Meeting of the Parliament

Meeting date: Wednesday, February 27, 2019

Official Report 1029KB pdf

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Eating Disorders Awareness Week 2019

The next item of business is a members’ business debate on motion S5M-15889, in the name of Emma Harper, on eating disorders awareness week. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that Eating Disorders Awareness Week 2019 takes place from 25 February to 3 March; understands that approximately 1.25 million people in the UK have an eating disorder; acknowledges the importance of organisations such as the Scottish Eating Disorders Interest Group and Beat in providing vital support to professionals and families; notes the work that Diabetes Scotland and UK carry out to help young people with, or at risk of developing, diabulimia; commends the Children and Young People’s Mental Health Taskforce for its delivery plan, which sets out an ambitious programme of work that aims to inform the whole public sector about how to ensure that young people get the right care at the right time in the right place; thanks CAMHS staff, who will be instrumental in supporting new services and the continued expansion of services in the community, and welcomes the commitment by the Scottish Government, local authorities and interest groups to bring the real and decisive change in CAMHS that it considers people in Scotland want to see.

17:10  

Presiding Officer, 25 February through to 3 March marks eating disorders awareness week 2019. The theme this year is tackling discrimination and breaking down the stereotypes that are associated with eating disorders. I would like to start by thanking colleagues across the chamber who signed my motion, allowing us to have this important debate to raise awareness of eating disorders.

For many years, this debate was led by former MSP Dennis Robertson, who still champions this issue. I am happy to continue to bring it before the Scottish Parliament. I remind the chamber that Clare Haughey led the debate last year.

My motion states that there are approximately 1.25 million people across the United Kingdom who have an eating disorder. Last year in Scotland, 536 people were treated for an eating disorder.

I would like to acknowledge the charities that are instrumental in supporting many such people across Scotland and the rest of the UK: the Scottish Eating Disorders Interest Group and the charity Beat. I welcome members of Beat to the gallery, as well as those watching online today. Those groups provide vital support to families, professionals and people who are seeking advice, help and support in relation to the many challenges that are faced by people who are at risk of developing an eating disorder or who have been diagnosed with one. The information that they provide on the web is invaluable, and I encourage people to access the sites to see for themselves the information that is out there.

On Monday this week, Beat posted research that showed that stereotypes about who gets an eating disorder prevent members of the black, Asian and minority ethnic community, people from the lesbian, gay, bisexual and transgender plus community and people from less affluent backgrounds from seeking and getting medical treatment. I would like to focus my speech this evening on the need to tackle the stigma surrounding eating disorders; the Scottish Government’s announcement on Monday about improving the way we support and treat those presenting with eating disorders; and the need for continued research into, and support for, people living with diabulimia.

The definition of an eating disorder involves someone developing an unhealthy attitude towards food. That can take over their life and make them very ill. There are various forms of eating disorders, from anorexia, which involves people trying to keep their weight as low as possible by not eating and by overexercising, to bulimia, which involves people losing control and eating a lot of food in a very short amount of time and being deliberately sick. There are other eating disorders, such as binge eating, and there are non-specific eating disorders, too. The key symptoms of those disorders include excessively worrying about weight and body shape; avoiding social situations where food might be involved; frequently visiting the toilet after meals and perhaps returning looking a bit flushed; and not being up front about particular food that might be consumed. It is important for family members, friends and colleagues to be aware of those signs. Research has shown that there is a link between eating disorders and depression, low confidence and low self-esteem.

I would like to touch on the relationship between social media use and eating disorders in young people. Social media sites allow today’s youth the opportunity to connect with others on multiple platforms and in multiple venues. That is great, as it allows connections to be made, as well as the sharing of ideas, knowledge and information. However, as I am sure that everyone in the chamber is aware, social media can also be a dangerous platform for hate and discrimination. Because engaging in various forms of social media has become a routine activity for adolescents—and, indeed, adults—it is important to consider how it has impacted on young people who are at risk of developing eating disorders. Seeing dieting advertisements or frequently being exposed to images that might provoke body-image concerns can have a damaging and dangerous impact on young people, particularly those who are at risk of developing an eating disorder. Research has suggested that it may affect as many as 12 per cent of girls and it is increasingly recognised in males as well.

Does Emma Harper agree that there is a responsibility on celebrities not to promote products that are dangerous, particularly for women and young girls, and does she agree that the Advertising Standards Authority should look into that and restrict it?

