 Ydyn ni'n adnwys eu cyfnodiwr miliwn i'r ddatblygu cyfnodiol i Mwysian nhw, ond I2285, ar y cyd-dysgriffeidio cyfnodiol,Exc אותו i ddim ni, i ei ddenni arlaeth ples yn ydym ni wedi ei bod yn ddigwyddrach i ddugwyr hynny. neu'r ddweud i'r ddugwyr sy'n ddim yn ei gweithio gyda'i cyd-dysgriffeidio y cyd-dysgriffeidio cyfnodiol i Mwysian nhw. ond Emma Harper to open the debate around seven minutes, Ms Harper. I welcome the opportunity to lead this evening's debate on eating disorders awareness week, which took place last week, 26 February to March 3. The theme of eating disorders awareness week 2024 is avoidance restrictive food intake disorder, also known as ARFID. This is largely an unknown and misunderstood eating disorder. It can have serious consequences for health if left untreated. The number of people affected by ARFID is unknown, and treatment is not currently available nationwide, with many people with ARFID reporting difficulty in accessing treatment and support both in Scotland and across the whole of the UK. I will come back to this later. I want to start by thanking colleagues across chamber who have supported my motion, allowing this debate to go ahead this evening. I also want to thank Eating Disorders Charity Beat for the excellent work that they continue to do to support those at risk of, or those who are living with an eating disorder. That includes supporting family and friends. Around 1.25 million people across the UK and about 1 in 50 people here in Scotland currently live with an eating disorder, and the numbers have increased during the Covid-19 pandemic. Types of eating disorders include binge eating disorder, bulimia anorexia, other specified feeding or eating disorders, which is also known as an osfed, avoidant restrictive food intake disorder, and that is what we are discussing today. Another very dangerous eating disorder is diabolemia. That occurs when people with type 1 diabetes deliberately omit their insulin to control their weight. Eating disorders have high mortality rates, with anorexia having the highest mortality rate of any mental illness, and 1 in 6 people with a binge eating disorder have reported trying to end their life. People with eating disorders typically develop severe physical health problems, and overall quality of life has been estimated to be as low as in symptomatic coronary heart disease or severe depression. With early intervention, many people become unable to participate in education or employment, however recovery is possible. Access to the right treatment and support is life changing, and early intervention provides the best chance of recovery. The key symptoms of eating disorders include excessively worrying about weight and body shape, avoiding social situations where food may be involved, frequently visiting the toilet after meals for prolonged periods, and not even being upfront about the food a person may be consuming. It is important for family members, friends and colleagues to be aware of those signs. However, research has shown that there is a link between eating disorders and depression, low confidence and low self-esteem. Today, I want to specifically describe again this year's theme, arford. Arford is a condition characterised by the person avoiding certain foods or types of food having restricted intake in terms of the overall amount eaten or both. Beat has experienced an increase in requests for support for people living with arford, and one of the people impacted by arford, Harriet, summed up the impact of arford when she said, and here's her quote, "...a lot of people thought I was just being picky, and friends would often get very offended when I went round to their houses for dinner and I wouldn't eat anything. Less than five people outside my immediate family knew about my condition, and when I explained it wasn't to do with losing weight, but it was because of anxiety." She was told to get over it. This example from Harriet shows exactly why we need to put the spotlight on arford, so people are aware of it, so we can break down the stigma and support people to access treatment. People with arford can be of any age. Arford is linked with anxiety, ADHD and autism. People with arford may be sensitive to taste, texture, smell or appearance of food or even the temperature of the food in front of them. In March 2021, the Scottish Government completed a national eating disorder service review. The national eating disorder service review includes a total of 15 ambitious recommendations focused on ensuring that all those who are affected by eating disorders receive timely and appropriate care and support. Those recommendations include better co-ordination of national activity and data collection and the national availability of self-help resources that should be available to everyone at any stage of life in Scotland and a focus on early diagnosis with the aim of prevention. It is welcome that the implementation group was set up to review the timescales and cost of implementation of the recommendations and that three subgroups were created—a training group, a standards group and a data group. One of the key policy asks of BEAT is that for the 15 recommendations to be implemented in full, so would therefore be grateful if the minister, in her response, could provide an update on the