 The final item of business today is the member's business debate on motion number 15580, in the name of Dennis Robertson, on eating disorder awareness week 2016. This debate will be concluded without any questions being put, and I'd be grateful if those members who wish to speak in the debate could press the request to speak buttons as soon as possible. I call on Dennis Robertson to open the debate. Seven minutes, please, Mr Robertson. Thank you, Presiding Officer. I begin by thanking all the members for supporting the motion and, indeed, the members who have stayed back this evening in this very late evening in the chamber. This is a historic day for this Parliament, Presiding Officer, given that we have had a, in principle, agreement with the UK Government in our fiscal settlement for the devolved powers. I'm sure that that will take the headlines tomorrow. What I hope is for this evening that at least what I'm about to say will be reported at some point and remain within the agenda, I sincerely hope, of the next Scottish Government. We have seen a great deal of movement within eating disorders over the past five years. That is partly due to the debates that we have had in this Parliament, but to the commitment of the Scottish Government in taking the whole aspect of eating disorders seriously. Accepting that it is mental illness and looking at it maybe from a different perspective than was the case beforehand has helped to bring us much further on. Indeed, I reflect where we were five years ago and where I was five years ago. Five years ago, on 25 February, the date that Caroline died because of an eating disorder, I felt the pain then and I feel the pain now. The pain I feel now is perhaps slightly different because the pain I feel now is not just in terms of the grieving because I miss Caroline very much, as does Ann and her carolines twin sister Fiona. Of course we miss her. We continue to look at trying to establish a pathway so that other people do not have to go through the anguish and the pain that we have gone through at that time. I think that we have made significant gains in that area. What confuses me, Presiding Officer, is when I look at the various websites in eating disorders, and when we are trying to look at providing the best possible care for those with an eating disorder, the confusion is that the statistics and the way we measure is all over the place. For instance, if you look at meat statistics in the London School of Economics and the various other eating disorder statistics, we now realise that there are percentages of, is it 1 in 100 women? Is it 1 in 250 women? What I would say, Presiding Officer, is that, regardless of the statistics, the fact remains that eating disorders is on the increase. It is something that we need to be careful about and recognise because it is on the increase within our younger population. We must address it. I am not saying for one moment that anorexia or bulimia is on the increase because those seem to be fairly stable. With eating disorders with non-specific diagnosis, it is certainly on the increase, including things such as binge eating. What we recognise is that there is peer pressure. Part of that, and what I was interested in was a phrase that came from one of the sites that I was reading, is that eating disorders seem to have become a socially transmitted disease. When I thought about that, I wondered what does it mean. When I looked into the facts, it is about the fashion industry again. It is about this body image and how we see ourselves and how other people perceive what we should be. That is something that we can probably address. As Governments in Scotland and in the UK, we can look at how that imagery is there and what influence it has on our young people. What I want to say perhaps to the minister is that, if we are going to do the best that we possibly can for our young people with eating disorders, we must be clear about what an eating disorder is, we must be able to detect it at the early stages and we must therefore be able to provide the best possible treatment and therapy. The relapse for people with eating disorders just now, Presiding Officer, regardless of therapy, is somewhere between 60 to 70 per cent. That is a relapse of 60 to 70 per cent. That is not good. We still have young people dying. Although, again, I think that that number has stabilised, it is not good. We are going to make the difference. If we are going to do the best that we possibly can, let us think about what we can do. Can we have a system whereby we record our eating disorders? Can we have a system whereby we look at the therapies available? Family-based therapies are certainly available and they are certainly the most effective, but, again, we do not have enough trained specialists. Perhaps some of the mental health monies that we are having that have come across from mental health could be going towards the education of people to give them that expertise within family-based therapies and to treat the eating disorders within the community. I still get emails and correspondence from people who are struggling with eating disorders and their children because they do not know where to turn. I think that we should be establishing, hopefully, whether it be a governmental website or something like that, but certainly the groups that are out there are coming forward. This week, on Friday, I have another eating disorder conference here in Parliament. What I want to say, I think, finally, is that Scotland can lead the way perhaps in looking at—there is no magic bullet. We cannot stop people having eating disorders. We will always have that, but what I want to say, I think, finally, is that this legacy for my daughter is important to me and is important to, I think, every other person with an eating disorder. We need to have a quality service—a quality service that is meaningful to those young people and is there to help the families. It is this family support