treatments that people with eating disorders require in the community. Let us take that step. Let us resource that necessary requirement not just for patients or carers, but for clinicians to provide the treatment that those with eating disorders deserve and need.
17:46
I welcome the opportunity to highlight for the third time in this parliamentary session the incredibly serious issue of eating disorders. I congratulate Dennis Robertson on his dedication and on lodging the motion. Many in the chamber will concur that he has been a brave voice in making the argument, and we must all thank him for his resolute campaigning.
Last year’s eating disorder conference, to which Dennis Robertson referred, was a significant event that I was pleased to attend. It was significant not only for the academic community and experts, but for the many individuals and families who attended and added their personal stories. We were moved by their bravery in coming to this place and sharing what is still a much misunderstood and stigmatised mental health issue.
At a clinical level, there have been steps forward in ensuring that GPs have the necessary information to deal with a presentation. As I pointed out in a previous debate, a managed clinical network for eating disorders that covers Grampian, Tayside, Highland, Orkney, Shetland and the Western Isles has been operational since 2005. However, as Dennis Robertson pointed out in the motion, there can still be complications in the clinical pathway that can be very discouraging for people who are suffering. We must continually reinforce the message that the problem is a serious mental health problem and that, when people present, they do so during one of the most difficult periods of their life. They cannot be turned away and be left to retreat back into themselves. Instead, the process of presentation must be made as unintimidating as possible, and that starts with an understanding GP who can make a quick and accurate assessment and communicate with families. Dennis Robertson emphasised the importance of that.
As is the case every year, a number of charities have put their best foot forward to raise awareness of eating disorders across Scotland and the United Kingdom—none more so than Beat, which, in its 25th year, is hosting its sock it to eating disorders event. That yearly event encourages supporters
“to get silly with their socks, and wear colourful, wacky socks for the day and donate £1 to Beat.”
The campaign is light-hearted and highly visual and helps to bring public attention to awareness week. However, as Beat’s website highlights, the inspiration for the campaign is a very sad story. I do not have time to recount it, but members can read it on the website.
ISD Scotland publishes up-to-date statistics on the number of presentations and referrals for eating disorders in Scotland. The figures for 2013 show that those with a eating disorder who presented to either a GP or a practice-employed nurse are mainly 15 to 24-year-old females. That trend has continued for many years although, as I stated in a previous debate, the number of presentations by young men has gone up recently. United Kingdom figures that the National Institute for Health and Care Excellence has provided suggest that 1.6 million people in the UK are affected by an eating disorder, of whom around 11 per cent are male.
What is most striking is that this mental health problem is consistently associated with a younger demographic. Policy makers must acknowledge that when they target their interventions. A study by Beat, whose awareness campaign I have mentioned, was published on Monday this week. It made the case for a more preventative approach. The in-depth report, “The Costs of Eating Disorders—Social, Health and Economic Impacts”, received 517 survey responses from individuals and carers affected by eating disorders. It identified a need to dramatically increase resources for earlier intervention and indicated how inconsistent access to treatment can be for individuals, which leads to a cost of tens of billions of pounds to the economy. Again, Dennis Robertson emphasised that. Successfully identifying eating problems as soon as behaviour changes are noticed will help to prevent damaging behaviours from worsening over time and becoming more costly to treat.
Respondents to the survey indicated that eating disorder symptoms are first recognised under the age of 16 in 62 per cent of cases. That is an important statistic, as it means that the cycle of treatment, recovery and relapse can cause severe disruption to sufferers’ education, impacting on their employment, professional development and lifetime earnings.
The effects can last a lifetime and can come at a high cost not only to immediate family, but to wider society. However, early detection can help. Those respondents who sought support at an earlier stage cited a relapse rate of only 33 per cent compared with an average rate of 63 per cent for all those who presented later in their illness.
The report highlights and the motion before us points out that we could be doing better, with more targeted early interventions and clear pathways of support for general practitioners, individuals and carers. The picture before us is one of fractured and inconsistent provision. When the cost to the individual and to society is so incredibly high, the area must be prioritised.
In this awareness week, let us join together to recognise the bravery of those who make their voices heard and the hard-working charities that give them support. Let us also look to make the improvements necessary to ensure that fewer people suffer each year that we debate this most important issue in the chamber.
