Meeting of the Parliament

Meeting date: Tuesday, June 5, 2018

Official Report 1141KB pdf

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Attention Deficit Hyperactivity Disorder

The final item of business is a members’ business debate on motion S5M-11127, in the name of Daniel Johnson, on the portrayal of ADHD treatment. The debate will be concluded without any question being put. I call Daniel Johnson to open the debate. You have around seven minutes, please, Mr Johnson.

Motion debated,

That the Parliament notes the documentary, Take Your Pills, which has been distributed by Netflix; expresses its strong concern about what it sees as the programme's unbalanced portrayal of ADHD and its treatment; notes the recent publication of updated NICE guidelines on the diagnosis and treatment of the condition and the Royal College of Psychiatrists in Scotland’s, ADHD in adults: good practice guidelines; acknowledges the calls for the Scottish Government to bring forward plans to update the SIGN guidance on ADHD, which, it understands, has remained the same since 2009, and notes the views that there is a need for a more informed understanding of the condition in Edinburgh and across the country and that taking prescribed medication to treat diagnosed neuro-developmental disorders and mental health conditions is as legitimate as taking prescribed medication to treat physical illness.

17:02  

In the few months since I first confirmed to Parliament that I have ADHD, I have been touched and slightly overwhelmed by the number of people who have thanked me for speaking up, and who have commented on what they perceive as my courage and bravery in doing so. However, I feel slightly guilty, because I am not sure that I was brave at all. The thing about ADHD is that one has very poor impulse control, and I just got very angry about the press coverage of ADHD and felt that I had to speak up. I quite often find, when I see something that I think is unfair or unjust, that I speak before I have thought about whether it is sensible to do so. However, that is probably quite a good thing for an MSP. I will touch on that later.

I got angry again, though, because Netflix released a documentary called “Take Your Pills” a month or so ago, which is a sensationalist documentary that explores a trope around there being an explosion in diagnoses of ADHD, and suggests that the medication for ADHD is unnecessary and compares it to crystal meth. The documentary peddles and perpetuates myths that those of us with ADHD battle against almost daily: that ADHD is not real, that the meds do more harm than good and that doctors are handing out pills as though they were sweeties.

As part of speaking up, writing articles and speaking at events, which I have done since speaking out in Parliament, I have told my story about how the diagnosis of ADHD has been empowering, how it has transformed my life and how medication has been the vital first step in that.

However, I am not alone, because ADHD is not a rare condition: one in 20 people is like me. Everyone in here will know people—friends and others—with ADHD, and in each classroom there will be at least two or three children with ADHD.

That it is such a prevalent condition but there is so little understanding of it is just not right. People know more of the myths regarding ADHD than they now about the facts. The very fact that this is—I think—the first time that ADHD has been debated in the Scottish Parliament as a topic on its own is not right.

We are here today to bust the myths surrounding ADHD, and to build the understanding that l believe we need. Let us start with the facts. I have ADHD and I have been taking methylphenidate, which most people will know as Ritalin, every day for the past five years. Those are facts—now let us deal with the fiction. I am not a victim and I am not looking for special treatment; my brain is just wired up in a slightly different way. Things that most people find easy, mundane and routine are things that people like me find incredibly difficult.

I am not constantly running around and bouncing off the walls like a naughty child. Attention deficit hyperactivity disorder is just that—it is a composite of different traits. Part of it is about inattentiveness, so it is as much about the daydreaming child at the back of the classroom who is not concentrating at all as it is about the naughty child who is running around. I am much more on the inattentive end of the spectrum than I am on the hyperactive side.

I am not making it up. I feel pained that I have to say this, but ADHD is real. It is not an excuse for bad parenting and it is not something for which I am seeking special treatment. It is not a social phenomenon. If members were to see a scan of my brain, they would see that my prefrontal cortex is just not as active as most people’s are. My brain also does not produce enough dopamine. There are genetic markers that are highly predictive of ADHD.

I take ADHD medication, but I am not a zombie. The idea that, by giving people ADHD medication, we somehow turn them into incommunicative zombies is false. ADHD medication is, for the most part, stimulant based. It is the complete opposite of a sedative. If that sounds strange, let me put it like this. How many members have a cup of coffee before they start work, or a cup of tea when they sit down to write a speech? We take stimulants because it is a way of helping our brains to deal with mundane and slightly banal chores. It is about keeping our brains interested in what we have at hand. That is especially true of ADHD medication. It is also why medication is so important as a first step, in order that people can learn the skills and techniques that they need to deal with the condition on top of the pills, because without taking the pills, they cannot do that.

