Do more good than harm
Susannah Kirkman reports
Secondary schools and educational psychologists in Wiltshire are in the vanguard when it comes to offering effective support to the growing number of pupils who self-harm. Guidance to schools on creating their own policies is twinned with imaginative training and better links with other schools and outside agencies.
The national statistics on self-harm among secondary pupils are disturbing; one in 10 injures themselves, according to figures from the Office of National Statistics, while a recent survey by the Priory Group puts the figure at 13 per cent. Oxford university research revealed that of Year 11 pupils who had harmed themselves, 55 per cent had done so repeatedly during the previous year. The problem seems particularly challenging in the UK.
"Our young people have among the highest rates of self-injury in Europe,"
confirmed Nicola Madge, a researcher on an international project into child and adolescent self-harm, co-ordinated by the National Children's Bureau.
"We ought to think very carefully about the stresses we are putting on them and how we can best offer support."
Yet many schools do not know how to respond.
Teachers interviewed for a Roehampton university research project spoke of feeling "fazed, freaked out, repulsed, bewildered, sorry and mystified", when they were confronted with pupils who had harmed themselves.
Professor Ron Best's research found that training for teachers in dealing with self-injury was at best patchy and was generally considered completely inadequate. Worse, there was an almost total absence of the support networks which professionals in social work, psychiatric nursing and psychotherapy take for granted.
In contrast, Bradon Forest school in Purton, Wiltshire, has worked closely with educational psychologists to produce an effective policy and comprehensive training.
Concern was sparked in Wiltshire by the suicide of a secondary pupil and it was swiftly translated into action.
According to Helen Wilkinson, the deputy head in charge of pastoral care, Bradon Forest shared ideas with a working group which included 10 "cluster"
secondaries, the local further education college, educational psychologists and an adolescent psychiatric unit.
"We discussed individual self-harm, research into adolescent suicide, suicidal tendencies, depression and low self-esteem and we shared good practice," said Ms Wilkinson. "We decided there was a definite need for a whole-school approach, training and an awareness of the support systems."
Bradon Forest now has a policy, plus an information sheet for staff on self-harm. All new teachers receive this guidance in the annual staff handbook, and Ms Wilkinson is confident that the message gets through.
"We recently had a new teacher who'd been here only three weeks and yet passed on details of a pupil who was self-harming," she said.
The school policy states that teachers who notice signs of self-harm should follow child protection procedures. Any information should be written on a child protection form and passed to the designated child protection teacher. Depending on the situation, the parents may be contacted. Other sources of help include the school nurse, an educational psychologist, social services or the Child and Adolescent Mental Health Service (CAMHS).
If a pupil is reluctant for their family to know, the school counsellor may invite the parents in and help the student to talk to them.
"Usually our students have good relationships with their families; if not, we will try to bridge the gap, as it's the parents who can give pupils the most support," said Ms Wilkinson.
Nevertheless, staff will encourage families to seek professional help if necessary.
But information is only shared on a "need to know" basis among teachers.
"At a weekly briefing session I might ask staff to keep an eye on a specific pupil without going into details," said Ms Wilkinson.
Every two years, the school runs a course for staff on safeguarding children, which will include advice on spotting signs and symptoms of self-harming behaviour and on appropriate responses. Staff are told to avoid expressing disapproval, anger or disgust, as this will simply reinforce the child's feelings of worthlessness and exacerbate the self-injuring.
Key stage leaders also give specific training to teachers on self-harm, explaining the causes and what action to take. "It's one thing spotting it and another understanding what's going on," said Evelyn Wheeler, head of key stage 4.
The year and key stage heads have their own six-week counselling course and all pastoral staff have specific training in self-harm issues, both run by an educational psychologist. "We learn about encouraging and listening,"
said Ms Wilkinson. "We are supposed to listen, not ask lots of questions."
Staff have a valuable opportunity to offload or seek advice from the school counsellor once a week, and close links with outside agencies are nurtured though twice-termly conferences to discuss any pupils who are giving cause for concern.
Prevention of self-harming behaviour is high on Bradon Forest's agenda; the school counsellor provides a course on building self-esteem for Year 7 pupils who are showing signs of insecurity or poor social skills. The PSHE curriculum also includes work on self-esteem and other factors which promote emotional resilience.
The school has gone to huge lengths to make sure that students understand who they can turn to. A recent questionnaire for pupils showed that they knew where to go for help and would be happy to do so.
Wiltshire's educational psychologists are working hard to extend good practice like Bradon Forest's. A questionnaire revealed that 87 per cent of the schools who responded had noted at least one incident of self-harm in the past five years, far lower than the national average, but still a cause for concern. Only 30 per cent reported any training for staff.
In response, two educational psychologists have written a guide for schools, Adolescent Self-Harm and Suicidal Behaviour. The psychology service is now about to carry out an audit of the provision in all Wiltshire secondary schools.
One of the educational psychologists, Moira Conroy-Stocker, said: "We're anticipating that a lot of schools who want to take this problem seriously will need additional training."
Professor Best warns: "If awareness is not accompanied by training, more harm than good may be done. Where those in caring roles are aware of the sensitivity with which those with self-harm require to be addressed and supported, much can be done to help."
"Adolescent self-harm and suicidal behaviour - a guide for schools" is published by Wiltshire county council, price pound;5.50 including postage.
To order a copy contact Sam Eldridge on 01249 652675 or email email@example.comBradon Forest school can be contacted at: firstname.lastname@example.org
'EACH TIME THE CUTS WERE DEEPER'
Not all self-harm is a precursor to suicide; it may be a response to strong feelings and distressing experiences which are hard to deal with. During adolescence, young people may encounter particularly painful emotional events for the first time. Adolescents who self-harm describe feelings of powerlessness and despair, and say they turn to self-harm to release powerful and frightening emotions, relieve unbearable tension, or gain a fleeting sense of control.
Case studies (with thanks to ChildLine)
JENNY, 12, said that her parents had gone through a messy divorce that resulted in her dad walking out of her life. She hadn't got on with her mother since and they were constantly fighting.
"I started cutting my wrists a few months ago and each time the cuts were deeper," she said.
Jenny said she didn't want to cause any more arguments because she felt there was enough of that in her family.
MARK, 14, said his parents were putting too much pressure on him to succeed. The first time he cut himself was after a row. Then his parents'
constant arguing made him so anxious he kept cutting his arms and legs.
He said: "They make me feel little, useless and depressed."
Where to go for help and information
* ChildLine: www.childline.org.uk; 0800 1111
* National inquiry into young people and self-harm: www.selfharmuk.org
* National Children's Bureau: information on a wide range of activities and initiatives relating to young people and self-harm.
* The Basement Project provides excellent booklets and training.
Particularly recommended: "Working with self-injury: A practical guide"; "Making sense of self-harm"; "What's the harm? A book for young people who self-harm or self-injure". All are written by Lois Arnold and Anne Magill.
http:freespace.virgin.netbasement.project Basement.email@example.com or 01873 856524
* Young Minds - a charity which provides information about all aspects of young people's mental health. Excellent publications and parents' helpline: 0800 018 2138. Main number: 0207 336 8445. www.youngminds.org.uk
* The national self-harm network, for self-harmers, their families and professionals, is at www.nshn.co.uk