I again thank Dennis Robertson for the debate and for all his work over the parliamentary session on the issue.
17:51
As a good friend of Dennis Robertson, I will do something that he is not very good at: blowing his own trumpet. I will use part of my speech to do exactly that, just like Malcolm Chisholm did at the end of his speech.
It is important to realise what Dennis Robertson has done in the past four years. As the man behind the man behind the dog for many years, I was in a privileged position to witness how much he has done and achieved as a father and as the member for Aberdeenshire West.
I vividly remember when Caroline Robertson died four years ago. We talked about that in last year’s debate. I mentioned the little steps that Dennis Robertson took, starting with going to my own Westhill academy, where he spoke to parents and teachers. He opened up the issue and the importance of awareness in schools. That was followed up with a conference on eating disorders in Aberdeenshire, which was held in Portlethen academy. The meeting was for teachers, although the aim was to raise awareness among not only teachers but students. After that, the first NUS in-patient eating disorder unit opened at NHS Grampian.
I had the privilege of meeting some of the NHS staff there. They are fantastic and inspiring. They recognise Dennis Robertson as a leading figure in the fight against eating disorders. I must say that NHS Grampian and the Eden unit staff are quite good at understanding the problems that patients of different ages face. I was pleased to notice that they have a video therapy unit—I would like to go and visit it; I have not had that pleasure yet and I promised that I would go—which is interesting, because having direct access to care and to clinics will help. We know that we must tackle the disorder at the right time and we must ensure that the services are ready to act.
I was delighted to see that the video therapy clinic works all across the region, from Banff, Elgin, Fraserburgh, Stonehaven, Peterhead and Turriff to Shetland.
One of the things about this job and every other is that if one does not learn something new every day, one is probably failing in one’s duty. Does Mr Allard agree that the education that Mr Robertson has helped to provide to members has been immense in moving forward on tackling eating disorders?
That is true. We have to direct our praise to Dennis Robertson. When he said that he had no idea, what we realised was that we had no idea. Most of us had absolutely no idea before Dennis Robertson brought the issue to the chamber. He was honest enough to say that he had no idea, and I would like to finish by saying that families have no idea. Dennis Robertson, as a father, and I, as a friend of the family, could have no idea what patients are going through.
We have to accept that people who are not suffering from this illness have no idea. We must ensure that help and support are available to families, friends and relatives, and that support must be tailored to make them understand from day 1 that we have no idea and that we need to let the clinicians guide the process and advise on the best thing to do.
I say again how much admiration Dennis Robertson has in this field. I spoke to Jacqueline Allan and Sarah Caltieri, both of whom we are going to hear from tonight, and they told me about the great admiration that they have for Dennis Robertson.
17:56
I apologise to members, as I shall have to leave before the end of the debate because of other commitments. For the same reason, I will be unable to attend the eating disorders seminar this evening.
I, too, add my congratulations to Dennis Robertson on once again bringing this serious issue to the chamber. The debate, which focuses on the prevalence of eating disorders and the serious long-term health conditions that can be associated with them, is the latest in a line of what has become an annual event. I would like to think that, as we go forward, awareness of the condition will continue to improve, as it has done in recent years. Many people do not associate eating disorders with conditions such as osteoporosis, type 1 diabetes, organ failure and other mental health conditions, and I commend Dennis Robertson for highlighting that in his motion.
The motion rightly emphasises the worrying figures from the NHS Information Services Division on the number of people in Scotland who ask for medical help or treatment each year. It is a significant number, but one that almost certainly masks a so-far unidentified group of people who have one of the disorders but who, for a variety of reasons, do not seek help.
I was aware through previous eating disorder awareness weeks that the campaign has been successful right across the United Kingdom and involves universities, charities, schools, health professionals, local authorities, those affected by eating disorders and individual carers. What I was not fully aware of was the extent to which eating disorders awareness week stretches around the globe, with many states in America participating, and also groups in Canada, Australia and Europe. Perhaps our work as politicians, and our participation in debates such as this, will assist in extending involvement in other areas of the world, thereby spreading the awareness of eating disorders to populations that are not yet aware of them.