Many people ask me what it is like to have ADHD and what goes on in my head. The best way that I have of explaining it is to say that it is a bit like a record player on which the needle keeps jumping out of the groove. The person with ADHD knows which track they want to play, but the needle just will not stay in there. Medication is the first step that they need to take in order to keep the needle in the groove.

However, there is another way of looking at that record-player analogy, because people with ADHD do not just look at an individual track at a time: they like to look at the whole album. People with ADHD view the world in macro and not in micro. We like looking at the big picture; we see the connections. We are constantly finding tangents and different ways of looking at things, which allows us to see things that other people do not see. As I said at the beginning, being slightly uninhibited about speaking up is useful for an MSP, but I think that seeing that bigger picture and those connections is also vital for my work. It allows me to bring something else to the job. Five per cent of people have ADHD, so there will be other politicians who have it. I hope that this debate will give them the courage to get a diagnosis or, if they already have one, to speak up about it.

As I said, 5 per cent of the population have ADHD, but the percentage of the prison population who have the condition is four times higher, at 20 per cent. I want members to think about that. What is going on? At the very least, it points to a social failure—a failure of all our understanding—but it also points to a policy failure. For people to end up in that situation and for there to be such a high prevalence in prisons, something is not right.

There is one brutal and blunt fact. There is a myth that we overdiagnose ADHD, but nothing could be further from the truth. We underdiagnose the condition. Some 1 per cent of the adult population have an ADHD diagnosis, and the proportion is similar for the child population. That represents massive underdiagnosis and undermedication of the condition. The myths that are peddled prevent people from seeking help and taking the vital first step that medication represents, yet they need it to deal with their condition and its consequences.

In the words of the National Institute for Health and Care Excellence, medication is a “first-line therapy”. That needs to be borne in mind. We need to destigmatise medication and we need better access to mental health services. We need more than just medication—it is about pills and skills.

If there was one positive outcome from the very negative Netflix documentary, it was that people like me took to social media to speak up about the positive impact that pills have had on their lives, and what medication has enabled them to do. If members look up the hashtag #ITakeMyPillsBecause, they will see people’s testimonies and positive experiences. Indeed, that hashtag out-trended the one for the documentary. So I just say this: I take my pills because they enable me to function and because they free up my head to develop skills and to learn to cope with my condition but—which is most important—I take my pills because they have transformed my life and the life of my family.

17:11  

I thank Daniel Johnson for bringing this important issue to the attention of the Parliament. I watched the “Take Your Pills” documentary and felt much the same way as others did. One reviewer called it “aggravatingly myopic” and “scaremongering”.

I refer members to my entry in the register of members’ interests, which shows that I am a nurse. I should also mention that I have had many years of first-hand experience of living with someone with ADHD. My husband has ADHD and he was diagnosed as an adult when he was 35 years old and living in Los Angeles. The diagnosis was life changing for him. When we met, he had been on the psychostimulant medication Adderall for his ADHD for almost two years, and I saw no symptoms of any kind and had no idea that he had ADHD until he told me.

Adderall worked for him. It helped him focus, it helped with project completion and it helped to promote positive relationships with everyone. My husband describes his ADHD like this:

“Imagine you are sitting in a room trying to read a book and there are three televisions on, all on different channels, and there are two stereos in the room playing different songs, and there are also three groups of people standing around you carrying on three different conversations.”

That is how he describes the way that it feels inside his head when reading a book. However, when he takes Adderall, there is only one television on and one stereo playing, so it is much easier for him to focus on what he is reading.

ADHD is caused by a variety of environmental and genetic factors and is usually a hereditary condition. It usually becomes apparent before the age of 12, but many people, such as my husband, are not diagnosed until adulthood. It is estimated that, globally, around 5 per cent of school-aged children have ADHD and that about 4 per cent of the adult population have it. In Scotland, however, only 0.08 per cent of the adult population—eight out of 10,000—is receiving medication for ADHD. I suspect that there are a lot of adults out there like my husband who know that medication would help them and who would like to receive it but who are currently not receiving it. Thirteen years ago, after we returned to Scotland, my husband went to his general practitioner and was informed that ADHD in adults was not high on the agenda. That was in 2005. Now in 2018, I have encouraged him to go to his current GP and try again, and I hope that he will get a more satisfactory result.

