Teachers left to pick up pieces from cuts to youth mental health services


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Teachers left to pick up pieces from cuts to youth mental health services

As the headteacher of large primary school in the west of England, Joan Cunningham is accustomed to the demanding aspects of managing an intake from a mainly disadvantaged area. However, for the past couple of years, she says, one issue has escalated so dramatically that it is nearly at crisis point. “There is so much more pressure on schools and teachers to deal with children’s mental health and behavioural problems,” she says. “We provide as much support as we can but, with fewer resources available and a massive increase in need … the pressure has been incredible.”

Cuts to mental health and other services for young people mean teachers are increasingly having to fill the gap, even though schools do not always have the resources or training to provide the extra support pupils with mental or emotional issues may need.

“It was already hard to access the right services before cuts but its getting worse,” Cunningham says. “Teachers … are not mental health professionals, and now there is a vacuum in the services we have [traditionally] relied on. Social services departments are under more pressure due to cuts, Sure Starts … have vanished, [and] in many cases the voluntary organisations we used to be able to turn to are disappearing. Sign-posting families to where they can get help is much harder because of all of this.” At a time when families are under greater financial strain and “even very young children” are under pressure to achieve academically, she concludes, the need for support is “growing very fast”.

Child and adolescent mental health services (Camhs) have been particularly hard hit. These specialist services assess and treat children and young people with mental, emotional or behavioural difficulties. Typically, when schools cannot offer the support of their own counsellor, or when a child has especially serious difficulties, they will seek out their local Camhs for help.

In many cases, local authorities commission and fund these services, and the impact of council budget cuts on Camhs in some areas has been severe. According to research by the charity Young Minds, two-thirds of councils in England have reduced their Camhs budget since 2010. And when the charity asked NHS trusts and councils about other mental health spending targeted at children and young people, such as youth counselling or specific services for schools, more than half had cut budgets – some by as much as 30%.

The cuts mean local authorities’ Camhs spending is increasingly redirected towards more serious cases of mental ill-health, at the expense of early intervention services. “Draining money from early intervention services is short-sighted and just stores up problems for the future,” says Sarah Brennan, chief executive of Young Minds. “The result is Camhs feels it is being asked to respond to an enormous number of issues and schools feel Camhs has left them high and dry.”

Chris Harrison, national executive member and former president of the NAHT, says part of the problem until recently has been that targets in education have allowed children’s wellbeing to slip down the agenda. “The issue of mental health [in schools] has been coming to the fore over the past four or five years; there’s a real groundswell of interest, but it isn’t yet a priority in schools. We need to accept that preparation for life is about more than academic results.”

Research by the Teacher Support Network, a charity focusing on teachers’ wellbeing, shows around half of teachers feel pupil behaviour is worsening. Its survey of over 800 teachers also found almost two-thirds were stressed as a result.

The cuts to Camhs mean schools are struggling to provide professional support on site. Some have set aside cash from the Pupil Premium to pay for a regular counsellor. Andy Bell, deputy chief executive at the Centre for Mental Health, says that an “ad-hoc” system of support relies too heavily on the initiative of individual heads or teachers, and is undermined by unsatisfactory and arbitrary access to funds. “We see raising awareness of this issue as a major priority,” he says. “When we conducted research on child behavioural problems we found that three-quarters of parents asked teachers for help … However, some schools are better equipped than others. Many have virtually nothing by way of [professional] support, while others have full-time counsellors.”

Inadequate and underfunded services mean undue stress is being put on teaching staff, who may feel they are not trained or qualified to tackle many of the emotional or mental health problems that come up.

And with anecdotal evidence suggesting the number of young people experiencing mental health problems is rising, the crisis in Camhs is set to get worse. In 2004, the last year that government statistics were centrally collected on the prevalence of mental ill-health among children and young people, 1.3 million children were deemed to have a diagnosable mental illness. The economic downturn, coupled with government austerity and exam stress, means this figure is now probably much higher. And with NHS England estimating that only a quarter of children and young people with a problem are ever seen by mental health services, the figures are just the tip of the iceberg.