Shona Robison has made a great point. I would encourage the Advertising Standards Authority to look into the matter and I agree that people who are personalities in the media have a responsibility not to promote certain products. I thank Shona Robison for that intervention.

Social media interactions are often an extension of an adolescent’s life, so it is important that we are aware of their online activity and the issues that children today may be facing online. I ask the Scottish Government to keep that in mind when overseeing the development of any proposed guidance.

I was pleased to see the announcement from the minister on Monday confirming that the Scottish Government will ask the Scottish intercollegiate guidelines network to introduce new guidelines to support the treatment and care of people living with eating disorders in Scotland. I was particularly pleased to see that those guidelines will focus on Scotland’s unique cultural and geographical make-up.

The guidelines will seek to improve services in our remote and rural communities, such as in Dumfries and Galloway in my South Scotland region, where people may experience greater difficulties in accessing specialist treatment. When my office contacted the dietetic team at NHS Dumfries and Galloway yesterday, it was confirmed that, because of the rurality of Dumfries and Galloway, some people who are at risk of developing an eating disorder may not be picked up as easily, or may be reluctant to access support because of the travel involved in attending appointments.

I highlighted that issue in my contribution to last year’s eating disorders debate, so I am pleased to see the Scottish Government take on board the asks that I raised on behalf of my constituents. Additionally, I am pleased to see that what the Scottish Government announced will not focus purely on young people but will look to better inform clinicians on best practice when dealing with adults presenting with eating disorders.

I would like to acknowledge Diabetes UK and Diabetes Scotland. I have carried out a great deal of work with them as co-chair of the diabetes cross-party group, from which I have become familiar with many of the issues presented, and I have sponsored parliamentary receptions. Diabetes UK and Diabetes Scotland have worked to raise awareness and understanding of diabulimia. That is a term that is used among the diabetes community and, although it has not been officially recognised by the international classification of diseases—ICD—index, it is a very real eating disorder.

Diabulimia refers to a person with type 1 diabetes who purposely reduces or omits their insulin dose to control their weight. Many years ago, when growing up with type 1 myself, I knew a young woman who died of the condition. I was aware from what people said that she had just stopped taking her insulin because she thought she was too heavy. Current research has shown that people with the condition have a much shorter lifespan. It can lead to severe diabetic ketoacidosis, which involves severely high blood glucose levels and can be fatal if not treated by medical professionals, so it requires an acute hospital admission. It can also cause complications of diabetes such as retinopathy, neuropathy and nephropathy.

Diabulimia is difficult to diagnose and extremely complex. People with the condition require mental health support as well as the physical medical needs associated with diabetes. Like any eating disorder, it is a mental health issue, so healthcare professionals and the family and friends of those with type 1 diabetes should be aware of the signs that could indicate diabulimia. Those can include weight loss or fluctuation in weight; regular symptoms of high blood glucose levels; secrecy over, or fear of, injections; reluctance to be weighed; lack of blood glucose monitoring, or a reluctance to monitor; and an encyclopaedic knowledge of nutritional composition of foods

I ask the Scottish Government what guidance and support it can provide for me to engage with the ICD to win support for the diagnosis of diabulimia as a stand-alone illness, as it is my understanding that the ICD is responsible for recognising conditions in Scotland.

I also commend the work of the children and young people’s mental health task force, which is chaired by Dr Dame Denise Coia and has created an ambitious plan to support the needs of children and young people in addressing challenges on diet, exercise and tackling eating disorders. The Scottish Government’s ambitious plan means that our young people will get the right treatment, in the right place, at the right time. I look forward to seeing further guidance being issued.

I conclude by welcoming the Scottish Government’s recent announcement of a package of measures to better support people with eating disorders and, in particular, to improve access to specialist services for people who live in our remote and rural areas. I reiterate my request that the Scottish Government support my engagement with the ICD to explore options for having diabulimia recognised as a stand-alone condition.

I look forward to hearing the contributions of other members.

We move to the open debate. I was going to say that speeches should be a maximum of four minutes, but I guess that members can have as long as they like. [Laughter.]

17:20  

Thank you, Presiding Officer. Let us all get comfortable.

