Wales, with its recent spate of teenage suicides, is looking to learn from Scotland, where voluntary organisations working in tandem with schools have helped to reduce the teen suicide rate. But pressure on funding is threatening to arrest development. Shirley English reports
In the past two weeks in one Scottish local authority, three teenage pupils have taken tablet overdoses, one boy has voiced an ongoing revenge suicide fantasy of hanging himself at school, and a girl has confessed she is secretly cutting herself. Another 12-year-old girl has said she wants to kill herself to be with her grandfather, and a depressed 13-year-old boy has admitted he is having suicidal thoughts.
This is not an exceptional fortnight in East Renfrewshire's seven secondary schools, and the area has never been identified as a blackspot for suicidal teenagers. In fact, three of its secondaries are among the top-performing in the country.
So it would be fair to say that East Renfrewshire's young people are pretty representative of Scotland as a whole - which is a worrying conclusion when faced with the 17 unexplained suicides among young people in Bridgend, Wales, already this year.
According to Choose Life, the Scottish Government's anti-suicide strategy, on average two people in Scotland kill themselves every day and a fifth of deaths among 15- to 24-year-olds are by suicide. In 2006, out of 765 suicides in Scotland, 31 were teenage boys and five teenage girls.
Those working in the field report that more young people are seeking help than ever before, with around 18 per cent of all calls to the Samaritans made by people under 25. The support service is now updating its services to include text counselling and email support.
This may be a sign that the efforts of schools to destigmatise depression and encourage children to talk about their feelings are filtering through. But it also raises the question of whether, when teenagers do seek help, an adequate support network is in place.
Mary Sparling, of HeadsUpScotland, the national programme for young people's mental health, says: "The vision for Scotland is that no child will be left unsupported. But in terms of the structures in place at present, I would say that a lot depends on the locality.
"The whole context in schools is becoming right for this agenda, with initiatives such as Health Promoting Schools, the Curriculum for Excellence and new guidance from the Schools Health Promotion and Nutrition Act 2007. But there is an issue about how we implement it and raise awareness. Where do we find the space and time to develop it?
"Teachers all have a pastoral care role. But suicide prevention is about skilled observation ... and staff need clear channels of support to address any difficulties."
What happens in schools will be crucial to the success of Scotland's suicide prevention strategy. The rationale is that children are more likely to come into contact with potential "rescuers" in school than any other community setting.
Enhanced training and continuing professional development has a part to play in helping teachers to recognise warning signs and access appropriate support services.
But while teachers can help to deliver the Government's inclusion agenda through the curriculum, they cannot be expected to provide pastoral care for all their charges single-handedly. The varied and often complex psychological problems faced by an estimated one in five young people today requires input from other care professionals.
In Scotland, a lot of good work is already being done, much of it co-ordinated by Choose Life, the 10-year programme launched in 2002 with the aim of stemming the then rising suicides rates and reducing them by 20 per cent by 2013.
Under its watch, and with an annual budget of pound;4 million, it is more than halfway to meeting that target. Suicides are down by 13 per cent. Now the Welsh Assembly is investigating the strategy.
However, there is no room for complacency. Scotland still has the highest suicide rate in the UK, at 14.7 per 100,000 population, compared with 8.2 in England and Wales and 8.5 in Northern Ireland.
But organisations such as the Samaritans believe Choose Life is on the right track with its multi-agency approach, involving the expertise of social and healthcare workers, public health specialists, teachers, voluntary agencies and young people themselves.
Frances Simpson, of Samaritans Scotland, says: "Often young people don't ask for help because they are frightened they will be bullied or that adults will not think their problem is important enough. Talking about emotional health, talking about suicide and encouraging young people to seek help before a crisis, that model seems to work.
"Choose Life encourages joint working at local and national level. We don't know what makes an individual decide to take their own life, but we do know it helps having all agencies working together."
Much of the work taking place in schools is being spearheaded by voluntary agencies in partnership with statutory bodies.
