 The final item of business today is the member's business debate on motion number 12192, in the name of Dennis Robertson, on eating disorders awareness week 2015. This debate will be concluded without any questions being put, and I would be grateful if members who wish to participate could press the request-to-speak buttons now, please. I call on Dennis Robertson to open the debate around seven minutes, Mr Robertson. I begin by thanking all those members who supported the motion in order for me to take forward the debate this evening. I welcome members to the gallery, who are here from the Diabetics with eating disorders, and members who will be participating in an event this evening in committee room 4 after this debate. Presiding Officer, prior to this debate, I asked myself why I am doing this. The answer is really quite simple. We still need to continue raising the awareness for people with eating disorders within the medical profession. It was once said to me, Presiding Officer, that things only change death by death. I am actually hoping to take a much more positive view on this. I am hoping things change by raising awareness, by awareness, by awareness. Presiding Officer, this is the third time I have come to the chamber in raising the awareness, and I believe that in doing so we have made significant changes. For instance, last year, we were the first ever eating disorder conference held in this Parliament. It was well attended. We brought clinicians together with families, carers, patients, people from the media, colleges, universities, fashion industry, and all had one aim in mind. That was to look at how best we serve those with eating disorders, how best we can make changes in their lives, how best we can resolve some of the problems that face those with eating disorders. In the past, Presiding Officer, I have focused on anorexia for very personal reasons, and perhaps I can come back to that later. I want to look at the whole spectrum—well, maybe not the whole spectrum, but there is a wide spectrum of eating disorders, and those with bulimia nervosa have huge problems in coming to terms with their eating disorders. Quite often, it goes undetected, and people secretly—yes, Presiding Officer—secretly cope with their condition. Thankfully, many more seek medical attention. Before they do that, quite often, much harm has been done to their body. It affects their fertility system. It can weaken their heart. It can damage their kidneys. It erodes the enamel from their teeth. Presiding Officer, it is a dreadful eating disorder. There are not specific eating disorders, and one of them, perhaps, is that related to those with diabetes. Presiding Officer, I have no idea when I first came to this chamber or when I first became aware of eating disorders. I have no idea of those with diabetes and eating disorders. There are five times more prevalent in terms of the mortality than those with anorexia nervosa, which is a shocking statistic to me. It would appear, Presiding Officer, that those with diabetes and eating disorders still do not have a recognised diagnosis. There is no medical name attached to this condition, as far as I am aware. But, hopefully, in raising this awareness and bringing this to Parliament and having an event here and listening to the clinicians and having the minister attend, perhaps we will make some strides forward in listening to their story. Presiding Officer, the chamber is well aware of my own story. It is with sadness that I recall the fact that Caroline died four years ago. Four years ago tomorrow, in fact. When this anniversary comes around, I do ask myself why. And I think I know the answer. It happened because it happened. It's as simple as that. It's not because there was an intervention. It's because there perhaps was the wrong intervention. It happened because maybe we were ill-informed as parents, as Caroline's main carers. However, this is still too often the problem, Presiding Officer. Communication between the clinicians and the parents and the carers is still not at a level that we can have confidence in, that the young person or those with eating disorders are getting the care and treatment that they need. NHS Grampian has had bad press recently, Presiding Officer. But let me give you a good story. A good story from NHS Grampian. They have probably an exemplary service for eating disorders at the moment. Exemplary, but with condition. They have a service that has a fantastic transition from the young person's eating disorder unit to adult services. Why? Because they learnt a lesson. They learnt a difficult lesson. They learnt a tragic lesson. But in saying that, they did learn a lesson. A lesson which needs to be replicated, I think, in other health boards throughout Scotland. And there are good practices. And the Marzipan code of practice, Presiding Officer, should be picked up and implemented throughout the whole of the eating disorder services. Young people going to medical services are not being appropriately cared for. They are not getting the appropriate treatment when they go to hospital. Why? Because the people giving that treatment are not aware of the full implications of the eating disorder. Help is