I thank Emma Harper for bringing the debate to the chamber and for giving us the opportunity to draw attention to the serious and growing issue of eating disorders. I am in a fairly unique position in that I have three daughters, with the youngest and the eldest having been born roughly a decade apart. I am very aware of a concerning change in young people’s language on body self-awareness. My youngest daughter is coming up on 11, and hearing some of the conversations that she has with her friends worries me. Down at the running track, I heard one of her friends saying to her, “Do you think I am fat?” I was thinking that her friend looked like a stick insect. My daughter’s reply to her was, “Well, you are not as fat as me.” The use of such language is developing, which is a worry.

I first became aware of eating disorders when I was still a competing athlete and a female long-distance runner was diagnosed with anorexia. I could not get my head around that. When I was not training, I was eating. Even though I was not a long-distance athlete, I still had to cram 4,000 calories down my throat every day, which was quite difficult to do. I could not understand how someone could be an international athlete and not be conscious of the amount of calories that they needed to eat. As I understand it, eating disorders overtake people in that position and the athlete’s need to carry as little weight as possible around the track develops into a condition.

For me, the problem was brought closer to home when I began to suspect that a close family member had bulimia. The tell-tale signs—with which I am sure that members will be familiar—were there, such as splatterings of vomit in the toilet pan. Ill equipped as I was to deal with such a situation, I asked the person whether they needed to talk to me about anything. The response did not come quickly, but eventually they wrote a letter and handed it to me rather than speaking to me, which I found massively distressing. It turned out that they had done so because they had thought that I would be disappointed in them and that they had somehow let me down. The thought that they were not worthy of my help speaks to the mental health aspect of eating disorders, which the debate gives us the opportunity to examine. Fortunately, in that case the problem was caught quickly and we managed to solve it. However, it has always stuck with me that although the person had considered the issues that they had, they had been unable to bring them to me other than by handing me a letter.

While I have been a co-convener of the cross-party group on diabetes, I have become aware of the condition known as diabulimia. We need to talk about the practice of deliberately not keeping insulin at reasonable levels, given its potential outcome. We need to keep that in the public eye, not least to highlight the risks, because, as Emma Harper quite rightly stated, people can die from the condition.

I will conclude where I started. I stress again the importance of the language that is used by and around our children about body shape and the expectations that it throws up. We need to change the language and the conversation, because this is a growing issue. I thank Emma Harper again for bringing the debate to the chamber and giving us the opportunity to debate the subject.

17:25  

I thank my colleague Emma Harper for bringing this important debate to the chamber. I am pleased to be able to contribute to it.

Most of us will know someone who has suffered from an eating disorder and the heartache that it has caused them and their family and friends. The misery that is caused to the individual sufferer is immense, but the pain that is felt by family members must be overwhelming. We can imagine watching a loved one inflict such an amount of self-harm that their life is endangered while we have to look on, helpless. As Emma Harper said, a former MSP colleague, Dennis Robertson, knows only too well of that pain. Although I do not know Dennis, my thoughts are with him and his family.

Many decades ago, two of my school friends suffered from anorexia nervosa throughout their teens. I spoke of them when I took part in our debate on this subject last year. In that debate, we highlighted the immensely damaging culture that glorifies thinness, which results in body dissatisfaction, mainly affecting young girls, and has devastating effects. I echo Emma Harper’s comments about the influence of social media nowadays.

In 2017-18, 536 people across Scotland were treated for an eating disorder. Studies tell us that the rate of eating disorders in teenage girls may be as high as 12 per cent and that the rate of male eating disorders is increasing alarmingly.

What are eating disorders? The most common conditions are anorexia nervosa, bulimia and binge eating. Some 40 per cent of those who are affected by an eating disorder are bulimic. Eating disorders are more common in young women, but there has been a 76 per cent rise in the number of middle-aged women with eating disorders.

What can be done to reverse the trend and start making a difference? Research suggests that the earlier eating disorder treatment is sought, the better the sufferer’s chance of recovery will be. These disorders are rarely about food or thinness. Instead, these unhealthy behaviours are coping mechanisms for stress and overwhelming emotion, which is why early access to mental health services and appropriate treatment is crucial.

I am pleased that the Scottish Government has announced new guidelines for doctors to support the treatment and care of patients with eating disorders. The announcement marked the start of eating disorders awareness week 2019. The campaign is organised by the national eating disorders charity Beat, which does a marvellous job in highlighting awareness and reducing the stigma around eating disorders.

