Best Practice

Pupil wellbeing: When to worry

In a new series for SecEd, mental health expert Dr Pooky Knightsmith will be offering practical advice to school staff to help them safeguard their students' wellbeing. Her first article looks at when you should begin to worry about a student

“Cutting is so widespread in our school that we couldn’t possibly provide effective support for every affected pupil – but I wonder, in any case, whether we need to? Some of them just seem to try it once or twice, then move on. But how can I tell which are the kids I should be prioritising? Which are the ones that actually need our help?”

A question I am regularly asked when training staff about pupil mental health and wellbeing is: “When should I be worried?” In particular this question comes up with regards to eating, exercise and self-harm.

Equally, with under-eating or over-exercising it can be difficult to tell the difference between diet and disorder, between health and obsession.

Of course, each case is different and there is no one-size-fits-all approach. However, as someone who works with staff up and down the country each week, I am not in a position to take each case on its individual merits and so I have come up with a couple of rules of thumb that you might find helpful.

Essentially, it boils down to two questions you can ask yourself which will help you decide whether this is a pupil you need to follow up with.

First, what’s the big picture? If you weren’t aware of the specific behaviour that is causing concern would you still be concerned about the pupil’s welfare?

For example, is your concern based solely on an observation of self-harm, changed eating or exercise or are there further factors involved? You might consider:

  • Do they seem generally fit, healthy and happy?
  • Have you noticed a change in behaviour?
  • Has there been a change in their attendance or attainment?
  • Have they said or done anything which indicates feelings of failure or hopelessness?
  • Have friends or family expressed concerns?

“It’s a good question – and yes, I am more generally worried about him. He seems generally down, he can’t find a good thing to say about himself. His grades are slipping and he’s spending very little time with his friends, preferring to be at the gym.”

Second, can the pupil take a break from the behaviour causing concern? For example, is this an occasional behaviour or one that the pupil feels compelled to complete every single day? As self-harm and eating disordered behaviours become more entrenched, it can feel more like the behaviour is controlling the pupil rather than the pupil controlling the behaviour.

So the pupil who won’t take a break from their diet in order to have a slice of their birthday cake, or whose first consideration when going on holiday is how they are going to complete their exercise routine is a cause for concern.

If a pupil is disproportionately harsh on themselves, if they do compromise on their diet or exercise – perhaps making value-laden judgements considering themselves “worthless” or a “failure”, then this is a further indication that the pupil is in need of our support.

So what next?

If you are worried about a pupil, the most important thing you can do for them is to listen or to ask a colleague to do so, to enable them to begin to explore their thoughts, feelings and behaviours. This will enable you to jointly think about what support or next steps might be helpful. These conversations work well when you are:

  • Patient and quiet – allowing the young person time to order their thoughts.
  • Non-judgemental – allowing the young person to tell their story without fear that their thoughts or behaviour will be judged.
  • Flexible – some young people struggle discussing emotional issues face-to-face. You could encourage them to try writing or drawing about their issues or have a conversation over email or instant messenger instead of face-to-face.

If you are interested to explore this topic in more depth, join our free webinar on September 20 – see below for the details.

  • Dr Pooky Knightsmith directs the children, young people and schools programme at the Charlie Waller Memorial Trust, a charity that provides fully funded mental health training to schools. Visit and

Mental Health Advice

Dr Pooky Knightsmith will be providing regular support and advice in SecEd. Her next article is due to appear on October 6. If there are specific issues you would like to see addressed, email or tweet @PookyH

Free Webinar

The free webinar, “When Should We Be Worried? Warning signs and what to do next” is being run by the Charlie Waller Memorial Trust and takes place at 6pm on September 20. Visit