Following the murder of schoolboy Adam Regis earlier this month, and 10 years after the deaths at Dunblane, Nick Morrison looks at the role of counselling.
It was Monday lunchtime and a group of teenagers gathered by the side of the road. They bowed their heads and stood in silence for a minute before slowly moving away. They had come together to mourn their friend, Adam Regis, who had been stabbed on that spot less than 36 hours earlier.
The schoolboy's death, on his way home from the cinema, devastated his friends and teachers at Kingsford Community School in Beckton, east London.
Joan Deslandes, headteacher, said: "The whole school community is extremely saddened and shocked by the news of Adam's death."
After the initial shock comes the grief and its attendant emotions: among them, misery, rage and despair. Adam's death earlier this month, one of a number of knife-related killings in London this year, has put renewed focus on ways of trying to deal with these feelings in schools that have experienced tragedy - particularly counselling.
It has fallen in and out of favour many times. At one time, it seemed no trauma was complete without a debriefing session. Then, in the early 1990s, it lost popularity. Stripping bare your soul risked opening a Pandora's box filled with future psychological problems and years of therapy. Denial was back as an acceptable coping mechanism.
But for all its bad press, how widely is counselling used today? Evidence from schools that have experienced tragedy suggests that, although counselling is widely offered, it is usually used only as a last resort when other methods of helping children recover from trauma have been unsuccessful. It may be that, ironically, we spend more time talking about it than on counselling itself.
Few teachers will ever have to deal with the consequences of a tragedy on the scale of Dunblane, where Thomas Hamilton killed 16 pupils and their teacher in the school gym. But according to a psychologist who played a key role in the aftermath of the shootings, one of its most important legacies was raising awareness of the tragedies that happen to children every day.
"It may be the sudden death of a member of the family or break-up of their parents," says Mike O'Connor, principal psychologist with Clackmannanshire Council. "It is the kinds of things that happen all the time, they just don't hit the headlines."
Mike was a member of the local authority incident team sent into Dunblane on the day of the shootings on March 13, 1996. He spent the day with parents, which was to prove the start of a five-and-a-half-year secondment to support the Stirlingshire community.
As a result of the team's experiences in Dunblane, six years ago Mike helped set up a project for children who had been exposed to trauma or abuse.
"By and large, the majority of children who experience difficult and traumatic events recover without the need for professional intervention,"
he says. "But the concern is the 25 per cent who don't and they tend to be children who are vulnerable for a lot of reasons."
Most children who go through difficult experiences will show signs of post-traumatic stress. At home, these could include sleeping problems, loss of appetite, a reluctance to leave the house, an unwillingness to go to school. At school, it could be a loss of concentration, withdrawal from friends or a deterioration in behaviour.
But the majority - about three-quarters according to Mike - will recover using the existing support of family and friends. "The key is to provide children with opportunities to talk about their reactions to significant events and, by and large, the people doing that should already be known to the children."
For most youngsters, the initial sense of shock will tend to disappear over a period of weeks. The danger of "forcing" counselling on children seems largely exaggerated, according to Mike. "It is just about having a conversation, 'I notice you're not completing your homework,' that sort of thing. And if you get it wrong and suggest things that don't resonate with them, children tend to let you know," he says.
This chimes with the advice Tim Benson, the headteacher of Nelson Primary in Newham, east London, was given from his local authority's educational psychologists when two pupils at his school were killed. The bodies of five-year-old Anika Khanum and her sister Thanha, six, were found alongside their mother, Juli Begum, at their East Ham home in January. Police are still looking for Juli's estranged husband in connection with the killings.
"They told us it was better to allow pupils to talk, either with their parents or a teacher. Youngsters feel more comfortable doing that with people they know than with a stranger," says Tim. He adds that the school was also advised to hold a remembrance service for the girls soon after the event so the children didn't revisit their trauma once they had got over the initial shock.
Tim says some of the teachers had been on a bereavement counselling course and had sessions with individual children, giving them the opportunity to talk, so in the end the school did not call in professional help. "A couple of parents said their children had talked about death and murder at home so we gave them space to talk about it at school," he says.
"Because the girls were so young, some of the children weren't quite aware of the whole circumstances and a lot of the older children didn't know the girls directly. I think if the girls had been older, the situation would have been quite different and we would have needed more extensive help."
But if most children recover without outside help, that still leaves a substantial minority who do not. And Mike O'Connor says it is not always those most directly affected who face the biggest struggle to cope. But there are factors that make it possible, at least to some degree, to predict who is going to be more at risk. These include: the nature of the event, how significant was the change, whether the child comes from a supportive environment where adults and youngsters communicate with each other and whether a child has already had a number of significant changes in their life.
In Dunblane, secondary pupils who had not been directly affected but showed signs of stress, often turned out to have already experienced significant loss in their lives but had not yet dealt with it. "They were more vulnerable because they were trying to deal with their own experience of loss at a time when the whole country was dealing with a terrible event,"
Some of the signs of post-traumatic stress do not appear until six months or so after the event so teachers and parents may not make the connection.
One of the key responses is to help children recognise that their reactions, including guilt - a common feeling among survivors - are normal.
"After somebody dies, it is normal to grieve for them but the experience of grief doesn't feel normal," says Mike. "You are teaching children to understand their reactions and their feelings, plus helping them see the connection between change and behaviour.
"Very often adults who have been bereaved say, 'I think I'm going off my head'. The difficulty for children is they might feel that but they don't often say it," he adds.
Identifying children at risk is complicated by the fact that some of them may be able to function well in one setting, such as school, and not at home, so maintaining contact with parents or carers is crucial. Children also tend to under-report their level of distress, both to parents and teachers.
"That was our experience of working in the aftermath of Dunblane, and the reasons are clear: children don't want to upset adults," Mike says.
"If your dad has just died you might not want to talk about how you're feeling because your mum's eyes fill up.
"Children tend to be protective of the adults around them, which is why we need to check things out." Coping with children's bereavement is also something teachers at Shakespeare Primary in Fleetwood, Lancashire, had to contend with when Max Palmer died on a school trip.
The 10-year-old drowned after jumping into a rock pool in the Lake District in May 2002 while on a trip organised by Fleetwood High School, where his mother, Patricia, worked as a teaching assistant.
Under the guidance of educational psychologists, teachers at Shakespeare Primary observed the children over two weeks to try and identify those suffering from post-traumatic stress.
"Some of the parents were quite shocked their child had been identified because they had been displaying normal behaviour at home," says Joanne Newson, Max's class teacher, whose son was one of his friends. "It became apparent that some children were not coping as well as others."
Parents of the eight pupils regarded as suffering from stress were invited to meet counsellors and the children then had an initial session.
The only child to go on to have further help had not been one of Max's friends but was new to the school. For him, the trauma had become bound up with his difficulty in adapting to a new school. Deputy head Carolyn Thackway says it was reassuring to know that professional help was available, even if it wasn't widely used. "It was a traumatic time for a close-knit community," she says.
"We talked about Max a lot and I think that was important. We looked after each other, but there were outside people if you needed them."
See grief counselling course of the week, page 39