implementation of the recommendations and comment on when they will be implemented in full. My office contacted NHS De Fries and Galloway ahead of this debate and specifically spoke with the dietetic team. The team has a specific dietitian who works and focuses with those people living with or at risk of developing eating disorders. I heard that because of the rurality of De Fries and Galloway, some people who are at risk of developing a eating disorder may not be picked up as easily or may be reluctant to access support because of the travel involved in attending appointments but also because of the stigma around eating disorders, which many people report feel ashamed to even access treatment and support. While the situation has improved through the move to virtual appointments, there still exists an issue that people are ruraly in accessing eating disorder support services. We need to continue to support that. I would ask that the minister ensure that rural areas are included in the approach moving forward. I would also press on the Scottish Government to ensure that it is part of the mental health stigma reduction strategy that eating disorders are included and that all possible action is taken to combat eating disorders stigma. Anyone with an eating disorder who thinks that they may be at risk of one can access judgment-free support from BEAT. Those helplines are free to call from all phones. Anyone affected by an eating disorder can call, email or contact BEAT's helpline advisers via a one-to-one web chat. That includes families, carers and anyone else who provides support to someone with an eating disorder. People can call the following number 0808 8010432 or email BEAT at scotlandhelp at beat-eating-disorders.org.uk. The helplines are open from three to eight seven days a week 365 days a year. In conclusion, I appreciate the opportunity to again lead this important debate. I reiterate my ask for the minister for further detail on when the recommendations of the review group will be implemented. I also again thank BEAT eating disorders and all the NHS staff across Scotland for the vitally important work that they do each day. I look forward to hearing the contributions from other members this evening. I thank my colleague Emma Harper for bringing this important debate to the chamber, and also to BEAT, an amazing organisation that has been amplifying the voices of those dealing with eating disorders for many years and to provide us with information on lead on eating disorder awareness week 2024. However, I want to make a special mention of ARFID UK, the UK's only charity dedicated to raising awareness of avoidant restrictive food intake disorder. She'll eat when she's hungry. If that was my kid, she'd clear that plate. If she doesn't eat it, heat it up again and give it to her for breakfast. You're spoiling her and you're making a rod for your own back. Just get her tilt. In my day, a scalp is what you would have used to fix this. She's just been picky and you need to put a stop to this fussy nonsense. Presenting comments such as these made me dread interacting with anyone as a family unit when food was involved, as they became ever more clear that my youngest was developing a serious aversion to the majority of foods that we all enjoy on a daily basis. I can trace it back to the moment as a three-year-old that she choked on a homemade chicken nugget. She went from enjoying a variety of foods to tolerating a handful almost overnight. There was a distinct link to anxiety and sensory issues and what we later understood to be neurodiversity. At times, her food intake was limited to only a couple of items, mostly beige and carbohydrate in nature. Our GP advised us after a year that she had selective eating disorder and that there was not a lot that we could do except offer her a wide variety of things in the hopes that magically one day she'd start to eat again. This approach often caused more harm than good in retrospect as new foods were seen with such suspicion and with terror that anything relating to eating had any scintilla of enjoyment removed leaving a highly distressed child and two highly distressed parents. We stopped eating out. I dreaded parties and social events when I knew well-meaning folk would try to coax her into trying to their lovely prepared food whilst casting aspargions on our parenting abilities with passive aggressive comments. In a sea of judgment, my mum was the only person who kept saying to me, Alana, if the way in is only going to eat your lentil soup and bread and nothing else, just feed her that with a smile and love and ignore what everybody else thinks it's just background noise. My child stopped eating at school when she was not allowed to bring in crackers and peanut butter, one of her staple safe foods due to the risk of allergies for other children. After protracted negotiations, she was allowed to have vegetable soup and bread from the canteen and would not be forced to eat a main course, maybe 200 calories that most would see her through the school day. She avoided the canteen totally whilst she still attended secondary school, as the smells and the noise of people eating overwhelmed her. At nearly 16, she has now a slightly longer list of safe foods, including her much-loved plain uddon noodles and bubble