available, Presiding Officer. It just needs to be recognised. We have got better. I think that the GP referral rate is better. I believe that psychiatric services are coming to terms with eating disorders. But resources are few. But let's look at the economic implication of eating disorders. It's estimated in the UK that somewhere between £7 billion and £8 billion is lost due to eating disorders. That is the cost to the NHS or people in lack of employment or those requiring care. Presiding Officer, I don't think that those with eating disorders are asking for too much. But if I said that the NHS Grampian service was an exemplar, it would be if they had the community services to support that of the hospital service. With the integration of health and social care, can I say to the minister, let's look at the intensive therapy treatments that people require in the community with eating disorders. Let's take that step, let's resource that necessary requirement for those, not just the patients and not just the carers, but for the clinicians to provide the treatment that those with eating disorders deserve and need. Many thanks. I now turn to the open debate speeches of four minutes or so, please. I call Malcolm Trism to be followed by Christian Allard. Presiding Officer, I welcome the opportunity to highlight for the third time in this parliamentary term this incredibly serious issue and congratulate Dennis Robertson on his dedication and on bringing forward this motion today. As many in this chamber will concur, he has been a brave voice in making this argument and we must all thank him for his resolute campaigning. Last year's eating disorder conference, which Dennis Robertson referred to, was a significant event that I was pleased to attend. It was significant not only for the academic community and experts but for the many individuals and families who attended and added their own personal story. We were moved by their bravery in coming to this place and sharing what is still a much misunderstood and stigmatised mental health issue. At a clinical level, there have been steps forward in ensuring that GPs have the necessary information to deal with the presentation. As I pointed out in a previous debate, a managed clinical network for eating disorders has been operational since 2005 covering Grampian, Tayside, Highland, Orkney, Shetland and the Western Isles. However, as Dennis Robertson has pointed out in the motion, there can still be complications on the clinical pathway that can be very discouraging for people who are suffering. We must continually reinforce the message that this is a serious mental health problem. When people present, they do so during one of the most difficult periods of their lives. They cannot be turned away and left to retreat back into themselves. Instead, the process of presentation must be made as unintimidating as possible. That starts with an understanding GP who can make a quick and accurate assessment and communicate with families. Again, Dennis Robertson emphasised the importance of that today. As is the case every year, a number of charities have put their best foot forward to raise awareness of eating disorders across Scotland and the UK, none more so than Beatt, who in their 25th year are hosting socket to eating disorders. This yearly event encourages supporters to get silly with their socks and wear colourful, wacky socks for the day and donate £1 to Beatt. It is a light-hearted and highly visual campaign that helps to bring public attention to Awareness Week. However, as Beatt's website highlights, the inspiration for the campaign has a very sad story behind it. I haven't got time to recount that story today, but you can read it on the website. ISD has published up-to-date statistics on the number of presentations and referrals for eating disorders in Scotland. Figures for 2013 show that those who presented to either a GP or a practised employed nurse with an eating disorder are for the majority of 15 to 24-year-old females. That is a trend that has been continuing for many years. Although, as I stated in a previous debate, the number of presentations by young men has gone up recently. UK figures presided by Nice suggest that 1.6 million people in the UK are affected by an eating disorder, of which around 11 per cent are male. However, what is most striking is that this is a mental health problem that is consistently associated with a younger age demographic. Policymakers must acknowledge that when targeting their interventions. A study by Beatt, whose awareness campaign I mentioned earlier, was published on Monday of this week, making the case for a more preventative approach. The in-depth report, eating disorders, a price too high to pay, received 517 survey responses from individuals and carers affected by eating disorders. It identified a need to dramatically increase resources for earlier intervention and indicated how inconsistent access to treatment can be for individuals, leading to a cost to the economy of tens of billions of pounds. Again, Dennis Robertson emphasised that. However, successfully identifying eating problems as soon as behaviour changes are noticed will help to prevent damaging behaviours from worsening over