In previous debates, I have focused on students who move away from home to an unfamiliar environment, one of the consequences of which can be depression that leads to conditions such as anorexia. In another debate, we looked at the influence that supermodels can have on girls, particularly teenagers, who feel the need to aspire to such levels of so-called beauty. Again, that can develop into complex emotions of inferiority, manifesting themselves in eating disorders such as bulimia and anorexia nervosa.
In the time available to me, I would like to look at another aspect of eating disorders that perhaps does not receive the coverage that it deserves, and that is the number of men who are affected. Between 10 and 25 per cent of people in the UK experiencing eating disorders are male, and the majority of men who have eating disorders struggle to get access to appropriate support and treatment. It is therefore particularly difficult to know how many men are actually affected by the conditions.
Often, as with similarly affected females, they want to achieve the body perfect, as displayed by footballers and athletes. Persistent use of gyms, not for fun or sport but to obtain that perfection, and slimming to dangerous lengths can eventually lead to life-threatening conditions. Only this week, statistics from Ireland showed a 30 per cent rise in the number of calls to eating disorder helplines, and the callers included boys and young men.
Thankfully, support is provided for males who are affected by eating disorders through organisations such as the Men and Boys Eating and Exercise Disorders Service. It does tremendous support work across Scotland and has bases in the cities in my region—Dundee and Aberdeen. One of the organisation’s key messages aims to make people understand that an eating disorder is a mental health condition. It also aims to remove the stigma that only women and girls are affected by it. I know that there are many people, particularly parents, who through ignorance or denial believe that it is a female-centric condition.
I would like to end by making a brief comment about eating disorders in men who are middle-aged or older. Although we are miles apart in our political persuasions, I thought that it was extremely brave of John Prescott to announce that he had suffered from bulimia for more than 10 years. It must have taken a great deal of courage for a bluff bruiser like him to come forward to help to end the stigma of eating disorders and I admire him for it. As he said at the time:
“I want to say to the millions of people, do take advice, it can help and it can help you out of a lot of misery that you suffer in silence.”
Before we move on, I advise members that given the number who still wish to speak in the debate I am minded to accept from Dennis Robertson a motion without notice, under rule 8.14.3, that the debate be extended by up to 30 minutes.
Motion moved,
That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Dennis Robertson.]
Motion agreed to.
18:01
I congratulate Dennis Robertson on bringing the debate to the chamber and recognise his strength in doing so, which we all admire.
Eating disorders, which are recognised by the medical community as a mental health issue, are just as important for the physical health of the individuals who are affected as they are for their mental and psychological health. Numbers show that eating disorders are more prevalent among young people, especially girls of up to 24 years of age, with 15 to 24-year-olds being most exposed to the pressures that lead to eating disorders.
We face a twofold crisis among our youth population. On one hand, what are often seen as societal pressures that affect young people’s thinking result in dissatisfaction with their physical appearance, which leads to extreme measures, unhealthy lifestyles and mounting health problems. As we know, as well as affecting young people’s physical appearance, eating disorders cause an obsession with their image of themselves and a slow deterioration from their healthy state of mind.
Approximately 2,000 people a year seek treatment for eating disorders but that figure counts only the people who seek help and treatment. An unknown number more—the majority of whom are members of the youth population—have not reported their condition to someone close to them or to a health practitioner.
Their issues affect us all. As a society, we are always seeking to improve, so we cannot leave our youth to succumb to the pressure to have an unrealistic body shape—young people who, when faced with a lack of adequate mental health support, seek to take issues into their own hands by harming their physical wellbeing.
What is our role and the role of the Government in providing support for young girls and boys who hold such perceptions of body shape? How can we expect to have healthy, motivated and engaged individuals if we do not do enough to provide support? I am not talking about our realising that someone is suffering from anorexia; I am talking about preventing anorexia from ever happening. We need to take a firm stand to make children, teenagers and young adults understand that shape does not matter and that what matters is a healthy body and a healthy mind.
We must show that, as a country, we are ready and we are capable of guiding anyone who might be suffering to take the right steps to avoid falling into the spiral of eating disorders. Unfortunately, like so many other conditions, eating disorders can spiral into a host of other conditions and diseases.