The member mentioned early intervention. What is her view on the length of time that patients wait for access to treatment?

I totally agree that it is not good enough and it has to be addressed. I hope that the new measures that the Government is bringing in will address that, because it is fundamental.

The theme for this year’s awareness week is tackling discrimination and breaking down the stereotypes associated with eating disorders.

The new guidance will focus on the unique cultural and geographical make-up of Scotland, which includes remote and rural parts of the country where there may not be access to specialist treatment. It will also give clinicians more advice on supporting patients with medical complications associated with disorders, and there will be a version of the guidance for patients and carers. The focus is on early intervention. Better access to services will be ensured as part of the Scottish Government’s 10-year mental health strategy, which is backed by investment of £150 million over the next five years. I sincerely hope that that makes the waiting times a lot shorter, because the current levels are not acceptable.

The guidelines aim to improve the care that people receive and improve services, provision and outcomes throughout Scotland. I hope that they will give sufferers and their families some comfort and hope.

17:29  

As Emma Harper’s co-convener on the cross-party group on mental health, I am grateful to her for securing today’s important and timely debate.

As we have heard, we are in the middle of eating disorders awareness week 2019, a campaign expertly organised by the charity Beat, which acts as a great opportunity for society to reflect on how we can better support those who live with an eating disorder. This year’s awareness week also sadly coincides with the heartbreaking anniversary of the death of Caroline Robertson, the daughter of my former MSP colleague Dennis Robertson, who is now a councillor. My thoughts throughout this week are with Dennis and his family, and I hope that they take comfort in the fact that MSPs across party divides are continuing his parliamentary campaign to improve mental health services, particularly for those living with eating disorders.

Eating disorders are more devastating and more common than people might be aware. Anorexia has the highest mortality rate of any psychiatric disorder, and Beat estimates that approximately 1.25 million people in the United Kingdom live with an eating disorder.

In 2017—the most recent full year with available published statistics—923 people across Scotland were diagnosed with an eating disorder. Of those, 214 were diagnosed in NHS Greater Glasgow and Clyde, the health board that serves my Glasgow Cathcart constituency, and over the past year I have been contacted by constituents living with anorexia nervosa.

There is a massive disparity between the estimated number of people living with an eating disorder and the number who come forward for help, which indicates the need to further tackle stigma and stereotype. Indeed, by their nature, eating disorders are secretive and stigmatised.

We know how hard it can be for people to ask for treatment, and that is even harder for a person if they do not meet the expectations of what a person with an eating disorder should look like. Stereotypes would have us believe that eating disorders are not serious illnesses, that they always take the same form and that only white middle-class women and girls suffer from them. Frankly, such stereotypes are dangerous: they discourage people from seeking help and make it less likely for employers and, in some cases, healthcare professionals, to take them as seriously as they should. It also makes eating disorders harder for the sufferer or a loved one to spot.

Eating disorders are serious mental illnesses that can have severe psychological, physical and social consequences, and they should never be downplayed as diets gone wrong or lifestyle choices. I therefore commend the work of the NHS, the Scottish Government and third sector organisations such as Beat and the Scottish Eating Disorders Interest Group, which are resolute in their commitment to eradicate stigma.

As members will be aware, I consistently make the case for this Parliament and the public to speak about and tackle female injustice, but I hope that on this occasion members will understand that I want to make an appeal to men and boys. I fully appreciate that eating disorders most commonly affect young women, but some studies suggested that up to a quarter of sufferers are male. I have recently seen for myself the concerns that some men have about their body shape; that is a particularly concerning issue in relation to young males.

The stigma around eating disorders, and male sufferers of them, means that we cannot say for certain how many men go undiagnosed. However, eating disorders among men are increasingly being recognised. What is certain is that males who are worried about themselves are not alone—many men share their experience. I ask them to please speak out and make sure that someone knows that they have those concerns.

I am delighted that, since last year’s debate, the Scottish Government has made real progress in improving the support available to people with eating disorders. There is specific support over and above the other steps taken to improve mental health services more generally. First, there is the peer-to-peer support service, which was relaunched yesterday after a trial period in NHS Lothian. Secondly, there was the announcement on Monday that new guidance will be produced by SIGN to give clinicians in Scotland more specific support for the treatment and care of patients with eating disorders. Those are positive steps that have been warmly welcomed by health professionals and eating disorder charities in the past few days.

