It began soon after moving to secondary school: a sudden rise in expectations, a gnawing pressure to fit in and unbearable fears about her mother's cancer all took their toll. Trapped by circumstances seemingly beyond her control, Connie began to hurt herself.
"At first I didn't feel like self-harm was a problem and shunned anyone who tried to help," she says. "Years later, I found myself stuck in a cycle of self-harm and it was terrifying."
Sadly, Connie is not alone. A recent World Health Organisation study reports that as many as one in five English 15-year-olds have self-harmed. The charity YoungMinds claims that UK hospital admissions resulting from self-harm increased by 68 per cent from 2001 to 2011, and the Royal College of Psychiatrists states that the UK has one of the highest rates of self-harm in Europe. The ATL and NAHT unions have both raised concerns that recent budget cuts have left schools less able to support young people.
Self-harm takes various forms including cutting, burning, scratching and hitting body parts. Young people self-harm for a myriad of often complex reasons, such as academic expectations, body-image pressure and bullying by peers.
Rather than "attention-seeking", as some people seem to believe, self-harm is often used as a distraction from emotional pain. It can become a habit, a haunting necessity that is hard to confront alone. It is often a young person's friends who form the crucial support network.
"Since I refused to speak to my parents about it, my main support came from my friends," Connie says. "A few were happy to listen but others decided we could no longer be friends. Early on, support from my school was limited. I was told, `People your age just don't do things like this.' "
The school's response may seem shocking but it is all too common. Barbara McIntosh, former national head of children and young people's programmes at the Mental Health Foundation, says this is all the more distressing because schools can play a pivotal role in helping such students. "Friends can be the most important factor but the school is also central," she says.
Here are some of the things that schools can do, in the short and long term, to make a difference to vulnerable young people and ensure that students like Connie are properly supported.
Spot the signs
Some young people who self-harm may openly disclose issues; at other times you will be able to see the evidence. But many fear losing their sense of control and will go to great lengths to hide their problems.
Caroline Harroe, director of the Harmless support group, says teachers should look for signs of distress in the young people they teach. "Notice if a young person appears isolated or behaves out of character," she advises. "Listen to friends who may express concerns. Above all, always be open, honest and direct. If you encourage young people to talk, they will talk."
"Take time to listen to the young person, without fear or judgement," Connie says. "Be aware that your reactions may influence how much a young person decides to disclose to you. It is not helpful to show shock, disgust or anger when talking to young people about self-harm."
Harroe adds: "Schools should respond to the distress. Don't respond to the harm. Don't express shock at the physical signs. It's better to ask, `How are you feeling?' "
Put students in control
"Young people who self-harm often feel they lack control, so ensure they take charge of their recovery and any procedures as much as possible," Harroe advises.
Although those procedures will vary according to the circumstances and degree of risk to the child, once you have established that a student is self-harming, it is recommended that a member of staff discusses with them what he or she wants to happen. Schools can elect to work with the young person or refer them to a counselling service. It has to be left to the student to make the decision on how to proceed.
Assign a member of staff
Connie's school eventually became more supportive, and two of its tactics in particular were extremely useful. "I had a designated teacher to talk to, and near the end they agreed that I could attend school part-time," she says.
"Schools should allocate a member of staff who the young person gets on with, and it should be made clear when this member of staff will be available."
Connie continues: "There should also be a space where the young person can go if they are feeling distressed. This was an issue for me as I often wandered down corridors and even out of school when being in the classroom got too much."
Be aware of issues at home
Connie explains how, initially, self-harm put a strain on her relationship with her family. "In the early days, self-harm created a rift between me and my parents, but now my mum is brilliant," she says. "When she notices me getting low, she keeps calm and suggests we do something to distract me."
Some schools contact parents in advance to explain what they will do if a child is found to be self-harming and state whether or not they will maintain confidentiality. The National Institute for Health and Care Excellence (Nice) publishes guidance that encourages those supporting young people who self-harm to "balance the developing autonomy and capacity of the young person with perceived risks and the responsibilities and views of parents or carers". Nice emphasises the need to foster a young person's autonomy "wherever possible".
Create a comprehensive policy
"Each young person is an individual and the reasons behind self-harm - and what will help - may be very different from person to person," Connie says.
"Schools should have a clear policy on when to involve parents and medical professionals, but young people should be given as much choice as possible in the process."
That policy should be informed by data about current levels of emotional well-being within the student body (McIntosh advises that school leaders use this questionnaire).
"Train all staff - teachers, teaching assistants, dinner ladies, caretakers - to identify struggling students," McIntosh says.
Harroe adds that the policy should have clear guidelines and expectations about what staff should do. Explanations of the causes of self-harm would also help to challenge the stigma and myths that surround it, she says.
Bring in outside help
School leaders will want to use the skills of their staff, but they can also call on the assistance of external agencies, which are only too willing to help. Harroe says: "Not all schools have the capacity to support young people who self-harm so it is beholden upon schools and organisations to work together".
Focus on prevention
"Young people need to develop self-management for emotional well-being," McIntosh says.
"One way to do this is through the curriculum, although not exclusively through a PSHE programme. In science, for example, students might not only learn about Marie Curie's great discoveries, but also how she overcame the challenges to her own well-being to make them."
You can also use the testimonies of people like Connie, which can be a very effective way to educate young people about self-harm. Charities such as Harmless also have a wide range of resources available to teachers.
"To young people experiencing difficult thoughts and feelings, I would say hang on in there - things can change for you, even if they have been tough for a long while," Connie says.
"If you reach out for help and you aren't happy with the response, don't be afraid to ask to see someone different. Keep asking and asking until you feel comfortable.
"Get creative and try as many alternatives to self-harm as possible; you never know what might work. And don't give up - there are sunsets to stare at, cookies to crunch and life to be laughed through and lived."
Tobias Fish is a secondary school English teacher in Cambridgeshire
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