I heard it said recently that describing anorexia nervosa as an eating disorder is like describing lung cancer as a cough. Does Jim Hume agree that we should move away from using the term “eating disorder” and state what it is—mental illness?
Yes. I could not agree more with Dennis Robertson. I am happy to take that on board.
We have to recognise that people with eating disorders can also have other pressures on their mental health and their psychological wellbeing, and that osteoporosis, anaemia and organ failure can and do occur. We must be able to stand by the people who need our support and we must enable the availability and flexibility of the most appropriate and necessary resources of our healthcare system to reach those who are most in need. Both children and adolescent mental health officers, on the mental health support side, and nutritionists, nurses and general practitioners, on the physical health support side, should be empowered to address eating disorder issues so that they do not have to address additional or more serious issues as a result of their not having done so.
As members know, it has been a personal priority for me to increase the focus on mental health services for children and adolescents. I will seek to work with the relevant bodies and the Government on that as a further commitment in order to prevent and to protect young people from resorting to eating disorders. I am sure that there will be cross-party support for such action that will cement our commitment to improving the mental and physical health of all those about whom we have been talking during the debate.
Again, I thank Dennis Robertson for bringing the debate to the chamber and for keeping awareness of eating disorders at the top of the agenda.
18:06
I, too, congratulate Dennis Robertson on securing this debate. Like others, I pay tribute to his courage in pursuing the issue.
Conditions that make a person damage themselves are probably the hardest for us to comprehend. What would make someone fight every instinct, and damage or even kill themselves in doing so? It is clear that it takes a great deal of self-control for someone to cut what they eat to an extreme, so it is often associated with people who feel that they have lost control of their lives and it is also prevalent in young people whose lives change quickly and uncontrollably during puberty and when growing up. Surely that signals that young people are naturally more at risk. We can see how loss of control would contribute to the development of type I diabetes.
That extreme eating disorders are difficult to understand shows that they will be difficult to treat, because the sufferers have already overcome their natural instinct to protect and nourish themselves. There needs to be more understanding of the causes as well as better research into treatments. There are very few specialist centres, which means that people do not receive the treatment that they require. There also appears to be ignorance in the health service about how sufferers should be treated in the first place. In extreme situations, force-feeding might be seen as life-saving, and we can see that that would be instinctive. However, unless we deal with the causes, we are at risk of creating an even greater aversion to eating by forcing somebody to eat against their will.
We need more dedicated mental health services for young people with eating disorders and those who self-harm, which is something that we are missing. We need to understand the conditions and to provide early intervention to help sufferers. It is sad that young people tend to have to leave home and loved ones, and to travel very great distances to access high-quality care. That situation needs to change. At a time in their lives when young people are vulnerable, they need to be close to their family and friends.
We also need to look at the care pathway. I recently spoke to a young people’s group called “speak”, who talked to me about how they access help for mental illness and disorders. They told me that their first line of support is often their guidance teacher at school but that sometimes it is very hit or miss, depending on the person who provides the support. They also told me that there is often no private space for them to make their first approach to get help. Guidance teachers are often in charge of detention and have to deal with young people for bad behaviour, which makes the setting very difficult and the system very difficult to access for those who need support.
There is often a long waiting time for professional help. The target is 18 weeks, but that is an eternity for a young person at a time when their brains are still forming and their life chances are being built. Those four months or so can change the direction of their whole lives.
In order to help them to receive help early, we also need to speak about the conditions and deal with stigma. Mental health conditions continue to be stigmatised, which appears to be stubbornly hard to deal with. Unless we have open discussions, we will not deal with that stigma.
As other members have said, we need to deal with the pressure to attain unrealistically thin bodies. Digitally altering images of extremely thin models in the first place to make them even taller and thinner portrays body shapes that are impossible to attain. Such bodies are then portrayed as perfection and something to which we should all aspire. We need to stop that and be realistic about what is normal. Indeed, we need to celebrate the spectrum of what is normal.
18:10
I congratulate my colleague Dennis Robertson on securing the debate. Dennis has secured a number of debates on this important issue, which, as he has highlighted on every occasion, has affected him quite profoundly. It is a great testament to Dennis that a huge amount of awareness now exists in the chamber and in wider society about issues relating to eating disorders and the mental health aspects of those disorders.
