Chamber and committees

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

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

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

Thank you, Presiding Officer.

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

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

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

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

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

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

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

and

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

The review also said:

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

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

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

One in 10 UK armed forces personnel was seen by military healthcare services for a mental health related reason in 2020-21. Although that represents a fall in numbers from 2019-20, that might be attributable to a reduction in routine and training activity during lockdowns.

As “Veterans Mental Health and Wellbeing Action Plan” states, the Ministry of Defence reported 1,578 medical discharges across the UK in 2020. It is estimated that 34 per cent of those discharges were on mental health grounds. If that is taken as a proportion of the size of the veteran population in Scotland, that would equate to approximately 50 Scottish veterans per year declaring a mental health difficulty at the point of being discharged.

Veterans therefore need access to mental health support and treatment, just like the rest of us, although, as others have noted, stigma is a specific factor. We must also acknowledge that veterans are exposed to stressors and experiences that most of the general population do not face, and that any mental health support must be person centred.

As we have heard, the action plan is based on three key principles. It focuses on veterans having timely access to well-planned mental health and wellbeing services, no matter where they live. It is vital that those principles be adhered to, so that no one slips through the cracks and is unable to access the support that they need. Some of the issues that we see are similar to those that we have previously discussed for the general population, but some treatment will be specific to veterans. As a party, Greens would always advocate for peaceful resolution, rather than armed conflict. However, we recognise that person-centred care is important for those who have been involved in conflict to ensure that they can deal with their experiences.

As the motion notes, we must deliver holistic care that takes into account the entirety of an individual’s needs. That will include services such as housing and rehabilitation, where appropriate. That care should also take account of family situations, and of children in particular. It is hard not to refer to the situation in Ukraine while taking part in this debate. For those who have experienced armed conflict, the blanket coverage of the current war might be retraumatising. I encourage anyone who is experiencing deterioration in their mental health because of that to seek help.

I would also like us to consider how we can support the children of people who have been involved in war. I am sure we have all seen in the past few days children in the news who have been forced to flee Ukraine and who tell reporters that their fathers have stayed behind to fight. Information and pictures from war are much more available to young people than they were previously. I hope that we will be able to give the appropriate support to children of veterans and to anyone who comes to Scotland from a conflict zone. Where appropriate, that should be whole-family support.

There should also be an appropriate mix of treatment, including counselling and trauma support services, to provide support in the most appropriate format for individuals. As with health support for non-veterans, we must ensure that people are asked to explain their trauma or symptoms only as often as is necessary. Some current practices mean that people might have to repeat their story many times to various clinicians. It is important to ensure that we can share data effectively. Any veteran who is disabled as a result of their deployment should not have to repeat their story every time they need physical support. That should be the same for mental health support.

We must also consider unmet need. The action plan highlights many reasons why individuals might not declare difficulties on discharge, including issues of discrimination and stigma. Studies have shown that stigma is particularly problematic for people in the armed forces, where physical and psychological resilience in the face of adversity are promoted and valued.

PTSD can develop years after a traumatic experience. Delayed onset PTSD might make it difficult to determine the true extent of mental health problems among veterans. A study that was published last year by researchers from the University of Glasgow highlighted that

“The risk of suicide among UK military veterans remains unclear. Few recent studies have been undertaken, and most studies found no clear evidence of increased risk.“

It is clear that we need more research into, and a better understanding of, veterans’ mental health.

The action plan highlights many risk factors that can lead to veterans developing mental health problems, and rightly notes that LGBTQ veterans might be at greater risk of poor mental health due to the discrimination that they have historically faced in the armed forces. It also highlights older female veterans as a group who are at risk of suicide. It is vital that mental health services for veterans take the needs of at-risk groups into account and develop tailored support for people who might have experienced discrimination in the armed forces.

The action plan also notes:

“The intake of Black and Minority Ethnic service personnel increased by 110% between March 2019 and March 2020 in the UK. Mental health and wellbeing services should therefore be cognisant of this growing cultural diversity in the future design and development of services.”

As I said, we need person-centred services that seek to treat the individual and which do not view veterans as a homogeneous group of people with similar experiences. It is vital that that approach be supported by good data collection, not only on mental health outcomes for our armed forces personnel and veterans, but on the demographics of the armed forces.

I welcome the “Veterans Mental Health and Wellbeing Action Plan” and the Government’s commitment to support the mental health and wellbeing of veterans. Veterans have specific needs and need dedicated support that takes account of the unique stressors that they have faced. The action plan represents an important step towards delivering truly person-centred care for Scotland’s veterans.

