The calls for attention that we just can't ignore

More schoolchildren in the Lothians are treated in hospital for self-harming than anywhere else in Scotland. Health Reporter Adam Morris examines what is behind the disturbing trend and asks what can be done to tackle this worrying problem.

IT is a scene which never fails to disturb the doctors called on to heal first the physical and then the mental wounds. A young teenage girl admitted into hospital with wounds which bear the tell-tale signs of self-harm.

Sadly, it is all too common a sight. In an average week, two schoolchildren are admitted to Lothian hospitals as a result of self-harming, while some studies suggest as many as one in seven Scots adolescents have deliberately injured themselves.

Disturbingly, experts describe the 97 under-16s admitted to hospital in the Lothians – more than in any other Scottish region – as merely "the tip of the iceberg".

A series of initiatives and campaigns over the last decade have failed to lead to a reduction in the number of cases across the country.

With often complex reasons behind the behaviour, it can be extremely hard to understand why anyone would want to inflict such pain on themselves.

So what does drive young people – teenage girls more often than not – to harm themselves? And what can worried parents or teachers do to protect their children?

City-based child education psychologist Charles Gibb says there is no typical "self harmer" and the problem can often appear to come out of the blue.

"Almost every case is different and those figures suggest it is a lot rarer than it actually is," he says.

"It is such a complex issue. What has to be addressed is not the self-harming itself, because that is just another problem manifesting itself.

"Tackling the reason for self-harm is the key.

"It is difficult to see the warning signs. Often, there won't be any period of contemplation, it will just happen, and perhaps they will never do it again.

"Some form of unhappiness with life lies at the root, and it is just trying to detect what that is."

The problem tends to occur most often among those approaching their mid-teens, with girls more likely than boys to be involved, and one of the most disturbing aspects is that there does appear to be a "copy-cat" element to some incidents, although Mr Gibb is sceptical about the problem's possible links to particular youth cultures, such as the "emo" music movement.

He says: "The problem with saying it is this group or that group is that there is always far more people in those circles who don't display that behaviour."

Peer pressure can be a factor though. He adds: "In certain groups it can be a bit of a fashion. One child will see another do it, watch the attention they receive and then try it themselves."

Child health expert Dr John Davis, a senior lecturer in Edinburgh University's school of education, says: "Research has shown geographical patterns; when you see one incident you then see a spate in the same area.

"It is often a culmination of things rather than one single issue. Money is also at the heart of a lot of it," he says.

"If a child is unable to take part in activities their friends are then this can be quite damaging.

"A lot of people associate a child's mental wellbeing with what's gone on in the past, but in fact, it is very much the present which concerns them. There is also the weight of expectation, and this can be seen if a child is struggling in school, or failing to make friends."

Despite the complexities surrounding self-harming, medics have pointed to some tell-tale signs of which concerned parents should be aware.

Not only should the obvious signs of bruises and cuts be looked at, says NHS guidance, but so should efforts to conceal them. The advice adds: "People who self-harm may also be quiet and withdrawn and emotionally uncommunicative, spend long periods alone or suddenly disappear to the bathroom after seeming upset, angry or sad."

Mr Gibb describes the behaviour as "almost always, one way or another, a call for attention".

As mental health issues across all age groups gain prominence, more support for parents is now available from NHS Lothian and charities like Childline.

Billy Watson, chief executive of Scottish Association of Mental Health, says: "It's important to realise that self-harm is almost always symptomatic of a deeper problem and should always be taken seriously. We also need to promote an open and supportive culture within schools and other places where young people go, and provide information and support for both paid workers and parents regarding self-harm."

Sally Lee, child health commissioner for NHS Lothian, says: "Our Child and Adolescent Mental Health Services provide link workers who deal directly with primary and secondary schools across Lothian to develop awareness of mental health issues.

"The service has also developed teaching materials on depression in teenagers sent to all Scottish schools."

She adds: "We are always concerned about cases of self-harm in all young people. That's why we offer a wide range of services to help improve young people's mental health and wellbeing."