I will focus my comments on the issues of diabetes and eating disorders. I spoke earlier to the individuals at the Diabetics with Eating Disorders stall. One of the issues that was raised during my discussion was that it is not enough just to focus on the issue of educating individuals on the use of insulin, because we are dealing with people who know exactly how to use their insulin—and not just how to use it but how to manipulate it to affect their weight.
I want to talk about a constituent of mine, Emma, who I first met during my by-election campaign in 2013. Emma identified as a diabulimic. Diabulimia is a term created to represent diabetic bulimia. The condition occurs when insulin-dependent diabetics skip injection in order to lose weight. This type of disorder usually affects type 1 diabetics. Young diabetics who already have numerous issues to deal with can realise potential weight loss by skipping insulin. However, they often do not understand how they are damaging their bodies as a result.
Emma has been admitted to hospital on multiple occasions for diabetic ketoacidosis, or DKA. Her feeling was that, at the time, that perhaps should have sounded alarm bells and led to a deeper understanding of the condition that affected her.
After meeting Emma, and returning to Parliament following the by-election, I lodged a parliamentary question on the issue of diabulimia. I asked the Scottish Government what guidance it had issued to NHS boards in respect of the diagnosis and treatment of diabulimia. The reply from the Minister for Public Health, Michael Matheson, said:
“In 2006, guidance was issued to NHS boards on the management and treatment of eating disorders in Scotland. While diabulimia is not specifically included, we expect the principles and good practice around care and treatment of individuals will be applicable to this cohort of people.”—[Written Answers, 17 July 2013; S4W-16066.]
I would say to the minister that that may merit some examination.
I am aware, from the conversation that I had at the Diabetics with Eating Disorders stall, that there is now some progress on inclusion in the list of identified mental health conditions in DSM-V, the “Diagnostic and Statistical Manual of Mental Disorders”, but that chronic insulin deprivation, or failure to take insulin, has not yet been readily identified in its own right.
An issue was raised with me about the cohesion between physical and mental health. We often talk about the parity between physical and mental health, which is vital, but there must be an element of cohesion when it comes to diabetics with eating disorders. When the physical health of the individual is looked at but not necessarily the mental health, and vice versa, it means that, potentially, those dealing with diabetics with eating disorders are not treating the individual in a cohesive and holistic fashion.
I ask the minister to look at that issue and see whether there needs to be some update to the guidance or some further guidance in relation specifically to eating disorders as they affect diabetics. That would be very welcome, certainly for my constituent Emma and, I suspect, for other diabetics who are affected by eating disorders.
18:15
I join other members in congratulating Dennis Robertson on securing the debate. Members all know of his personal interest in these matters and I thank him for his personal testimony. I know that it must be very difficult for him to come to the chamber and provide us with that testimony.
Malcolm Chisholm described Dennis Robertson as “a brave voice” and I certainly concur. Dennis has campaigned assiduously on behalf of people with an eating disorder and, as Mark McDonald said, he has raised the issue in Parliament on a number of occasions. It is important that, as a legislature, we are seen to be debating the issue regularly, not least to raise our own awareness of the issue. Mark McDonald and Christian Allard pointed out how much better informed they and all of us have become because of the work that Dennis Robertson has done.
As we mark this year’s eating disorder awareness week, it is right that we recognise the efforts of all the people and organisations across the country that are working to raise awareness of eating disorders. I pay tribute to the dedication and continuing work of all the professionals, staff and volunteers across all sectors, and particularly to people who are living with an eating disorder and their carers and families in their efforts to tackle this serious and potentially life-threatening illness.
I have listened carefully to the range of comments and issues that have been raised and I will pick up a number of them. I can certainly reassure members of the Government’s commitment to ensuring that we are improving care, services and support for those who have an eating disorder.
Dennis Robertson raised the importance of treatment in the community. It is important to recognise that the vast majority of people with eating disorders are treated in the community, with support being provided by primary care or community mental health teams. All NHS boards keep arrangements and services under review and are working towards improved access and outcomes for service users and their families, based on prevention, appropriate intervention and sustained recovery.
