Eating Disorder Awareness Week 2014
The final item of business is a members’ business debate on motion S4M-08741, in the name of Dennis Robertson, on eating disorder awareness week. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes that 24 to 28 February 2014 marks Eating Disorder Awareness Week; recognises that, throughout the country, people and organisations will mark the week by raising awareness of the impact of eating disorders and the challenges faced by those who are affected by them; commemorates the third anniversary of Caroline Robertson’s death, and acknowledges the continued work by clinicians, government and people affected by eating disorders in the progress that is being made in the fight against this illness.
17:08
Presiding Officer, it was two years ago this week that I stood on this very spot and opened my first members’ business debate. It was emotional for me because it was when I was grieving the loss of my daughter, Caroline. That debate was about raising awareness of eating disorders. I come back to the chamber today to give members an update on where we are and where I hope we are going.
Yesterday was the third anniversary of Caroline’s death, but this debate, like the previous debate, is about leaving a legacy in Caroline’s name.
This week, many events will be held in the Parliament. This afternoon, I had the pleasure of sitting in with the child and adolescent mental health services teams from NHS Greater Glasgow and Clyde, NHS Lothian and NHS Grampian. Apart from the psychologists and specialist nurses, there were parents of people with eating disorders. Although the medical profession, the clinicians and the specialists are important, the parents and those with eating disorders are more important. I welcome many of the people who were there this afternoon to the public gallery this evening, along with many of the parliamentary staff, and I make special mention of my wife, Ann.
The pain never leaves you, although the period of grieving eases. Where are we now? During the first debate, I was raising awareness and hoped at that time that we would raise awareness among general practitioners, guidance teachers, school nurses and the medical profession in general. I believe that we have come a long way, as more GPs are now aware of eating disorders. They are more aware and can refer at an earlier stage, but the sad fact is that young people are still dying because the mental illness is such that, sometimes, the pathway to recovery just cannot be found.
In many ways, it is with a heavy heart that I stand here, but it is important that I do. It is important that MSPs such as me go into their constituencies and listen to the patients, parents and clinicians who are fighting the illness.
Just at the end of last year, we held the first conference of specialist school nurses and guidance teachers at Portlethen, just outside Aberdeen. The conference was organised by a headteacher called Neil Morrison who, at the time when Caroline died, was a depute principal at Westhill academy in my constituency. There was a young girl with an eating disorder in his school and he felt that we needed to do something. He felt that the awareness needs to be within the schools, so the conference was held and involved other people in the Grampian area, and it was a success. A conference on the same lines is now being held here, in Edinburgh. We are moving forward, and the pathway is not as difficult as it was back then.
I believe that awareness among the media has also shifted. I no longer hear the same sensationalist stories about people with eating disorders, although I still challenge the people at Channel 4 and their programme “Supersize vs Superskinny”, which I mentioned in my last debate. The programme demeans the problem with eating disorders, sensationalising it to a point, and I challenge them now, as I did then, to speak with me. They have not done so.
On Friday, we will have a conference here, in the Parliament. We will look at social media and at the fashion industry and how it impacts on people with eating disorders. Most important of all, we will have a debate with families and carers, who are the people who need to be listened to.
Presiding Officer, it is a difficult journey. It is a journey that I will have to continue, not just for this debate but for many years to come because I fear that many more young people will die. Many more young people will lose their lives to this dreadful illness. We must do what we can and that is not just about resources, but about networking and sharing good practice. This is a global problem, but here in Scotland we can take it forward. We can be leaders, and we should be.
17:15
I thank everybody who listened to Dennis Robertson’s speech. I offer him an apology: two years ago, I was not here, as I was not yet an MSP, but I watched his marvellous debate on eating disorders, much like many other people will be watching today online or on TV.
Dennis talked about a journey. Perhaps I can explain a little bit about the journey that he and his family have been on—it is a journey that, unfortunately, a lot of families are going through. Three years ago, when Caroline died, I was with Dennis, Ann and Fiona. I tried to give as much support as I could, although I did not always use the right words, I did not know about the issue and I did not always know what to say or do. It is for every one of us to put the issue before the Scottish Parliament and create more awareness about it. It is for every one of us to understand not only what the sufferers are going through, but what the families, guardians and siblings are going through. I take the opportunity to thank Dennis and Ann, who is here today, for having the strength to champion the issue. However, it is an issue that we should all champion.