I fully support the Government in driving the necessary changes to improve the support available to those with eating disorders. It will not be an easy task, but things are certainly improving. As Emma Harper said, the current Minister for Mental Health, Clare Haughey, led a debate on this subject last year, so she will be well aware of the challenges that lie ahead, and I am sure that she will meet them head on.

17:33  

I thank Emma Harper for lodging the motion for debate. I declare an interest, in that my daughter is an occupational therapist who works with people with eating disorders.

Members have spoken about the number of people in Scotland and the UK who suffer from eating disorders, and have said that they are people of all ages, genders and backgrounds—although we know that women and girls are disproportionately affected. They are people with serious mental health conditions that, in far too many cases, become fatal. Anorexia has one of the highest fatality rates of any mental illness.

The impact on individuals can be devastating, with the ripple effect on loved ones multiplying that impact several times. I cannot begin to imagine the pain of watching a daughter, son, partner or sibling dying because they do not want to eat or take in nutrition. Of course, many people develop such mental illness because of previous trauma in their life—abuse, violence, substance misuse, bullying, neglect or some other trauma.

I am taking part in the debate because constituents who suffer from serious eating disorders have come to me, but also because my daughter and a close friend work as specialist OTs in the field. Hearing from them about their work is very illuminating. They point to early intervention, which others have mentioned, as the key factor on the path to recovery, but eating disorders and other mental health conditions are subject to an 18-week treatment time guarantee. I have to say that by no stretch of the imagination is that early intervention. I genuinely hope that the minister will address that very serious and specific point in her speech. Can we imagine seeing a loved one in crisis and being told that they will not be seen for treatment for another four and a half months? There are no targets in place to support that work in the national health service.

The Government likes to point to England regularly for a wide range of comparators when it suits its argument. If we look at what is happening in England, we see that all people under 19 with an eating disorder should receive specialist treatment within four weeks and, in urgent cases, within one week. We can compare that to what is happening here and see a stark difference.

I clarify for Mr Findlay that all child and adolescent mental health services triage their referrals, so that when young people are referred in crisis, they can be seen the same day or the next day. Not everyone is put on an 18-week waiting list target.

The very important word that the minister used there is “can”. I am sure—this is not a party-political comment in any way—that the reality is that MSPs of all parties will have in their case loads constituents who have children with real mental health crises who cannot access therapy and treatment. That is the reality. We can all go back to the issue of waiting times and what should happen, but the reality is that many people are not getting access to treatment in a way that is anywhere near the description that the minister has just given.

People in our constituencies are waiting far too long for specialist treatment: they are people who are in desperate need. We should therefore be considering replicating the better standards that we see elsewhere for people of all ages.

I know from my previous training as a teacher that my education on mental health awareness and, most certainly, on eating disorders was almost non-existent, despite the fact that I was going to be working with children and adolescents. I would have thought that such training would have been much better in medicine courses, but research tells us that that is not the case, and that many medical students have zero, or very limited, training on eating disorders.

The reality is that access to mental health services in our communities is very inadequate. I have recently been dealing with a number of constituents who have acute mental health problems but are being told by NHS Lothian that there is a 10-month wait to see a psychologist—they are in crisis, but they are being told that they have a 10-month wait. When a person is in crisis, they need to see somebody today, tomorrow or, at the latest, this week. Their being told, “It doesn’t matter—we’ll see you in nine months,” helps no one.

We need more specialists working at community level. In relation to eating disorders, we need people working with patients one to one to help them to manage and cope with shopping, meal planning, cooking and eating a meal, and to help them to look at food in a healthy and positive way. We need people to help them to look at exercise positively rather than negatively, to help them to care for and love themselves as they are, and to help them to be comfortable with themselves, while also addressing the trauma that caused their problems in the first place.

I am pleased that we are having the debate. We hear—as we do in this type of debate—very good, supportive and consensual speeches for this one day in one week of the year, and then we will return next year to do exactly the same, while not a lot has changed on the ground in our communities. However, I hope that when we come back next year to the issue we can say, “You know what? The services that we provide to people with eating disorders are far better than they were when we had the debate last year.”