Nanette Milne, who has left the chamber—she could not stay for the entire debate—raised a concern about people not accessing services. The national guidance on recommendations for the management and treatment of eating disorders was published in 2006. Mr McDonald referred to that guidance. It covers general principles, the role of the GP and primary care teams, specialist services, dietitian training and awareness raising for staff. We expect NHS boards and their partners to take account of that guidance and other relevant guidance in the management and organisation of eating disorder services across Scotland.
We are driving our improvement agenda forward through delivery of the national mental health and suicide prevention strategies. Those strategies combine to deliver a range of commitments that will impact positively on improving care, services and support for those with an eating disorder and their families. Malcolm Chisholm rightly emphasised that this is an important mental health issue, and the Scottish Government views it as such. As the first nation in the UK to introduce a target to ensure faster access to psychological therapies for all ages, we recognise the positive contribution that such therapies can make to treating mental illness and in particular eating disorders.
The target for NHS boards is that patients get a referral to treatment—to psychological therapies—within 18 weeks. The latest data shows that the average adjusted waiting time is eight weeks and that 81.4 per cent of people were seen within 18 weeks. Of course, we are working to ensure that that percentage is higher. That target complements our priority attention to improving the mental health of children and young people and the 18-week target for referral to specialist child and adolescent mental health services. The latest data shows that 78.9 per cent of people are seen within 18 weeks, which is not a high enough percentage, but we are moving in the right direction and we have an average waiting time of seven weeks.
I appreciate what the minister has said. With reference to the figures, can he advise us whether those who are presenting with eating disorders are being seen, and seen appropriately?
The minister referred to the 2006 guidance. Several young people have died, and I suggest that the implementation of that guidance is not universal.
We certainly expect any guidance that we issue to be taken seriously by all health boards throughout the country. We have prioritised the need to improve access to CAMHS, which I recognise is important for those with eating disorders. We have invested nearly £17 million in those services since 2009, and the workforce has increased by 24 per cent. The number of children and young people who have been seen by CAMHS has increased by 60 per cent in the past few years; I do not have the exact figures in front of me for those who were seen and who have an eating disorder.
I recognise that things are improving, but there are still difficulties in certain areas, including the area that NHS Grampian covers. I wrote to the chief executive of NHS Grampian today—I copied my correspondence to the minister—because I have some concerns that the board is failing to deal with matters appropriately. What does the minister intend to do in the areas that are not meeting the targets that have been set?
I received the correspondence, and I will respond to Mr Stewart in due course. I recognise that some areas are not performing as well as others and, before Mr Stewart wrote to me, I instructed my office today that I want to speak to all the chief executives of the boards that are presenting particular issues with access to CAMHS. I will discuss the issues with those chief executives as soon as possible.
There has been a dramatic increase in the numbers who are being seen by CAMHS, which is a good thing, as it is a sign that stigma is reducing and that more people are willing to come forward.
I see that I am running low on time, Presiding Officer, so I will comment on just a few other areas. I am pleased to see the recent formation of the Scottish child and adolescent mental health services eating disorder group to promote service development and training and to share innovative practice for children and young people with eating disorders throughout Scotland. We will seek to learn from that work and, where further improvements are found to be necessary, we will seek to act.
On the prevalence of diabetes diagnosis among those with an eating disorder, I hope to learn more about that when I attend the parliamentary reception after the debate. In November last year, the Government published a diabetes improvement plan that sets out a range of actions for people who are living with diabetes. It includes a focus on preventing complications, improving glycaemic control and—crucially—reducing disengagement from services and improving outcomes for disadvantaged and minority groups.
To pick up on Mark McDonald’s important point, I note that we funded the psychology and diabetes pilot project through the Scottish diabetes group. The project has now concluded, and we expect the lessons that have been learned from it to be shared appropriately among health boards. Work is on-going to consider how best to disseminate the learning outcomes from the pilot and, if it is appropriate to update our guidance accordingly, we will seek to do so.
I could say much more, but I am way over time, so I will not do so. Dennis Robertson made the point that things have got better, but we can always get better still and ensure that we do all that we can to support those with an eating disorder. I make the commitment to take forward that work through my ministerial office, and I thank Dennis Robertson again for bringing the debate to the chamber.
Meeting closed at 18:24.Previous
Decision Time