tea, but we often lose some of these when recipes change or when something is no longer made, or she has eaten it every single day for a whole year and just can't face it anymore. She is slight and she's often exhausted. I'm presenting officer, the health services still don't really know how to help her or the thousands of other young peoples living with ARFID. I know that the Scottish Government has a special focus on eating disorders and I hope that the minister will say a wee bit about how they plan to help those like my Sophie. We must ensure that every layer of our health service, from health visitors to GPs and carm services, understand the needs of those living with ARFID. We also need to educate the public and our public services, including our schools, so needless pressure and guilt stops being laid at the feet of parents who are doing their level best just to get enough calories of any kind into their children. That is far more serious than the fussy label that they are often saddled with. I thank Emma Harper for securing the debate to mark eating disorder awareness week. I know that I speak for everyone here when I say that it is vital to take these opportunities to raise awareness of this cruel and complex mental illness. As policy makers, the better informed we are, the better we are equipped to make decisions to help sufferers and their families to get the help they need. I also want to thank Beat, the charity behind so much of the effort that goes on into supporting those who are suffering, and we are honoured to have them supporting today. Going back to the point about awareness, it is even more important than usual this year. That is because, as today's motion sets out, the theme for this year is ARFID, which is short for a avoidant restrictive food intake disorder. Despite being a serious condition that can have a severe effects on sufferers, it is not widely understood. That need for early and sustained intervention is one thing different eating disorders have in common. It is concerning to hear from Beat that, despite an increase in calls to their helpline about ARFID, they are hearing how sufferers are struggling to get the help that they need. No doubt that that is partly down to a lack of awareness that I have discussed, but Beat also points to a lack of standardised treatment pathways. They are calling for better access to intensive outpatient treatment, noting that it can achieve similar results to inpatient treatment while avoiding admitting people to hospital. That is not only preferable for the patient but for the NHS. I urge the Scottish Government to ensure that every health board has the resources needed to offer that treatment model. In particular, I cannot help by thinking about NHS Tayside in my own north-east region. Speaking with constituents, I know the struggle they face trying to access support, and NHS Tayside themselves have admitted their CAMHS waiting list is likely to get longer. I would also like to highlight the issue of calorie labelling on menus, which was the theme of last year's Eating Disorders Awareness Week. Having formerly worked with the Healthy Living Award, the benefits of a balanced diet cannot be overstated. From our fruit and vegetable intake to high-fibre foods and protein, nutritional value is paramount. In my view, calories on menus are a blunt instrument taking into account one metric in terms of nutrition. The minister knows that for individual suffering or recovering from eating disorders, this policy could cause immense harm. I would appreciate an update on the Scottish Government's thinking in this area, either now or in closing. Overall, when it comes to eating disorders, warm words will not cut it. We need investment in treatment services and staff recruitment. We need to fund more research and public awareness campaigns. We need to get the national eating disorder network off the ground and ensure that calories are not on menus. I know that ministers take this issue seriously, so I urge them to now give action to their convictions. I now call Jackie Dunbar to be followed by Carol Mawchen again around four minutes. I congratulate my friend and colleague Emma Harper on securing this debate on this very important subject. I would also like to take the time to commend Elena Whitham on her very moving personal contribution. It is very welcome that, during eating disorder awareness week 2024, we have this dedicated time in the chamber to speak at length about it. In this year, in particular, where the theme is avoidant restrictive food intake disorder, or ARFID for short, raising awareness is absolutely key. Awareness that ARFID is real, awareness that it is not just in your head and awareness that, if you have any sort of eating disorder, then there is help out there for you. When, ahead of this debate, I searched ARFID as well as when I searched eating disorder awareness month, I was particularly pleased to see that the first thing on Google was not a result. It was just a line, help is available. Underneath it, it said, speak with someone today, beat eating disorders and then followed a range of helplines along with other contact information. That sends a message to folk that I hope that it is a message that gets to them, that they need to see it because those helplines and