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Chamber and committees

Meeting date: Wednesday, February 28, 2018

Meeting of the Parliament 28 February 2018

Agenda: Business Motion, Portfolio Question Time, UK Withdrawal from the European Union (Legal Continuity) (Scotland) Bill, Early Years and Childcare, Business Motions, Parliamentary Bureau Motions, Decision Time, Eating Disorders Awareness Week 2018


Eating Disorders Awareness Week 2018

The Deputy Presiding Officer (Christine Grahame)

The final item of business is a members’ business debate on motion S5M-09834, in the name of Clare Haughey, on eating disorders awareness week 2018. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that 26 February marks the beginning of Eating Disorders Awareness Week 2018; acknowledges that these disorders are serious mental health conditions that affect people psychologically, socially, and physically; understands that approximately 1.25 million people in the UK have an eating disorder, of which an estimated 89% are female; praises the Scottish Eating Disorders Interest Group and the charity, Beat, on providing what it sees as vital help for people with such conditions and their families; notes that the Scottish Government's Mental Health Strategy 2017-2027 commits to working toward the development of a digital tool to specifically support young people with eating disorders; highlights the programme, See Me, which it considers has been instrumental in tackling the stigma and discrimination associated with mental health issues, including eating disorders, and notes the calls for all stakeholders to continue to working together to ensure that the appropriate help is available and that early intervention is essential in reducing unnecessary deaths.


Clare Haughey (Rutherglen) (SNP)

It is a great honour to open the debate three days into this year’s eating disorders awareness week, which runs until 4 March.

At this point in proceedings, I was going to ask members to welcome visitors who should have been in the gallery today; unfortunately, the weather has beaten them. However, I would like to mention the Eating Disorders Association, which is known as Beat, and the Scottish Eating Disorders Interest Group, both of which helped greatly in my preparation for the debate.

Before I start, I refer members to my entry in the register of members’ interests, in that I am a registered mental health nurse and hold an honorary contract with NHS Greater Glasgow and Clyde.

Most people will be aware of anorexia, bulimia and binge eating disorder. However, they may not be aware that such eating disorders are actually serious mental illnesses. They are conditions that are diagnosed according to a list of expected behavioural, psychological and physical symptoms but, sadly, they are often misunderstood as being merely diets gone wrong or phases.

Evidence shows that, over the past three or four decades, instances of eating disorders have increased to such an extent that Beat estimates that approximately 1.25 million people in the United Kingdom live with one. The most recent figures for Scotland show that, in 2015-16, a total of 726 people were treated in hospital for an eating disorder, which represents a 66 per cent increase on the corresponding figures a decade earlier. However, the rise does not necessarily have to be viewed as a negative, nor may it indicate a rise in suffering. It could, instead, point to increased awareness on the part of healthcare professionals and improved access to treatment, which, as I have been a mental health nurse for over 30 years, is an assertion with which I would agree.

Although many people have been diagnosed and are receiving treatment, many more remain undiagnosed and at risk. The risk of not treating any mental illness can be incredibly dangerous. However, for eating disorders that is even more true. They are responsible for more loss of life than any other form of psychological illness, with anorexia nervosa having the highest mortality rate of any mental illness. Even when eating disorders are not fatal, they can still lead to severe long-term physical health consequences, such as organ damage and fertility issues, and can increase the risk of heart problems and type 2 diabetes. The deniability, secrecy and stigma that are associated with such disorders will prevent many from seeking help and others from taking responsibility for helping a sufferer. However, the latest available figures for Scotland are only the tip of the iceberg, as most people are treated in community out-patient settings and have no need or desire to visit a hospital.

The systems that currently operate in Scotland and England are different and should not be directly compared. However, for information’s sake, the Scottish Government has set a target that all patients, no matter their age, should not have to wait longer than 18 weeks from referral to the start of treatment for mental health conditions, including eating disorders. In my own constituency, the average time to refer an adult to appropriate services is within 15 days—a fact that I checked yesterday—while urgent cases are seen within the day, which is much quicker than the standard target. Although I appreciate that that is not the case everywhere, good practice is to be found across the country. In England, for under-19s only, the target referral time for non-urgent eating disorder cases is four weeks and for urgent cases it is seven days. Scotland is already doing tremendous things in tackling mental illness, with the groundbreaking “Mental Health Strategy 2017-2027”, and I have full trust in our Minister for Mental Health. Nonetheless, we can always look to see how we can improve things, and it may be the case that the successes in my constituency could be looked at to be replicated across Scotland.

When preparing for today’s debate, I had the pleasure of hearing about Beat’s ambassador programme from its senior national officer, Sara Preston. Beat’s ambassadors all have lived experience of eating disorders and, through their own knowledge and expertise, they help others who are going through similar situations.