time and becoming more costly to treat. Respondence to the survey indicated that symptoms of eating disorders are first recognised under the age of 16 in 62 per cent of cases. That is an important statistic, as it means that the cycle of treatment, recovery and relapse can cause severe disruption to sufferers' education, impacting on their employment, professional development and lifetime earnings. The effects can last a lifetime and come at a high cost to not only immediate family but wider society. However, early detection can help. Those respondents who sought support at an earlier stage cited a relapse rate of only 33 per cent, compared to an average level of 63 per cent for all those who presented later in their illness. In conclusion, what this report highlights and what the motion before us points out today is that we could be doing better with more targeted early interventions and clear pathways of support for GPs, individuals and carers. At present, the picture before us is still one of a fractured and inconsistent provision, when the cost to the individual and to society is so incredibly high, that is an area that needs prioritisation. On this awareness week, let's join together in recognising the bravery of those who make their voices heard and the hard-working charities that give them support. Let's also look to make the improvements necessary to ensure that fewer people suffer each year that we debate this most important issue in the chamber. Thank you once again to Dennis Robertson for the debate today and all the work that he has done over the period of this Parliament on this most important issue. Thank you and I now call Christian Allard to be followed by Naniot Milne. Thank you, Presiding Officer. As a good friend of Dennis Robertson, I would like to say something he's not very good at, is to blow his own trumpet. So I might use part of my contribution today to do exactly that and I know Malcolm Chisholm did a little bit of that at the end of his contribution. Because it's important, it's important to realise what Dennis has done the last four years. As myself, the man behind the dog for many years, I was in a privileged position to see, to witness how much Dennis has done as a father and as a member of Aberdeenshire West. How much he has achieved over the years. It was four years ago and I remember it vividly. And we talked about it in previous debate and I was contributing to the debate last year. And what I said about it is the little step that Dennis took after the event. Starting with my own academy in West Hill, the secondary school, where he spoke to parents and he spoke to teachers and he really opened it up and made it so important at schools. That's what followed up with confidence, the first confidence in Aberdeenshire in a Portland schools academy, where really that was a meeting of mine for a lot of the teachers and try to progress this awareness, not among the teachers but among the students as well. And thereafter, the opening of the first NHS in patient eating disorder unit at NHS Grampian and we had the privilege, I had the privilege to meet some of the NHS staff and I've got to say, not only they are fantastic and inspiring but they recognize Dennis Robertson as the leading figure in the fight against this absolute disease. And particularly, I love to say that NHS Grampian and the staff are the leading unit. I understand the problem of patients at a different age and I was quite pleased to notice and I would like to go and visit. I didn't have the pleasure to go and visit yet and I did promise I would go. We've got a video therapy unit which is quite interesting because it will help to have direct access to care and to clinic. And sometimes we know that this kind of disorder, you need to tackle them at the right time and you've got to make sure that the services are ready to act. And I was delighted to see that this video therapy clinic works all across the region from Banff, Elgin, Fraserborough, Stony and Shetland and Peterhead, Tariff and Shetland. I thank Mr Allard for giving away, Presiding Officer. One of the things about this job and every other is that if you don't learn something new every day, then you're probably failing in your duty. Would Mr Allard agree with me that the education that Mr Robertson has helped to provide to us as members has been immense in terms of moving forward in tackling eating disorders? Thank you very much to notice me because again it's a praise we have to direct to Dennis. When Dennis said that he had no idea, what is it that he realised is that we had no idea and most of us had absolutely no idea before Dennis Robertson brought it to this chamber and he was honest enough to say he had no idea and what I would like to finish on this, Presiding Officer, it's families have no idea. We can't as a father Dennis Robertson or as a me as a friend of the family, I have no idea what patients are going through and we have to accept that fact that people who are not suffering from this illness have no idea. So we have to see that help and support to families, to friends, to relatives have to be tailor made to make them understand from day one that we have no idea and we need to let the process and