Official Report 1032KB pdf
The final item of business is a members’ business debate on motion S6M-15868, in the name of Emma Harper, on eating disorders awareness week 2025. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises that the week of 24 February to 2 March is Eating Disorders Awareness Week 2025, and that the theme is that anyone can be affected by an eating disorder; understands that eating disorders affect at least one in 50 people across Scotland, including people of all ages, genders and backgrounds, with anorexia nervosa having a higher mortality rate than any other mental health condition, and that there is a range of recognised eating disorders; further understands that the sooner someone is treated for an eating disorder, the better their chance of making a full recovery, but that people too often delay seeking help due to perceived stigma and misconceptions about who can develop an eating disorder; welcomes the work of Beat, a UK-wide charity supporting people living with eating disorders and their families; understands that Beat continues to provide help across Scotland through funding from the Scottish Government; notes what it sees as the importance of protecting vital eating disorder services during the current fiscal challenges, and further notes the calls encouraging anyone in Scotland concerned about an eating disorder to contact their GP surgery and reach out to Beat on 0808 801 0432 or at beateatingdisorders.org.uk.
18:05
Dennis Robertson MSP led the first debate in Parliament on eating disorders awareness week in 2012, following the loss of his daughter, Caroline, in February 2011; she had been diagnosed with anorexia nervosa. This is what Dennis said then:
“I want people to be aware of the symptoms and get help as soon as they can. I’m trying to ensure GPs and other medics become more aware of the dangers.”
As Dennis said, people need to get help as soon as they can.
I thank colleagues across the chamber for signing my motion to bring the debate to the chamber. This year, eating disorders awareness week runs from 24 February until 2 March. The eating disorders charity Beat provides so much support, and I welcome to the public gallery Alex Jones from Beat, along with members of the lived experience panel and trustees of SupportED. I thank them all for being here.
It is necessary to continue to raise awareness so that, as knowledge improves, better care can be provided. An estimated 1.25 million people in the United Kingdom, and one in 50 people in Scotland, are living with an eating disorder right now. These devastating illnesses can affect anyone of any age, size, gender or background, and they can easily go undetected. We know that the signs and symptoms are not always visible or easy to pick up, but people’s symptoms can include spending a lot of time worrying about their weight and body shape; avoiding socialising when they think that food will be involved; eating very little food, making themselves sick or taking laxatives after they eat; exercising too much; having very strict habits or routines around food; and changes in their mood, such as being withdrawn, anxious or depressed.
Each year, eating disorders week takes a different theme that focuses on the many types of eating disorders. They include anorexia and bulimia nervosa; avoidant restrictive food intake disorder—ARFID—and binge-eating disorders; and variants that are classified under other specified feeding or eating disorders, or OSFED.
Last year’s debate highlighted ARFID, and those in previous years have included a debate on diabulimia, which is a condition where a person with type 1 diabetes deliberately omits taking their life-saving insulin in order to help them to lose weight. Eating disorders have the highest mortality of all mental disorders and have serious medical consequences, as well as risks of suicide.
A lot of work has been done in recent years, and there have been advances in treatments, as well as in tackling associated stigma. Inclusive services have been created to treat all people, regardless of age and severity, with the development of all-age services and early intervention approaches. Last year, the number of children and young people who presented to child and adolescent mental health services and were then admitted to hospital with an eating disorder increased rapidly. Children and young people are presenting to paediatric settings later and are often more physically unwell. In the past seven years, there has been a significant increase in the annual incidence among 10 to 14-year-olds.
The prevalence of anorexia nervosa in the general population is approximately 1 per cent among women and 0.5 per cent among men. It is reported that half of those who meet diagnostic criteria in the community do not access treatment. Bulimia nervosa is reported to have a prevalence of about 2 per cent, and binge-eating disorders a prevalence of up to 4 per cent. The population prevalence of ARFID is not known, largely because it is a relatively new diagnosis and is still not well known.
At the Scottish Government’s request, NHS Education for Scotland has delivered education seminars as a response to the high number of children and young people presenting. That is providing support and learning to staff who work in acute paediatric settings in order to help better support children and young people and their families. I am keen to hear from the Minister for Social Care, Mental Wellbeing and Sport about the uptake of those seminars, including attendance rates by NHS board and by clinician specialty, including general practitioners. It would be good to hear how GPs are engaging with assessment and onward referral for persons who have a suspected eating disorder. It would also be good to hear feedback on the uptake of the Turas online learning platform, especially in rural health boards such as NHS Dumfries and Galloway and NHS Borders.