The motion notes that the SIGN—Scottish intercollegiate guidelines network—guideline for the management of ADHD in children and young people, which is SIGN guideline 112, has not been updated since 2009. In fact, at the bottom of the SIGN 112 web page, it states:

“This guideline was issued in 2009 and will be considered for review in three years.”

It continues:

“Use with caution, declaration of interests governance may not be in line with current policy.”

The web page warns that the guideline is out of date. I urge the Scottish Government to encourage Healthcare Improvement Scotland to update SIGN guideline 112, on the management of ADHD in children and young people, as a matter of urgency.

I thank the Scottish ADHD Coalition for its work and excellent website, which is full of helpful factual information. I note that there are 15 ADHD support groups across Scotland and that only three of them are for adults with ADHD. I was perturbed to see that there are no groups south of the central belt in my South Scotland region. There is no group in Dumfries, none in Ayr and none in Stranraer, and I would like that to change. I also discovered a terrific YouTube channel called “How to ADHD”, which was created by Jessica McCabe in the USA. She has excellent information in her videos and I encourage everyone—professionals as well as folk with ADHD and their family members—to check it out.

17:15  

I congratulate Daniel Johnson on securing today’s debate and pay tribute to him for his work speaking out about his experience of ADHD and raising awareness of these issues. It is important that we have such debates in Parliament and, when members bring their personal interest and experience, it makes for excellent debates.

I completely agree with Daniel Johnson that we need to see the media, especially documentary programmes, provide a balanced and informed portrayal of ADHD and how it is treated. Today’s debate is therefore timely and extremely important.

As Emma Harper has done, I thank the Scottish ADHD Coalition for its useful briefing ahead of the debate, and I commend the coalition for all that it does on behalf of children and families across Scotland. The coalition’s establishment in 2017, which brought together all the voluntary organisations that provide support to families, was a very positive step forward.

ADHD is a significant health issue for our society. As has been said, it is estimated that 5 per cent of children have ADHD and that approximately 1.5 per cent have a severe ADHD disorder. As has been mentioned, a large number of adults have never received any diagnosis.

I know that Daniel Johnson was concerned about some of the comments that I made last year in relation to the sharp increase in drugs such as Ritalin being prescribed to children with ADHD. I want to make it very clear, as we have discussed in the past, that I recognise that such medication can make a huge difference to many children and, indeed, adults, and that that is a positive thing that we should all support.

Absolutely no one should feel in any way that there is anything wrong with taking such medication, any more than they would feel about taking medication for a physical illness. However, each individual is different and medication alone will often not be the answer for every single case. Among the many concerns that I wanted to highlight was the suggestion that, in many cases, medication was all that was being offered, and other treatments and support systems such as parental training, school interventions, counselling and psychological support were simply not being made available to families across Scotland. That continues to be the case.

SIGN makes it clear that for mild symptoms of ADHD, clinicians should consider behavioural approaches in the first instance. Concern about a medication-only approach is a key finding from the “Attending to Parents” report, which was published by the Scottish ADHD Coalition. The report also noted that parents who refuse medication for their children are often discharged from services in Scotland, which all of us, I think, will find unacceptable and has to change. We also need to ensure that, for each patient and individual, the continuing benefit from and need for medication is assessed at least once a year, as SIGN recommends.

The coalition’s report also highlights concern about excessively long child and adolescent mental health services waiting times, which all of us in the chamber have raised and expressed concern about. It is a continuing source of anguish for many people in my region of Lothian and across Scotland. The report also calls for teachers to receive much greater training on ADHD, and I support that because such training is vital.

I have recently received a copy of a letter from my Perth and Kinross Council colleague Chris Ahern, who has written to the Cabinet Secretary for Health and Sport about ADHD. Councillor Ahern makes a number of important points and emphasises that, in Scotland, there is a lack of reliable datasets on ADHD and its impact in schools, the workplace and—as Daniel Johnson highlighted—in prisons. That was one part of the Health and Sport Committee’s work that we did not really touch on but, when we looked at prisoner health, we highlighted the opportunities. We need to continue to look at prisoners’ mental health, head trauma and prisoner populations not having access to any assessment of such aspects of their health, which were areas that were highlighted in the committee’s work.

