Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, March 2, 2021

Official Report 930KB pdf

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Eating Disorder Awareness Week 2021

The final item of business is a members’ business debate on motion S5M-24181, in the name of Rona Mackay, on eating disorder awareness week 2021. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that 1 to 7 March 2021 is Eating Disorder Awareness Week; understands that more people lose their lives from eating disorders than any other psychiatric condition; recognises that people and organisations throughout Scotland and across the world, will mark the week by raising awareness and understanding of the issue; believes that the vast majority of people with these conditions are treated in the community; welcomes, therefore, the announcement of £120 million for a mental health recovery and renewal fund, with a focus on additional support for mental health in primary care settings and enhanced community support; notes the publication of the Mental Welfare Commission for Scotland’s report into the care, treatment and support for people with an eating disorder, which forms the foundation of a review of services; believes that this review will be a crucial first step in a programme of work to improve these services, and guided by the review’s findings, looks forward to work in the next parliamentary session to improve support for people living with an eating disorder.

17:33  

I am very pleased to be leading the debate on eating disorders during eating disorders awareness week, and I thank members from all parties for supporting my motion. We debate the topic annually in the Parliament, because we must promote awareness and provide an update on the steps that we are taking to tackle the devastation that these conditions cause. I pay tribute to Emma Harper, who has led this debate in the past few years, and I look forward to hearing her speech tonight.

During the pandemic, much attention has—rightly—been placed on issues involving mental health. We are all experiencing anxiety and stress like never before, which manifests in many different ways.

The organisation Beat is an expert body that is renowned for its research on, and campaigning for awareness and recognition of, eating disorders. I urge everyone to visit its website, as it offers a wealth of information that is impossible to relay fully in a short debate such as this. Beat tells us that, in a survey of people with an eating disorder that was conducted during the first lockdown, nine out of 10 respondents said that their symptoms had got worse as a result of the pandemic. One young woman said:

“I was doing well but I just know this is going to lead to a relapse and I’m terrified.”

Referrals for children and young people to eating disorders services in Scotland were rising significantly before the pandemic. Now they are rising even faster. Child and adolescent mental health services are reporting unprecedented referral rates. Demand from Scotland to access Beat’s support services was 283 per cent higher in 2020 than in 2019. Let that sink in for a moment. Clinicians across the country are reporting that far more patients are presenting at a stage where they are already severely ill or in crisis.

Eating disorders are serious mental illnesses. Around 1.25 million people in the United Kingdom suffer from one, and they affect people of any age, gender, ethnicity or background. They have major impacts on individuals, the national health service, social care and, of course, families.

I want to mention former MSP Dennis Robertson and his family. The 10th anniversary of the passing of Dennis’s daughter Caroline from an eating disorder was on 25 February. I do not know Dennis, but colleagues have told me of his courage and dignity as his family went through one of the worst experiences most of us could ever imagine.

Dennis Robertson held a members’ business debate in every year of the previous parliamentary session. He also held two conferences on eating disorders in Parliament, bringing together families, clinicians and policy makers for the first time. I think that we all know that Caroline would be very proud of him. The thoughts of the Parliament and those beyond it are with Dennis and his family.

The theme of this year’s campaign is binge eating. The disorder affects one in 50 of us in our lifetimes, making it the most common, but perhaps the least understood, eating disorder. People with a binge eating disorder regularly feel out of control when they eat and feel distressed afterwards. It is not about being greedy or lacking in willpower; it is, in fact, a serious mental illness. It can affect anyone of any age, gender, ethnicity or background. In 2020, 30 per cent of contacts from Scotland’s Beat helpline were about binge eating disorder.

People with the disorder experience significant shame and often suffer alone without seeking help due to the fear of how others might react. That is a prime example of how, if we are to achieve our vision to end the pain and suffering of eating disorders, we need to change the conversation about binge eating. We must challenge harmful stereotypes about the disorder, so that people living with this serious mental illness can find kindness and compassion when they bravely reach out for help.