the clinician going through what they need to do best. So in conclusion I would like to say again how much admiration Dennis Robertson has in this field and I spoke to Jacqueline Losella, which we both are going to hear tonight and they told me about the great admiration they have for Dennis Robertson. Thank you, Presiding Officer. May I first apologise to the chamber as I'll have to leave before the end of the debate because of other commitments and for the same reason I'll be unable to attend the eating disorder seminar this evening. I'd also like to add my congratulations to Dennis Robertson for once again bringing this very serious issue to the chamber. This debate, which focuses on the prevalence of eating disorders and the serious long-term health conditions which can be associated with them, is the latest in the line of what has become an annual event and I'd like to think that as we go forward awareness of the condition will continue to improve as it has done in recent years. Many people don't associate eating disorders with conditions like osteoporosis, type 1 diabetes, organ failure and other mental health conditions and I commend Dennis Robertson for highlighting this in his motion. The motion rightly emphasises the worrying figures from NHS ISD regarding the number of people in Scotland who ask for medical help or treatment each year. A significant number but one which almost certainly masks the so far unidentified people who have one of the disorders but for a variety of reasons do not seek help. I was aware through previous eating disorder awareness weeks that this has been a very successful campaign right across the UK involving universities, charities, schools, health professionals, local authorities, those affected by eating disorders and individual carers. What I was not fully aware of was the extent to which eating disorders awareness week stretches across the globe, with many states in America participating and also groups in Canada, Australia, Europe and so forth. Perhaps our work as politicians and our participation in debates such as this will assist in seeing an extension of involvement in other areas of the world, thereby spreading the awareness of eating disorders to populations not yet aware of them. In previous debates, I have focused on students moving away from home to an unfamiliar environment, one of the consequences of which can be depression leading to conditions such as anorexia. In another debate, we looked at the influence supermodels can have on girls, particularly teenagers, who feel the need to aspire to such levels of so-called beauty. Again, that can develop into complex emotions of inferiority, manifesting themselves in eating disorders such as bulimia and anorexia nervosa. In the time available to me, I would like to look at another aspect of eating disorders which perhaps does not receive the coverage that it deserves and that concerns the number of men who are affected. Between 10 and 25 per cent of people in the UK experiencing eating disorders are male and the majority of men who have eating disorders struggle to get access to appropriate support and treatment, therefore it is particularly difficult to know how many men are actually affected by the conditions. Often, as with females similarly affected, it is to achieve the body perfect as displayed by footballers and athletes. Persistent use of gyms, not for fun or sport, but to obtain that perfection and slimming to dangerous lengths can eventually lead to life threatening conditions. Only this week's week statistics in Ireland showed a 30 per cent rise in calls to eating disorder health plans which included boys and young men. Thankfully, there is support for males affected by eating disorders through organisations such as men and boys eating and exercising disorders service, which does tremendous support work across Scotland and has bases in my regional cities of Dundee and Aberdeen. One of this organisation's key messages is to make people understand that an eating disorder is a mental health condition and it also aims to remove the stigma that only women and girls are affected. I know that there are many people, particularly parents, who through ignorance or denial do believe that it is a female-centric condition. I would like to end by making a brief comment about eating disorders in men of middle age or later. Although our political persuasions are miles apart, I thought that it was extremely brave of John Prescott when he announced some years ago that he had suffered from bulimia for over 10 years. For a bluff bruiser like him, it must have taken a great deal of courage for him to come forward to help end the stigma of eating disorders and I admire him for it. As he said at the time, I want to say to the millions of people affected, do take advice, it can help and it can help you out of a lot of misery that you suffer in silence. Thank you. Many thanks. Before we move on, could I just advise the chamber that given a number of members who still wish to speak in this debate, I'm minded to accept a motion from Dennis Robertson, under rule 8.14.3, that the debate be extended by up to 30 minutes, Mr Robertson. So moved. Thank you. Is Parliament agreed? We are. I