Ballari Conner from Glasgow is a Beat ambassador—she was going to be with us in the public gallery today. Ballari has the rare experience of having previously suffered from anorexia nervosa and now suffering from bulimia. She spoke bravely to me of her difficult and challenging battles. One of the positives of her experience is the help that she has received through peer support groups. Many years ago, after growing impatient and frustrated with being unable to access services, she began to meet up with others in Glasgow and they created their own support service to assist one another through their journeys to recovery. Groups such as the Glasgow eating disorder support group are easily found online, so I hope that, from coverage of today’s debate, people will know that they can look on the internet to find help from others who are in similar situations.

Another great example of online support is the tremendous website that is managed by Eva Musby; it is called Eva’s daughter fell ill around 10 years ago, and she now devotes a substantial portion of her time to helping other parents and sufferers. Her website and the book that she has written are great resources for those who are looking for further help. From a parent’s perspective, her website assists with general information and practical advice, as well as offering the companionship of someone who knows what it is like to support a child with an eating disorder, all while providing hope and confidence.

I cannot thank Eva and Ballari enough for their assistance to me in preparing for today’s debate, and I hope that they will be encouraged by what they have heard so far.

I wish to pay tribute to former MSP and current councillor for Stonehaven and Lower Deeside, Dennis Robertson. Dennis was supposed to be here for today’s debate but, sadly, due to the weather, he is unable to attend. By bravely sharing his own harrowing experiences, Dennis was the main driver behind me lodging today’s motion for debate. Nearly seven years ago to the day—25 February 2011, to be exact—Dennis lost his daughter Caroline to anorexia. She had suffered from the illness for five years.

In a heartfelt speech marking eating disorders awareness week two years ago, Dennis recalled the death of his beloved daughter. He said:

“I felt the pain then and I feel the pain now, but the pain that I feel now is perhaps slightly different. It is not just grief. I miss Caroline very much, as do Ann and Caroline’s twin sister, Fiona. Of course we miss her, but we continue to try to establish a pathway so that other people do not have to go through the pain and anguish that we have gone through.”—[Official Report, 23 February 2016; c 111-12.]

I am incredibly sorry that Dennis is no longer an MSP to continue his campaign at Parliament. However, I wish to reassure him that there are others such as me who will continue to fight the fight for him.


Annie Wells (Glasgow) (Con)

I thank Clare Haughey for bringing this important topic to the chamber today.

Eating disorders are complex mental illnesses and anybody can develop one, no matter their age, gender or background. We know that around 1.6 million people around the UK are affected by an eating disorder, so it is important not only that we provide the proper support to those who need it but that we work together to raise awareness among the population at large about who can be affected and what having an eating disorder means.

Our views about who can be affected are sometimes distorted, so our response in identifying and supporting friends, family and colleagues who might be struggling can also be distorted. Studies suggest that around one quarter of people with eating disorders are male and that sufferers might not show visible symptoms, as 80 to 85 per cent are not underweight. Further, data from Beat shows us that 15 per cent of the phone calls that were taken by its helpline in 2015 were from those aged 40 and over.

As a society, we are constantly bombarded with messages about food, weight and body image and, to an extent, many of us are affected by emotional eating, using food as a means to reward or to improve self-esteem.

There is no specific cause for an eating disorder and people might not have all the symptoms that pertain to one specific type. The term “eating disorder” refers to a broad number of conditions, which is another reason why it is so important that we raise awareness by encouraging everyone in Scotland, whether currently affected, knowingly or not, to go online and look at websites such as those of the charities Beat and SEDIG. These sites were invaluable to me in broadening my knowledge of different types of eating disorders, their signs and their symptoms.

I strongly feel that, in supporting people with eating disorders, we should work towards improving identification and treatment of such disorders before the people involved are hospitalised. It is worrying that the number of people being hospitalised has risen by about two thirds over the past 10 years and that, in 2015-16, the number in my Glasgow region increased by 15 per cent from the previous year. That said, it is crucial that people can be admitted to hospital.

However, improving the provision of evidence-based psychological treatments in community settings across Scotland is fundamental in allowing people to access treatment quickly, particularly when around one in four children and adults are waiting too long for mental health treatment. I am pleased to see such examples; for example, NHS Lothian child and adolescent mental health services have partnered with Beat to provide online peer support for young people under 25 and their families to reduce the sense of isolation that an eating disorder can cause. Volunteers who have recovered from such a disorder and parents who have cared for a young person who has recovered are paired with young people or families who are currently experiencing these difficulties. I am also pleased that, this week, NHS Lothian CAHMS will be launching a website that is designed to support parents in the first few weeks of diagnosis and treatment. That kind of support will be essential in treating eating disorders in their early stages, and I am interested in seeing how that will be rolled out across Scotland.