that is essential and it is the family support that I hope that we can focus on. In the next Parliament, I sincerely hope that the Government will consider having a debate specifically on eating disorders and perhaps even the committee could look at how we best provide services for those with eating disorders. Many thanks. We now turn to the open debate speeches of four minutes, please. A call mark on chism to be followed by David Torrance. This is, I believe, the fourth year that I have had cause to thank Dennis Robertson for bringing discussion of eating disorders to the Parliament. It is a subject of profound importance and this week affords an opportunity to reach out to sufferers to challenge stigma and to make a clear statement that this is a mental health problem with very serious physical and emotional repercussions. Many people in this chamber will know someone who has been drawn into this debilitating and isolating world. Eating disorder often starts as a coping mechanism, a means of exerting control over one's body or of punishing your body until it fits society's predetermined mould. It chips away at a person's life day by day and sometimes it envelops them entirely. We must resolutely challenge any preconception that these are shameful or self-indulgent conditions, and eating disorder is not a phase. Those who suffer have a right to be understood, helped and heard. During that start with prevention, teaching about healthy body images to children from an early age and in schools and helping them to develop a critical response to media and advertising messages. It also means ensuring that educational psychologists in schools and GPs in communities have the resources available to identify children who might be at risk of developing negative coping behaviours. At the same time, information on finding support for recovery must be widely available, helping individuals to find the strength to self-refer to their GP, and when they do, they must receive appropriate and accessible treatment within the target time of 18 weeks. I mentioned just now the need to provide information and support more widely, and the motion rightly notes the excellent work of the Scottish Eating Disorders Interest Group. This is an invaluable resource that both connects communities of interests with professional advice and services and also encourages carers and sufferers to share their own experiences to inform research. Their site allows sufferers, carers and medical professionals alike to become members and to use resources like case studies, useful books and links to relevant websites. They also share details of services in specific areas and offer advice and steps to take when seeking help with referral and recovery. I very much look forward to meeting some of their members at EDaw 2016 Scotland's journey quality eating disorder services, which Dennis Robertson is hosting. This will take place on Friday and will, for the first time, include a specific discussion on males with eating disorders. We must remember that, while that is an illness that predominantly affects women, many young boys and men also find themselves trapped in this seemingly endless cycle and are equally afraid to reach out. I will briefly. Mr Chisholm, for giving way, it is the second year that the conference will look at men and boys. That is immensely important. Dennis has done much to bring that to light. I congratulate the charity Mbeads, which is based in Aberdeen, for the work that they have been doing to highlight eating disorders in men and boys. Thank you for reinforcing that point. Finding the right path to recovery starts with an informed and sensitive GP who recognises the real courage that it takes to present as a patient with an eating disorder. That cannot be emphasised enough. Recovery starts when a person builds up the courage to speak out. The GP is the vital first step. They then direct that vulnerable person to the correct door. In September 2015, the charity CME funded the group Seen But Not Heard, a Collective Advocacy Eating Disorder Project, to produce a GP resource pack about eating disorders. It was called Living with an Eating Disorder, what you need to know. It includes a poster for raising awareness in the surgery, a booklet available in the waiting room for people with eating disorders, as well as a general public to take away, and an information leaflet for GPs and other members of the primary care team. This GP resource pack was developed by people who have a lived experience of eating disorders to produce crucial information that can help GPs to gain a better understanding of how to offer effective, appropriate care and treatment. In conclusion, this is the fourth and final time that I will speak here in support of Dennis Robertson. I do so in solidarity with all of those people, young and old alike, who fight a daily battle with food and a daily battle with the unseen dark force that takes control, wears them down and sometimes does not let go. We must let them know that the battle is not theirs to fight alone. We recognise them this week and every week, and I thank Dennis Robertson again for ensuring that we never forget them. I apologise because, in two minutes' time, I have to be at the divo more parish committee to question David Mundell, so I apologise to Dennis Robertson, the Presiding Officer and the Minister. Many thanks. I now call David Torrance to be followed by Nannette Milne. Thank you, Presiding Officer. I want to join Dennis Robertson in welcoming eating disorders awareness week 2016. In his motion, he highlights much progress has been made over the last five years, both in the terms of raising awareness for eating disorders and ensuring that all patients have access to services they need. I understand that eating disorder week is an international initiative to tackle misconceptions surrounding eating disorders. This year's focus is on the workplace, how colleagues and employees can support someone's