Mental health: Self-harm and suicide


Probably many more students than you think self-harm or have suicidal thoughts, warns Dr Stephanie Thornton. She offers her advice on recognising the early signs of problems.


How many teenagers in our classrooms self-harm? How many are suicidal?

The answer is that nobody really knows, but it is probably more than you think: this is not a small problem. 

Twenty per cent of teenagers admit that they self-harm, most without being discovered by family or school. Five in 100,000 actually kill themselves, but this is just the tip of the iceberg: very many more feel suicidal.

The classic image of self-harm is a girl cutting herself with a razor blade, burning herself with a cigarette, or dieting to the point of emaciation.

The revelation of recent NHS reports is that these things are also common among boys. Boys hide the problem more assiduously (for fear of teasing, since self-harm might be regarded as “girlish”).

But it may come to light because boys also engage in more violent forms of self-harm which land them at hospital: head-butting or punching walls, for example. More than 600 such cases were recorded last year. Again, this is likely to be the tip of the iceberg, with many such self-inflicted injuries passed off as accidental.

Why are rates of self-harm so shockingly high? Suicide and self-harm are strategies for managing stress – albeit dysfunctional ones. Somehow, the pain of self-harm can soothe anxiety or frustration, even if only for a short while.

Suicide is different: it is total escape. It is a sad indictment of society that so many of our young are stressed to the point of resorting to such measures. And the problem seems to be escalating. Official estimates suggest that the number of adolescents self-harming has trebled over the past decade.

Equally sad is the fact that we so often fail to identify teenagers with these issues until the situation is intense and chronic, or in the case of suicide (and sometimes anorexia), fatal.

This is perhaps not surprising, given that sufferers very often hide or disguise their actions or intentions, and given that many teenagers are painfully slim without being anorexic, many are moody and depressed without being self-harmers or suicidal. 

Recognising individuals who are suicidal or self-harming can be hard. But late “diagnosis” exacerbates the problem: as ever, the earlier the intervention, the better the prospects.

First advice is to stay vigilant to the possibilities. Self-harm in particular is far more common than we tend to suppose (if you have 30 students in your classroom, chances are that six are self-harming in one way or another).

Look for signs of depression, anxiety, mental health issues. Teenagers do not self-harm or feel suicidal when they are happy and all is going well.

So any sign of negative emotional states should prime us to consider whether there is also self-harm, or suicidal feelings. The more hopeless and helpless the individual, the lower the self-esteem, the more likely is self-harm or suicidal thoughts. 

Go beyond the obvious. Just as not all the depressed and anxious self-harm, so some of the apparently happy do, or are suicidal. Sometimes cutting (and so on) “works” so well that the cutter can hide their pain; and sometimes, pain must be hidden at all costs. 

So look out for individuals at high risk of self-harm or suicide, however okay they may seem: individuals struggling with very difficult family circumstances, or being bullied are at high risk, for example. 

At highest risk of all are those coming to terms with lesbian, gay or transgender identities: a shockingly large percentage of these contemplate, or engage suicide.

Look for subtle cues. Visible scars or wounds should, of course, always be followed up. Are they evidence of abuse? Bullying? Self-harm? But such obvious signs are rare. Whether self-inflicted or not, wounds from such causes tend to be hidden on parts of the body that are seldom exposed: the top of the arm or thigh, or on parts of the wrist normally covered by sleeves. Cues to look for include a reluctance to take clothes off for any reason – reluctance to get changed for sports, for example, or to take off a sweater in a hot classroom.

Watch out for strange behaviour. Anorexics, for example, often deny a problem, but give themselves away through faddy eating, picking at or refusing meals, following strict diets when there is no apparent need, obsessing about food.

Listen well, watch well. Teenage suicide is often thought to come without warning, but in fact, research shows that there are usually subtle clues to the individual’s intentions. 

For example, suicidal teenagers are more likely than their peers to show an interest in death and suicide. The more seriously suicidal often make preparations for their departure, the most suggestive of which are giving away prized possessions, or abandoning hobbies or school work that previously absorbed them. 

And surprisingly often, it turns out that the suicidal have dropped hints as to their feelings and intentions, albeit in an oblique way and often to friends rather than family or teachers. The common view that “if s/he is talking about suicide, s/he isn’t serious” could not be more dangerously wrong.

What to do, when suspicions that a pupil is self-harming or has suicidal feelings arise? These are serious matters, and the first step is to report your concerns and get advice – most urgently when the possibility of suicide is involved.

Whoever is responsible for student welfare in your school is the obvious first port of call. Information and advice can also be gleaned from specialist helplines including Young Minds (see further information).

Can you (or some other responsible person) find a quiet moment to talk to the individual causing concern? Expert advice is to take things gently. Let the teenager dictate the pace, offering them non-judgemental empathy. 

Confiding deep feelings takes time and trust. But when the moment is right, don’t be afraid to ask direct questions. If you fear that a teenager may be suicidal, for example, it may be helpful to offer a tactful opening such as: “Are you feeling that life isn’t worth living?” 

Responding appropriately to an upsetting reply requires sensitivity – and that is something you should work out how to handle before embarking on the conversation, perhaps with expert advice. 

But it can be a vast relief to a troubled youth to be given permission to talk about such dark feelings, and to have them treated respectfully. We underestimate the healing power of just listening sympathetically and non-judgementally.

That is the gift such troubled youth needs most immediately. And then, a good follow-on from a suicidal revelation is to ask, “what would you like your life to be like?” – which may open a constructive discussion on how that might be achieved (that follow-on can work well after a revelation of the stress driving self-harm, too).

When to get expert help? The answer is immediately if you suspect an individual is self-harming, and especially if you fear that they are having suicidal thoughts.

  • Dr Stephanie Thornton is a chartered psychologist and former lecturer in psychology and child development.

Further information
  • YoungMinds: 0808 8025544, Mondays to Fridays, 09:30am to 4pm or via
  • Samaritans: 08457 909090.
  • ChildLine: If you are an adult worried about a child, you can call ChildLine on 0808 800 5000. Visit
Mental health
In this on-going series, expert Dr Stephanie Thornton is tackling a range of mental health issues, offering practical advice to school staff and leaders. This is the fourth article. To see the articles as they publish and for all SecEd’s mental health advice and guidance content, visit


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