Eating disorders can be fatal and can cause serious physical health problems. The overall quality of life of people suffering the condition is estimated to be as low as in symptomatic coronary heart disease or severe depression. Without early intervention—which is crucial—many people become unable to participate in education or employment. However, recovery is possible. Access to the right treatment and support is life changing, and early intervention provides the best chance for recovery.

I welcome the announcement of £120 million for a mental health recovery and renewal fund, and the publication of the Mental Welfare Commission for Scotland’s report on the care, treatment and support for people with an eating disorder, which forms the foundation of a review of services. It has never been more needed. Currently, those who are able to access treatment experience an average three-and-a-half-year gap between the onset of an eating disorder and start of treatment, due to delays in identification, referral and waiting times. Surely that is wrong.

The provision of treatment for binge eating disorder is patchy in Scotland. Only five health boards provide specific treatment for under-18-year-olds with the condition, and 11 health boards provide specific treatment for adults with binge eating disorder, much of which is offered through weight management services. The Scottish Government and NHS Scotland health boards should ensure that there is equitable access to evidence-based treatment for binge eating disorder, and I believe that that should be a core part of implementing the review of Scottish eating disorder services from 2021 onwards.

Only two health boards in Scotland have specialist CAMHS eating disorder services, and eating disorder services for children and adolescents sit in generic CAMHS units for the other health boards. Some 10 health boards reported having specialist adult eating disorder services, and one health board has specialist eating disorder services across all ages.

Research has shown that, in many cases, intensive day-patient and intensive home-based treatments can be as effective as in-patient admission, and they are generally more acceptable to patients and their families. Despite those advantages, a freedom of information request by Beat found that three of the 11 mainland health boards in Scotland do not provide suitably intensive day or home-based treatment for patients of any age. That must be addressed urgently.

As we see light at the end of the tunnel and begin to see recovery from the Covid-19 pandemic, I would like sufferers of an eating disorder, and their families, to have the same optimism that eating disorders will get attention, resources and treatment pathways that are in line with those that all other serious illnesses get. For everyone suffering now, and for those who have suffered in the past, that is the very least that we can do.

I look forward to hearing other members’ contributions and the minister summing up tonight.

17:40  

I congratulate my colleague Rona Mackay on securing debating time on this important matter. In early March 2008, I led a debate on eating disorders and the devastating impact that they have on the 100,000 people in Scotland who it is estimated suffer from these illnesses—many in secret, undoubtedly. Today’s debate presents us with an ideal opportunity to recognise the efforts of the people and organisations across Scotland who work hard to raise awareness and treat eating disorders effectively. I also want to look at the progress that has been made over the past 13 years.

In 2008, I highlighted how Scotland trailed the rest of the western world in the treatment of eating disorders. I noted that we had no specific advice for general practitioners, and only two private clinics in Edinburgh and Glasgow provided specialist care, at a cost of around £3,000 per patient per week.

I am, therefore, heartened that, in 2009, the first specialist adult national health service in-patient unit opened in Aberdeen, with a second one opening in West Lothian four years later, while some specialist adult eating disorder NHS beds were also made available in Glasgow.

A number of services have been developed to provide alternatives to hospital admission or to provide shorter admissions, where possible, such as the anorexia nervosa intensive treatment teams in Lothian and Fife, the day programme in Aberdeen, a specialist team in Glasgow and the connect-eating disorders service, which cares for all children and young people with eating disorders in the NHS Glasgow and Clyde area.

People under the age of 18 with eating disorders continue to be treated in general child and adolescent mental health care services, where clinician expertise and patient outcomes have been improved by the introduction of evidence-based family therapies.

That is all significant and important progress, not least because experts remind us that it is possible for all patients to make a full recovery from eating disorders. However, there is not one specific cure, and it is important that a diverse range of services is available to patients. As Rona Mackay has just explained, the services can be patchy across the country.