The national review of eating disorder services in Scotland published its report in June 2021. The “Scottish Eating Disorder Services Review—Full Report” contained 15 short-term, medium-term and long-term recommendations. Subsequently, the national eating disorders network has been established, chaired by Professor Cathy Richards, to take forward the remaining medium-term and long-term recommendations.
It is interesting that the first recommendation related to the Covid-19 pandemic. It asked for emergency funding to
“be provided ... as a direct result of an increase in the number and severity of ... presentations related to the Covid-19 pandemic.”
The recommendation prioritised physical health stability, risk reduction, supporting in-patient discharge and preventing admission to hospital.
Recommendation 4 was to establish a lived experience panel to
“advise the Implementation Group and work alongside the National Eating Disorders Network.”
That recommendation advised that
“The ... panel should include patients, families and loved ones, and third sector representatives”,
with diversity of membership, including representatives of
“all eating disorder diagnoses, men with eating disorders, LGBT representatives and people from ethnic minorities.”
Again, I welcome members of the lived experience panel to the public gallery.
I also highlight recommendation 7, on early intervention, which states:
“Key Stakeholders and Healthcare professionals should be able to identify the signs and symptoms of all eating disorders including at early stages and know how to support and sign post people into treatment.”
The Scottish intercollegiate guidelines network’s guidelines from August 2022 contain key recommendations on early intervention, support for family and carers and achieving and maintaining recovery, as well as healthcare professional training. I remind members that I am a healthcare professional, as I am still a registered nurse.
Beat has developed training for health professionals that has the potential to save lives, and it is free. The Royal College of Psychiatrists recognises how important it is to have guidance across all healthcare settings, and it has created the “Medical emergencies in eating disorders (MEED): Guidance on recognition and management”. That replaces the previous management of really sick patients with anorexia nervosa—MARSIPAN—and junior MARSIPAN guidance.
A lot of actions have been implemented. I am conscious of time, so finally, I would ask anyone who has a worry about themselves or a family member to consider calling the Beat helpline in Scotland on 0808 801 0432 and speaking in confidence to an adviser.
There is so much work being done, and I say to the minister that it needs to continue at pace. I look forward to hearing colleagues’ contributions and the minister’s response.
We move to the open debate. I ask for back-bench speeches of up to four minutes.
18:12
I refer members to my entry in the register of members’ interests. I am a registered mental health nurse and hold a current registration with the Nursing and Midwifery Council, and I am employed as a bank nurse by NHS Greater Glasgow and Clyde.
I am pleased to speak in the debate, which has become an annual fixture in the Parliament, to mark eating disorders awareness week. I thank my colleague Emma Harper for lodging the motion and for her commitment to bringing the subject to the chamber and focusing minds on how important it is.
Eating disorders do not discriminate and anyone can be affected by them. They are serious illnesses that can change, and even end, lives. The eating disorders charity Beat estimates that at least one in 50 people in Scotland are living with an eating disorder, but the real number could be even higher. Disorders such as ARFID, anorexia, bulimia, binge-eating disorder and OSFED are complex mental health conditions. Of course, they affect not only the person with the condition but their family and friends, who can feel helpless and heartbroken as they watch their loved ones struggle.
With that level of prevalence, most of us probably know someone who is, or who has been, affected. That is why the focus of this year’s eating disorders awareness week is that eating disorders can affect anyone, regardless of their age, gender, sexuality, ethnicity or background, and it is not always those whom we might expect. Eating disorders are often misunderstood, mislabelled or undiagnosed, which can prevent people from reaching out for help.
The risk of not receiving support and treatment for any mental illness can be incredibly dangerous, and that is even more true for eating disorders. Together, they are responsible for more loss of life than any other form of psychological illness, and anorexia nervosa has the highest mortality rate of any mental illness. When they are not fatal, such disorders 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.
This year, Beat’s eating disorders awareness week survey showed that four in five respondents answered that they would feel
“more comfortable opening up to others about their experiences if there was greater awareness and understanding of eating disorders.”
Respondents reported fearing
“stigma around saying they have an eating disorder due to misconceptions about who is affected and the lack of knowledge about how eating disorders present.”
Challenging those misconceptions can lead to people seeking help earlier, which can increase their chances of a full recovery.
The topic of stigma frequently arises when we talk about eating disorders; last year’s debate in Parliament underlined that with its focus on ARFID, which is a less well-known condition. In that debate, our colleague Kevin Stewart spoke about the fact that
“one in four people who develop an eating disorder is”
male and highlighted that there is still much work to be done to raise awareness of that fact and change attitudes to ensure that
“no one is afraid to come forward for help.”—[Official Report, 5 March 2024; c 90.]
