Angst that can kill

A joined-up approach to mental health is picking up early warning signs of suicide and self-harm among vulnerable youngsters in East Renfrewshire, writes Henry Hepburn

A SCOTTISH local authority is believed to be the UK's first with common guidelines for approaching the widely misunderstood issues of suicide and self-harm among young people.

East Renfrewshire's approach sees five counsellors from Renfrewshire Association for Mental Health working across the authority's seven secondary schools, which have 7,500 pupils.

Senior youth counsellor Wendy Kinnin said: "What's special is that anybody who comes into contact with a vulnerable young person has a clear method to approach that person. There were child-protection guidelines before, but it was difficult to get everybody working to the same outcome."

The guidelines, designed to reduce waiting times for those aged 11-18 seeking access to mental health services, were drawn up with educational psychologists, social workers, mental health workers, teachers and support staff. Miss Kinnin said she had found no similar authority-wide guidelines elsewhere in the UK.

Most in counselling are seen at school - young people said they preferred to talk to someone in confidence at school - which has resulted in 85 per cent attendance at sessions. Similar services based outside schools are more likely to experience 50 per cent attendance.

By the end of the last academic year - the service emerged from a 2003 pilot - there had been almost 400 young people assessed, and 56 were found to have medium-to-high levels of risk. Of these, 25 had not been previously identified as at risk. One was even working on a suicide plan and date, but was helped to deal with the difficulties identified and is now at university.

"It can be the case that someone is enveloped by their suicidal thoughts, but will appear normal - perhaps isolated and withdrawn, but able to put on a good display of functioning," says Miss Kinnin.

Anyone can make a referral - including other pupils - and each leads to assessment. This is important, as those who self-harm are far more likely to tell friends first than their parents or another adult.

The sesssions are confidential and, in most cases, the only adults aware of them would be the counsellor, senior counsellor, guidance teacher and a senior member of school staff. But families are automatically contacted where serious risk is identified - unless to do so would put the child at further risk - as are GPs and social workers.

"We work on the basis that confidentiality is not absolute, because we have to give priority to child protection and duty of care."

There was initially scepticism about the service among teachers, especially the level of confidentiality, but Miss Kinnin said feedback was now uniformly positive. One deputy head said the service, which is funded by the Scottish Executive, was a "wonderful resource to have, and means advice and guidance is immediately on hand".

Another respondent said: "Knowing someone is in school who has the skills and expertise in this area gives staff a huge feeling of support."

The service has also helped overcome persistent misconceptions about suicide and self-harm.

"There is this myth that if you talk to young people about suicide, they will go away and try it," said Miss Kinnin, explaining that externalising thoughts about suicide often made it less likely.

She emphasises that self-harm and suicide can be separate issues. Some people self-harm to relieve stress but do not have suicidal thoughts, although there is the possibility of killing themselves by mistake; some girls take paracetamol to reduce their anguish, not realising that an overdose could be fatal.

Key statistics

In 2004, 99 people aged 15-24 died by suicide or suspected suicide in Scotland. (Source: Choose Life)

Suicide is the second most common cause of death for a young person.

(Source: Choose Life)

One in 10 children aged 5-16 has a clinically diagnosed mental disorder.

(Source: Office of National Statistics)

One in 10 young people self-harms. (Source: Samaritans)

One in three girls aged 14-16 self-harms. (Source: Edinburgh University)

Warning signs:

Actual talk of suicide or death.

Dropping out of usual activities.

Isolation from family or peers.

Refusing help, feeling beyond help.

Making a will.

Giving away favourite possessions.

Offering verbal clues about wanting to die.

Sudden improvement of mood and outlook after period of being very sad and withdrawn; the child may have come to a decision about ending his or her life.

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