I extend my heartfelt thanks to the charities supporting those with eating disorders such as see me, Beat and SEDIG. Raising awareness, reducing stigma and creating a clear pathway of help in the early stages of an eating disorder are absolutely key to ensuring that we provide the best support to those who need it.


Stewart Stevenson (Banffshire and Buchan Coast) (SNP)

I thank Clare Haughey for providing us with the opportunity to have this important debate. She mentioned our colleague Dennis Robertson, and it reminded me—and, I guess, others who were in the chamber at the time—of how Mr Robertson’s first speech on this subject, which was about his daughter, made the hairs on the back of my neck stand up. I remember the personal and emotional charge that I felt as he talked about his personal circumstances. However, he turned what could have been a life-constraining tragedy into the driver of a very worthwhile campaign that we would all support, and I note that he continues his public service in Aberdeenshire Council, where I see him regularly and continue to have good discussions with him.

We have all referred to the increase in the number of people presenting with eating disorders. I am delighted to hear that, in Clare Haughey’s constituency, the 18-week target for being seen has been substantially bettered, but perhaps more interestingly—and more troubling—it takes, I am told, an average 149 weeks before those experiencing eating disorder symptoms seek help. Perhaps we should look in the mirror with regard to some of the ways in which we and wider society respond to people with eating disorders and perhaps, without meaning to, discourage them from seeking the kind of help that they really need. It is said that 34 per cent of adults in the UK cannot identify signs of an eating disorder, while 79 per cent do not know that there are psychological symptoms associated with such disorders.

Some of these anomalies lie in the fact that we still view those who suffer from eating disorders as having only one body type—skinny and sickly—and perhaps as being selfish. That is utterly wrong. Many believe that people of normal weight or who are overweight cannot be suffering from an eating disorder; unless you look very unhealthy and weak, people will assume that you are fine. It is a common misconception that sufferers are simply attention seekers.

Clare Haughey mentioned anorexia and bulimia, and gave us a list of other conditions that apply, of which there are a huge number that we need to pay attention to. I want to talk a little about social factors. I am disturbed—I do not know whether others will be—by the fact that Weight Watchers has started offering free six-week memberships to children as young as 13. I am sure that it has reasons for doing so and that part of what it will say is that it is fighting childhood obesity and other health complications. However, offering that kind of illusory opportunity to people who are potentially vulnerable emotionally and whose body shape is likely to be rapidly changing is not something that I feel comfortable to support. The simple consent of parents is all that is required for teens to be granted that imperfect opportunity to get that supermodel physique.

It has been some years since I have paraded my physique on the beach or at the side of a pool and there are good reasons for that, because I am somewhat short of that ideal shape. I can see that members around the chamber are nodding in agreement with that. However, we live in a society that glamorises that illusion of perfection, which is something that we should all seek to address. We need to educate people about symptoms and treatments and the fact that there is no condemnation in accepting that we have eating disorders. We are endomorphs or ectomorphs from genetic disposition.

Again I congratulate Dennis on having first brought this issue to Parliament in the way that he did and I congratulate Clare on giving us the opportunity to discuss further a very important subject.

The Deputy Presiding Officer

Thank you, but I remind members that they should address other members by their full name, even in the usually rather more friendly members’ business debates.


Mary Fee (West Scotland) (Lab)

I thank Clare Haughey for bringing this important issue to the chamber. I will touch on two main points in my speech: first, the importance of improving general awareness of the symptoms of eating disorders to help aid earlier detection; and, secondly, the support that is available to children and young people who experience mental health problems, particularly those around eating disorders.

Knowledge of eating disorders is not extensive among the population at large, with anorexia nervosa often portrayed as the archetypal and only eating disorder. However, there are four classifications of eating disorders: anorexia, bulimia, binge eating and eating disorders not otherwise specified. The expression of each of those eating disorders is often discreet and unseen by the untrained eye of family and friends. It is important to raise general awareness of the key indicators of eating disorders to help family and friends identify an eating disorder in an individual as early as possible.

In advance of the debate, I posted on Facebook that this was eating disorder awareness week and that I intended to speak in the debate. I was contacted by a constituent who asked whether the issue of compulsive eaters could be raised because many people are eating themselves to death. The individual said that some people still see such individuals as just being too greedy. However, no sane or rational person wants to eat themselves to death for the sake of having an extra pudding. I know how heartfelt that constituent’s comments are, because I know that person and know that they have been at both ends of the unhealthy weight spectrum. That individual acknowledged that they suffer from a psychological problem and said that the national health service needs to invest in the treatment of obesity as it would generate long-term savings.

