Children as young as three are self-harming, say teachers

Some have used a rubber on their arms - rubbing their skin gives them a temporary feeling of relief. Others have banged their heads against walls or pulled out their hair. Suzanne Skeete, a mental health worker, is listing the ways the young primary school children she works with have self-harmed. “They may also bite, scratch, punch or slap themselves.”

Some are as young as three. “These same children, as they get older, will often use razors from pencil sharpeners, or glass. They do it to get rid of pent-up feelings. Physical pain lets them temporarily escape their mental pain.”

Skeete runs Tappy Twins, a non-profit social enterprise that sends counsellors into 50 nurseries and schools across the Midlands, Derbyshire, Gloucester and Staffordshire to provide support and therapy for children. She says self-harming among very young children is an untold story, and she wants it discussed. “We are seeing more and more younger cases of self-harm – and we suspect there’s a lot of children we don’t know about.”

At least 500 primary school children have reported to Tappy Twins that they self-harm and the organisation has waiting lists full of four to 11-year-olds. “We can’t fit them all in,” says Skeete.

New data from NHS Digital, obtained by the Guardian this week, suggests the number of nursery and primary school pupils who self-harm is rising rapidly. In the five years to 2017, hospital admissions for self-harm by children aged three to nine in England increased by 27%, with admissions jumping 13% among this age group between 2016 and 2017 alone. In 2016-17, 107 children aged three to nine were admitted to hospital for self-harm.

At the same time, teachers are struggling to get help for the children who need it. A 2017 survey by NAHT, the headteachers’ union, showed that 56% of headteachers who tried to get mental health support for their pupils found it “difficult” and more than one in five failed, with most citing a lack of NHS services or budget constraints.

Despite a government pledge to invest in Child and Adolescent Mental Health Services (Camhs), some local NHS areas were spending less than £10 a head on children’s mental health in 2017, research by the Royal College of Psychiatrists shows. The YoungMinds charity calculates that £85m was cut from children’s mental health services in the five years to 2015 alone.

“When primary school children self-harm, but not in a life-threatening way, parents and schools are being told the child does not meet the threshold for treatment. That happens a lot,” says Skeete.

More than a quarter (26.3%) of the children referred to specialist mental health services were not accepted last year – a total of more than 50,000 children, according to the Education Policy Institute. In Norfolk, Suffolk, Hertfordshire and Nottinghamshire, more than 60% of children referred for mental health treatmentwere rejected.

Skeete believes this will have long-term consequences. “Children won’t just grow out of self-harm. But what they will do is teach each other how to cut themselves better, so no one knows where they’re doing it on their bodies. And they will continue to do it until they get support.”

Gertrude Wilson, a child psychotherapist, agrees it is vital to intervene early. She recently started working with a three-year-old boy whose whom his nursery teacher had noticed he was repeatedly biting himself in the same place. “I’m very concerned it’s self-harm. He seems to do it when he feels overwhelmed, and says he feels better when he does it.”

She is confident she and his teachers can work together to help him but worries that, if he hadn’t been offered support, he may have had gone on to self-harm in more conventional ways in the future. “There needs to be more state support for schools and nurseries who are struggling with young children with mental health problems.”

Skeete wants every primary school teacher to be trained to recognise the signs that a young child may be self-harming, and to know how to respond. “Teachers need to avoid showing shock or any reaction that makes the child feel ashamed. These are children displaying very raw emotions – they shouldn’t be told they are doing something wrong or told off for doing something dangerous, they should be calmly taken to one side and asked whether they are OK.”

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She is also concerned about the teachers who encounter very young children who self-harm. “We need to make sure teachers have someone they can talk to. Primary schools are simply not getting enough support.”

This is reflected in the results of a 2016 Department for Education (DfE) survey, which found nearly a quarter (23%) of teachers did not feel equipped to identify behaviour linked to mental health issues and more than a third (34%) feel ill‑prepared to teach children in their class who have mental health needs.

“Far more needs to be done to get support into schools so that children’s wellbeing can be treated as a priority across the education system,” says Tom Madders, a spokesperson for YoungMinds. “Even at a young age children face a huge range of pressures, including school stress, bullying, worries about body image and a lack of access to help if they’re struggling to cope. Difficult experiences at home – including domestic violence, neglect or bereavement – can also have a serious impact.”

Jon Robinson is the designated safeguarding lead at his primary school in Birmingham. He recalls the case of a bubbly eight-year-old girl who became withdrawn and, coincidentally, stopped wearing skirts. “After we talked to the children about self-harm during Health Week, she told her teacher her friend had been self-harming – scratching her legs.” When the teacher asked her to write her friend’s name down, she wrote her own. “That was her cry for help. Her parents had been arguing at home, and she felt it was her fault.”

In his experience, referrals to Camhs regarding young children who self-harm were often turned down and he believes 70% to 80% of primary children who self-harm will struggle to get help. “You have to be savvy when you write the referral or the child will get rejected. You have to use the buzzword ‘self-harm’ and show how the child is hiding their situation by persistently avoiding certain activities, and how that is restricting them and potentially influencing other children.”

Gemma Walker, a primary teacher and designated safeguarding lead in her school in the Midlands, says she has learned to control her emotions when she hears about very young children self-harming. “I used to go home and have sleepless nights. You develop coping mechanisms, I suppose.”

She recalls a four-year-old girl who started pulling her hair out and biting and pinching herself and others. It turned out the girl had lost a sibling and her mother was talking a lot about the dead child. “The self-harm was a mechanism to release her feelings of low self-esteem and low self-worth. But she didn’t understand that. She didn’t know why she was hurting herself.”

Walker believes mental health is too low on the DfE’s agenda, compared with academic success. “When teachers are stressed about league tables and exam results, they may lack the time, resources and empathy to notice a child is showing signs of self-harm.”

The DfE says training for teachers on self-harm is available through MindEd.org.uk, and that the government has invested £1.4bn in young people’s mental health care, as well as funding guidance and lesson plans on teaching about self-harm in PSHE. It said: “Schools have a statutory duty to safeguard and promote the welfare of children and staff. All school staff must have undergone safeguarding training.”

It added that the government was currently consulting on its green paper on children and young people’s mental health, which will encourage every school to have a designated lead for mental health by 2025, as well as improving the links between schools and NHS services.

However, Labour and YoungMinds have criticised the slow phasing in of these teams; it is expected that even by 2022-23, only a fifth of England will be covered.

Extra support cannot come soon enough for Marie Evans and her class of eight primary school children with special needs. Four of them self-harm. “One started at five. He would hit his head against the wall and bite himself. He’d seen his older siblings self-harming and was copying them.” Three years later, with support from Tappy Twins, he is self-harming less often. “I think no one had taught him you’re not meant to get hurt as a child.”

Others have not been as fortunate. She gives the example of another child who, in year 1, would pinch and scratch himself to make himself bleed and an eight-year-old girl who would try to run out on to a road when she was distressed. “But when I refer them to mental health services, often the buck just gets passed back to special needs.”

In her experience, young children who self-harm often feel a sense of worthlessness. “They may have thoughts like: no one cares if I harm myself. There are days I’ve almost cried in front of my class. My ability to fight for these children is limited if I want to keep my job. Without support, these children are going to end up broken adults. They are the children everyone gives up on – and they deserve so much better.”

Some names have been changed