the beat website are some of the best places you can look to get help. If you go to Beats website, where, among so much helpful information, details of where to get support, training resources and so much more, there is a section titled Your Stories. One of those stories, Frankie's story, outlines exactly why this year's theme of ARFID is so important. So let me share some of Frankie's story and I quote, I didn't realise I even had an eating disorder until I discovered the ARFID page on Beats website. I felt so scared of food for a long time and yet because I wasn't worried about my weight, neither me nor anyone else could pinpoint why I had felt like this. It had been suggested I had PDSD or OCD, but nothing quite explained the way I felt about food. When I finally found out about ARFID, you might think a diagnosis would have scared me more, but the truth is I had a name for what I was feeling and I found out that it's actually really common. My eating disorder means that I'm scared of eating in case I'm ill and doesn't relate at all to my body image physically. It was really hard when I had this diagnosis later by a professional too, but at least with my diagnosis I could now put into words and share my experiences with people in my family. Frankie goes on to say that living with an eating disorder is really tough, it makes everyday harder and overthinking comes into play at all times. I'm still in the process of recovering and whilst I'm so thankful for everyone who's helped me over the years, I also want to say well done to me. So let me finish up on a similar note to Frankie. Well done to Frankie for their progress and for openly talking about their ARFID to help raise awareness. Well done also to Beat for all of the excellent work they are doing across Scotland to support folk and to raise awareness. And to anyone who is worried about an eating disorder, whatever it is, whether it is ARFID, anorexia, bulimia, stress eating, something else or you're just not quite sure. Well done for recognising that and please consider offers of help that are available from Beat and from elsewhere who can't support you on your journey to overcoming this. Thank you. Thank you Ms Dunbar. I now call Carl Mawchen to be full of a Kevin Stewart around four minutes. Miss Mawchen. Thank you, Presiding Officer. I also thank Emma Harper for bringing this really important debate to the chamber and to everyone for their contributions. I think it has been very interesting to listen to all the different contributions this evening. Like other parties, Scottish Labour supports the aims and objectives of eating disorder awareness week, which, as we've heard, was held from 26 February to 3 March with the particular focus on avoidance, restrictive food and take disorder. As we've heard, avoidance, restrictive food and take disorder is more commonly known as ARFID and it's a condition characterised by the person avoiding certain foods or types of foods having restricted intake in terms of overall amount eaten or perhaps both. It can be someone of any age, of course in children, teenagers and adults. Although people with ARFID may lose weight or have low weight, as we have heard in the last contribution, it's not a criteria and it can occur when people have no necessity to think about their weight. As we have already heard, eating disorders are not uncommon when 50 people in Scotland and the wider UK are affected by them and we know that tragically their impact can be life-changing for the individual and, of course, their family and friends and, sadly, sometimes fatal. I think that it is good that the chamber does quite rightly at times focus specifically on eating disorders and I know that many of the members here this evening and in my research other members across the chamber put frequent questions to the Government on this issue and it's quite right that we should do that. Today we are focusing on the experience of a condition that we know very little about and in my reflections on thinking about the debate, I thought to myself how last year we were able to, for instance, produce some statistics which told us about one in four people who experienced eating disorders are men and one in five of those men had reported that they struggled to talk about these things. It is different this year that we are talking about a little known condition. We are unable to make that clear in terms of how many people are affected and I think that this is important and it is why we need to raise this in the chamber so that we can talk about things that perhaps people find that they are unaware of or that they are being untreated. My first indication about this disorder was a caught the end of a television programme which was a mother who was talking about how she had been quite frantic trying to get a diagnosis and even she felt dismissed although her GP was kind and trying to be helpful it was kind of dismissed. So that was quite shocking to hear but it does act to remind us that eating disorders while they are both prominent and serious they can also continue to have that taboo in particular when people feel they have a condition difficult to diagnose difficult to discuss and difficult for health professionals to understand. So can I thank be for their helpful website which has been discussed