Dennis talked about a meeting with Neil Morrison, the depute head of a local academy. I was at that meeting. Neil said something strange at the end of the meeting. He said, “Christian, I have been to a lot of meetings with you, but this is the first one where you haven’t said a word.” There is something very important in all this: Dennis is the right person to lead the debate because he has fantastic listening skills. I remember that meeting, when he listened to everyone, including the teachers and the parents. He knew all about the issues and how it affected them.
We need a lot more support for professionals but, more important, for parents, guardians and siblings. Families and friends—friends like me—need to have a lot more awareness. That awareness can come through the media but, unfortunately, that is sometimes too sensationalist, as Dennis pointed out. We must treat the matter as we would any other issue of such importance, in which a lot of people suffer and which some people, such as Caroline, unfortunately do not get through.
Last week, we passed the Children and Young People (Scotland) Bill, which talks about getting professionals not only from education but from the police and health all working together. We really need everybody to work together because the idea that families must go through such suffering with one of their children without having help is unbearable.
As Dennis said, it is a global problem, but we can do something here in the Parliament. My niece left a clinic in Paris last week under similar circumstances. She had an eating disorder and now she is self-harming. These issues are all bound together. We need the support of everyone to help families get through.
17:20
I thank Dennis Robertson for, and congratulate him on, bringing forward his motion, and I join other members in honouring the memory of his very dear daughter, Caroline. I would like to show my absolute support for his motion and to put on the record my admiration for his strength of character in tirelessly campaigning to improve the lives of so many others who suffer.
As parliamentarians, we can do our best to provide a framework for clinical and emotional support, but we must acknowledge the need to engage with others in campaigning and awareness raising. Before I mention some of what has been done, I want to touch on why it is necessary and to give up-to-date statistics on the task that confronts us.
Material published by the Royal College of Psychiatrists in Scotland cites studies that suggest a
“prevalence of eating disorders in teenage girls as high as 13%, with about 1% meeting criteria for anorexia nervosa”.
We know, too, that male eating disorders are increasingly being recognised. The conditions are seen throughout life,
“because of persistence, recurrence or new occurrence.”
Figures provided by the National Institute for Health and Care Excellence suggest that 1.6 million people in the United Kingdom are affected by an eating disorder, of which around 11 per cent are male.
What is encouraging is that eating disorders have now become a recognised mental health problem. As we learn more about how best to approach treatment and awareness raising, we start to hear stories of help and successful recovery. For example, I have seen figures that suggest that almost 50 per cent of people with anorexia nervosa or bulimia make a full recovery but, as Dennis Robertson reminded us, far too many people are still dying.
The Royal College of Psychiatrists in Scotland points out that anorexia and bulimia nervosa are not always exclusively a result of attempts to regulate appearance. In some cases, they may relate to deeply rooted trauma and other mental health issues. The college correctly points out that management of disorders
“depends on people being helped to tolerate difficult feelings without using dysfunctional strategies”.
Fundamentally, that comes down to giving individuals an opportunity to come forward and present confidentially, creating a relationship of trust and equipping them with the tools to adopt new coping strategies. Ideally, those strategies would include receiving help from friends and family, who require support and direction to cope with the pressure and distress that are often felt.
Later this week, I will chair a session at the all-day conference that Dennis Robertson mentioned. The conference will explore the challenges that individuals and their families face, and the session that I will chair will involve discussion of the issues that families and carers face in supporting those who suffer. That is extremely important, as the better equipped a family is to recognise and understand destructive behaviours, the more able it will be to offer support without experiencing as much of the fear and anxiety that are often experienced.
The conference will also address the role of new technologies, particularly social media, in eating disorders. It will, in part, analyse the impact of negative images on young people and the effect of media pressures, but I hope that it will also look at how new online technologies and apps can be used as a tool.
However, there is no substitute for face-to-face therapy and a supportive human relationship in the fight against eating disorders. That is why it is important to make sure that that is available at the point at which a patient presents to a GP, and I was pleased to hear Dennis Robertson say that GPs’ knowledge and awareness of the issue have increased markedly.
There are several excellent examples of services for people with eating disorders in Scotland, such as the managed clinical network for eating disorders that was set up at the end of 2005 to cover Grampian, Tayside, Highland, Orkney, Shetland and the Western Isles.
I see that my time has almost run out. I again congratulate Dennis Robertson on bringing the debate to the chamber. As he said at the beginning, two years have passed since he led a members’ business debate on the subject, and we are a little closer to gaining a better understanding of what is a complex and challenging mental health problem.
More important, we have been able to show our own support as a Parliament for the incredible work that is being done across the country and to put the full weight of our cross-party backing behind the people involved. We must speak out so that in future the thousands who suffer feel able to speak out as well.