A recent survey by YouGov revealed that one in three adults could not name any signs of an eating disorder and that 79 per cent were unable to name the accompanying psychological symptoms, such as low self-esteem. The Scottish Eating Disorders Interest Group has a very useful section on its website that outlines a comprehensive, but not exhaustive, list of symptoms that might indicate that an individual is suffering from an eating disorder. The symptoms include self-induced vomiting, the use of laxatives and drinking large quantities of fluids before and after a meal.

Secondly, it is important to recognise that eating disorders commonly manifest themselves during adolescence. That is why it is so important that child and adolescent mental health services are able to provide the appropriate support to young people who are suffering from an eating disorder. However, at present, the provision of CAMHS across Scotland can be patchy and unsatisfactory. Too many children are waiting too long to be treated, resulting in their condition deteriorating significantly before they receive their first treatment. Simply put, too many children and young people face a postcode lottery in relation to their access to CAMHS.

The Government target is that 90 per cent of children and young people reporting mental health problems should be seen within 18 weeks. Last year, however, only 73 per cent of children and young people were seen within 18 weeks, and across the country there was a huge variation in waiting times. NHS Grampian saw only 33 per cent of children and young people within 18 weeks, and in Lothian the figure was only 57 per cent. We must ensure that we improve the provision of CAMHS across Scotland, to guarantee that all children and young people are given a service that provides the appropriate level of support for their condition, no matter where they live.

In Scotland, we should do more to identify and support individuals suffering from eating disorders, particularly children and young people. As a starting point, we must work to improve general awareness of the discrete physical and psychological symptoms of eating disorders and support greater investment in child and adolescent mental health services, to reduce waiting times and to reduce the geographical discrepancies in provision.


Alison Johnstone (Lothian) (Green)

I thank Clare Haughey for bringing this important issue to the chamber for discussion, and I associate myself with her moving comments on the experience and contribution of our former colleague Dennis Robertson.

The motion reminds us that eating disorders are serious mental health conditions that have psychological, social and physical effects on those who suffer from them, but often those effects are not clearly recognised by those suffering from an eating disorder or those closest to them. As Stewart Stevenson and Mary Fee noted, a recent survey by the charity Beat found that 34 per cent of adults could not name a single symptom of an eating disorder, reflecting the fact that these illnesses are not widely seen to be mental health conditions.

Symptoms are often not directly related to someone’s physical appearance or weight, which may not always dramatically change, but the disorder can be revealed in their behaviour, from being secretive about what and when they eat, to social withdrawal, excessive exercising and displaying feelings of guilt and shame around food. A person’s symptoms may also not be neatly classified as anorexia or bulimia, but may overlap multiple areas and be an unspecified eating disorder. Better understanding of the symptoms and range of disorders can help family and friends to support their loved ones and encourage those with an eating disorder to seek help.

We must change our view about who is affected by eating disorders. Around 10 to 15 per cent of patients are men and boys, although it is likely that a large number are not reporting their symptoms in the belief that these are illnesses that affect women only. Black and minority ethnic populations are also likely to be underreporting their symptoms. There remains a high level of stigma and shame around eating disorders, which prevents people from coming forward, and I applaud the work of Beat, the Scottish Eating Disorders Interest Group and the see me campaign in supporting people to open up about their mental health and providing a wealth of resources for understanding eating disorders.

In yesterday’s healthy weight strategy debate, it was clear that there is growing awareness of the need to address issues around under and overeating with the utmost compassion, and I warmly welcome that. The resources that the organisations I mentioned provide emphasise the importance of supporting someone with an eating disorder in a compassionate way, but just as important is support for the family members and loved ones of those affected. Reducing carer stress can make a big difference in speeding up recoveries, because when carers are able to model self-reflection and self-care it is easier for an ill person to treat themselves with kindness.

I welcome the Scottish Government’s 10-year mental health strategy and note its target to create a digital tool to support those with an eating disorder. I would be interested to hear more detail from the minister on what that tool might offer and when it might be delivered.

However, there is an urgent need to reduce the time that it takes for someone with an eating disorder to receive professional mental health treatment. Beat estimates that it takes sufferers an average of 18 months to become aware that they have an eating disorder, that it can be another year before they seek help from their loved ones and that a further six months can pass before they approach their general practitioner. It can be about three and a half years before people receive specialist treatment, which is why the figures that suggest that only one in three requests for CAMHS are being met within the 18-week waiting time target are particularly worrying.

The research shows clearly that the earlier that health professionals intervene, the easier it is for a young person to recover from an eating disorder. Anorexia becomes much more difficult to treat after three years, so it is imperative that waiting times are kept to a minimum. The target in guidance in England is to reduce the waiting time for treatment of an eating disorder in those who are aged under 18 to four weeks by 2020-21.