Councillor Ahern believes that the Scottish Government should address the issue and consider setting up a cross-party working group to look at the diagnosis and treatment of ADHD. Perhaps the minister can respond to those points in her closing speech. It might be something that members across the chamber want to take forward.

I again welcome the debate and the way in which Daniel Johnson brought it forward. In light of the new guidelines from NICE and those from the Royal College of Psychiatrists in Scotland, I am sympathetic to the view that our SIGN guidelines should be updated, to ensure that people in Scotland of all ages who have ADHD, and their families, know what type and level of care they should receive.

17:20  

Like other members, I congratulate Daniel Johnson on securing this important debate. In his opening speech, he was extremely modest in saying that there was no such thing as his bravery and courage in speaking out. I say as his friend that he does not often do modesty, and he should not do it on this subject. It is extremely brave and courageous of him to speak out, particularly about his circumstances.

I know Daniel Johnson as a friend and a colleague and I have seen him acting as a parent, and I think that he is a first-class human being in all three of those aspects. He is a fantastic and diligent member of the Parliament—not an ineffective or hyperactive one. He is a first-class parent and he is always a pleasure and a joy to be around.

Daniel Johnson has not only initiated this important debate but, by speaking about his circumstances, done so in a manner that will effect change. I hope that that will give the confidence to speak out to other people—not just parliamentarians and others who are involved in politics but the wider public, who I hope will have confidence to seek access to services and speak openly about their circumstances with their friends, families, loved ones and healthcare professionals. I hope that we will send a unified message against what the Netflix documentary portrayed and instead open a dialogue about positive treatment.

I will focus on a few areas, including the destigmatisation of ADHD, which is no different from any other physical or mental condition. We should be clear that there is no shame in having ADHD or in taking medication such as pills for ADHD or any other condition.

It is important to recognise that, although ADHD is a neurodevelopmental condition, people who have it access mental health services, so the pressures on our CAMHS and adult mental health services have an impact on patients and families who are affected by ADHD. It is extremely important to address how we have an effective CAMHS and adult mental health system.

In a survey, 80 per cent of parents said that it took too long for their child to be diagnosed with ADHD. That is not good enough and we must look into achieving quicker diagnosis.

We must recognise the huge variation in access to courses of treatment. Mr Johnson said that 5 per cent of the population have ADHD and that it affects 20 per cent of the prison population. The average treatment rate across the country is 1 per cent, but the figures vary so much and can be much higher—for example, 2 per cent of the population who are aged between five and 19 take ADHD medication in the Borders, in comparison with a rate of only 0.4 per cent in Lanarkshire. That shows the huge variation in how ADHD is diagnosed and treated in different parts of the country, which needs to be addressed more seriously and openly.

Mr Briggs and Mr Johnson mentioned pills, and it is important to end the stigma about using medication. I make it clear that it is important to have access to counselling and support services, particularly in our schools and in primary and community care, so that we not only medicate individuals but empower them to make interventions in their lives that will help them to deal with ADHD better. That will have a positive impact not only on their life circumstances but on those of their colleagues, their friends, their families and their children.

I hope that, as a result of the debate, there is a more open and honest conversation about ADHD; a challenging of the stigma about ADHD and using pills for it; an improvement in the diagnosis of ADHD and in the referral pathway for it; and a look at a more holistic approach, so that ADHD is recognised as a genuine condition alongside other conditions and so that people feel that they have someone to turn to and that they will not be written off by society. I thank Daniel Johnson again for bringing forward this important debate.

17:24  

Like others, I thank Daniel Johnson for the opportunity to have the debate. I congratulate him on his very individual and particular contribution and the courage that it takes to make it. Fortunately, I am not in a position where I have to exercise that kind of choice.

Members may have heard me talk previously about the first job that I had when I left school. For about eight months in 1964, I worked in a locked ward in a psychiatric hospital, just at the time when the very first medications were becoming available that would give people with quite a wide range of psychiatric and other conditions better treatment than simply being locked up in the old asylums. The asylum in which I worked had about 1,200 patients; today, the hospital that sits on that site has around 100 patients. My starting point, therefore, is that medication is an important part of dealing with a wide range of conditions, one of which is ADHD.