Since I first spoke on the subject in the chamber, there has been much positive progress. The Scottish Government’s mental health and wellbeing strategy and delivery plan specifically mentions stigma as a phenomenon that requires a sustained effort to tackle. There has also been a national review of eating disorder services; the establishment of the national eating disorders network; and work with those with lived experience. Challenging stigma is not an easy task, especially as eating disorders are, by their nature, associated with deniability, secrecy, stigma and shame. However, to help and treat people and save lives, we must all rise to that challenge.
I again thank Beat for all that it does to that end and for the material that it has provided for this year’s awareness week. I recommend Beat’s website and helplines as a trustworthy, reliable and judgment-free source of support to anyone who is concerned about themselves or about a friend, colleague or loved one.
18:17
I am pleased to contribute to this members’ business debate, and I thank Emma Harper for bringing it to the chamber. As we know from the motion, this year’s eating disorders awareness week, which runs until 2 March, is already under way. The theme this year is that eating disorders can affect anybody. I welcome that theme. I feel that it is vital that the great many misconceptions about eating disorders are challenged as vigorously as possible, especially as public misunderstanding and stigma can often prevent people from reaching out for help. Help is available, but we need to make sure that it is provided across all areas and that there is not a postcode lottery, which does happen from time to time.
Not only can eating disorders affect anyone, but it is often the case that they affect those individuals whom we would not expect to be affected. We are currently seeing many younger people being affected, as a result of portrayals and images of what they should or might look like. We know that, at present, around 1.25 million people in the UK are living with an eating disorder, which equates to more than one in 50 people in Scotland. However, the real number is probably much higher, because many cases go unreported.
Is the member aware of last week’s Radio 4 programme that highlighted that many children, in particular those in secondary school, and especially—although not exclusively—females, are afraid, for various reasons, to use the lavatories and toilet facilities in schools to the point that some of them refrain from eating and drinking for the whole day?
One mother who contributed to the programme said that that had triggered an eating disorder in her daughter, which had very serious complications for her. Does the member believe that the Government should look at that issue when it is consulting on changing the separate and same-sex provision of toilets in schools?
I thank Fergus Ewing for that intervention—he makes a valid point. We are aware that—as that radio programme highlighted—a number of schools are finding that girls are now not using their facilities because of what may happen in those facilities, and that that is having an effect on them when it comes to eating. The Government should look at that, and I whole-heartedly agree with Fergus Ewing’s comments in his intervention.
As I said, eating disorders are underreported, which may be due to people feeling that their GP may not know how to help them with what is happening. We have heard this evening about the charity Beat and the work that it does, which I whole-heartedly support. We know that eating disorders, which come in many forms, such as anorexia, bulimia and binge-eating disorder, as well as lesser-known conditions, are often misunderstood, mislabelled or even undiagnosed.
It is salient to mention that eating disorders do not affect only the person who has the condition. Friends and family often become carers, with many feeling helpless and heartbroken as they watch their loved one struggle with the disorder.
Eating disorders are one of the largest mental health challenges of our time. Such disorders are about so much more than just food—image, social media and many other issues are in the mix. They can also be a coping mechanism for broader and more complicated issues that have progressed. Beat, which was formerly known as the Eating Disorders Association, does extremely strong and positive work in that regard, and its national helpline encourages and empowers people to seek support and advice.
As we have heard, ensuring that individuals get support for their illness is vitally important. Beat also supports family and friends to ensure that they are equipped with the skills to look after their loved ones. In addition, Beat advocates to increase knowledge of eating disorders among healthcare staff and other relevant professionals.
When people have the courage to come forward, it is important that they get the right help in the right place at the right time. I hope that the minister’s summing-up speech will provide the Scottish Government with an opportunity to indicate the position that it is taking, not least as we need to see much more focus on the issue brought to the fore at a national level. We all want to ensure that every individual who has such an issue is supported, and that they and their families can support one another together and live free of eating disorders.
18:22
I thank Emma Harper for bringing this important debate to the chamber again this year. I also welcome the guests in the public gallery—it is great to have them here.
Like other parties, Scottish Labour supports the aims and objectives of eating disorders awareness week 2025 and its goal to raise awareness of how eating disorders can affect anyone. I ask people who need support to seek it, if they can, as the motion says, by contacting their GP surgery, or by phoning the Beat helpline or contacting that organisation through its website.