17:25
In 2010, the United Kingdom Royal College of Psychiatrists said in what was at the time a very well covered public statement:
“Although biological and genetic factors play an important role in the development of these disorders, psychological and social factors are also significant.”
As Malcolm Chisholm pointed out, there are both dysfunctional strategies and contributing factors at work. The RCP called for public restraint in how the issues and eating disorders in general are portrayed in society, but as we have heard, more progress has been made in some areas than in others.
As a policymaker, I cannot change biology or genetics, but social factors might come within the ambit of what can be changed. When, almost 200 years ago, the poet Lord Byron starved himself out of 5 stones in weight, he triggered a moral panic as the ladies of the day went on a rice and vinegar diet to imitate him. Moving on two centuries, we have the Atkins diet, the Dukan diet, the South Beach diet, the 5:2 diet, the paleo diet, the cabbage soup diet, the apple cider vinegar diet, the acai berry diet, Slim Fast, WeightWatchers, fruitarianism and Beyoncé’s diet of maple syrup and cayenne powder. Some people are motivated by health considerations but, being what they are, most human beings are at least partly motivated by other reasons. A £2 billion industry has grown up to make people feel that they can look like what the £21 billion fashion industry repeatedly tells them they should look like.
Many people today are caught between the immovable object of how they are told they should look and the irresistible force of the relentless and seductive marketing of fast food. We should remember that the makers of Slim Fast are also the makers of Ben & Jerry’s ice cream.
Having been born into a chip-shop family, I accept that that industry in a small way put a roof over my head, clothes on my back and so much food on the table that I left school at the age of 18 clinically obese. UK figures are hard to find but, as far as the United States is concerned, in 2010 Yale academics estimated the sum of less-healthy food advertising at $4.2 billion per year. I am sure that even when scaled for size, that figure dwarfs by far the minister’s health promotion budget.
We all like to believe that the advertising, the magazines, the television shows, the body images and the presentation of what is normal do not get to us and that we alone can stand against that tide.
Mr Biagi might be aware of legislation in Israel that stipulates that models in the fashion industry cannot have a body mass index of below 18.5. Although that is still very low, at least the industry is subject to legislation. I am not suggesting that we go that far, but the fact is that steps are being taken in other countries.
You can take that time, Mr Biagi.
I saw that fact when I was researching the debate. It is not often that we look to Israel for examples, but in this case the example is a useful one that we might want to follow.
We like to think that we are different here, but we know that in politics as in everything else a certain look commands air time and column inches in a way that other looks might not. We have to factor into this subconscious chaos the fact that we live in a nation where 62 per cent of adults are overweight. We face a dual-effect dilemma. Taking a stand that is even slightly off-key can trigger counterproductive anxiety among the general overeaters, while giving those who take to the so-called pro-ana websites at the corners of the internet validation that they can whisper to each other. The human mind is a great tangled complexity.
To date, this has, I am sad to say, been a gendered problem—it affects more women than men to the tune of nine times—and that figure is consistent from country to country. There is also a crying need for more peer-reviewed research somewhere in the world into reports that there is a greater propensity to eating disorders among men who are gay or bisexual.
To look ahead, we cannot all be Naomi Wolf and attempt to tackle the beauty myth single-handedly, and no one has solved how to be passionately evangelistic about sensible moderation. Those two approaches seem to be almost contradictory. However, the explosion of eating disorders across the developed world has a human cost, which is paid in every life that is lost and every life that is ruined. They are illnesses that are real, terrible and life limiting, and we owe it to ourselves to look at all the factors that may cause them, and to take resolute action. Until a solution is found, let us raise awareness, reach out, and try to understand and help anyone around us whose life may be a silent daily battle with one of those conditions.
17:30
I, too, thank Dennis Robertson for once again bringing to the chamber the challenging and complex subject of eating disorders. I acknowledge his tragic personal experience and his on-going strenuous efforts to make things better for people who are still struggling to fight their personal battles with the conditions.
Last November, Dennis Robertson led a members’ business debate on one aspect of eating disorders: the presence in culture and fashion of an unrealistic image of size 10 models and mannequins. Marco Biagi referred to that. The knock-on effect of such images on vulnerable people—especially young girls—was highlighted. I hope that that subject will play a part in this year’s eating disorder awareness week and that other subjects will be looked at in it.