now call Jim Hume to be followed by Rhoda Grant. Thank you, Deputy Presiding Officer, members. Of course, I congratulate Dennis Robertson on again bringing this debate to the chamber and recognise the strength of him in doing so. It's something that we all admire. Eating disorders, recognised by the medical community as mental health issues, are equally as important for the physical health of the individual as for their mental and psychological health. Numbers show that eating disorders are more prevalent among young people and especially girls of up to 24 years of age, with 15 to 24-year-olds most exposed to the pressures that lead to eating disorders. Members were facing a crisis among our youth population, which is twofold. On one hand, what is often seen as societal pressures affecting young people's thinking into dissatisfaction with their physical appearance leads to extreme measures and healthy lifestyles and mounting health problems. As we know, that doesn't just affect physical appearance but causes an obsession over one's own image and slowly deteriorates young people's healthy state of mind. Approximately 2,000 people yearly seek treatment for an eating disorder. That number accounts only for the people who are seeking help and treatment. There lies an unknown number of yet more people, youth in the majority, who have not reported their condition to a close person or a health practitioner. The issues affect us all. As a Scottish society, we are always seeking to improve. We cannot leave behind our youth succumbing to the pressures of unrealistic body shapes. We face with a lack of adequate mental support, seek to take issues into their own hands by harming their physical wellbeing. So what is our role and the role of the Government in providing support for young girls and boys who hold those perceptions of body shapes? How can we expect healthy, motivated and engaged individuals if we don't do enough to provide our support? Not when we realise that someone is suffering from anorexia, but to prevent anorexia from ever happening in the first place. We need to take a firm stand to make children, teenagers and young adults understand that shape doesn't matter. What matters is a healthy body and a healthy mind and show that we are ready and capable as a country of guiding anyone who might be suffering to take the right steps and avoid falling into that spiral of eating disorders. Unfortunately, eating disorders, just like so many other conditions, can spiral into a host of other conditions and diseases. Recently, I heard a quote and that was to say that those who attribute anorexia nervosa to an eating disorder is like attributing lung cancer to a cough. Does the member agree that we should move away from the term eating disorder and actually state what it actually is, a mental illness? Yes, I couldn't agree with Dennis Robertson more than that. I'm quite happy to take that on board. Thank you for that. We have to look at further pressures on mental health and psychological wellbeing. Osteoporosis can happen and anemia and organ failure can and do occur. I think that we want to make it clear that we have to be able to stand by those who need our support. We have also got to enable the availability and flexibility of the most appropriate and necessary resources of our healthcare system to reach those who are in need the most. Both children and adolescent mental health officers are on the side of mental support as well as nutritionists. Nurses and GPs on the side of physical support should be empowered to address those issues before they have to address additional or more serious issues as a result. As the chamber knows, it has been a personal priority to increase the focus on mental health services for young children and adolescents. It is a further commitment that I will seek to work with the relevant bodies and the Government to prevent and protect people from resorting to such issues as the eating disorders that we are talking about. I am sure that support for this action will be across the party and cement our commitment to improving the mental and physical health of all those that we have been talking about tonight. I would like to again thank Dennis Robertson for bringing this debate into the chamber again and for keeping the awareness of eating disorders top-of-the-gender. I now call Rhoda Grant to be followed by Mark McDonald. I want to congratulate Dennis Robertson for securing the debate and also, like others in the chamber, pay tribute to his courage for pursuing the issue. Conditions that make somebody damage themselves are probably the hardest for us to comprehend. What would make someone fight every instinct and damage or even kill themselves while doing so? It is clear that cutting what you eat to the extreme takes a great deal of self-control. Therefore, it is often associated with people who feel that they have lost control of their own lives. It is also prevalent in young people whose lives change quickly and uncontrollably during puberty and growing up. Surely that signals that young people are naturally more at risk. You can see how this loss of control would also be an attribute of developing type 1 diabetes. Those extreme eating