The youth counselling service in East Renfrewshire, pioneered by Renfrewshire Association for Mental Health, began five years ago with start-up funding from Choose Life. It is now recognised as a model of good practice. Aberdeen, Glasgow and East Dunbartonshire have introduced similar schemes, and several other local authorities have adopted its guidance for teachers on suicide prevention.
The service has three therapists who offer confidential one-to-one or family counselling. The 50-minute sessions slot into the school timetable and take place at on-site counselling suites.
Currently, it has 254 referrals across seven schools, amounting to around 3 per cent of the cohort. But all the schools have waiting lists, ranging from two to six weeks.
Wendy Kinnin, senior youth counsellor, has dealt with six suicidal teenagers in the past fortnight.
"There are some pretty unhappy young people in our schools," she says, from the counselling room at Woodfarm High in Thornliebank.
Pupils can ask for help or be referred by their peers or teachers. Their problems range from bereavement to academic stress.
"Sometimes children can't talk to their friends and have no family support network," she says. "Counselling offers the chance to access an adult and be listened to and not judged.
"It is easy for some adults to say they never needed counselling, but the world has changed. In the past, I couldn't be electronically bullied or have my most embarrassing moment posted on YouTube. There was no expectation that if I didn't have the right clothes or mobile phone, I would not fit in.
"In the past, people might have 10 jobs in a lifetime; this generation will have 30 or 40.
"It is a completely different world, and the capacity to manage change is more vital than ever before."
At the start, some teachers were curious as to how the system would work. "There is an expectation that teachers can do everything," says Ms Kinnin. "Our ethos is to enable teachers to focus on teaching and, when necessary, receive support from other professionals.
"Our biggest area of impact is in classroom learning, because if children have clear minds and are managing their emotions, they are fired up to learn. Teachers are now saying this is almost core business."
Peebles High in the Borders has taken a different route to tackling the often complex problems faced by some of its more vulnerable pupils. For two years it has been running a peer advocacy scheme in which sixth and fifth formers are paired with younger children identified by support staff as being at risk (see panel).
The volunteers go through Disclosure Scotland checks and are then professionally trained in listening skills and counselling, learning how to support their young person. They negotiate with teachers or health workers on their behalf and encourage them to speak out. They meet each week to talk, or pursue common interests, and also give support with school work.
Teachers at Peebles believe peer advocacy is an essential service for struggling children. Yet, in common with other voluntary projects, its future is uncertain due to funding. Mental health is no longer ring-fenced in the Government's new budget concordat with councils, and there are no guarantees that Scottish Borders Council will agree to meet the scheme's pound;15,000 annual running costs.
East Renfrewshire's youth counselling service is in a similar position, currently negotiating another two years' funding of pound;160,000, in competition with statutory services.
Ms Simpson says: "There is a lot of good work being done and it is about consolidating that and reinforcing key messages. There is not one solution to problems such as emotional distress or suicide, but there is a key message about not being afraid to ask for help."
The question is, without adequate funding, will teachers be left to pick up the pieces?
- For curriculum-based suicide prevention with lesson plans:
- For East Renfrewshire's guide to helping suicidal youngsters:
- For school counselling research:
LEND THEM YOUR EARS
There are 18 peer advocates at Peebles High, two of them boys. This year, the fifth-form volunteers have been paired with vulnerable Primary 7 children in feeder schools.
Holly Hamilton, 17, signed up as a peer advocate last summer and has been matched with a first-year boy who shares her love of music.
"I have cerebral palsy and had a difficult time in second and third year," she says. "I felt vulnerable and alone. I know I would have benefited from something like this, so I really wanted to do it."
Part of the training involved suicide prevention work. "We have shown the P7s that there is always someone to talk to and there is always another option," says Holly.
"We also have to make it clear that this information is not something we can keep to ourselves and we will have to speak to an adult."
Holly thinks peer advocacy works because "the young person is talking to someone nearer their own age, who may have recently gone through the same sort of experience. They know the way things work in school, something that teachers might not understand."