recovery. That already shows how complex eating disorders are. Eating disorders affect all aspects of a person's life. Relationships with family and friends, ability to perform well at school or at work and, most importantly, eating disorders can have a serious long-term impact on physical health. I believe that it is also important to know that eating disorders are long-term conditions. Around half of all affected people take six years or more to recover. The majority of patients first experience symptoms under the age of 16. Many sufferers wait more than a year before seeking treatment. According to Beat Eating Disorders UK, around 63 per cent of patients relapse, and the Royal College of Psychiatrists report that anorexia nervosa has a high mortality rate of all psychiatric disorders. What are the implications of those facts, as Dr Robert Dennison and expert in eating disorders have pointed out, is that more action needs to be taken to support early intervention and prevent deaths. Without the doubt, early intervention is crucial. Research has shown that earlier people with eating disorders seek treatment, unless they are to experience relapse and have a greater chance of a full recovery. However, we need to recognise that individuals find it extremely difficult to seek help. Eating disorders seriously affect mental and physical health, and many sufferers experience depression, personality disorder and substance abuse. That is why support is so crucial. Often, such support comes from small, non-for-profit organisations. As an example in my constituency in Fife, Linda Trebo Foundation organises regular support group meetings for people with eating disorders, as well as her families. Overall, there has been many positive developments, but more attention needs to be given to support individuals with eating disorders. Once diagnosed, more needs to be done to ensure that patients receive effective care in hospital, at home, at university or in any other environment. There is also still a lack of services, especially in more rural areas of Scotland. In Fife, the only anorexic and nervosa intensive treatment team, which is part of Strustine hospital, has limited capacity and can therefore not accept all referrals. However, today I also want to take the opportunity to commend the dedication of all NHS staff, GPs and organisations that support people with eating disorders. Treating eating disorders requires the close co-operation of all involved, and the new projects are proving to be very promising. In Dumfries and Galloway, a new approach has been undertaken by local GPs to ensure that patients receive right care, involves monitoring their physical health of people with eating disorders through manual training and specific guidance from a resource path, aimed at identifying and treating eating disorders. Of course, we cannot be oblivious to the fact that these projects require funding, and I am pleased that the Scottish Government is committed to strengthening mental health services. That is important for many reasons. Apart from the human impact, mental health is a substantial economic burden. Across the UK, 725,000 people suffer from eating disorders. Many of those effects note a financial loss due to the detrimental effect that eating disorder has had on their educational development, or if they are already in the workplace at times they need to take off work. As a result, sufferers sometimes become dependent on carers, family members and friends to survive. Beyond the personal cost, treatment costs the health sector between £3.9 billion and £4.6 billion across the UK. Although the economic burden is only a small part of many different effects, people with eating disorders suffer over a prolonged period of time, it is important to acknowledge the commute effect of all the factors involved. As I said in the beginning, diagnosing, treating and promoting long-term recovery of eating disorders is complex. However, there are many indicators to show that the service provides for those with eating disorders continue to develop and expand on a range of treatment options available. The increased access to effective treatment will hopefully provide benefit to all those who most need it. We must continue to support and help both those who suffer from eating disorders and those who seek help. In the five-year term of this Parliament, Dennis Robertson has brought the issue of eating disorders to the chamber on numerous occasions through debates and questions, and I am sure that he should be re-elected so that that will continue. From dealing with the effect on females of mannequins and size 10 models with the body beautiful to the rising problem of eating disorders in young men and boys, we can be proud of continually raising awareness of those conditions, thanks in no small measure to Dennis Robertson's persistent efforts. As an international awareness event that stretches across the globe, eating disorders week has clearly become a fixture in many countries' calendars. The pivotal point of the week is that it helps to bring people together, those affected as individuals, in the medical profession or as carers, and as we all know, many carers are family members. I note that on Friday there will be a day-long conference here in Edinburgh, organised by the Scottish Eating Disorders Interest Group, and hosted by Dennis Robertson. It is organisations like this that do so much to raise awareness of eating disorders, but it is not only conferences that help. There are many fun events such as live bands, pub nights, cake baking and so on, all to raise money for various eating disorder charities. In previous debates, I have referred to the number of celebrities and those in public life who have come forward to talk of their condition. Although I do not watch it myself, I did read about the Emmerdale actress Gemma Oten, who has spoken movingly about her own battle with anorexia. She said that she was doing this ahead