I hope that the minister will reflect on those concerns and consider including actions to reduce the time to receive treatment for young people and adults in any future revisions of the mental health strategy. I thank for their efforts all those who are involved in raising awareness of such conditions, running eating disorders awareness week and working to help people into recovery.


Alex Cole-Hamilton (Edinburgh Western) (LD)

I thank Clare Haughey and pay tribute to her for the work that she does not just on eating disorders but on many aspects of mental health, and for the immense professional expertise that she brings to the chamber.

In yesterday’s debate on the healthy weight strategy, Johann Lamont referred to the stark corollary between that debate and this debate. She reminded us that we spend a great deal of time in the chamber debating issues such as obesity but that we seldom address important aspects of the issues that we are discussing today. There is also a link to many debates that we have about mental health and pressure in the NHS and to the members’ business debate a month ago, on a motion in the name of Gail Ross, on adverse childhood experiences.

Dramatic and significant life events, such as traumatic experiences that are beyond a person’s control, can trigger any one of the four types of eating disorder that we have heard about today. Sometimes, an eating disorder involves a grief response—it is a person’s subliminal attempt to regain some control of their life. Relationships can also be a cause, whether that is because the eating disorder is a response to abuse or because it is an aspect of coercive control in an abusive relationship. We know that personality types and genetic factors are also some of the reasons for eating disorders.

To an extent, societal pressures are the most egregious factor, and in some respects we as a Parliament are most empowered to do something about them. We are all familiar with the pictures of airbrushed supermodels that we see in magazines, which create a narrow and punishing idea in society of what beauty should be. That is amplified by the body shaming that we see every week, particularly in tabloid newspapers, which involves privacy being invaded and photographs being taken without permission and exploited for sensationalist journalism. There is also the peer pressure that we have seen in the rise of online bullying, particularly with the advent of social media.

We have heard a lot about the statistics, but they bear repeating. Across the UK, 1.25 million people are experiencing some kind of eating disorder, and the impact is much wider. Anyone who has a family member with a mental health issue of any kind will know the strain and anxiety that that can cause to families.

We have heard a lot about Beat, which has launched a campaign with the hashtag #WhyWait. That is important, because it brings attention to the average time of three and a half years between the start of a disorder and first-line treatment. I thank Louise Allan and Louise Giboin from my constituency for bringing that to my attention; I did not know about it before.

In some parts of Scotland, that period is compounded by the two-year wait for first-line treatment in child and adolescent mental health services, by the lack of tier 4 in-patient bed capacity and by what our chief medical officer described to the Health and Sport Committee in referring to an “atlas of variation”—the postcode lottery that exists, which is absolutely made clear by the formation of the peer-led eating disorder support group in Orkney, where no eating disorder services are provided.

We need a transformational investment in mental health services, because that is the first-line treatment in our response to the problem. We need to ensure that each of our territorial health boards offers meaningful provision in this area. We need to build awareness in our society, but we also need to challenge society and to address body shaming. Many media outlets are complicit. We need to make it clear that there is help and that people need only ask for it.

The Deputy Presiding Officer

Four members still want to speak in the debate, so I am minded to accept a motion without notice, under rule 8.14.3, to extend the debate.

Motion moved,

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

Motion agreed to.


Rona Mackay (Strathkelvin and Bearsden) (SNP)

I thank my colleague Clare Haughey for bringing this important debate to the chamber and raising further awareness of a condition that has affected many people for decades but which, as she said, has often been misunderstood.

I think that most of us know, or have known in the past, someone who suffers from an eating disorder. Tonight, I am learning about many eating disorder variants that I was unaware of before the debate.

Two of my school friends suffered from anorexia nervosa throughout their teens and the condition has dogged them all their lives. Back then, little was known about that terrible condition and it was scary for people to watch their friends almost fade away before their eyes. I know now that those friends had suffered adverse childhood experiences. One girl was teased mercilessly in front of the entire class by a sadistic teacher about her appearance and build. She was hospitalised when her weight reached four stone and just pulled through. Her body was so damaged that she became infertile.

Stewart Stevenson and Alex Cole-Hamilton—and Johann Lamont in yesterday’s debate on healthy weight and obesity—made excellent points in speaking about the immensely damaging culture that glorifies thinness, resulting in body dissatisfaction, which mainly affects young girls, and which has devastating effects. Societal attitudes must change to allow our youngsters to feel happy in their own skin, without having to conform to some unrealistic notion of what looks good.

What is an eating disorder? One definition is that it is extreme shape and weight control behaviour that leads to the development of rigid rules about food. The most common conditions are anorexia nervosa and bulimia. The word “control” is the key here, but it is about someone taking control of their body in the worst possible way.