In seeking to better understand these complex mental illnesses and abolish stereotypes, I thank Beat for its survey, which shows that four out of five respondents
“thought that greater public awareness would make them feel more comfortable to talk about their eating disorder.”
That is an important point, and we in the chamber can contribute to that awareness.
We know that eating disorders affect not only the person with the condition but their friends and family, who can become carers and are often forced to watch their loved one struggle with that battle. Having open conversations can relieve the stigma for families, too, so it is important that we ensure that we have those conversations and reduce the stigma to allow the discussions to continue.
Carol Mochan mentions stigma, which is important. Would she agree that social media is an issue that can contribute to the increased prevalence of eating disorders? Stigma, social media and various other aspects are all tied in and are leading to an increase in the numbers of young children and adolescents with eating disorders.
I thank the member for that intervention—it is a very important point. As the parent of a teenage daughter, I am concerned about some of the things that we see on social media. We all have a responsibility to talk about that so that we can address it.
As we have heard, eating disorders are not uncommon: one in 50 people in Scotland, and many people across the wider UK, are affected by them. We know that, tragically, the impacts can be fatal, and that is why we must raise these issues whenever we can.
I also highlight the issue of age at diagnosis, because that can sometimes be misunderstood. We know that most eating disorders develop during adolescence; however, there are cases of eating disorders developing in very young children and in adults, including examples of adults who develop such disorders well into their later years.
That might be shocking but it acts as a reminder to us all that eating disorders are prominent and serious across our whole population, and that they still have a taboo surrounding them. We know that that is particularly true when men are involved and they feel that they cannot speak about it. Again, that is very important for today’s debate.
As Beat has indicated, it is essential that we, as MSPs, take our role seriously. We need to raise awareness, fight for funding for research and scrutinise the Government’s delivery of full implementation of the plans for eating disorder services. I know that other members have asked the minister to respond to that.
One of the review’s recommendations was to establish a national eating disorder network to oversee implementation of the Government’s plans, and its terms of reference were published in July last year. The network is responsible for co-ordinating training and research implementation, along with improving links between primary and secondary care services. I am very interested in that point. Members will know that I worked in the national health service as an allied health professional, so I am aware of the importance of training and the link between primary and secondary care. Professionals in the network often discuss the importance of training and how we should ensure that people are aware of and can spot the various conditions or build-up across the spectrum to ensure that we can signpost and have appropriate resources.
I am aware of the time, but I want to make it clear that I have been impressed by the speeches in the chamber tonight. I hope that we can continue to have this conversation, because that is what tonight’s debate was about.
18:26
I am grateful to Emma Harper for lodging the motion and for enabling us to have a debate to mark eating disorders awareness week. I am also delighted to welcome representatives of Beat to the gallery this evening. It is lovely to see them here.
Raising awareness is crucial to understanding the significant impact that eating disorders have on individuals and their families and friends. I begin by assuring members and all those who are affected by an eating disorder that the Government continues to dedicate significant efforts and resources to ensuring that anyone who is affected receives the right support in the right place at the right time. We remain committed to improving eating disorder services in Scotland.
I express my sincere gratitude to everyone across the country who works tirelessly every day to support the recovery of individuals with eating disorders and their families.
As we have heard, the theme of this year’s awareness week is about raising awareness that anyone can be affected by eating disorders, regardless of age, gender, sexual orientation, ethnicity or background. Early recognition of the symptoms and timely intervention significantly improve the chances of a full recovery, so raising awareness plays a crucial role in breaking down stigma, empowering individuals to seek help sooner and ensuring that they receive the support that they need.
During the past four years, we have taken significant action to ensure that those who need support for an eating disorder can receive timely access to the appropriate treatment. We continue to provide funding to NHS services and to the third sector, as well as working with people with lived experience to deliver the recommendations of the national review of eating disorder services.
Since the publication of the review’s report, we have made real progress in delivering the short-term recommendations, and work is under way to deliver the remaining recommendations. The recent publication of the “National Specification for the Care and Treatment of Eating Disorders in Scotland” marked a major step forward in improving eating disorder care in Scotland. It provides a clear framework for supporting the NHS and community services in delivering high-quality, person-centred, safe and effective care for children, young people and adults. We will support NHS boards and other partners to implement the specification, aiming to ensure that everyone who is affected by an eating disorder receives the right support at the right time, no matter where they live. That is a crucial milestone in strengthening services, improving outcomes and ensuring that no one faces an eating disorder alone.