of eating disorders awareness week to highlight the bullying that she had endured, but also to demonstrate that eating disorders can affect people from all backgrounds and all walks of life. Gemma also referred to anorexia as a recognised mental health condition, and we cannot reiterate that enough. Sadly, there remains a stigma not only in relation to mental health issues but also to eating disorders as mental health conditions. That stigma is largely brought about through misunderstanding and ignorance, and there remain a significant number of people who believe that conditions such as anorexia or bulimia are largely about individuals with fatty eating habits. That is clearly not the case, and those who suffer from those disorders should be referred promptly for the psychological support and the psychiatric help that they and their families need. One area that requires closer scrutiny is the recognition of eating disorders outwith teenagers and young adults. It is telling that the UK's leading eating disorders charity, BEAT, has chosen as its theme this year eating disorders in the workplace, which will concentrate on the impact that those disorders can have in the workplace and highlighting what individuals, colleagues and employers can do to support someone's recovery at work. The motion makes mention of the Scottish Government's additional mental health spending, and I recognise that there has been a significant investment that will cover the next four years. Additionally, the Prime Minister pledged in January of this year a revolution in mental health treatment, with a commitment from 2018 that all teenagers suffering with eating disorders will be seen within a month of being referred or within a week for urgent cases and additional resources and funding are being made available. The motion refers rightly to the commitment of the Scottish Government to seek improvements in the treatment of people living with eating disorders, but I hope that the minister and members will also appreciate the similar commitment given by the UK Government, because I think that this is one area where there has to be greater co-operation north and south of the border to tackle a condition that, for too long, has not been taken seriously enough by society and its elected representatives. If I got some right, I think that Dennis Robertson hinted about the need for a managed clinical network across Scotland to deal with the various issues associated with eating disorders, and I would be very supportive of such a scheme that would help to ensure equity in accessing treatment for those affected and their families. Finally, as this will undoubtedly be my last speech in this chamber regarding eating disorders, I thank all members who have worked together over the years to improve the lives of the individuals who are involved with what can often be tragic circumstances. I wish them well, and I look forward to hearing about the progress that they make in continuing to raise awareness of those conditions in the next session. I invite Jamie Hepburn to respond to the debate minister's seven minutes. I begin by joining others in congratulating Dennis Robertson for securing today's debate. As in the net, the mill has set out this. It continues Dennis Robertson's long-standing interest in bringing these matters to this parliamentary chamber, and I thank him for bringing this debate before us this evening. I also thank him for speaking very movingly about his own family's personal experience. I know that it cannot have been easy for him to do so, and I do not think that any of us could fail to be moved by him doing so. I think that it is very important to hear about such experience, and it reflects the point that the net mill has made about others who have spoken publicly about their own challenges and their own struggles with eating. I recognise that it is never easy for individuals to come forward and talk on that basis about their own challenges with not necessarily just eating about any form of mental health challenge, but those who do so do as a great service, because it helps to challenge the tremendous issues of stigmatisation that we know still pervade and still exist. Dennis Robertson and Malcolm Chisholm mentioned the conference that will take place on Friday. I am sorry that I am unable to personally attend, but I look forward to hearing some of its outcomes. I am very pleased to be able to respond to the debate on behalf of the Scottish Government. It gives me the opportunity to join others in marking 18 disorder awareness week this year and to recognise the efforts of all those people and organisations across the country working to raise awareness of 18 disorders, including the Scottish eating disorder interest group. I would very much associate myself with the remarks of Malcolm Chisholm earlier about the nature and impact of eating disorder as a serious mental health problem. It might be the last opportunity for him to me to remark on it, so I should take the opportunity to know that he is standing down at the election and wants to pay tribute to the work. The interest that he has shown in mental health over the years and similarly to Nanette Milne, if I do not get the opportunity between now and this solution to pay tribute to the work that she has undertaken in the time that she has been an elected representative. I have listened carefully to the range of comments and issues that were raised during the debate. I want to assure members of the Scottish Government's commitment to doing all that it can to tackle eating disorders and further improving care services and support. One of the issues that were raised by both Dennis Robertson and Nanette Milne raised the impact of the fashion industry. We know that BEAT, which is a UK-wide eating disorder charity, acknowledges that influences are wide-ranging and, although the media and fashion industry do not necessarily directly cause eating disorder, we all agree that their