Unfortunately, that is also the case when it comes to treating binge eating disorders, which are the theme of this week’s awareness week. Beat, an eating disorder charity, found that provision of treatment for binge eating disorders is still patchy in Scotland, and only five health boards provide specific treatment for under-18s with binge eating disorder. I am hopeful that the record £12 million of funding for the mental health recovery and renewal fund that was announced by the minister will help to ensure that there is more equitable access to evidence-based treatment for binge eating disorders. That would also be a core focus of the implantation of the Scottish eating disorder service review, which is designed to assess and improve support for people who are living with an eating disorder and will be informed by the Mental Health Commission’s first ever themed report on eating disorder services.

Among other things, the commission’s report still sees opportunities to improve GP training and implement new and improved protocols to follow and monitor. For example, only one third of GPs who responded to the commission’s questions said that they were aware of integrated core pathways for services that look after people with eating disorders in their area.

It is now more important than ever to have a full picture of the current system of support that is available for people with an eating disorder. The negative impact of the pandemic is evident through the scale of demand for many charities’ services, including those that are provided by Beat, demand for which was 278 per cent higher in 2020 than in 2019.

We have come a long way since the 1990s, when there were no official in-patient or specialist services for people with eating disorders, and we have also made some significant progress on eating disorders over the past 13 years. However, the challenge that we face, exacerbated by the pandemic, is huge, not least with regard to preventing eating disorders from arising in the first place.

We must ensure that resources that have been made available by the Scottish Government for mental health will further improve services for people with eating disorders and support early intervention and community services. I look forward to hearing the minister’s response to this debate in that regard.

Again, I thank Rona Mackay for bringing the debate to the chamber.

17:44  

I add my congratulations to Rona Mackay on bringing this debate to the chamber. It is a subject that is being revisited, but it is always well worth the attention that it receives.

The last time that I spoke on this topic, I mentioned that eating disorders are far more common than most of us recognise. I doubt that many people in the chamber do not know someone who suffers from an eating disorder. However, I was interested to hear Rona Mackay say that it is a disorder that is not well understood. That got me thinking back to my journey of understanding with regard to where eating disorders come from. With that in mind, I will mention a name that the older ones in the chamber—by that, obviously, I mean Kenny Gibson—might remember: Lena Zavaroni, who won “Opportunity Knocks” with her fantastic, big voice. She is the first person in connection with whom I heard the word “anorexia” and, of course, she ended up dying from that condition.

The next time that I heard of it was during my athletics career, when the word was attached to a female distance runner. I could never quite understand how someone could suffer from not eating enough and be an international-class distance runner. I remember some of the language the coaches used to use back then. I heard one coach quite vehemently say to one of his athletes that they should go away and not come back until they had lost weight because they had “a fat backside”. When I took my coaching exams, one of the things that were brought to the fore in the senior exam was the responsibilities of a coach in terms of the language that they use when discussing such issues with athletes.

Parents also have those responsibilities with regard to the language that they use with their children. One of the challenges that people face at the moment is an unrealistic expectation of the shape that they are supposed to be, because of what they see in the general media and on social media. I have three daughters, 10 years apart, and I can see the evolution of that debate. I think that the situation is quite dangerous.

It is all very well to consider the issue when it is far away and concerns other people but, when it comes into our own families, it is extraordinarily distressing. I discovered that someone close to me, in my family, suffered from bulimia, which is, obviously, an overeating disorder. They had been driven towards bulimia by the societal pressure on them to conform to a particular shape.

I think that, as Rona Mackay indicates, eating disorders are a symptom of something else. As she said, eating disorders are not well understood, because they still have a serious stigma attached to them, which means that they tend to be hidden conditions.

Eating disorders are a mental health issue. As Rona Mackay said, we are starting to get our heads around that. I saw a report that said that eating disorders had grown enormously during the period of the pandemic, and that doctors are treating eating disorders at a much higher rate now. When we come out the other side of Covid, we are going to have to be cognisant of the mental health services that are available, both the statutory services and the third sector organisations, which I have spoken about before.

We must recognise that society’s expectations of what we need to look like is putting unrealistic pressure on our youngsters. That must be addressed.

