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Listen in, speak out and never give up

Although awareness of mental health issues is growing and the stigma gradually lessening, young sufferers continue to miss out on the help they need. Henry Hepburn asks what schools can do

Although awareness of mental health issues is growing and the stigma gradually lessening, young sufferers continue to miss out on the help they need. Henry Hepburn asks what schools can do

Anxiety and eating disorders took hold of Laura Caven when she was 15. When she stopped turning up to classes, her teachers dwelled on her attendance record. "The first question was `Why aren't you at school?' not `Are you OK?'," she recalls.

But Caven, now 26, is not bitter. Her school's ability to help was undermined because she did not want to share what she was going through. "If I had been more open perhaps there would have been more support, but I didn't feel I could be. I was worried about the future - I wanted to go to university."

A little over a decade ago, at about the time Laura was starting to struggle, Scotland began making a concerted effort to lessen the stigma around mental health. The See Me campaign hit the media with the message that one in four people will suffer from mental health difficulties. That statistic now trips off the tongue almost as easily as the mantra about five fruit and veg a day, with a crucial difference: one campaign tells us only that a problem exists, the other tells us what to do.

Well-meaning mistakes

The Lauras at school today can expect better understanding of their troubles. But unhelpful and potentially dangerous misconceptions about how to help still exist. Earlier this month, See Me convened a national event in Dunblane to draw a line under its first decade and identify new priorities.

"We've done a lot of work to shift public attitudes and increase awareness - what we really need to do now is change behaviour," says programme director Judith Robertson.

The widespread outrage over Asda and Tesco selling "mental patient" and "psycho ward" costumes last Halloween shows how far public attitudes have come, Robertson says. But even well-meaning people can fail to spot signs of mental distress or make poorly judged attempts to help.

Caven warns that questions such as "Why are you so upset when you've got so much going for you?" can be counterproductive, as "people feel guilty for feeling so bad - it invalidates what they're feeling".

No matter what the intentions of the speaker, if their words sting the impact on those they are speaking to can be devastating. "It can be the difference between a slow and quick recovery, or between life and death," Robertson says.

No one is sure exactly how many children in Scotland suffer from mental health problems, but the Behaviour in Scottish Schools 2012 report found that primary and secondary teachers felt there had been an increase in severe cases. A 2011 report from Her Majesty's Inspectorate of Education, entitled Count Us In: mind over matter, estimated that in a school of 1,000 students, 50 would be seriously depressed and 100 would be suffering "significant distress". According to Heather Sloan, a health improvement lead for NHS Greater Glasgow and Clyde, research suggests that two students in every secondary classroom will have self-harmed.

Since 2012, a See Me resource, What's On Your Mind?, has been used to lead students aged 12 to 15 through activities that simulate the isolation of those suffering from mental health problems. One exercise, Piggy in the Middle, puts students in groups of three, with two ignoring the other, to demonstrate what it feels like to be excluded.

As a result, attitudes are slowly shifting, according to See Me campaign development officer Mandi Cliff. Initially, 55 per cent of teachers and youth workers disagreed with the statement "Young people who cut themselves are selfish and attention-seeking". But by 2013, after the resource had been implemented, this had risen to 65 per cent.

Cliff believes that mental health education should now be introduced in primary schools, with a more general focus on feelings and emotions.

See Me has been bolstered by pound;500,000 in annual funding from Comic Relief for three years (in addition to the pound;1 million it receives annually from the Scottish government). With this money, it aims to fuel grass-roots activity, notably through "change networks". These groups will share geographical areas or common interests, and in some cases could be entirely comprised of young people. They will use their experiences to create new approaches.

Schools have become fairly good at responding to students in crisis, says Isabella Goldie of the Mental Health Foundation. But she believes they must become more pre-emptive, exploring mental health issues across the curriculum by, for example, covering mental as well as physical health in PE or using story time to deliver messages about well-being to primary children.

Helping to combat self-harm

Sloan, meanwhile, says that teachers need more help from education authorities, adding that not every council has a self-harm policy for schools. NHS Greater Glasgow and Clyde has put together On Edge, a resource designed to meet demand from teachers for help on the issue. It confronts the belief that self-harming young people are trying to kill themselves. In fact, that is often far from the truth.

"It's a coping mechanism," Sloan says. "These young people don't necessarily want to end their lives. It's how they're dealing with what's going on in their lives. Generally, it's about staying alive and keeping safe."

And for teenagers, safety comes from places that adults would not necessarily expect. According to Goldie, panicky media coverage of cyberbullying and pro-anorexia websites obscures the fact that the online world is hugely important for young people with mental health problems. They may be reluctant to be referred to a middle-aged GP, but they can remain anonymous online and feel more in control.

"They are saying, `This is our world, and actually there's a lot of good out there,'" Goldie says. "It tends to be only adults who talk about the risk and pressures in online forums."

Teachers and classmates need to be open and persistent if they want to help sufferers, says Caven, who now works as the mental health campaigns officer at the National Union of Students Scotland.

Schools should make it clear that students can open up to anyone they choose to. "Sometimes you don't want to speak to your guidance teacher because you have them for another subject," Caven says. "A lot of the time you've got an assigned teacher, but that's not how relationships work."

Some attempts to help may be rebuffed. At one time, Caven says she would have "bitten the head off" anyone who mentioned food or weight. But she is absolutely clear that no one should give up. "If someone says `I'm going to stick by you, I'm going to keep chapping your door until you answer' - people just don't realise the impact that positive words can have."

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Case study: Gemma Welsh, 23, councillor in East Dunbartonshire

Fifteen is a difficult age for most people, but I was dealing with extra problems. I couldn't sleep. I had lost my ability to learn. Things I used to love I didn't do any more. I felt numb, but every now and then my emotions would flood back, leaving me confused and terrified. I was suffering from depression and started to self-harm.

At school I learned that I should exercise and eat five portions of fruit and vegetables a day to keep my body healthy. But I didn't learn a thing about mental health. It wasn't until my mum announced that she was taking me to the doctor that I realised I might be unwell.

The stigma around mental illness made me petrified that people would find out. I'd heard friends laugh and joke about self-harm, and talk with disgust about attention-seekers who had nothing to feel sad about. This stigma meant that, for a while, I missed out on support that could have helped my recovery enormously.

Thankfully, I had a few friends I could trust and I built up the courage to share what I was going through. It felt like the weight of the world was lifted off my shoulders. I can't begin to explain how key it is to have friends and family to support you in the process of recovery.

I completed cognitive behavioural therapy and could see things were getting better, but I continued to self-harm. It was like a crutch that was there when I needed it.

In my second year of university I couldn't concentrate. When I tried to study, the words jumped up and down until I couldn't understand a thing. I was missing deadlines and classes, making excuses not to see friends, spending days on end in bed and not eating. I was in a horrible place and considered taking my own life.

I went to see a GP, who let out a long sigh and said, "Well, your hair is clean, your clothes are clean - I don't think you're depressed." I felt my heart sink. I went home and wondered if maybe this was how I would feel for ever. I thought, once again, that I would be better off dead.

A loyal and persistent friend came over, and I have no doubt that she saved my life by doing so. She convinced me to see a different GP who thankfully took me seriously. I started a course of antidepressants and therapy, which got me to where I am now.

I am no longer depressed and I haven't self-harmed in nearly three years. But the stigma is still there. I have been told that I shouldn't be revealing a "weakness" in public and that it will make people think less of me and affect my career prospects and reputation. Do I take any heed? No.

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