I would like to use the time that is available to me to focus on situations that occur in our schools, colleges and universities. The UK-wide programme of events that Beat has organised to promote further understanding of illnesses such as anorexia and bulimia is impressive. In particular, I welcome events that are taking place in our university towns, from Durham to Bournemouth, where students arrive in unfamiliar settings for the first time to face the challenges of student life. It is a difficult time for young people, as they adjust to being away from home and their parents, make new friends, meet students from other backgrounds, and deal with the pressures of their academic subjects.
A recent survey of 200 students with eating disorders found that 32 per cent of them were diagnosed after they started their courses, and almost a fifth said that their condition had forced them to drop out of university altogether. I fully acknowledge the important role that student support bodies play in reaching out to people on campuses who have eating disorders, but the same survey showed that a significant majority of those who were asked—nearly 70 per cent—said that they had struggled to access treatment while they were at university. It is clear that we need to do more.
On schools, I will not be the only member in the chamber who was shocked by reports in various newspapers on what The Times described as
“A silent epidemic of anorexia ... sweeping through”
Britain’s
“top independent schools, affecting thousands of teenage girls”.
The desire to achieve high grades and the competitive nature of highly academic girls schools are often celebrated and championed. I make absolutely no criticism of that, but they are also risk factors that contribute to eating disorders at such schools, as key experts such as Susan Ringwood of Beat have identified.
In independent schools, unlike in the state sector, there are no guidelines on provision of pastoral and psychological support for pupils. I recognise that many of those schools have a designated teacher who is responsible for pupils’ wellbeing, as well as having nurses and counsellors to deal with issues, such as anorexia, that affect teenage girls. However, it is quite clear that some girls—especially those who are away from home at boarding schools—feel more vulnerable and are at risk of turning to eating disorders as a response to the stresses that are associated with such institutions.
On a more positive note, I read with great admiration about Constance Barter, who is a student in Edinburgh. At the weekend, she had the courage to speak publicly about her battles with anorexia while she was at school. She described how her desire to succeed as a runner on the track led her down the road to an eating disorder and how, after the initial feeling that she was not given the emotional support that she required, her school, once it became aware of her illness, was “very helpful” and she had
“a really amazing time there”.
Sadly, Constance acknowledges that other girls with similar conditions did not recover. That is why we must have in place in all educational establishments the right tools to aid those who are afflicted by these terrifying and isolating illnesses.
I welcome the various events that are being held in Parliament this week and hope that the exposure that is generated will help people—especially teenage girls—to come forward and seek help to tackle the problem of eating disorders.
Once again, I thank Dennis Robertson for his enormous contribution.
17:35
I am proud to call Dennis Robertson my friend, and I am proud of the fact that he, his wife Ann and his daughter Fiona continue the campaign to have eating disorders recognised by many more people. I know that this is not easy for Dennis, but what he is doing is definitely providing a legacy for Caroline.
I am pleased that Parliament has rallied round and has allowed the conference and the events to take place here this week. Beyond that, I am pleased about the recognition that the Government has given to the campaign. However, one of the main things about this week is that it gives us all the opportunity to talk to folk who are in the front line on eating disorders, whether they are folks who have been affected by the disorders because they have suffered themselves, are family members of sufferers or are professionals. I think that if we do not learn something new every day, then we are probably failing. Over the past few days I have learned quite a number of new things about eating disorders.
I had the pleasure today to talk to Kathryn Kerr, who is a young ambassador for Beat, the beating eating disorders organisation. She is a very articulate girl who has suffered from an eating disorder herself. We had quite a long conversation, but one thing that struck me during it was that she said that we do not blame someone for having cancer, but we blame folk for suffering from eating disorders. Far too often in life we tend to look at folks with mental health difficulties and treat them so differently from folk who are suffering from physical ailments. Although we are getting better in our response as human beings to those things, I feel that we still have a long way to go.
The education that will be provided through the events that will be held in Parliament this week will help us to some degree to understand and will—I hope—make us crusaders against the folks who are prejudiced against people with mental health difficulties and eating disorders. Beat should be immensely proud of Kathryn and she should be immensely proud of how she articulated her thoughts today. I understand that she has been speaking in schools, which will be of great benefit.
Dennis has told me that we have a greater incidence of eating disorders here in the UK than exists in the rest of Europe, which is extremely concerning. Members have already pointed out the media’s fixation with body image. I think that some people need to reflect on what they are publishing in their magazines and broadcasting on their radio shows or television programmes. If we do not fix some of those issues, we will continue to have this problem.