Politicians are becoming more aware of the scale of the problem. The health select committee has begun a parliamentary inquiry into Camhs, which campaigners hope will push mental health in schools higher up the agenda when it is published this year. “What we need is a consistent, national system that is accountable. What we need is for Camhs to be transformed.” says Bell.

Harrison says more needs to be done to ensure heads and schools have access to effective support services. “Schools and heads are battered at the moment. We want the government to look at the evidence. It’s common sense. There is overwhelming evidence that students learn better and are more effective in environments where they are supported and their teachers are supported.”

For now, charities and campaign groups are having to help schools themselves. Young Minds offers guidance on its website for teachers and is about to pilot a helpline for school staff, while the anti-stigma campaign Time to Change is running a project promoting pupil wellbeing and offering practical guidance for teaching staff. “Pupils are under much more stress these days and so are staff, yet teachers don’t have training in mental health – or spare time,” says Moira Clewes, lead teacher on health at Sandwich technology school, Kent, one of the schools piloting the project. “We are breaking down misconceptions around mental illness. Students are opening up. Teachers are grateful for advice. You’d be amazed at the impact this is having.”

A Department for Education spokesperson points to a range of initiatives, including the MindEd website, launched in March, designed to help people working with children, including teachers, “to recognise when a child needs help and how to make sure they get it”. The Department of Health says it has a “priority” focus on children’s mental health and, among other things, has put additional cash in to “talking therapies”, adding that it is liaising with the DfE to improve links between schools and Camhs.

For Cunningham, while any help is welcome, she is adamant that “nothing short of a clear, coherent and properly funded approach nationally will work for schools and for children”.

• Some names have been changed

A group of neuroscientists believes it can communicate with “locked-in” coma patients


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A group of neuroscientists believes it can communicate with “locked-in” coma patients

“Imagine you wake up, locked inside a box,” says Adrian Owen.”It’s a perfect fit, down to every last one of your fingers and toes. It’s a strange box because you can listen to absolutely everything going on around you, yet your voice cannot be heard. In fact, the box fits so tightly around your face and lips that you can’t speak, or make a noise. At first, this feels like a game. Then reality sets in. You see and hear your family lamenting your fate. You’re too cold. Then too hot. You’re always thirsty. The visits of your friends and family dwindle. Your partner moves on. And there’s nothing you can do about it.”

People in a “vegetative state” are awake yet unaware. Their eyes can open and sometimes wander. They can smile, grasp another’s hand, cry, groan or grunt. But they are indifferent to a hand clap, unable to see or understand speech. Their motions are not purposeful but reflexive. Their minds remain firmly shut. Still, when their eyelids flutter open, you are always left wondering if there’s a glimmer of consciousness.

A decade ago, the answer would have been a bleak and emphatic no. Not any longer. Using brain scanners, Owen has found that some may be trapped inside their bodies yet able to think and feel to varying extents. The number of these cases has soared in recent decades, ironically, because doctors have steadily become better at saving patients with catastrophic injuries.

Today, trapped, damaged and diminished minds inhabit clinics and nursing homes worldwide – in Europe alone, the number of new coma cases is estimated to be 230,000 annually, of whom 30,000 will languish in a persistent vegetative state. They are some of the most tragic and expensive artefacts of modern intensive care.

Owen knows this only too well. In 1997, a close friend set off on her usual cycle to work. Anne had a weak spot on a blood vessel in her head, known as a brain aneurysm. Five minutes into her trip, the aneurysm burst and she crashed into a tree. She never regained consciousness.

The tragedy of Anne’s accident would shape Owen’s life. He began to wonder if there was a way to determine which of these patients were in an unconscious coma, which were conscious and which were somewhere in between?