Again, I thank Rona Mackay for bringing the debate to the chamber.

17:49  

As co-convener of the cross-party group on mental health, I welcome the opportunity to speak in this debate on eating disorder awareness week, with the theme of creating a future in which people experiencing a binge-eating disorder are met with understanding and compassion.

I welcome the attendance of representatives from Beat who have attended many of the recent mental health cross-party group meetings and contributed to our discussions. I congratulate my friend and colleague Rona Mackay on securing this debate—I have had the opportunity to lead similar debates in previous years—and I associate myself with her comments on Dennis Robertson, his work on eating disorders and the 10th anniversary, this year, of the loss of his daughter Caroline.

Between 1.25 million and 3.4 million people in the United Kingdom are living with an eating disorder of some type, and the numbers are increasing, partly as a result of the Covid-19 pandemic. The restrictions have presented challenges for the delivery of treatment and services for people who are at risk, and the pandemic has caused additional stress.

Eating disorders vary from anorexia to bulimia and another, very dangerous disorder, diabulimia, which occurs when people with type 1 diabetes deliberately omit to take their insulin to control their weight. I congratulate Diabetes Scotland on its work on diabulimia and encourage anyone who is interested to have a look at the organisation’s advice and support. I remind members that I have type 1 diabetes.

The theme of today’s debate is binge eating, which is one of the eating disorders that are largely associated with stigma. Binge eating episodes can involve someone eating much faster than normal, eating until they feel uncomfortably full, eating a large amount of food when they are not hungry and eating alone, through embarrassment.

Research from universities, including the University of the West of Scotland in my South Scotland region, continues to point to the relationship between social media and eating disorders, particularly among young people. Social media is great and can enable people to make worldwide connections and share ideas, knowledge and information, but it can also be a dangerous platform for hate, discrimination and shaming. Dieting ads and frequent exposure to images that might provoke body concerns can be damaging and dangerous for some young people. Ads and posts can lead to the development of eating disorders in some young people and can put others at risk.

Social media interactions are often an extension of an adolescent’s life, so awareness of online safety and the issues that young people face online is important for families and friends.

I ask the Scottish Government to keep that in mind when it oversees the development of the proposed guidance on eating disorders. Last year, the Scottish Government announced that eating disorder services will be subject to a national review, which is designed to assess and improve the support that is available to people who live with an eating disorder. The review is to publish its findings in spring this year and aims to provide a full picture of the support that is currently available. It will make several recommendations to inform improvement work throughout the year. I ask that consideration be given to eating disorder support in rural Scotland and to tackling social media issues.

This week, I learned that the dietetic team in NHS Dumfries and Galloway has been working with people who are at risk of developing diabulimia, among other eating disorders. I was interested to hear that D and G is able to raise awareness in relation to young people who might not be picked up or who might be reluctant to access support because of the travel to appointments that is involved because of the area’s rurality. I am passionate about ensuring that there are support services in rural Scotland, given my rural South Scotland region.

I welcome the debate and again congratulate Rona Mackay on bringing it to the Parliament.

17:53  

I am pleased to respond on behalf of the Scottish Government. I believe that this is the fourth eating disorder awareness week debate in which I have spoken, either as a back bencher or as Minister for Mental Health, and I welcome this debate to mark eating disorder awareness week 2021.

The debate allows us to raise awareness of eating disorders and their terrible impact not just on those who are diagnosed but on their families and friends. I thank Rona Mackay for lodging the motion this year and for focusing our minds on how significant the subject is. It is now more important than ever that people who require help and support for disordered eating can receive the treatment that they need. The pandemic has not been easy on any of us, but there is growing evidence that people with eating disorders have been particularly impacted.

Like other members, I pay tribute to our former colleague Dennis Robertson. Dennis has continued to ensure that greater awareness is brought to eating disorders. I assure him that raising the profile of eating disorders is a priority for this Government.