before and would reference to people to that because it does tell you a bit about the condition. We have had quotes from people about what it feels like for people suffering from this condition and Eleanor with them very helpful told us what it was like to be a family member so I'm not going to go over that just in terms of time but it was most helpful but just to conclude I think it is essential we as MSPs take seriously our role in raising awareness and fighting for funding for research and for scrutinising the government and delivering services and that's why it's important we bring this debate to the chamber and we have the minister here to respond and I look forward to the remarks from the minister on where as other members have said eating disorder the eating disorders plan is going within Scotland just now thank you Presiding Officer. Thank you Ms Malkin and I call the final speaker in the open debate Kevin Stewart around four minutes Mr Stewart. Thank you very much Presiding Officer and I commend Emma Harper for bringing forward this now annual debate to mark eating disorders awareness week and as always I'd like to pay tribute to my friend Dennis Robertson who kicked off these debates because these debates allow us to raise awareness about eating disorders and the terrible impact that they can have on those who are diagnosed and on all of us who have family, friends and loved ones who live with an eating disorder. As has been said this year's eating disorder awareness week has a focus on avoiding restrictive food intake disorder and we have heard that ARFID is a condition characterised by the person avoiding certain foods or types of food having restrictive intake in terms of overall amounts of eating or indeed all of that. I'd say that Ms Whitham in a very powerful speech has gone into some real depth about the difficulties that people face but I want to reiterate a point that has been made before and one that cannot be repeated enough. ARFID is not fussy eating. It is not fussy eating and we have got to get away from some of the old fashioned ideals that are still out there. I know that the Scottish Government has a commitment to ensure that people with eating disorders get the support and the treatment that they need. As a minister, I established the implementation group to drive forward the recommendations that came from the national review that took place in 2021 and I would be very grateful if the minister in her contribution could provide us all with an update on where the Government is in delivering the 15 recommendations that came from the review. I would also be obliged if the minister could give us an indication of where we stand on data collection, the status of the national eating disorders network and to comment on whether the Government's resource allocation is meeting the demand on services, including the vital services that are provided by BEAT. In last year's debate, Presiding Officer, we heard that one in four people who develop any eating disorder are men. I said then that for men we need to get the awareness right, change attitudes and we need to reduce stigma further so that no one is afraid to come forward for help. I am not convinced that we are getting this right yet for men. Unfortunately, I am hearing of more men and boys who are suffering and who are not getting the help, support and treatment that they need and deserve. I urge the minister to look at what can be done to run an anti-stigma campaign with a greater focus on men and boys so that those folks are not afraid to come forward for the help and treatment that they deserve. Once again, Presiding Officer, I would like to thank Emma Harper for bringing forward the motion for debate for the many powerful speeches that there have been today, particularly that of Elena Wattam. I do hope that the minister will address the points that I have made in her speech, which we are yet to hear. I welcome the annual debate to mark eating disorder awareness week. It is really important to raise awareness about eating disorders and the substantial impact that they can have on those affected and their families and friends. I thank Emma Harper for lodging the motion this year and for focusing our minds on just how significant the subject is. I want to assure Emma and all members across the chamber this afternoon that this Government is committed to supporting people with eating disorders, including ARFID, to get the right support at the right time. We recognise that our early diagnosis is absolutely vital in treating an eating disorder. It is essential that someone who is diagnosed receives a thorough assessment and gets the right care and treatment for every aspect of their illness as soon as possible. I want to extend my thanks and appreciation to everyone across the country who works day in and day out supporting the recovery of people with an eating disorder and their families. As we have heard today, the theme of this year's eating disorder awareness week is ARFID. Now, if left untreated, ARFID can have very serious health consequences like weight loss, poor nutrition or both of which can impact on growth and development in children and poor health and adults. ARFID, as we have heard, is not an easily recognised condition, but BEAT has reported a significant increase