We know that psychological factors are a huge cause, because eating disorders are common among those who deal with depression, anxiety and obsessive compulsive disorder. They can develop due to a combination of, for example, genetic and biochemical factors. People with eating disorders usually have abnormal levels of chemicals that regulate appetite, mood, sleep and stress. For example, it is known that people with bulimia and/or anorexia have higher levels of the stress hormone cortisol.

As I mentioned, if a person experienced an ACE or other trauma in their childhood, they are more likely to use eating disorders to cope. However, one size does not fit all and sometimes a child who has experienced a happy childhood and had loving parents can be affected for no obvious reason. At this point, I pay tribute to former MSP Dennis Robertson.

Clinicians rarely publish statistics about eating disorders, because the stats can be misleading; as Clare Haughey said, many people who are affected are not receiving treatment. Although every statistic on eating disorders is tentative, we know that anorexia nervosa affects, on average, about one in 250 females and one in 2,000 males. It has the highest mortality rate of any psychiatric disorder of adolescence.

To conclude on an optimistic note, I am delighted that the Scottish Government has announced new resources to give young people and families peer support, including an online peer support tool that allows young people to pair with a trained volunteer who has recovered from an eating disorder such as anorexia or bulimia. I am sure that we will hear more from the minister about the new resources in her closing speech.

For all those who are struggling with the condition and the families who are at a loss to know how to support their daughter or son, there is light at the end of the tunnel and, hopefully, the dark days of confusion and fear about how to cope with the terrible condition are coming to an end.


Jeremy Balfour (Lothian) (Con)

I congratulate Clare Haughey and thank her for bringing the issue of eating disorders to Parliament’s attention. I first became aware of the issue as a young teenager, when I attended the family funeral of a lady who died of an eating disorder. She was brought up in a loving family; the disease got her for different reasons and ultimately led to her death.

Mary Fee is absolutely right to say that we need to ensure that eating disorders, as well as how to identify the symptoms, are on everyone’s radar. Too often, people are simply unaware of the problem. As the father of two young girls, I want to be sure that I look at them and their friends, so that I am aware if the symptoms appear.

This year’s eating disorder awareness week campaign asks the question “Why wait?”, which is an absolutely valid question, particularly in relation to young people. The eating disorder charity, Beat, which has already been mentioned, states that, on average, nearly three years pass before those experiencing the symptoms of eating disorders seek help. As Alison Johnstone said, it becomes harder to treat the condition when there is that delay.

On top of that, a YouGov survey revealed that more than one in three adults in the UK who responded could not name any signs or symptoms of eating disorders. That low level of awareness, combined with delayed treatment, results in an increased risk of the illness becoming severe and enduring and, in some very sad cases, leading to an early death. Alison Johnstone also picked up on the surveys that show that as many as 25 per cent of people with an eating disorder are male. We need to recognise that and deal with it appropriately.

The causes of eating disorders are complex and may be linked to social pressure to be thin—as others have pointed out—mental health issues or issues from somebody’s past. However they come about, eating disorders are serious. Ultimately, they are a form of mental illness, and they need to be treated quickly and appropriately. I welcome the recommendation in the Scottish Government’s mental health strategy that a digital tool should be developed to support young people with eating disorders. I, too, ask the minister to give more details on that in her closing speech.

The Scottish Government has waiting time targets for access to treatment by NHS child and adolescent mental health services. As we have heard already, there is no accurate picture across Scotland, but it is the case that different health boards have different waiting times. I encourage the Scottish Government to work with health boards to ensure that they meet the target, as early intervention is clearly key in the treatment of young people with eating disorders.

As we approach international women’s day on 8 March, I urge us all to use that important date to help and encourage teenage girls, young women and ladies of all ages to challenge the view, which is often portrayed in the media and in social media, that in order to be successful, accepted or attractive they must be skinny. Let us stop that expectation and instead support women of all ages to redefine success in ways that are healthier for them and for the rest of society.


Emma Harper (South Scotland) (SNP)

I add my congratulations to my colleague Clare Haughey on securing this debate during eating disorders awareness week. I also pay tribute to members of the Scottish Eating Disorders Interest Group. I know that they were intending to be here for the debate, as was former MSP Dennis Robertson, who deserves enormous credit for his heartfelt and continued campaigning on the issue.

As Clare Haughey and I are nurses, Dennis asked us both to carry on his work. Immediately after the debate, I was due to sponsor an event to highlight the work of SEDIG. Unfortunately, the red weather alert and the snow have prevented that from going ahead, but I hope to reschedule it as soon as possible. I hope that, when it happens, members who are present, as well as Dennis, will come along.