We have also established the national eating disorders network to support the implementation of the specification and the remaining recommendations from the review. The network aims to create a more integrated, person-centred approach, leading to better outcomes and ensuring that individuals receive the support that they need. The network launched a series of educational webinars for clinicians to enhance expertise in emerging areas of eating disorder care. For example, the first session focused on the intersection of eating disorders and autism, offering insights to support more tailored and effective treatment approaches. More than 100 people attended that first session in November.
Recognising the value of partnership working, the network has organised regional meetings in the west and south-east of Scotland. Those bring together national health service teams, third sector organisations and private practitioners to share best practice, foster innovation and strengthen joint working across all age groups.
Emma Harper is absolutely correct that it is vital that professionals feel confident in spotting the early signs of an eating disorder and understanding the complexities of the illness, which is a point that other members have raised. There are key areas in which training needs to be improved and where training is already available that needs to be mapped out. Last month, the training on eating disorders in children and young people was updated. It now includes refreshed resources that incorporate role play. I cannot give Emma Harper a breakdown by board, but training was moved to live online delivery during 2020, and that has continued since. That enables equal access to all boards across Scotland, and we hope that they will continue to take up the offer.
NHS Education for Scotland offers a variety of training courses through Turas, which includes family-based therapy for eating disorders, which has been completed by 175 clinicians; cognitive behavioural therapy for eating disorders, which has been completed by 223 clinicians across CAMHS and adult services; and eating disorder assessment and management training, which has been completed by 213 clinicians. Through the funding that is allocated to Beat, we have introduced “Beyond the symptoms” training seminars for GPs and healthcare professionals to support them to identify when a patient has an eating disorder and to confidently intervene early. By the end of the financial year, Beat predicts that it will have provided training to 300 healthcare professionals. That includes people from all 14 health boards, with the highest rates of involvement coming from NHS Forth Valley and NHS Highland.
I am delighted to share that we have significantly enhanced the eating disorder resources on NHS Inform, which is Scotland’s trusted and freely accessible health information platform. Those resources support individuals, families and professionals, acknowledging the challenges of living with or caring for someone with an eating disorder. The resources offer clear and reliable guidance on the different types of eating disorders and their symptoms. Crucially, they highlight that support is available and that recovery is possible. By improving access to high-quality information, we are empowering individuals and communities to take informed steps towards recovery.
I will pick up again on the issue of stigma, because I think that it was raised by every member in their contribution. As I have said before in the chamber, it is the absolute bane of my life. Stigma around mental health issues, including eating disorders, prevents people from accessing the help that is available and to which they are entitled. We all have a collective responsibility to have open and supportive conversations about our mental health with those who are closest to us, with our communities and in our workplaces. That remains a key priority for the Scottish Government, which is why our mental health and wellbeing strategy sets out a vision for a Scotland that is free from stigma and inequality.
It would be remiss of me not to link to my earlier statement, following the recent BBC programme, which highlighted some completely unacceptable experiences of in-patient mental health care. Many of those who were featured in that programme suffered from severe eating disorders. As I set out earlier, we are taking a number of actions, with health boards and the bodies that scrutinise them, to ensure that our most vulnerable young people receive the high level of care that they deserve. I assure members that enhancing mental health services is a top priority for the Government. The core mental health standards clearly outline expectations for mental health services, including those that treat individuals with eating disorders.
I will also highlight some of our wider efforts to improve support. In this financial year, we have provided just under £3.5 million across the west, east and north of Scotland to support the planning and development of regional elements of the CAMHS service specification, which aims to ensure that services meet the needs of all children and families. That includes the development of a four-bed adolescent intensive psychiatric care unit in the west of Scotland, alongside the development of intensive home treatment CAMHS services and regional pathways.
The north of Scotland is leading the development of the regional intensive mental health home support, ensuring treatment closer to home and reducing psychiatric in-patient admission. Those will be vital additions to Scotland’s children’s and young people’s mental health services. They sit alongside the vital work that third sector organisations such as Beat do to support those with eating disorders—work that we are proud to support.
Like others, I use this opportunity to urge anyone who feels that they need support for an eating disorder to speak with their GP and to access the resources that have been highlighted, to ensure that they receive appropriate help as promptly as possible.
I close by thanking Emma Harper again for lodging the motion for debate. I also reaffirm my gratitude and support for all the people who work tirelessly to care for individuals with eating disorders and their families.
Thank you, minister. That concludes the debate.
Meeting closed at 18:36.Air ais
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