As others have done, I thank the Scottish ADHD Coalition for its briefing for the debate. The briefing talks about the coalition’s survey of parents and refers to

“medication, parent training, school interventions and psychological support.”

I must confess that I have not watched the Netflix film—I take Daniel Johnson’s word for what is in it, supplemented by what Emma Harper said. However, a few weeks ago I saw “The Doctor Who Gave Up Drugs”, which was on BBC Four on 23 May 2018. What was interesting was that the doctor used a mindfulness approach to support school students who had ADHD, the idea being not to get them off the drugs but to give them choice and space. I was quite impressed, although of course television programmes always short-circuit complexities; we need to be very careful about that. I am not assuming that the magic bullet was contained in that one hour of television.

That leads me to an important general point, which is our use of the word, and concept of, “normal”. We increasingly view normal as a much narrower range than it is proper to consider. Normal is anything—behaviours, aptitudes, abilities and conditions—that does not harm the individual or cause the individual to harm anyone else. We should review normal as covering a much wider range and variety.

I have my own phobias. I cannot go to my office on the fourth floor of this building—I am generally in first—without straightening up all the rubbish bins. It is just something that I feel compelled to do. I rarely use the phone—I am virtually phobic about that—and I hate pills. There is a reason why I hate pills; I was in an experimental drug programme for a condition that I had when I was 12. The trial did not sort the condition and has left me with lifelong issues associated with it. I use self-hypnosis to deal with pain and asthma. I have not taken medication for my asthma for 35 years; I am fortunate in that I am able to do that, because my condition is probably not severe enough to require medication. Is that not at the heart of the issue? We have to treat people as individuals and find individual treatments that suit them. That might involve a mix of medications, psychological support, family support and educational system support. When we think about ADHD, we should perhaps consider the diversity and range of what is normal.

Daniel Johnson deserves our thanks for raising the issue in this context and showing us that there is more—or perhaps less—to the issue than we might otherwise have thought.

17:29  

I join members from across the chamber in congratulating Daniel Johnson on gaining cross-party support for his motion on the portrayal of ADHD treatment, and on his incredibly personal and compelling opening speech. Most, if not all, of us will have met someone who has ADHD. I am grateful to colleagues such as Emma Harper for sharing their experiences of that.

Those of us who think that we have not met someone with ADHD probably have done, but we just did not realise it at the time because, as with many health issues, the symptoms are not necessarily physical. In recent years, there has been a move towards treating mental health conditions differently from how physical health conditions are treated, but we must assess each and every condition individually in order to effectively help those in need.

Those who know me know that I am an avid rugby fan and a former player, and I am sure that we are all well aware of the benefits of physical exercise, no matter which sport may be of our choosing. I have found it immensely rewarding to coach a couple of players who have ADHD and to see their progress and improved participation both on and off the field. Learning how to coach people with ADHD within a wider group has been a great lesson for me. Physical exercise has been proven time and again to have a massive benefit on our mental health. I am not saying that picking up a rugby ball will treat ADHD definitively, but many studies have shown that playing a sport can help children and adults to manage their ADHD.

Although SIGN and NICE guidelines recommend multimodal treatment for ADHD, including parent training, school interventions and psychological support, in many areas medication is all that is offered, and parents who refuse medication for their children are often discharged from services.

Despite unhelpful programmes such as “Take Your Pills”, medication is a valid option that helps many people with ADHD to manage their symptoms and to lead a better life. For some, it is the additional treatments, including psychological support, that are able to help, so we must listen to those with ADHD and to organisations such as the Scottish ADHD Coalition on which treatments make a real improvement to people’s lives.

It is not just the health service, schools and individuals who can help to improve the way in which we manage ADHD treatment. The business world needs to get involved, too. As stated in an article published in The Guardian in March 2018, those with ADHD can be a huge asset to the workplace if they are supported. There were many stories on individuals’ struggles in the workplace, but research has found that by utilising the symptoms of ADHD, such as hyperfocusing, businesses can benefit from hiring people with ADHD. Every manager and employer knows that they should use the different strengths of their employees, and it is no different for those with ADHD. I was therefore pleased to read that Scottish ADHD Coalition has published a guide for employers, which I look forward to sharing across my constituency and the wider business community.