disorders are difficult to understand and show that they will be difficult to treat, because the sufferers have already overcome their natural instinct to protect and nourish themselves. There needs to be more understanding of the causes, as well as better research into treatments. There are very few specialist centres, meaning that people do not receive the treatment that they require. There also appears to be an ignorance within the health service as to how they should be treated in the first place. In extreme situations, force feeding might be seen as life-saving, and you can see that that would be instinctive. However, unless you deal with the cause, you are at risk of creating an even more greater aversion to eating by forcing someone to eat against their will. We need to have much more dedicated mental health services for young people with eating disorders, and indeed dedicated services for those who would self-harm as well—something that we are missing. We need to understand those conditions and put in early intervention to help sufferers. It is sad that young people tend to have to leave home, love ones and travel some very great distances to access quality care. I think that that needs to change, because at a time in their lives, when young people are vulnerable, they need to be close to their family and friends. We also need to look at the care pathway. I recently spoke to a group of young people—a group of people called Speak—who talked to me about how they accessed help for mental illness and disorders. They told me that their first line of support was often their guidance teacher at school. That was sometimes very hit and miss, depending on the person who was providing that support. They also told me that there was often no private space for them to make that first approach to get help. Guidance teachers were also often in charge of detention and indeed had to deal with people for bad behaviour, making the setting and indeed the system very difficult for them to access. There is also often a long waiting time for professional help. The target is 18 weeks, but 18 weeks for a young person is an eternity at a time when their brains are still forming and their life chances are being built. Those four months or so can change the direction of their whole lives. In order to help them to receive help early, we also need to speak about those conditions and deal with stigma. Mental health conditions continue to be stigmatised, and that appears to be stubbornly hard to deal with. Unless we have open discussions, we will not deal with stigma at all. Finally, as other people have said, we also need to deal with the pressure to attain unrealistic, thin bodies, digitally altering images of extremely thin models in the first place to make them even taller and thinner, portray bodies that are impossible to attain. That is portrayed as perfection and something that we should all aspire to. We need to stop that and be realistic about what is normal. We need to celebrate the whole spectrum of what is normal. I congratulate my colleague Dennis Robertson on bringing this debate to the chamber. Dennis has brought a number of debates on this very important issue to the chamber, which, as he has highlighted on every occasion, is something that has affected him quite profoundly. It is a great testament to Dennis that the huge amount of awareness that exists in the chamber and in wider society about issues relating to eating disorders and the mental health aspects in relation to that. I want to focus my comments on the issues of diabetes and eating disorders. I spoke with the individuals at the Diabetics with Eating Disorders stall earlier on today. One of the issues that was raised during my discussion was that it is not enough to just focus on the issue around educating individuals on the use of insulin. You are dealing with people who know exactly how to use their insulin and not just how to use it but how to manipulate it in order to affect their weight as a consequence of that. I want to talk about a constituent of mine, Emma, who I first met during my bi-election campaign in 2013. Emma identified as a diabolemic. Diabolemia is a term that is created to represent diabetic bulimia. The condition occurs when an insulin-dependent diabetics skip injection in order to lose weight, and that type of disorder usually affects type 1 diabetics. Young diabetics who already have numerous issues to deal with can realise potential weight loss by skipping insulin, but they do not often understand how they are damaging their bodies as a result. Emma herself had been admitted to hospital on multiple occasions for diabetic ketoacidosis or DKA. Her feeling was that, at the time, that perhaps should have sounded alarm bells and should have led to a deeper understanding of the condition that affected her. After a meeting with Emma and then returning to Parliament following the bi-election, I put down a parliamentary question on the issue of diabolemia. I asked the Scottish Government what guidance it had issued to NHS boards in respect of the diagnosis and treatment of diabolemia. The reply from the minister Michael Matheson said in 2006 that guidance was issued to NHS boards on the management