Has anyone ever told a teacher 'cos you can't talk to anyone else?" runs a message posted by a teenage girl on the website of the National Self-Harm Network. This is one of the growing number of voluntary groups trying to help the many young people who injure themselves.
Self-harm seems to be reaching epidemic proportions and school leaders are desperate to know how to respond to it. A recent survey by the Samaritans of 6,000 15 to 16-year-old pupils showed that one in 10 had deliberately harmed themselves, mostly by cutting or taking small overdoses.
Other methods of self-harm include burning the skin and pulling out hair or eyelashes. The Samaritans' study revealed that girls were almost four times as likely as boys to self-harm.
Meanwhile, a BBC survey of hospital casualty departments has found that 66 per cent believed that incidents of self-injury were increasing among children and young people. More than 24,000 teenagers are admitted to hospital in the UK every year after deliberately harming themselves.
Experts describe self-harming as a coping mechanism akin to chain-smoking, binge-eating or drinking. It is a response to feelings of extreme stress, anxiety or unhappiness.
"It is a common problem," says Jane Norman,(not her real name) the head of a large sixth form at a comprehensive school in Suffolk. "You can feel helpless and it is vital to know where to get help."
Many heads are reluctant to admit that some of their pupils have harmed themselves. Most of those who talked to The TES asked not to be identified.
It is almost impossible to put figures on the numbers of secondaries dealing with pupils who are cutting themselves, but all involved agree that the practice has increased dramatically in the past few years.
All schools need to have a clear philosophy and a well-organised programme to look after self-harmers, says Paul Strong, head of William Farr C of E comprehensive in Welton, who is chairman of the Lincolnshire Association of Secondary Heads.
Mr Strong believes staff should be trained to recognise the signs. PE teachers, for instance, might be the most likely to spot the scratch marks and scars on pupils' arms.
Mr Strong believes that supporting the friends of self-harmers should be another priority. The Samaritans' survey indicated that 40 per cent of young people told their friends before they injured themselves.
Offering effective counselling, involving the school nurse and getting specialist help are all part of her school's strategy, says Ms Norman. She warns teachers against trying to deal with the problem themselves.
"Staff may feel they can manage it themselves but this is definitely something for a professional," Ms Norman said.
A huge problem for state schools is the lack of expert support available.
"The child and adolescent mental health service is direly underfunded and, in this area,we have only three educational psychologists for 100,000 pupils," says Mr Strong.
His comprehensive has no school nurse, and he has been trying to find funding from the budget for several years.
Lack of official services means more and more teachers and governors are contacting voluntary groups for support.
"We are overwhelmed with the demand," says Katie Foulser, who runs the Self-Harm Alliance, a support group which also runs workshops in schools.
"Teachers are under huge pressure,but if they are well informed it's easier for them to help."
"What schools most want to know is why pupils self-harm, how many are involved and what to do about it," according to one governor at a comprehensive school in a large southern town.
"One of our main difficulties was how to refer pupils for specialist help when parents refused to do so."
Staff and governors at this school were forced to confront such issues recently when there was an epidemic of cutting among teenage girls.
Dr Ann York, a child and adolescent psychiatrist with a special interest in self-harm, says: "Girls share their experiences in the same way that they might discuss getting drunk."
Fans of the alternative bands Marilyn Manson and Slip Knot, may cut themselves in imitation of their rock heroes. Others may be copying events in Hollyoaks, where one character has been struggling with self-harm.
"It's opened people's eyes to harmful habits, but maybe some young people actually have been encouraged to give it a go," says Katie Foulser who acted as a consultant to the series.
The alliance believes that anyone who repeatedly injures themselves needs help. Dr York says that the best thing teachers can do when pupils are copying harmful behaviour is to talk to them.
Ideally, pupils should be linked to appropriate specialist services which will try to help them cope with the underlying problems. This could involve family therapy or cognitive behavioural therapy, where they will learn to change responses to pressures.
Many doctors would like all pupils to be more aware of mental health issues and some schools have now started including self-harm as a topic in personal and social health education lessons. The national curriculum guidelines for key stage 3 say that pupils should be taught "how to deal positively with the strength of their feelings in different situations".
The Bristol Women's Crisis Service, which is extending its support for teenagers, says that young people need to learn ways of looking after themselves and coping with their feelings.
"It could be strenuous physical exercise,writing a diary, painting a picture or spending time with their cat,' said Catherine Lucas.
Schools should develop policies which are sympathetic and flexible, Ms Lucas says. She has come across some where self-harmers are banned from trips.
"It is important for teachers not to make pupils feel even more guilty and disgusted with themselves,'' says Katie Foulser.
Staff at many public schools are being trained in counselling skills.
Liaison with parents is also essential. Sometimes they will not admit there is a problem and refuse to seek specialist help.
"Self-harm can be related to some ghastly trauma at home and parents are often the last people to be constructive," says Jane Norman.
The best approach, say the Samaritans, is to involve parents, pupils and all school staff in a programme which teaches young people better ways of coping.
Joe Ferns, emotional health promotion manager for the Samaritans, says:
"Because of coursework, targets and having to take responsibility at an earlier stage, teenagers are under far more pressure than a few generations ago."
WHERE TO GET HELP
www.readthesigns.org - Mental health awareness campaign for young people Self-Harm Alliance - 01242 578820. www.selfharmalliance.org
National Self-Harm Network - www.nshn.co.uk
Samaritans - Helpline: 08457 909090, main office: 0208 355 1984.
Young Minds - www.youngminds.org.uk. Helpline for concerns about the mental health of a child or young person, 0800 018 2138.
Bristol Women's Crisis Service - Helpline: 0117 925 1119. Main office: 0117 927 9600. Contact Hilary Lindsay for training.
Has just published a Rainbow Journal for teenagers to record their thoughts and feelings, pound;8 but free to under-18s.
Royal College of Psychiatrists - www.rcpsych.ac.uk.CD-Rom, Changing Minds, for 13 to 17-year-olds and their teachers, pound;14.99
www.wiredforhealth.gov.uk - Resources on health for teachers
DOS AND DON'TS
Don't dismiss self-harm as attention-seeking.
Do use strategies which will raise all pupils' self-esteem.
Do ask parents in so that you can give them plenty of background information. Parents of pupils under 16 must be informed .
Do try and encourage pupils to tell their parents .
Do teach pupils different ways of handling stress.
Do encourage young people and their families to seek professional help. If they refuse, the school can write to the pupil's GP or the mental health services, providing staff explain to parents what they have done and why.