17:40  

I congratulate Emma Harper on securing this important debate, and I thank her and Clare Haughey for taking on the cause in the Scottish Parliament for our colleague and friend Dennis Robertson, the former MSP for Aberdeenshire West, who campaigned so hard to raise awareness of the illnesses that cause eating disorders.

I take issue a little with Neil Findlay, who said that things will always stay the same. When Dennis Robertson stood up in the chamber to call for things to get better, it happened. He was a staunch campaigner who made changes. I phoned Dennis last week to let him know that I would be speaking in the debate, and to talk about how he raised awareness and the importance of keeping the level of awareness high. As members know, Dennis and his wife Ann lost their daughter Caroline, who suffered from anorexia nervosa throughout her adolescence and into early adulthood. As James Dornan said, last week was the eighth anniversary of Caroline’s passing.

I pay tribute to all the work that Dennis Robertson has done to bring agencies and individuals together to work more collaboratively to support families and people who are affected by eating disorders. He was very clear in our phone conversation that the phrase “eating disorder” is not adequate, because the conditions are psychological illnesses. Eating disorders are not just about the person’s relationship with food: they are also about anxiety, and can often be an attempt by the sufferer to control one thing in their life, when they feel that other things are beyond their control.

Anorexia nervosa is a condition that often finds its victims when they are in puberty. Withdrawal from family life, irritability and secretiveness are part and parcel of the behaviour that parents accept as normal parts of adolescence, so early signs of anorexia can be hidden by that behaviour.

Many young women are victims of eating disorders, but young men are becoming increasingly susceptible, and are just as vulnerable to the body-image problems that the media exacerbates. As Emma Harper and other members said, the illness can be with a person throughout their entire life, so we should not just look at the services that are available to young people.

It is not normal for adolescents to withdraw from their social scene, to make excuses for not meeting friends, not to engage in activities that other people their age are enjoying, and to spend all their time alone. Those behaviours, coupled with obsessive behaviour around eating or over-exercising, or missing school for weeks on end, are not normal parts of teenage life. They could be indications that something serious is starting to take hold.

One of the biggest worries for parents who know that something is wrong is about knowing where to turn. In his speech in the debate in 2012, Dennis Robertson said something that relates directly to this year’s campaign against discrimination and stereotyping. He said:

“Our general practitioners and other medical professionals need to recognise that, when a young person goes to their surgery with their parents or a friend, their condition is not to be dismissed as a teenage fad.”—[Official Report, 22 February 2012; c 6463.]

Awareness of eating disorders among primary care health professionals and the teachers and educational support professionals who see those young people every day is absolutely vital.

Every time I stand up in the chamber to talk about mental health, I want to use the opportunity to direct the people who might be listening to the support that is available. What we say in such debates might be the signpost that someone needs in order to get help.

In that regard, many members have mentioned Beat, which has a fantastic website that is a great resource. It has lots of information on identifying the early signs of eating disorders, first-hand testimony from people who have been affected, and regionally tailored signposting. In my area in Grampian, there is a CAMHS eating disorder team, and eating disorders are a priority issue for a quick referral to CAMHS in the north-east. North East Eating Disorders Support Scotland—or NEEDS—has teams for people in recovery and their families. I will put links to all those organisations on Facebook when I post my speech later.

In relation to suicide prevention, I have been campaigning about the fact that search engines need to do more to remove content that promotes self-harm. Just as it is with pro-suicide sites, the internet is distressingly awash with pro-anorexia and pro-bulimia sites. There are websites that promote methods of extreme weight loss, that glamorise those diseases and which give excuses that people can use to hide their condition from people around them who love them. Support agencies should not have to pay for their sites to appear in search results above such pro-ana sites, as they are called. Just as I did in my campaigning with regard to pro-suicide sites, I will write to the major search engines to ask for their policies on pro-ana sites. The content is dangerous and it should be removed. If it is not removed, it should be way down the list in the search results.

I have run out of time, but I thank Emma Harper again for bringing forward the debate.

The last of the open debate contributions is from Alison Harris.

17:45  

Thank you, Presiding Officer. I , too, thank Emma Harper for bringing this debate to the Parliament today.

As my party’s spokesperson for children and young people, I welcome the motion’s focus on young people. Eating disorders can affect anyone and everyone and they are a growing problem that affects many people’s lives, especially those of young people.

There is a wide range of eating disorders—far more than just anorexia and bulimia, which are the two that I was most aware of when I was growing up. I will discuss that later.