That year, he had moved to the Medical Research Council’s Cognition and Brain Sciences Unit in Cambridge, where researchers used various scanning techniques. One, positron emission tomography (PET), highlights different metabolic processes in the brain, such as oxygen and sugar use. Another, known as functional magnetic resonance imaging (fMRI), can reveal active centres in the brain by detecting the tiny surges in blood flow that take place as a mind whirrs. Owen wondered whether he could use these technologies to reach out to patients, like his friend, stuck between sensibility and oblivion.

Today, being alive is no longer linked to having a beating heart, explains Owen. If you are on a life-support machine, are you dead? Is a failure to sustain independent life a reasonable definition of death? No, otherwise we would all be “dead” in the nine months before birth.

The issue becomes murkier when we consider those trapped in the twilight worlds between normal life and death – from those who slip in and out of awareness, who are trapped in a “minimally conscious state”, to those who are severely impaired in a vegetative state or a coma.

In the wake of the development of the artificial respirator during the 1950s in Denmark, pioneering work to categorise disorders of consciousness was carried out in the 1960s by the neurologist Fred Plum in New York and the neurosurgeon Bryan Jennett in Glasgow.

Plum coined the term “locked-in syndrome”, in which a patient is aware and awake but cannot move or talk. With Plum, Jennett devised the Glasgow Coma Scale to rate the depth of coma, and Jennett followed up with the Glasgow Outcome Scale to weigh up the extent of recovery, from death to mild disability. Together they adopted the term “persistent vegetative state” for patients who, they wrote, “have periods of wakefulness when their eyes are open and move; their responsiveness is limited to primitive postural and reflex movements of the limbs, and they never speak”. In 2002, Jennett was among a group of neurologists who chose the phrase “minimally conscious” to describe those who are sometimes awake and partly aware, who show erratic signs of consciousness so that at one time they might be able to follow a simple instruction and at another they might not.

Kate Bainbridge, a 26-year-old schoolteacher, lapsed into a coma three days after she came down with a flu-like illness. A few weeks after her infection had cleared, Kate awoke from the coma but was diagnosed as being in a vegetative state. Luckily, the intensive-care doctor responsible for her, David Menon, was also a principal investigator at the newly opened Wolfson Brain Imaging Centre in Cambridge, where Adrian Owen then worked.

Menon wondered whether elements of cognitive processing might be retained in patients in a vegetative state, and discussed with Owen how to use a brain scanner to detect them. In 1997, four months after she had been diagnosed as vegetative, Kate became the first patient in such a state to be studied by the Cambridge group. The results, published in 1998, were extraordinary. Her brain responses were indistinguishable from those of healthy volunteers; her scans revealed brain activity at the back of her brain, in a part which helps recognise faces. Kate became the first such patient in whom sophisticated brain imaging (in this case PET) revealed “covert cognition”. Of course, whether that response was a reflex or a signal of consciousness was, at the time, a matter of debate.

The results were of huge significance not only for science but also for Kate and her parents. “The existence of preserved cognitive processing removed the nihilism that pervaded the management of such patients in general, and supported a decision to continue to treat Kate aggressively,” recalls Menon.

Kate eventually surfaced from her ordeal, six months after the initial diagnosis. She described how she was indeed sometimes aware of herself and her surroundings. “They said I could not feel pain,” she says. “They were so wrong.”

Sometimes she’d cry out, but nurses thought it was nothing more than a reflex. Hospital staff had no idea how much she suffered in their care. Physiotherapy nurses never explained what they were doing to her. She was terrified when they removed mucus from her lungs. “I can’t tell you how frightening it was, especially suction through the mouth,” she has written. Her pain and despair became such that she tried to snuff out her life by holding her breath. “I could not stop my nose from breathing, so it did not work. My body did not seem to want to die.”

Kate says her recovery was not so much like turning on a light but a gradual awakening. By then she had lost her job, her sense of smell and taste, and much of what might have been a normal future. Now back with her parents, Kate is still very disabled and needs a wheelchair. Yet, 12 years after her illness, she started to talk again and, though still angry about the way she was treated when she was at her most vulnerable, she remains grateful to those who helped her mind to escape.