and treatment of eating disorders in Scotland. While diabolemia is not specifically included, we expect that principles and good practice around care and treatment of individuals will be applicable to the cohort of people. To the minister, it may be something that merits some examination. I am aware from the conversation that I had at the Diabetics with Eating Disorders stall that there is now some progress in terms of inclusion within the DSM-5, in terms of the list of identified mental health conditions, but that chronic insulin deprivation or failure to take insulin has not yet been readily identified in its own right. An issue was raised with me about the cohesion between physical and mental health. We often talk about the parity between physical and mental health, and that is absolutely vital. However, there is an element of cohesion when it comes to diabetics with eating disorders, because where you have the physical health of the individual being looked at, but not necessarily the mental health and vice versa, it means that potentially those dealing with diabetics with eating disorders are not treating the individual in a cohesive and holistic fashion. I would ask the minister to have a look at that and see whether there needs to be some update to the guidance or some further guidance in relation specifically to eating disorders as they affect diabetics, because I think that would be very welcome, certainly from my constituent Emma, and I suspect from other diabetics who are affected by eating disorders. Many thanks, and I now invite Jamie Hepburn to respond to the debate. Minister, around seven minutes please. Thank you very much, Presiding Officer, and can I begin by joining with other members to congratulate Dennis Robinson on securing this debate? I think that we all know of Dennis Robinson's personal interest in this matter, and I want to thank him for his personal testimony, which I know must be very difficult for him to come to the chamber and provide it with. Malcolm Chisholm described Dennis as a brave voice, and I certainly would concur with that. I know that he is campaigned assiduously on behalf of the people with eating disorder. As Mark McDonald said, he has raised this issue in part on a number of occasions. I think that it is very important that we, as a legislature, are seen to be debating this issue regularly, not least in terms of raising our own awareness about this. I think that both Mark McDonald and Christian Ard made the point about how better informed they and all of us have been by the work that Dennis Robinson has engaged in. If we mark this year's eating disorder week, it is right that we recognise the efforts of all the people and organisations across the country working to raise awareness of eating disorders. I would like to pay tribute to the dedication and continuing work of all the professional staff and volunteers across all sectors, particularly to those people living with eating disorder and their carers and families in their efforts to tackle the serious and potentially life-threatening illness. I have listened carefully to the range of comments and issues that were raised during the debate. I will try to pick up a number of them as I go through my own contribution, but I certainly want to reassure members of the Government's commitment to ensuring that we are improving care services and support for those who have an eating disorder. Dennis Robinson raised the importance of treatment in the community. Of course, it is important to recognise the vast majority of people with eating disorders will be treated in the community with support provided by primary care or community mental health teams. I should say all NHS boards keep arrangements and services under review and are working towards improved access and outcomes for service users and their families based on prevention, appropriate intervention and sustained recovery. The net mum who I know has left, she could not stay for the entire debate, which she raised concern about people not accessing services. I would say that national guidance and recommendations for the management and treatment of eating disorders in Scotland were published in 2006, Mr McDonald referred to that guidance. The guidance covers general principles, role of the GP and primary care team, specialist services, dietitian training and awareness-raising for staff. We would expect NHS boards and their parts to take account of that against other guidance in the management and organisation of eating disorder services across Scotland. I should also say that we are driving our improvement agenda forward through the delivery of the national mental health and suicide prevention strategies. Those strategies combine to deliver a range of commitments that will impact positively on improving care, services and support for those with an eating disorder and their families. Malcolm Chisholm rightly emphasised that it is an important mental health issue that the Scottish Government views it as such. As the first nation in the UK to introduce a target and ensure faster access to psychological therapies for all ages, it recognises that the positive contribution such therapies can make to treating mental illness