I ask members to visit the SEDIG website, which includes information about conferences and events to support affected persons and carers. The next event is on 10 March.

Prior to tonight’s debate, SEDIG passed me a written account of anorexia from the point of view of a woman called Hazel. Reading her account, I was struck by the difficulties that she encountered in engaging with health professionals, who thought that she did not look thin enough. Because she was not thin enough, she was misdiagnosed by a psychologist as having a personality disorder and faced lengthy waiting times for counselling on the NHS. Clearly, more needs to be done to educate people about the reality of how eating disorders manifest themselves to ensure that help can be offered as quickly as possible. Similarly, a constituent of mine whose daughter suffers from an eating disorder was told that she would have to wait six months to see a psychiatrist. That is not optimal, especially as we know that early intervention is key to tackling the disease.

There is one condition that, as a person with type 1 diabetes, I am well aware of and would like to highlight: diabulimia. The term is common among the diabetes community; although it has not been officially recognised as such, it is a very real eating disorder. Diabetes Scotland is doing important work to raise awareness, and my colleague Annie Wells MSP led a members’ business debate on the subject last year.

Individuals who have diabulimia reduce their insulin—or do not take it at all—in an effort to control their weight. When I was growing up, I knew a young lady who, sadly, died of the condition; had she survived, she would have been my age today. It is an incredibly dangerous condition. Research shows that people who have it have a much shorter lifespan. It can lead to severe diabetic ketoacidosis, which can be fatal, and to complications from diabetes such as retinopathy, neuropathy and nephropathy appearing much earlier. It is extremely complex and difficult to diagnose, and people who have it require mental health support over and above support for the physical and medical needs that are associated with diabetes. The good news as far as Dumfries and Galloway is concerned is that NHS Dumfries and Galloway has a diabetes dietician with a special interest in diabulimia.

Research that emerged last year from Toronto suggested that 60 per cent of females with type 1 diabetes will have experienced a clinically diagnosable eating disorder by the age of 25, and the situation also affects men. Like any eating disorder, diabulimia is a mental health issue. As a result, healthcare professionals and the families and friends of those who have type 1 diabetes should be aware of the signs indicating diabulimia, which, according to Diabetes Scotland, can include: fluctuations in or loss of weight; regular symptoms of high blood glucose levels; secrecy about or fear of injecting; reluctance to be weighed; and lack of blood glucose monitoring or a reluctance to self-monitor. It is important that healthcare professionals are aware of diabulimia as a condition, and I ask the Scottish Government, in considering its approach to eating disorders, to put in place measures to ensure that sufficient time, resources and training are available to enable diabetes healthcare professionals to identify and effectively support people who have the condition.


Edward Mountain (Highlands and Islands) (Con)

I, too, thank Clare Haughey for bringing this debate to the chamber. I had not planned to speak, but, having been prompted by quite a few constituents who have contacted me, I have decided to speak briefly in order to make a plea.

I doubt that there are many of us who do not have a family friend who has had the distressing experience of having a child with an eating disorder. A great friend of mine watched helplessly as their child starved themselves to the stage at which doctors judged their life to be in danger. Despite all that they did, they could not move their child on from their self-destructive actions, which were more about the child’s wish to take control of their life as they felt that the rest of their life was spiralling out of control. Warm words, supervision, support and counselling do not always work, and sometimes it is only when the individual’s body mass index gets so low and their weight plummets that medical care becomes available.

In this week highlighting eating disorders, I make a plea that we do more to support families who are struggling to cope as they watch their child wasting away in front of them. We should tackle the problem head on, with compassion, support and—I stress—early intervention when that is asked for. I am sad to say that I am not convinced that such intervention is as widely available as it should be, especially in rural areas and the islands. I hope that that situation will change and that we can dramatically reduce the average three and a half years that it takes for treatment to be given post the diagnosis of an eating disorder. I give the Government an undertaking that, if it does that, I will do everything I can to support it.


The Minister for Mental Health (Maureen Watt)

I am pleased to be able to respond to this debate on behalf of the Scottish Government. I congratulate Clare Haughey on continuing this Parliament’s long-standing interest in eating disorders. It is disappointing that due to adverse weather conditions, we will not be able to have the reception that Emma Harper had planned to host tonight, although I look forward to it happening on another date. I see that we have some people in the public gallery listening to the debate.

As Clare Haughey said, Dennis Robertson had hoped to be here this evening but he has had to go home because of the weather. As has been said, his daughter Caroline died seven years ago this week, and, as he was the neighbouring MSP to my constituency, I can assure Dennis and others that he has seared eating disorders in my brain.