She sent Owen a note:

“Dear Adrian, please use my case to show people how important the scans are. I want more people to know about them. I am a big fan of them now. I was unresponsive and looked hopeless, but the scan showed people I was in there. It was like magic, it found me.” k

Nicholas Schiff is a neurologist at Weill Cornell Medical College in New York. His working life is a balancing act between putting the interests of his patients and their families first and keeping true to the science as he wrestles with disorders of consciousness. “There’s a lot we don’t know,” he admits. “Frankly, I am wrong a lot of the time.”

In 2005, Schiff applied his emerging understanding of the circuits of consciousness to Jim, a 38-year-old man who had been beaten and robbed and was left minimally conscious. Jim’s eyes had mostly remained shut. He was unable to speak and could communicate only by a nod, or tiny eye or finger movements. His plight seemed hopeless. Eventually, Jim’s mother gave a “do not resuscitate order” to doctors. Schiff thought differently.

Schiff had earlier scanned Jim with fMRI in 2001. His team had played subjects, including Jim, an audiotape in which a relative or loved one reminisced. In detailed fMRI scans, Jim had shown that, despite having a very underactive brain, he had preserved large-scale language networks. When he heard a story that meant something to him, his brain lit up. What, thought Schiff, if Jim’s thalamus could be activated by deep brain stimulation?

A brain pacemaker was implanted into Jim. After its two electrodes delivered pulses of electricity to his thalamus, he was able to use words and gestures, respond reliably to requests, eat normally, drink from a cup, and carry out simple tasks such as brushing his hair. Schiff believes that once a brain re-engages with the world, it accelerates processes of repair. For the next six years, before Jim died of unrelated causes, he kept his mind above the minimally conscious state. “He could converse in short sentences reliably and consistently and make his wishes known,” says Schiff. “He could chew and swallow and eat ice-cream and hang out. His family told us that they had him back.” The case made the front page of the New York Times. “I prayed for a miracle,” his mother told me at the time he was brought back. “The most important part is that he can say ‘Mummy and Pop, I love you.’ God bless those wonderful doctors. I still cry every time I see my son, but it is tears of joy.”

In a forested campus south of Liège, Steven Laureys studies vegetative patients in research that dates back decades. Working there as part of the Cyclotron Research Centre in the 1990s, he was surprised when PET brain scans revealed that the patients could respond to a mention of their own name. Meanwhile, on the other side of the Atlantic, Nicholas Schiff was finding that partially working regions lay within catastrophically injured brains. What did it all mean?

At that time, doctors thought they already knew the answers: no patient in a persistent vegetative state was conscious. Medical practitioners, with the best intentions, thought it was perfectly acceptable to end the life of a vegetative patient by starvation and the withdrawal of water. This was the age of what Laureys calls “therapeutic nihilism”.

What Owen, Laureys and Schiff were proposing was a rethink of some of the patients who were considered vegetative. A few of them could even be classed as being fully conscious and locked-in. The establishment was doggedly opposed. “The hostility we encountered [in the late 1990s] went well beyond simple scepticism,” says Schiff. Looking back, Laureys pauses and smiles thinly: “Medical doctors do not like to be told they are wrong.”

Then came 2006. Owen and Laureys were trying to find a reliable way to communicate with patients in a vegetative state, including Gillian. In July 2005, this 23-year-old had been crossing a road, chatting on her mobile phone. She was struck by two cars and diagnosed as vegetative.

Five months later, a strange piece of serendipity allowed Gillian to unlock her box. “I just had a hunch,” says Owen. “I asked a healthy control [subject] to imagine playing tennis. Then I asked her to imagine walking through the rooms of her house.” Imagining tennis activates part of the cortex called the supplementary motor area, involved in the mental simulation of movements. But imagining walking around the house activates the parahippocampal gyrus in the core of the brain, the posterior parietal lobe, and the lateral premotor cortex. So, if people were asked to imagine tennis for “yes” and walking around the house for “no”, they could answer questions via fMRI.

