Thread by @ProfLAppleby

Guidance to schools on suicide prevention in the RSHE curriculum was published this week.

It’s an illustration of how we go from a campaign by bereaved parents to Govt policy.

But what does suicide prevention in the curriculum mean? Which children? Are there risks?

🧵 & TW

There is no more distressing subject in suicide prevention than the deaths of young people.

It challenges who we are as a society that such tragedies occur.

@ONS records around 100 suicides/year in under 18s. Rates have risen in the last 15 years, though not since 2018.

Some of the most impressive #suicideprevention campaigners are bereaved parents.

These include @3dadswalking - whose message has focused on the place of suicide in RSHE.

Their commitment to saving young lives has been incredible.

Most people - in my experience, at least - instinctively agree greater openness about suicide can help overcome the shame that once surrounded the subject.

The campaign has been welcomed from media studios to Downing St.

Last year the Govt agreed to examine what could be done.

At this point, though, a number of questions arise.

Are we talking about “teaching” about suicide, the word implying a didactic approach, an agreed factual content (agreed by whom?).

Or something more discursive - a chance to raise questions, to explore a sensitive topic?

Is suicide prevention in the curriculum an aim or a description of content?

If it’s the former - an aim - much can be achieved by saying more about mental health generally, about key risks such as loneliness, bullying or online experience.

Should the emphasis be on suicide itself or self-harm, which is far more common, starts younger and usually happens without suicidal intent?

Self-harm is not only rising but appears to be moving down the age range.

A recurring phrase in RSHE is “age appropriate” & in suicide prev there’s a case for distinguishing primary from secondary school.

But beyond that? What is appropriate at age 12, 15 or 18?

What other factors determine appropriateness? Vulnerability? A self-harming sibling?

Then there is the question of who will “teach” it.

Teachers I hear from are wary of a responsibility for which they feel ill-equipped.

Perhaps it will be outsourced? There will be “not for profits” lining up as we speak. How do ensure what they do is effective, or even safe?

The most serious question is whether talking about suicide could put children at risk.

Here we have to distinguish between:

(1) helping people who are suicidal to talk about what they are feeling - this is a vital part of offering support & carries no risk.

And….

(2) Opening up a wider discourse about suicide across society - in the media, for instance, or in this case, schools.

Here the evidence is not so clear.

What is the risk?

In our study, based on repeated national surveys of mental health, increasing self-harm in young people has been accompanied by a rise in those who see SH as a way of coping with stress.

thelancet.com/journals/lanps…

Many in suicide prevention are concerned about this “normalisation” of self-harm.

By which suicidal behaviour may seem a reasonable response to certain situations.

Any classroom discussion must be careful to promote safer alternatives - the most obvious being asking for help.

On the other hand, most young people are likely to have already heard about self-harm. We are fooling ourselves to think otherwise.

They may know someone who is doing it.

Surely it is better for them to be given facts by a trusted source.

So our simple starting question - should we teach about suicide? - becomes more complex.

Add to that the caution of ministers & officials, keen to avoid a mis-step.

And yes, expert advisers, pointing to gaps in evidence everywhere. We are in the end purveyors of uncertainty.

The evidence from several studies is of benefits from suicide prevention programmes in schools - often a reduction in suicidal ideas rather than suicide itself, which is too rare for a typical trial.

These studies report no evidence of harm.

But the usual limitations of trials apply too.

Bias, selection of willing schools, intensive interventions delivered by enthusiasts, in other countries.

How will this work in a cash-strapped school in the UK with countless competing priorities?

Now the guidance is published.

It does in fact stress that promoting general mental health is where suicide prevention starts.

It aims to be age appropriate, setting a lower limit of year 8 for direct references to suicide.

consult.education.gov.uk/rshe-team/revi…

It refers to warning signs & looking out for friends.

Most important, it stresses the need to find other ways to deal with problems. This is a crucial message.

There will be differences of opinion among parents, teachers & young people themselves. The guidance is out for consultation.

It is a measured attempt to respond to public concern, to families who know the heartbreak of suicide.

A start, on a major social issue.

An acknowledgment that schools have a role in prevention.

As we all do.

/Ends

@samaritans are on 116 123.