and particular eating disorders. The target for NHS boards is that patients get referral to treatment for psychological therapies within 18 weeks. The latest data shows that the average-adjusted waiting time is 8 weeks and 81.4 per cent of people were seen within 18 weeks. Of course, we are working to ensure that that figure is higher. That target complements our priority attention to proving the mental health of children and young people in the 18-week target set for referral to specialist children and adolescent mental health services. The latest data shows that 78.9 per cent of people were seen within 18 weeks, which, again, is not a high enough that we are moving in the right direction. We have an average waiting time of seven weeks. I appreciate what the minister has said. Is the minister able to advise us with reference to those figures in terms of those that are presenting with eating disorders that are being seen and seen appropriately? Does he refer to the 2006 guidance? Minister, several young people have died, and I would suggest that the implementation of the guidance is not universal. Of course, we would certainly expect that any guidance that we issue is taken very seriously indeed by all health boards across the country. In terms of the priority that we are giving to improving access to CAMHS services, because I recognise that that will be important for those with eating disorders, that is an area that we have absolutely prioritised. We have invested in nearly £17 million since 2009 in those services, and we have seen workforce increased by 24 per cent. We have seen some 60 per cent increase in the number of children and young people seen by the service over the past two years. I do not have the exact figures in front of me, but I know that a number— That is the way of that point. Yes, indeed. Kevin Stewart. I thank the minister for giving way. I recognise that things are improving, but there are still difficulties in certain areas, including in NHS Grampian. I wrote to the chief executive of NHS Grampian today and copied that to the minister, because I have some concerns about them failing to deal with things appropriately. I wonder if the minister could comment on what he intends to do in those areas that are not achieving the targets that are set. Of course. I have received that correspondence, and I will respond in due course to Mr Stewart. I recognise that there are some areas that are not performing as well as others. I have instructed my office earlier today, in advance of Mr Stewart having written to me in fact, that I will be wanting to speak to all the chief executives of those areas that are posing a particular issue in terms of access to CAMHS services, and I will be having a discussion with those chief executives as soon as possible. However, the point that I was going to make is that we have seen a dramatic increase in the numbers being seen by CAMHS services, which is in itself a good thing. It is a sign that stigmatisation is reducing and more people are willing to come forward. I say that I am running low in time. Let me comment on a few other areas. I was very pleased to see the recent formation of the Scottish Child and Adolescent Mental Health eating disorder group to help promote service development training and share innovative practice for children and young people with eating disorders across Scotland. We will look to learn from that work and where further improvements are found to be necessary to act. Indeed, I want to focus on the issue of the prevalence of those with eating disorders who also have a diagnosis of diabetes. I will be attending the Parliament's reception after this debate, and I look forward to learning more there. I would say, of course, that the Government has published a Diabetes Improvement Plan, which was published in November of last year. It sets out a range of actions that support people who are living with diabetes. The actions in the plan include a focus on prevention of complications, improving glycemic control, crucially reducing disengagement from services and improving outcomes for disadvantaged and minority groups. I am picking up Mark McDonald's very important point. I should say that, through the Scottish Diabetes Group, we fund the psychology and diabetes pilot project, which has now concluded and we expect the lessons learned from this to be shared appropriately across health boards in Scotland and work is on-going to consider how best to disseminate the learning and outcomes of the pilot and if it is appropriate to update our guidance accordingly, we will seek to do so. I could, of course, say much more. I see him well over time, so I will not do that. Dennis Robertson made the point that things have got better, but I would suggest that we can always look to get better still in relation to ensuring that we are doing all we can to support those with an eating disorder. I will make that commitment to taking forward that work in my ministerial office. I conclude by once again thanking Dennis Robertson for bringing forward this motion for debate. Many thanks minister. That concludes Dennis Robertson's debate on eating disorders awareness week 2015, and I now close this meeting of Parliament.