“Three students this academic year, and two of them within the Easter term.”
Joan* is a headteacher at a secondary school. What she has just referred to is the number of pupils who have tried to take their own lives at her school since September.
“The mental health of my young people is not as secure as it was when I was working 10, 15, 20 years ago,” she says. “It’s getting worse and worse.”
Exclusive: Self-harming pupils turned away four times in CAMHS crisis
Joan’s experiences provide a disturbing snapshot of the mental health crisis engulfing young people, and the impossible demands this is placing on schools.
Two cases involved overdoses. The third case involved a youngster who “self-harmed so badly that they actually got a knife stuck in their leg”.
The circumstances of the three pupils were all “slightly different”, Joan says. One of the students is believed to watch “some really dark things on the internet”. But Joan points out that “there are probably loads of other kids as well who are like that” at her school who have not acted in the same way. She says childhood trauma and a history of depression were factors in the other cases.
These aren’t the only incidents the school has had to deal with. A child in Year 8 tried to take their own life during the summer holidays. “We have, shockingly, a Year 7 boy who has got an online friend who keeps telling him to hurt himself. Even though Mum keeps taking the phone off him and stuff like that, they keep finding a way to communicate.”
The NHS is 'overwhelmed'
While harmful online influences appear to feature in a couple of these cases, Joan says there’s nothing that otherwise obviously links the suicide attempts. Asked what is behind the deterioration in young people’s mental health, her best guess is it’s because the NHS is “overwhelmed” and “can’t cope”. There are no “preventative measures” to catch young people before they get seriously unwell.
Joan says young people’s mental wellbeing is the worst she has seen during her 25-year career. The closest precedent she can recall was a period about 10 years ago where there was an “awful lot of self-harming” among girls and “almost everybody seemed to have scratches on their arms”.
Reflecting on the current situation, she says “it just seems a little bit out of control”. “I don’t know whether we’re going through something where it just seems the most logical solution if they’re having a bad time.”
Mercifully, the students at Joan’s secondary all survived. However, each of them returned to school a few days later with no additional clinical support. Joan puts the students on the waiting list for children and adolescent mental health services (CAMHS), but this is not a solution in itself.
“CAMHS can only do something about it if the parents and the children engage,” she explains. “The minute a parent decides to have a strop and takes them out, or the child doesn’t really want to talk, that’s it, they just cut them off.” The waiting lists are so “huge” that CAMHS will cut families off “really quickly” in these circumstances, she says.
Those who stick it out can languish on the waiting list for months or even years. “By then they’ll be 16, 17, 18, they probably won’t get to see CAMHS. They’re going to be in that awful gap between child and adult.”
Self-harming 'not extreme anymore'
One sign of the pressure on CAMHS is the rising thresholds to qualify for support. “These days if you’ve got a child that’s self-harming – and it is just self-harming, they’re not trying to take their life – they are so far down the list of priorities. It’s just not extreme anymore, it’s not one of those things that rises to the top…The thresholds have moved and moved and moved.”
To Joan, it sometimes feels like the system is designed to trip people up. “When they’re phoning the crisis team, it’s a different person every time and they have to explain again what’s happening. For our parents they’re really intimidated by it, you’ve got to have an awful lot of resilience to get through the system, and think, 'I’m going to sit on the phone all day'…It’s like the entire system is made for failing.”
It’s not surprising that many parents give up trying to get outside help. They take the attitude “They’re my kid, I’ll look after them”, Joan says. It’s laudable, but misguided, she feels. “Your child is properly ill. It’s like you’re saying, ‘He’s got cancer, I’m going to look after him’”.
The school is happy for the young people to be back in school once they’ve been discharged from hospital, to help them regain a sense of normality. But Joan is conscious they “need additional support” which her staff are just not equipped to deliver. “I’ve got no one trained for that sort of level – I mean, that’s not mental health first aid, that’s proper crisis care, you need proper therapy.” She has teachers working to support vulnerable children, but their caseload is “horrendous”. “They’re just so busy – I could employ another 10 and they’d be all busy by the end of next week.”
'They're the ones we know about'
Perhaps the most worrying thing for Joan is that she only finds out that one of her students has made a suicide attempt if the family decide to tell her. “If there’s been domestic violence in the household, the police are really good, we’d normally know within 48 hours,” she says. “If there’s been a suicide attempt or something like this we don’t know, we don’t get the same alerts from the NHS.” She thinks some sort of “referral service” is imperative. “Health isn’t what we do, but we work with young people and we need to know how they are.”
Without such information sharing, Joan is left with the lingering fear that this is just the tip of the iceberg.
“What scares me is they’re the ones we know about because the families told us.”
*Not her real name