We are two years into a pandemic, which will undoubtedly have an effect on the ability of countries around Ukraine to take people in. Moldova has thrown its doors open and is probably the country in Europe least able to afford to take people in. Will the cabinet secretary outline what humanitarian support the Scottish Government will be able to provide to Moldova and Ukraine itself?

To ask the Scottish Government how it will apply fair work and net zero criteria to the freeport developments with the United Kingdom Government. (S6O-00766)

Can the minister confirm that, if companies did not provide the living wage or recognise trade unions, for example, they would be ineligible for support?

At the beginning of the pandemic, dentists had to adapt quickly to new ways of working. They were forced to close during the early months of the pandemic and then drastically reduce the services that they could offer due to the risk of Covid transmission during aerosol-generating procedures. It has been an extremely challenging period for dentistry, and the huge backlog of care that has built up over the past two years means that it will remain challenging for some time. Dentists continue to operate considerably below pre-Covid levels due to infection prevention and control measures, which mean longer waiting times.

As we recover from Covid, it is right that people who are at higher risk be prioritised and that the frequency of dental appointments be based on clinical need. We need to trust dentists to make those assessments, because they are the experts. However, we currently have a system in which people who can afford to pay can access dental care more quickly. That inequality cannot continue; otherwise, as other members have said, a two-tier system will be established in Scotland.

Dentists have a vital role to play in the prevention and early detection of illnesses such as oral cancer. That is one of the best examples of how preventative healthcare can make a difference to lives, but it is undermined when patients cannot see dentists regularly. Figures that were published last month by Public Health Scotland revealed a sharp fall in the number of patients attending an NHS dentist, as well as a widening gap in attendance between the most and least deprived areas. In Scotland, we have lifetime registration, which the Greens fully support, but we need people to go to the dentist. The pandemic will certainly have discouraged some people who might be less likely to attend; others will have fallen out of the habit of going.

Oral health inequalities existed before the pandemic and the gaps continue to widen. The data show record gaps in participation rates. In 2008, the gap in the participation rates between the most and least deprived areas was only three percentage points, but, by September 2021, it had increased to 18 percentage points. Every effort must be made to re-engage people with services, particularly those who are most at risk of developing tooth decay or other health conditions, such as oral cancer. I am keen to hear from the cabinet secretary what strategies could be used to reach people who have fallen out of contact with dental services.

As I said, dentists have an important role to play in the detection of oral cancer. Since the early 1970s, oral cancer rates have been increasing, and the rate in Scotland is significantly higher than the UK average. According to the BDA Scotland, it remains unclear how the pandemic has impacted on that. Deprivation is a risk factor for oral cancer, which underlines the importance of improving participation rates in deprived areas. Given the difficulties with access to dentistry that have been caused by the pandemic, it is more important than ever that everyone is aware of the symptoms of oral cancer. Those include red or white patches on the lining of your mouth or tongue, ulcers that do not heal, or a lump in your neck. A person’s risk is also increased if they are a heavy smoker or drinker. I encourage anyone who has concerning symptoms to seek medical advice.

I will conclude with a few words on the future of dental charges. The Scottish Greens believe that dentistry, like other parts of the NHS, should be free at the point of need.

I am sorry, but I am in my last minute. I need to conclude.

Access to healthcare should never be dependent on someone’s ability to pay. We fully support the Government’s intention to remove all dental charges to patients by the end of this session of Parliament. However, for patients to feel the full benefit, issues with access must be addressed and the backlog of care must be worked through. That will be no small undertaking, and the dental profession must be supported.

The BDA Scotland has expressed concern about a lack of communication regarding the decision to extend free NHS dental care to 18 to 25-year-olds. I would be grateful to hear from the cabinet secretary about the Government’s plans to engage with the dental profession while we move towards the removal of dental charges entirely.

I will briefly pick up on something that Donald Macaskill said. For some care workers, there is a lot of recording of visits. It is often to support families in terms of knowing what has happened during visits, but it can be used to try to keep track of workers because of mistrust in them. How do we improve the culture for care workers in particular, as we go forward?

Audit Scotland highlights in its briefing that there is

“No individual social care record in the same way that each member of society has an NHS record.”

It says:

“This makes it difficult to assess whether social care is meeting people’s needs.”

What are your views on the introduction of a single social care record?