We are here today because more action is needed from the Scottish Government to bring forward plans to update NICE and SIGN guidelines. I also encourage ministers to ensure that all Government departments are working to ensure that those with ADHD can enjoy all aspects of life, with the support of those around them.

17:33  

I, too, begin by commending Daniel Johnson for bringing the motion to the chamber. On a previous occasion, he bravely shared his experience of being diagnosed with ADHD, and I thank him for that.

Mental health is something that we all have, and by being open about our own experiences of mental health issues and neurodevelopmental disorders we can reduce stigma and promote understanding. It is important that we lead by example. I share the concerns expressed by Mr Johnson and other members about how ADHD was portrayed in the documentary “Take Your Pills”, which was distributed in the United Kingdom by Netflix. I watched the programme, and I think that it is important to note that the film focuses on the United States and should be viewed in that context. However, I was disappointed to see the condition portrayed in such an unbalanced and stigmatising manner, which is not helpful for people who live with the condition and those who support them.

I welcome the recent publication of the NICE guidelines on the diagnosis and management of ADHD, and the guidance that was published last summer on the management of adult ADHD by the Scottish division of the Royal College of Psychiatrists. Accordingly, we are looking to update the SIGN guidance on ADHD at the earliest opportunity, which I hope will be welcomed by Emma Harper and the other members who mentioned it.

Members also mentioned the prescription of medication, which gets a lot of media attention with regard to not just ADHD but depression and other mental health conditions. I understand that people have concerns about the issue, which we must take the time to address. It is also important, as Daniel Johnson said, to acknowledge that the treatment of ADHD in adults and children can be, but is not only, about medication. It is also about making sure that the right support is in place at the right time. I will say more later about what we are doing to support children and young people with ADHD.

I make it clear that people who experience mental ill health and those who live with a neurodevelopmental disorder should expect the same standard of care as people who have a physical illness, and they should receive medication if they need it. Stewart Stevenson’s historical analogy was important. In the 70th year of the national health service, we should reflect on just how far we have come in treating people with neurodevelopmental disorders and mental illness, who are no longer institutionalised as they were so unnecessarily in times past.

The prescription of any medication is a clinical decision that is made by health professionals in discussion with the patient, and there is good evidence that health professionals assess and treat these conditions appropriately.

Other treatments can be used to help people with such conditions, and it was interesting that Alexander Burnett mentioned the benefits of sport. Members might have attended the tennis aces project event that was held at the Parliament a few weeks ago, which showed that when children, young adults or older people with neurodevelopmental disorders concentrate, they get relief from what is going on in their heads. There is a similar project in the north-east of Scotland at a Moray golf course.

All those things are important and we must realise that medication is not the only treatment. We are committed to improving access to alternatives, such as psychological therapies, that increase choice and best accommodate patient preference. The Scottish Government supports services such as NHS 24’s breathing space and living life phone lines, which help people who experience depression and low mood for whatever reason. That support is a key element of the wider work around Scotland to intervene early and prevent problems from becoming worse. It aligns well with our policy on improving prevention and early intervention, which is one of the areas of focus in our new 10-year mental health strategy.

We are absolutely committed to giving children and young people who are living with ADHD the opportunities to succeed in school. Pupils should get the support that they need to reach their full learning potential. It is up to education authorities to have in place appropriate policies and guidance to support all staff who work with children and young people with ADHD to ensure that they make the most of their learning opportunities. To support staff with that, we recently published the revised code of practice on supporting learners, which explains the duties on education authorities and other agencies. We have also worked closely with Education Scotland to roll out mental health first aid training, which is aimed at staff in secondary school communities. The training seeks to increase their confidence when they approach pupils who they think might be struggling with a mental health problem. All those measures are designed to ensure that children and young people with ADHD are supported to reach their full potential, free from stigma.

Miles Briggs mentioned the evidence session on ADHD and prisoner health. As a former prison visitor, I am well aware of the number of people in prisons who have not only ADHD but other behavioural issues and who should not be part of the prison population, to be frank.

I thank Daniel Johnson for bringing the motion to the chamber. He did not mention that he has written to me to suggest a round-table discussion, which I am absolutely up for. I look forward to our working together on that—we should have it earlier rather than later in the next parliamentary term. I think that it will contribute to the greater openness on the subject that Anas Sarwar asked for.

Meeting closed at 17:41.