I thank Dennis Robertson for giving us the opportunity to highlight the issues again today. I pay my regards to his wife, Ann, and his daughter, Fiona, who I know are great rocks for him. I thank Dennis’s staff as well, who have done a huge amount in setting up events here this week. I thank especially the people who are here this week and who are able to articulate their stories so that we can all learn a little more.
17:40
Like others, I offer Dennis Robertson my congratulations on securing time for this debate. It is the third such debate that he has brought to the chamber, and I had the responsibility of responding to the previous debates as well. One thing that always strikes me about the debates that he brings to the chamber on this important issue is his level of personal insight, which no other member is able to offer. Given his drive to do something in memory of his daughter Caroline, I am sure that no member is in any doubt about the work that he has undertaken over the past three years. He has done a tremendous amount in memory of his daughter and he continues to undertake a whole range of work in order to build on her memory.
I thank the minister for his kind words, but I pay tribute to him, because he has been listening and he has been supportive, both of many of the events that are taking place this week and in relation to many of the challenges that we have faced over the past couple of years. I put on the record my thanks for the support that he has given on this issue.
I thank the member for his intervention. It has certainly been my intention to offer what support I can and to do as much as I can in taking this agenda forward in Scotland.
In my engagement over the past three years with Dennis Robertson and others in the sector, I have been struck not only by the focus on improving the way in which services are delivered and taking further action to raise greater awareness, but by the focus on helping to provide greater support to families and individuals.
Back in 2012, I was honoured to attend, with Dennis Robertson and his family and many others, the first Scottish memorial service, at St Giles in Edinburgh, to remember all those who have lost their lives through eating disorders. I am sure that all members recognise that a tremendous amount of effort is being made by a range of individuals and organisations across the country to raise greater awareness of eating disorders. I take this opportunity to pay tribute on the record to their dedication and the continued work that they undertake—the professionals, the staff and the volunteers across all sectors, and particularly those people with eating disorders and their carers and families, who have undertaken a tremendous amount of work to raise greater awareness of the issue and support families as well.
I am sure that all members will be particularly pleased about the range of activities that are taking place this week as part of eating disorder awareness week. Several members mentioned the conference on Friday, at which I will be speaking, and a range of other events are taking place. I know that some members will be joining us at Edinburgh castle later tonight at the First Minister’s reception to recognise eating disorder awareness week.
I listened carefully to members’ comments and the issues that they raised in the debate, and I want to take this opportunity to provide members with some insight into the work that we are taking forward as a Government to tackle eating disorders and further improve care and support services. In its briefing in advance of this evening’s debate, the Royal College of Psychiatrists in Scotland acknowledges that, although more needs to be done,
“Scotland has seen striking improvements in the provision of specialist eating disorders services over the past decade”.
The range of community and specialist in-patient services that are now in place across the country clearly demonstrates that. Malcolm Chisholm referred to the managed clinical network in the north of Scotland. We have the specialist eating disorder unit at the Royal Cornhill hospital in Aberdeen, and we now also have the unit at St John’s hospital in Livingston to serve the east of Scotland, which I had the pleasure of opening a couple of years ago.
Our improvement agenda is also driven by work to improve mental health services across the country. That is being taken forward as part of our mental health strategy, which takes us up to 2015, and our recently published suicide prevention strategy. The mental health strategy will deliver a range of commitments that will have a positive impact on improving care services and support for those with an eating disorder and their families.
For example, one aim is to deliver faster access to psychological therapies, which we know contribute significantly to treating mental illness such as an eating disorder. Early data shows that, even before the deadline of December 2014 that we have set for ensuring that no one waits longer than 18 weeks to access psychological therapies, 83 per cent of patients had begun treatment within 18 weeks by the end of September last year, and the average wait was eight weeks. The figures are encouraging and are the result of significant work that colleagues are undertaking across the national health service.
Dennis Robertson referred to the need to improve access to child and adolescent mental health services. For several years, we have put significant additional investment into improving those services, in order to speed up access to them. Significant improvement has occurred in the past couple of years and the targets have been achieved across all our NHS boards.
Alongside that, we are working on how we can improve our response to people in distress in our community, for example, which includes those with an eating disorder who might present to our services in distress. We must respond to those people much more effectively and give them more comprehensive support than we do at present.
We have made progress. Dennis Robertson has been a major driver for much of that progress in recent years. The Scottish Government remains committed to continuing to tackle all the issues that relate to eating disorders. I have no doubt that all members in the Parliament will support Dennis Robertson in taking the work forward.
I thank all members for taking part in the debate.
Meeting closed at 17:47.