Rise in adolescent self-harm shows need for early intervention

Mette Ystgaard has two very different perspectives on the mental health of children.

As a trustee of Partnership for Children, she has been closely involved in Zippy's Friends, a programme that helps six and seven year olds to develop coping skills. Yet in her work at Norway's Centre for Child and Adolescent Mental Health, and previously as an associate professor at the University of Oslo, she has researched self-harm and attempted suicide among adolescents.

Mette worked on the European Multi-centre Study on Child and Adolescent Self-harm, a major study which was funded by the World Health Organisation and surveyed 5,000 fifteen and sixteen year olds in each of seven countries - Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. The study found that in most countries, ten per cent of adolescents self-harmed, with the rate among girls being almost double the rate for boys.

"If you ask teachers, school nurses or other people who have contact with adolescents, they all say that there has been a tremendous increase in self-harming," says Mette.

"Only 20 per cent of these adolescents end up going to hospital or seeing a psychiatrist. They can be at home in their room, and sometimes the actual self-harm is not very serious, but it is a very clear indication that they don't have other ways of dealing with their emotions.

"For many adolescents, self-harm is a way of making themselves feel better. They will say 'When I cut myself, when I cause myself physical pain, I feel a psychological relief.' We need to help these young people to develop other ways of coping with their feelings, instead of cutting themselves or putting pills into themselves. This involves helping them to identify and label their feelings, and to understand why they are unhappy. What is it that causes such intensity of feeling that they feel almost a hunger to cut themselves?

"We think that young people today, certainly in a country like Norway, are so free and can talk about everything, but when we actually listen to them, particularly the ones who are having problems, we find that they don't have a good vocabulary for labelling their emotions, and many of them just don't talk about their feelings."

It is this inability or reluctance to identify or talk about feelings, and the tragic statistics of self-harm and youth suicide, that convince Mette of the value of programmes such as Zippy's Friends.

"I see a strong link," she says. "In fact, when I am talking about one I always mention the other, because to me the relationship is so clear. The self-harm statistics show what happens if children do not learn coping strategies, and Zippy's Friends is a way to teach them those skills.

"Of course, many children learn how to cope in a natural way, particularly those who grow up in loving homes with good parents. But the school has a very, very important part to play in this, because there can be all sorts of reasons why children don't learn these skills at home."

Some years ago, Mette worked with Prof Brian Mishara of the University of Quebec at Montreal on a major evaluation of Zippy's Friends in Denmark and Lithuania. She subsequently became a Trustee of Partnership for Children and has seen the programme spread to eight more countries, as culturally diverse as Brazil and China. Is she surprised by this expansion?

"The challenges that young children face are similar in different countries, and Zippy's Friends was designed to be culturally neutral, so in that sense I'm not surprised to find that it works in different countries and cultures. I am more surprised on the political level. I wouldn't have thought that some countries would have made the effort or devoted resources to this type of programme, and so it has been wonderful to see how teachers have welcomed it around the world."

Mette will be retiring from the Board shortly, to concentrate on another major evaluation of Zippys venner in Norway. In addition to looking at how the programme is implemented and its impact on children, this study will look at children's self-esteem and the effects on family life and classroom atmosphere. It will also show whether the programme is equally effective with children who have problems.

Almost 1,000 children are taking part in Zippys venner in Norway this year, in Oppland and Stavanger. The programme will expand to other parts of the country later this year, and a workshop was held in Oslo last month, to train the people who will train teachers to run it.