Eating disorders affect many people in many different ways. I cannot stand here without mentioning the problem of weight gain and obesity and the daily struggles that people have with that. People truly struggle with their weight and eating—whether it is undereating or overeating. We need more research, perhaps into the effects of a person’s metabolism—I cannot say that word—on eating disorders.

Will the member take an intervention?

Are you going to correct her pronunciation?

Far be it from me to do so.

Does the member agree that it is perfectly possible to be overweight and malnourished at the same time and that we need to change the language? We need to stop talking about diet and start talking about nutrition.

The member makes a valid point and, although it seems strange to say that it is possible to be overweight and malnourished at the same time, he is correct that nutrition is very important.

Overall, it is about health and wellbeing. Encouraging balance and a healthy attitude to food from an early age can help to prevent the development of eating disorders.

The motion mentions the charity Beat, which aims to beat eating disorders. Its website provides useful information on what eating disorders are and the effects that they can have. It also offers tips on how to spot the signs of an eating disorder: from the easier-to-notice signs, such as an obsession with food or exercise, to the more subtle signals, such as someone’s distorted views on body size, problems in concentrating or frequent trips to the toilet after meals.

That reinforces the importance of moving away from old stereotypes. In the past, the term “eating disorder” would usually make people think of a teenage girl with anorexia or bulimia who was trying to be a certain body weight or shape. In fact, most people with eating disorders are not underweight. Rising levels of obesity, especially in young people, are also worrying, because if a person is overweight when they are young, they are more likely to have weight-related problems later in life.

As I said earlier, there are far more eating disorders than anorexia and bulimia; obsessive, emotional or binge eating can be hard to spot, but just as uncontrollable for the sufferer as the more well-known disorders.

It is important to move past old stereotypes, because eating disorders can affect anyone; a growing number of boys and men experience them. When I was growing up, people would say that magazines air-brushing people’s photographs affected our self-image. However, I have grave concerns with the way that the world in which we live—dominated by social media—now affects eating disorders. Back in the day, the moment was captured in a photograph and we moved on and did not find out how we looked until the photo was developed. Now, we double and triple-check photos on our phones, taking more and more until we get one that we like. I bet that everyone in the Parliament—including me—does that. I worry that it has a negative effect, especially on young children, because everything is now about how they look and how they will be perceived by their friends, instead of them focusing on having fun.

As Gillian Martin mentioned, at the more extreme end of social media the effects are so-called pro-ana and pro-mia groups. Those groups often consist of teenagers who congratulate each other on their anorexia or bulimia and create group rules around daily calorie intake, fasting challenges and compulsory weekly weigh-ins, often without their parents even knowing that the groups exist. That is truly frightening. Those young people often find comfort in finding people who are going through the same as them. However, without professional help, it can make matters far worse.

The motion focuses on young people, and a growing number of young people whose lives are affected by eating disorders need help. Help can take many forms, but I welcome the chance to mark eating disorders awareness week by supporting this motion in the hope of raising awareness and understanding.

Due to the length of some speeches, if we wish to hear from the minister, I am minded to accept a motion without notice, under rule 8.14.3, to extend the debate by up to 30 minutes. I ask Emma Harper to move the motion.

Motion moved,

That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Emma Harper]

Motion agreed to.

17:50  

I am sure that members will be relieved to hear that I promise not to speak for 30 minutes.

First, I acknowledge the Beat ambassadors who are in the public gallery as well as the work that the charity does during eating disorders awareness week and throughout the year.

I am pleased to respond to the debate on behalf of the Scottish Government. The debate has become an annual fixture to mark eating disorders awareness week, which is important on many levels. It shows that we are all taking eating disorders seriously and are committed to raising their profile across Scotland. I will pay tribute to the work of a few people in particular.

I thank my colleague Emma Harper for lodging the motion, and for continuing to focus minds on how important this subject is, including through her continued work to raise awareness of diabulimia. We know that diabetes is commonly a comorbid condition with eating disorders. That is an incredibly serious issue, which Emma Harper’s motion rightly reminds us of.

I also wish to honour our former colleague Dennis Robertson. I am sure that nobody in the chamber is a stranger to Dennis’s tragic experience of the devastating effects of eating disorders, which was one of the main drivers behind my decision to lodge the motion on eating disorders awareness week that we debated last year. As I said then, I want to reassure Dennis that there are many others who will continue to fight for the right help and support to be available across Scotland.

