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How best to support troubled teenagers

Adolescents are, almost by definition, moody, truculent and difficult. But the standard adult response to unco-operative teenagers is to shake your head and wait for them to grow out of it.

Now, though, teachers and mental health professionals say it is not just abused, self-harming or under-eating adolescents who require specialist help. Many average teenagers also need counselling to cope with the transition to adulthood.

David Trevatt, a specialist child and adolescent psychotherapist, says some pupils find the tribulations of growing up harder than others.

"A lot of children can be fearful about the whole process of physical development," he said. "Some can't wait to grow up, but others take refuge in a very childlike relationship with their parents. There are a lot of fears there: are they going to be successful? Attractive enough? Able enough?"

Mr Trevatt works at Open Door in north London, a free counselling and psychotherapy service for anyone aged 12 to 24. Behind an anonymous shop front, sandwiched between an Italian restaurant and a designer interiors shop, Open Door operates a self-referral system: to arrange an appointment, pupils must contact the centre themselves.

Specialist psychotherapists discuss problems such as difficulties with friends, stress, self-harm or pregnancy. Weekly sessions can continue for up to two years.

Under the Every Child Matters guidelines, organisations such as Open Door should be working with schools to meet the full social, emotional and academic needs of pupils. The "be healthy" aim requires that pupils not only live physically healthy lives, but also are mentally and emotionally healthy.

This is intended to pre-empt self-destructive behaviour, such as drug- taking, truancy or the recent mass teen suicides in Bridgend. Several of the "be healthy" goals, such as sex and drugs education, can be easily incorporated into the existing personal, social and health curriculum. But for many teachers, meeting pupils' mental health needs is the hardest challenge of all the five aims of Every Child Matters.

Philip May, head of Costessey High in Norwich, Norfolk, believes teachers are often limited by lack of knowledge. Many simply do not realise that organisations such as Open Door exist in their area.

"The biggest problem is that teachers don't do as much as they could because they don't have easy access to other organisations," he said. "So staff unknowingly can be doing the wrong thing.

"They should be able to say, `I don't know much about this problem, so I can't help. But I know someone who can.'"

Mr Trevatt said: "There are a lot of issues around adolescence. Teenagers look to peers as a substitute for reliance on their parents. But that can be troublesome for people who feel isolated, feel that they don't have the right friends, or fall out with their friends.

"It's the nature of adolescents to become more independent. Some manage, but others become totally withdrawn. They lack confidence to move away from their parents at all. They need support to be able to function as adults." In many schools, attention is focused on pupils who misbehave, disrupting lessons. But unhappy pupils often remain quietly attentive and go unnoticed by teachers.

Growing numbers of schools are appointing pastoral managers or heads of year who can dedicate time to dealing with pupils' emotional concerns. But other teachers can struggle to know when to step back from pupils' problems and refer them elsewhere.

Ros Curtis retired recently from John Hampden Grammar in High Wycombe, Buckinghamshire. While head of sixth form, she often found herself counselling pupils through emotional crises. "I've waded in where I shouldn't have," she said. "One boy's girlfriend was expecting a baby and he came to me saying, `You'll have answers. Help me'.

"Teachers tend to have an I-can-fix-anything sort of attitude. But adolescents are often in such tangles. You straighten out one bit and pass them on. You need to know when to step out."

Open Door psychotherapist Nicole Wyvill believes specialist counsellors should step in at exactly such points and provide what schools cannot.

She said: "We have a different way of listening. We also understand where they are emotionally. We're trying to look more deeply."

Many government-run mental health services can be forbidding to teenagers, who are reluctant to be stigmatised as "mental". Open Door receives funding from two local boroughs, but is independently run. "A lot of young people worry that they'll be seen as failing or mad," said Mr Trevatt. "But we're just a shop front. People can get in touch without the taboos associated with a formal setting."

Mr May, of Costessey High, would like to see organisations such as Open Door based at or next to schools so that teachers and therapists can liaise informally and pupils can be easily referred.

"Schools aren't trying to take over the world," he said. "But children spend a lot of time there. So teachers could be more help if they could say, `This person works down the corridor'. There would be a better awareness. People would be looking at the whole young person.

"We're a long, long way from the ideal at the moment."


The main health aims identified by Every Child Matters are for young people to:

- be physically healthy;

- be mentally and emotionally healthy;

- be sexually healthy;

- live healthy lifestyles;

- choose not to take illegal drugs.

Actions inspectors expect include that:

- parents and carers receive support to keep children healthy;

- healthy lifestyles are promoted;

- children's physical and mental health is promoted;

- children are enabled and encouraged to take regular exercise;

- environmental health risks to young people are identified and minimised.

The Government's targets include:

- a reduction in the percentage of obese children under the age of 11;

- a reduction in the death rate from suicide and from undetermined injury;

- a reduction in rates of pregnancy and sexually transmitted diseases among under-18s;

- a reduction in average alcohol consumption, harm caused by illegal drugs use and the percentage of children smoking;

- an increase in the percentage of children eating five portions of fruit and vegetables a day.

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