•If children are directly exposed to self-harm, suicide, eating disorders or their effects, for example, in a classmate, then I would prioritize teaching about the topic in an age-appropriate manner even if students are very young. This may require specialist support.
•As a general rule, I would wait to teach explicitly about self-harm or eating disorders until high school/secondary school. About age 12 is an appropriate time to begin to explore these topics with most children.
•The skills needed to prevent and manage unhealthy coping mechanisms including self-harm and eating disorders can be taught from an early age. Children as young as five or six will benefit from lessons which develop:
-communication skills
-problem-solving skills
-healthy coping mechanisms
-stress management
-knowledge about where and how to seek help if needed.
•Many schools introduce lessons for the age group at which they see an increase in prevalence in issues such as self-harm (often around age 13 or 14 though this varies between settings). This is useful, but what is more useful is to introduce these lessons six months or a year prior to this age, as this will help to prevent the onset of these difficulties for some of your students. This learning can be reinforced and built on as students enter the peak age of onset.
•Finally, I think it’s important for us to move away from the idea that these topics need to be fitted into the curriculum and taught once at an appropriate age. Preferably, students should develop their skills and knowledge over a period of several years within the context of a broader developmental curriculum.
What you should teach
You should teach students basic information about the major eating disorders or forms of self-harm and their warning signs. You should explore why people might develop these difficulties and try to tackle the stigma and taboo associated with mental health and emotional wellbeing issues. It’s also very helpful to teach students about eating disorder and self-harm warning signs and give them some clear direction on where they can go for help and support if they are concerned about themselves or a friend.
What you should not do is go into too much detail about the technical details of self-harm or eating disorders as this could trigger unhealthy responses in any vulnerable individuals in your group. For example, those students already struggling with eating-disordered thoughts could have their existing condition exacerbated by:
•talking about specific weights – an eating-disordered student may try to ‘beat’ any weight you’ve talked about
•showing pictures which glamorize eating disorders – showing a lot of pictures of models who are ‘too thin’ may actually work as ‘thinspiration’ for students who may not find the images disturbing, but consider them beautiful and aspirational
•talking about specific weight-loss or purging techniques – a student who is struggling with an eating disorder may never have thought of, for example, taking laxatives to further control their weight until they heard the idea in your class. Make sure you’re not providing a kind of ‘how-to’ guide.
Similarly, talking about specific methods of self-harm can be instructive to vulnerable students, so whilst you might choose to talk about different methods of self-harm which could include cutting and burning, I would not recommend talking about specific methods that students might employ for cutting or burning themselves as these suggestions may be taken on board by any students who are currently harming.
POTENTIAL LEARNING OUTCOMES
Students should learn about self-harm and eating disorders as part of a developmental curriculum rather than in a single catch-all lesson. Relevant learning outcomes that you might look to build into your lesson planning might promote students’ understanding of:
•what self-harm and eating disorders are
•some of the reasons why people develop unhealthy coping mechanisms
•common misconceptions about mental health and emotional wellbeing difficulties
•warning signs to look out for in a friend
•how to be a supportive friend, including the importance of disclosure of concerns
•where and how to seek help if needed
•what happens next following a student disclosure at school
•using anonymous helplines to ‘practise’ preceding a face-to-face disclosure
•how to safely seek support online and avoid potential pitfalls
•what to do in an emergency.
More generally we can promote student wellbeing and help prevent students turning to unhealthy coping mechanisms by promoting learning about:
•healthy ways of managing difficult thoughts and feelings
•verbal and written communications skills
•problem-solving skills – both preventative and in response to difficulties
•promoting good physical and mental health
•looking after ourselves at times of high stress, for example, exam season.
All teaching and learning resources should be inclusive of different ethnicities, sexual orientations, gender identities and disabilities.
Students will value knowing how best to support a friend
You can also give students some guidance on how they could support a friend who is struggling with eating-disordered or self-harming behaviours, or who they are concerned may be developing a problem. They will really value this advice and will often act on it if they have concerns already. You should work hard to encourage students that one of the most supportive things they can do for a friend at risk is to inform a trusted adult at school or home. You may need to explore reasons why a student may or may not choose to do this. This can be a good opportunity to discuss any concerns students might have about talking to an adult when they are worried that a friend might be self-harming or have an eating disorder, and also to put straight any misconceptions whilst taking on board valuable feedback. You can teach students that they can support their friends by doing things such as:
•never allowing weight or appearance-related bullying or teasing
•being a good listener to their friend
•standing by their friend but allowing them a little distance if they need it
•forgiving their friend if they are rude, difficult or unsociable
•not complimenting their friends’ weight or appearance – you can practise paying compliments using other attributes instead.
Utilizing ground rules to promote a culture of safe discussion
When teaching about topics such as self-harm and eating disorders, it is important to think carefully about the possibility of personal disclosures from students who, as a result of the lesson, may develop the skills, language, knowledge and understanding needed to make a disclosure about their own mental health or emotional wellbeing. Whilst this is not to be discouraged, it is very important that if students make personal disclosures to school staff, they do so in a suitable, one-to-one setting. It is not appropriate, therefore, to encourage students to talk about sensitive personal matters in the classroom.
Therefore, it’s important that, before teaching about these issues, clear ‘ground rules’ are established or reinforced and the concepts of confidentiality and anonymity covered at the start of the lesson. Ground rules need to be consistently adhered to, regularly revisited and, if necessary, renegotiated and reinforced. The teacher should lead the way by modelling the ground rules in their own communications with the class.
Where time allows, ground rules are most effective when they have been negotiated and agreed with the students, rather than imposed