influence cannot be ignored. The Scottish Government helps to fund work to promote mental health and wellbeing, including a positive body image through the benefits of a healthy lifestyle and doubt. There is work under way by that organisation, but let me be clear that I would accept, Presiding Officer, more can always be done and I would call on all those responsible, including retailers in the fashion industry to play their part in tackling unhelpful or unrealistic ideals that can contribute to unhealthy lifestyles. Let me turn to some of the work that has been under way. Our improvement agenda has been driven forward with the last few years through delivery of the national mental health and suicide prevention strategy. We will be publishing a new three-year mental health strategy later this year. I met Dennis Robertson last year to discuss the important issue of eating disorders, a part of the engagement process around that strategy. No decisions have been made on the content of the strategy, but in maintaining continuity with the work that has already been progressed over recent years, some priorities have naturally emerged. I expect a new strategy to focus on encouraging development of new models of managing mental health problems in primary care. I anticipate a focus on child and adolescent mental health and on better responses to distress. There will also be a focus on developing and measuring outcomes for them to be improved. Mental health is broad priorities at present, but there are clear links in there to eating disorder, which will develop the detail of the coming months as the strategy is finalised. There are opportunities for Mr Robertson and any member of that department. Those that Dennis Robertson works with on eating disorders to contribute to the process for the new mental health strategy could include any conclusions from the conference on Friday. I will be very happy for such contributions. It is important to look forward, but also to look back at some of the successes that we have had. I was able to visit Mr Robertson's invitation to visit both the adult and young pupils eating disorder services in NHS Grampian in July last year. I spoke to staff working on the front line. I spoke to families and those who use the service to see it first-hand—impressive care and support, which is delivered the day in and the day out. I saw the Royal College's marzipan guidance being used to better manage sick patients with anorexia. I heard about the wide range of treatments available and the benefits of improved access to therapies, including increased availability of family therapies. It is clear that there is great work taking place in the north-east. I would like to thank Dennis Robertson for arranging for me to visit. Members have talked about some of the funding decisions that we have made. It is part of the significant £150 million additional investment that the Scottish Government recently announced for improving mental health and wellbeing will contribute directly to the aim of working closely with NHS Scotland and the partners to ensure that we offer the best quality of life and opportunity for all people with mental health problems, including those living with an eating disorder. The First Minister announced that, in January, part of that funding—£54.1 million—will go towards directly improving access to mental health services for adults and children. Part of that funding that the First Minister announced is directly related to the point that David Torrance made about the requirement of the point that has been raised as part of eating disorder awareness week, focusing on the need for the responsiveness of the workforce. We need to ensure that the workforce has the requisite skillset and part of the funding that the First Minister announced will be used to improve the workforce supply but also training existing staff to better deliver services for children and young people, as well as psychological therapies for all ages. Malcolm Chisholm spoke about the importance of primary care and general practitioners. Again, as part of the funding that we are at £10 million over the next three years is going directly to improve mental health support in primary care, I would absolutely agree that we need to have a better response to the challenges of poor mental health and primary care. The bulk of the additional investment that will be invested from next year will take time to deliver results, but I do believe that it will make a difference to the man on which we support those with poor mental health, including those who present with eating disorder. Dennis Robertson made a request that we utilise some of the remainder of the funding specifically for eating disorders. I will be very happy to consider any specific proposition. We have not decided how the entirety of the funding will be utilised, so I will be very happy to speak with him further about that matter. I hope that what I have set out demonstrates that there is a great deal of work taking place by partners across all sectors to tackle eating disorders and wider mental health problems. Dennis Robertson expressed hopes that the agenda on eating disorders remains and retains its prominence politically after the Scottish Parliament election. I am confident that that will be the case. That is not a political or a partisan political issue. That is a shared agenda, and I am sure that it will remain high on the political agenda. It is right that we recognise eating disorder awareness week and reaffirm our commitment to deliver on our ambitions for improved outcomes and quality of life for all those living with eating disorder. On that basis, I thank Dennis Robertson for providing us with the opportunity to do that this evening. That concludes Dennis Robertson's debate eating disorder awareness week 2016. I thank members for participating and particularly those who will not be speaking again on this subject. I now close this meeting of Parliament.