I welcome the opportunity to mark eating disorder awareness week and it is right that we recognise the efforts of all the people and organisations across Scotland involved in raising awareness and treating eating disorders. The motion recognises the valuable contribution made by Beat, the UK eating disorder charity, and the Scottish Eating Disorders Interest Group; I know that there are many others.

I am in no doubt about the seriousness of eating disorders and the impact that it has on those individuals who live with one, as well as on their friends and families. Emma Harper mentioned diabulimia. As was said, we debated this topic last year, with the cabinet secretary responding. It highlights the importance—I think that Edward Mountain mentioned this too—of health professionals looking at physical and mental health conditions together. Health professionals need to look at the whole person when someone presents with an eating disorder, as it is obviously a mental health condition that has triggered that.

It is the guiding ambition of our mental health strategy that someone should only have to “ask once, get help fast”, and that we must prevent and treat mental health problems with the same commitment, passion and drive as we do physical health problems.

The strategy commits to specific actions to help to improve prevention and early intervention, drive improvement in the quality of care provided, ensure equal access to effective and safe care and treatment, and ensure that services promote and support recovery-based approaches. We will best demonstrate equal access to effective and safe care and treatment by increasing the proportion of people who receive and benefit from treatment for a mental illness.

Several speakers mentioned the stigma surrounding eating disorders, including self-stigma, and the see me campaign, which is funded by the Scottish Government, is instrumental in realising, through its work, the importance of reducing stigma and discrimination. Better identification of and early intervention for eating disorders, together with a reduction in stigma and a greater willingness to seek treatment, will inevitably lead to greater demand. It is excellent that Beat’s campaign this year is called “Why wait?”. Why are people waiting so long to access treatment for this condition? It is important that more people realise what the signs are, and what the actions and behaviours are of people with eating disorders.

The increased demand on services means that we must all work together if we are to realise our ambition for a sustainable health and social care system that helps to build resilient communities. Through delivery of the strategy, we also seek to improve access to psychological therapies and to treatment for children and young people. I admit that there are significant on-going challenges in delivering on the waiting time standards, but I will not shirk that task.

It is important to recognise that we have made progress. As Clare Haughey mentioned, some boards are making significant efforts to drive down waiting times. I assure Mary Fee and others that I am very concerned about waiting times. I am in the process of meeting the chief executives and chairs of the worst performing boards; a few have cancelled because of the weather.

Alison Johnstone mentioned the commitment in England, but that commitment will not come in until 2020. We are working now to meet our “ask once, get help fast” commitment; we are not waiting to start work on it.

Alison Johnstone

My point was that the commitment in England is to a four-week waiting time, which is notably shorter than the waiting time that the Scottish Government is currently committed to. There are many people in the Lothian region, which I represent, who are not getting an appointment within the 18-week waiting time. I appreciate that it will not happen tomorrow.

Maureen Watt

I assure the member that, in many board areas, the mean waiting time is much shorter than 18 weeks. In some areas, it is as short as nine weeks, and some people who are seriously ill are getting help much more quickly than that.

However, I accept that we need to do better, and I am keen to ensure that the work that is being done to deliver improvements at a local level fully reflects the national mental health priorities and ambitions.

As several members have mentioned, the motion highlights the mental health strategy action to develop a digital tool to support young people with an eating disorder. I was delighted to launch that resource earlier today at the Royal Edinburgh hospital and thereby fulfil action 22 in the mental health strategy. I assure Annie Wells that it is available across Scotland. If she visits, she will be able to see what is available. There is one-to-one email support, as well as befrienders, from whom people can expect one to three emails per week, a listening ear, encouragement and signposting. I can give Ms Wells a leaflet on the resource if she would like one.

The resource is funded by the Scottish Government and has been developed by NHS Lothian in partnership with Beat. The technology-enabled care—TEC—programme has also been involved. At the launch, I met parents and people who have recovered, along with many of the child and adolescent mental health services professionals at the Royal Edinburgh hospital who have been involved in the development of the resource. It aims to provide an innovative forum and a training resource to promote early intervention for children and young people, and to support people to manage their own mental health.

We know that, as with most health conditions, quick and timely access to help can make a real difference. We need to ensure that we have services that reflect the digital lifestyles that many young people now have, and I think that the new resource will do that, so I make no apology for repeating what I said at the launch earlier today. The development of the resource has demonstrated the boundless ability of our partners in the mental health system and the third sector, and people with lived experience, to think creatively and innovatively about how we can improve mental health and our response to eating disorders. It is that kind of spirit and co-operation that will help us to achieve the wider ambitions of our 10-year mental health strategy.

I again thank Clare Haughey for raising such an important issue and allowing me to reaffirm our commitment to improving the quality of life for all those people who are living with an eating disorder.

Meeting closed at 17:59.