Last year’s debate focused on ensuring that everyone who needs help and support for an eating disorder receives it as soon as possible. We know that early diagnosis is vital in treating, and recovering from, any form of eating disorder. Eating disorders are acutely serious conditions, but it is possible for affected people to recover and to maintain healthy and productive lives.

The theme for this year’s awareness week is tackling discrimination and breaking down the stereotypes that are associated with eating disorders. Eating disorders do not discriminate and anyone can be affected by them. They are serious illnesses that can change lives. If one message comes out of today’s debate, it should be that one.

We also know that eating disorders are highly complex and can manifest in many different ways. There are multiple different classifications across the fifth edition of the diagnostic statistical manual—DSM-5—and ICD diagnostic criteria. As we have heard, those conditions are not always about weight loss. Binge eating disorder, for example, can be just as devastating as anorexia or bulimia, which is why it is critical that we have the right help and specialist services.

We will commission a needs assessment of CAMHS in-patient provision in Scotland. That will look at capacity in the in-patient system as well as community provision, patient flow through the system and issues such as delayed discharge, including the consideration of provision for patients with eating disorders.

Work is also taking place through the children and young people’s mental health task force, whose importance is alluded to in the motion. One of the task force’s strands of work is the consideration of specialist services that cover young people with serious mental health conditions who need help. That is a key part of the picture for eating disorders.

I also want to mention two announcements that the Scottish Government made to mark eating disorders awareness week 2019. I am pleased that we have been able to bring forward improvements that will make a real difference to people’s lives. Yesterday, we relaunched our digital peer support service, which was created in collaboration with NHS Lothian and Beat. The relaunch included the addition of a telephone coaching service for parents and carers. That project was initially launched last year, and those who took part found that type of support to be incredibly helpful. One young person said:

“the service allowed me to realise that my support buddy has felt the same way. She has battled through to become a much happier person. It gives me hope”.

That is proof of how incredibly important peer support can be for people with any type of mental illness.

We have committed to the project for a further three years because of that feedback. I want to ensure that those who are diagnosed with an eating disorder and their families are supported and given hope of recovery, whatever their circumstances.

Additionally, at the start of this week, I was pleased to announce the first ever Scotland-specific guidelines on the management and treatment of eating disorders, which will be produced by the Scottish intercollegiate guidelines network. SIGN will shortly begin work on those guidelines, which will be different from the DSM and ICD diagnostic classifications that I mentioned previously. They will provide practical and specific details on how to address common issues and will focus on the particular cultural and geographical need that exists in Scotland. We want to ensure that everyone is seen on the basis of clinical need, is prioritised accordingly and is seen by the most appropriate services. When the SIGN guidelines are published, we will have a Scotland-specific blueprint, and we will expect it to be carefully followed.

We have heard some very interesting contributions to the debate, including from Emma Harper, whose motion we are debating. I agree that the issue of social media is important in relation to mental wellbeing; we know that it is an issue for young people in particular because they have told us that. Alison Harris also raised that issue. We have committed to producing guidance, and I am happy to ensure that it covers eating disorders advice. Brian Whittle spoke about the pressures on young people and his own family experience of bulimia. Rona Mackay reminded us of her contribution last year. I remember very well her talking about friends whom she had lost through eating disorders. Neil Findlay spoke about his concern about early intervention and his constituents’ experiences of accessing services. James Dornan reminded us that men and boys are also affected by eating disorders, and Gillian Martin spoke about the importance of raising awareness of eating disorders and the signs and symptoms of them. Those were all very important contributions to a worthwhile debate.

Is the minister going to mention the point that I made about targets?

I think that Mr Findlay raised an issue about the target that has been set in England, which has not been met. We want to ensure that everyone is seen on the basis of clinical need, is prioritised accordingly and is seen by the most appropriate services. It is key that the SIGN guidelines are written by clinicians and that we have a Scotland-specific blueprint. The Government will expect that to be followed very carefully.

I and many others across the chamber feel strongly about the topic. The level of interest in today’s debate reflects that. It is up to us to ensure that eating disorders have the profile and public understanding that they deserve and that everyone who suffers with these most serious of conditions is able to get the help that they need.

Meeting closed at 17:58.