in people who are seeking help. That is why I am pleased to be providing BEAT with over £600,000 this year alone to provide a range of support services for those people who are impacted by an eating disorder, including a range of self-help and peer support groups. This partnership continues to be successful and individuals who have been using BEAT services say, as we have heard from across the chamber tonight, just how important it is to have access to a range of support throughout their recovery. Now, before I go on to talk about the work that we have undertaken specifically to improve eating disorder services, it might be helpful for me to set out some of the wider policy context. As many of you will be aware, last year the Scottish Government published our new mental health and wellbeing strategy, an associated delivery plan. The vision set out in that strategy is for Scotland free of stigma and inequality, where everyone fulfills their right to achieve best mental health and wellbeing possible. Within the delivery plan, actions include the establishment of a national eating disorder network, as well as the publication of a national specification for eating disorder care and treatment. I will come on to talk about both of those pieces of work in more detail. Over the past three years, we have taken significant actions to ensure that those people who require support for an eating disorder can receive timely access to appropriate treatment. That includes providing funding to NHS services and to the third sector, as well as working with people with lived experience to deliver the recommendations from the national review of eating disorders services. Since the review was published, we have made a really positive way to deliver the remaining recommendations, including developing a national specification for the care and treatment of eating disorder services in Scotland, which is due to be published later this year. Work is also under way to establish a national eating disorders network, and I was delighted to appoint Professor Cathy Richards as the chair of the network. The network will support the delivery of the specification and the remaining recommendations from the national review. To bring us back to the theme of eating disorder awareness week, we have heard that ARFID is a complex condition that is not easily recognised and often presents with other mental health conditions and neurodivergence. I want to assure members that improving mental health services is absolutely a key priority for me and this Government. There are clear standards outlined in the recently published core mental health standards that apply to all mental health services, including those that treat someone with an eating disorder. I want to use this opportunity to urge anyone who thinks that they may need support for an eating disorder to speak to their GP to ensure that they can access the right help as quickly as possible. As I said, to pick up on some of the specific points that were raised in the debate, we have made real progress as Emma Harper and Kevin Stewart both asked on delivering those recommendations. Later this year, as I said, we will be publishing national specifications, and we have made progress in establishing the national eating disorder network. I am very happy to continue to work with them to make sure that they are updated on the progress on these issues. On the rural question, Emma Harper will be aware that there is a subject very close to my own heart since I also represent a rural area. We know that specialist treatment in remote and rural areas is difficult and that is why during the Covid-19 pandemic we were pleased to see the expanded use of digital appointments and other technology across Scotland. The national eating disorder network and the implementation of national specification standards will welcome remote and rural health boards working together to provide specialist care and treatment to their population. The network will definitely take that into consideration moving forward. On stigma, I absolutely agree. I have said before in this chamber that stigma is the bane of my life because it prevents people from accessing the care and support that they require. We need a sustained effort to tackle stigma, including providing disorders, particularly the less well-known eating disorders. Members will be aware that we have paused before making a final decision on mandating calorie labelling, but that has gone ahead in England, so we have the potential to learn from what has happened in England before we implement any changes in Scotland. I am sure that Maurice Golden would also welcome the CAMHS data today, which showed really sustained improvement on access with all but one of our health boards having eliminated long waits and a performance restored to the better than pre-pandemic levels, frankly. I certainly welcome it, and I am sure that members across the chamber would welcome that very much. I thank Emma Harper for lodging the motion for the debate this afternoon. I also want to reiterate my support and thank the staff who have been working tirelessly throughout to care for people with an eating disorder and their families. Thank you. Thank you very much indeed, minister. That concludes the debate, and I close this meeting of Parliament.