Finally, I extend my thanks to all those across the country who work day in and day out to support the recovery of those with an eating disorder and their families. That is now more important than ever, as we recover from the impact that the pandemic has had on our services and also on us as individuals.

This year’s theme is binge eating disorder. Binge eating disorder is the most common eating disorder, but perhaps the least understood. It is a disorder that has unhelpful and damaging misconceptions attached to it. We must challenge those misconceptions so that those who live with the illness can have the confidence to seek the help and support that they need.

We know that the Covid-19 pandemic has had a substantial impact on the mental health of the population. We have been through several stages of lockdown, restrictions and recovery. Each of those phases has had widespread impacts on people across the country, including those with diagnosed and undiagnosed eating disorders.

We know that eating disorders thrive in isolation, and that the earlier that someone can access treatment, the better their chance of a full recovery. During the pandemic, there has been a focus on physical activity to stay healthy. It is important to recognise that such messages, however well intentioned, can often cause serious harm to those suffering with an eating disorder.

That is why, during the early stages of the pandemic, we provided Beat, the UK’s eating disorder charity, with funding to ensure that its online and telephone services could support as many people as possible during this difficult time. In addition to those services, it provided support through a new moderated online group called the sanctuary, which focuses on supporting sufferers with concerns relating to their eating disorder and Covid-19. With that funding, Beat supported more than 4,000 people between April and November.

Furthermore, we provided funding to deliver additional capacity to NHS Lothian and Beat’s national peer support services for young people with an eating disorder and their parents and carers. Through that funding, 150 young people were paired for peer support, resulting in more than 2,300 emails being exchanged between them. Forty-eight carers were paired, resulting in more than 600 phone calls.

That type of support can be incredibly helpful for those who are impacted by an eating disorder. Knowing that someone else feels the same way, and that recovery is possible, can be a lifeline. Digital and non-face-to-face methods of support have also become even more important in the past year, allowing us to stay connected and supported, while staying safe.

Last year, during eating disorder awareness week, I announced that we would take forward a national review of eating disorder services that would build on the work of the Mental Welfare Commission’s report. The review began its work last year and will provide its final report and recommendations to me at the end of this month. The review is an important first step in a phased programme of work to improve the outcomes of people who are living with an eating disorder in Scotland. As I announced earlier today, the review’s recommendations will be taken forward in phase 2 of this vital work by an implementation group, which will be made up of relevant stakeholders, including those who are experts by experience.

As mentioned in our mental health transition and recovery plan, which was published in October last year, the review has taken into account the effects of the pandemic on access to help and support. It will provide us with a specific recommendation on what support is required as we move towards recovery.

Members will be aware that we recently announced £120 million for our mental health recovery and renewal fund, which will prioritise our on-going work to improve specialist CAMHS services, address long waiting times and clear waiting list backlogs. The funding will also provide significant additional support for mental health in primary care settings, and we will also invest in enhanced community support.

I reassure members of the Parliament, and members of the public who might be watching, that providing the right support for those with an eating disorder is a priority for this Government.

Members might recall that two years ago, I announced the production of new Scotland-specific guidelines on the management and treatment of eating disorders. The Scottish intercollegiate guidelines network has been leading on those, and I am pleased to say that they are due to be published later this year. The guidelines will cover areas such as referrals, management of risks, and transitions. Along with the review’s work, the guidelines will ensure that those who require support will receive it.

The debate has been really interesting. We have heard valuable and interesting speeches from across the chamber. Kenneth Gibson talked about the evolution of services in Scotland. Brian Whittle gave us an interesting personal reflection on his journey to recognising eating disorders and the things that he could do personally as a coach to challenge people and raise awareness, and he raised an important point about stigma. We all have a part to play in challenging stigma around all mental illnesses. Emma Harper spoke passionately about diabulimia, which she has spoken about in previous debates.

I thank Rona Mackay for lodging the motion for the debate. I also reiterate my support and thanks to the staff who have been working tirelessly throughout the past year to support those who have an eating disorder and their families. I assure you that you have this Government’s full support.

Meeting closed at 18:00.