Gazing into Gillian’s “vegetative” brain with the brain scanner, he asked her to imagine the same things – and saw strikingly similar activation patterns to the healthy volunteers. It was an electric moment. Owen could read her mind.

Gillian’s case, published in the journal Science in 2006, made front-page headlines around the world. The result provoked wonder and, of course, disbelief. “Broadly speaking, I received two types of email from my peers,” says Owen. “‘This is amazing – well done!’ and ‘How could you possibly say this woman is conscious?’”

As the old saw goes, extraordinary claims require extraordinary evidence. The sceptics suggested that it was wrong to make these “radical inferences” when there could be a more straightforward interpretation. Daniel Greenberg, a psychologist at the University of California, Los Angeles, suggested that, “the brain activity was unconsciously triggered by the last word of the instructions, which always referred to the item to be imagined”.

Parashkev Nachev, a neurologist now at University College London, says he objected to Owen’s 2006 paper not on grounds of implausibility or a flawed statistical analysis but because of “errors of inference”. Although a conscious brain, when imagining tennis, triggers a certain pattern of activation, it does not necessarily mean the same pattern of activation signifies consciousness. The same brain area can be activated in many circumstances, Nachev says, with or without any conscious correlate. Moreover, he argues that Gillian was not offered a true choice to think about playing tennis. Just as a lack of response could be because of an inability to respond or a decision not to co- operate, a direct response to a simple instruction could be a conscious decision or a reflex.

What is needed is less philosophising and more data, says Owen. A follow-up study published in 2010 by Owen, Laureys and colleagues tested 54 patients with a clinical diagnosis of being in a vegetative state or a minimally conscious state; five responded in the same way as Gillian. Four were supposedly in a vegetative state at admission.

Owen, Schiff and Laureys have explored alternative explanations of what they observed and, for example, acknowledge that the brain areas they study when they interrogate patients can be activated in other ways. But the 2010 paper ruled out such automatic behaviours as an explanation, they say: the activations persist too long to signify anything other than intent. “You cannot communicate unconsciously – it is just not possible,” says Owen. “We have won that argument”.

Since Owen’s 2006 Science paper, studies in Belgium, the UK, the US and Canada suggest that a significant proportion of patients who were classified as vegetative in recent years have been misdiagnosed – Owen estimates perhaps as many as 20 per cent. Schiff, who weighs up the extent of misdiagnosis a different way, goes further. Based on recent studies, he says around 40 per cent of patients thought to be vegetative are, when examined more closely, partly aware. Among this group of supposedly vegetative patients are those who are revealed by scanners to be able to communicate and should be diagnosed as locked-in, if they are fully conscious, or minimally conscious, if their abilities wax and wane.

There is anecdotal evidence that when contact is re-established with the occupant of a living box they are understandably morose, even suicidal. They have been ground down by frustration at their powerlessness, over the months, even years, it can take to recognise their plight. Yet the human spirit is resilient, so much so that they can become accustomed to life in this twilight state. In a survey of patients with locked-in syndrome, Laureys has found that when a line of communication is set up, the majority become acclimatised to their situation, even content (again, these insights took time to be accepted by the medical and scientific establishment – and even to be published in a scientific journal – reflecting the prevailing unease about the implications for hospitals and care homes).

The important question is detecting the extent to which such patients are conscious. Studies of large numbers of patients with brain injuries, and how they fare over the years, show that it makes a huge difference to the chance of recovery if a patient is minimally conscious rather than vegetative. The former have fragmentary understanding and awareness and may recover enough to return to work within a year or two.

Yet there are still surprises, such as the case of New York fireman Don Herbert, who awoke after a decade from a minimally conscious state caused by a severe brain injury suffered while fighting a fire in 1995. Schiff has used a technique called diffusion tensor imaging to show how a brain can rewire itself even decades after an injury – yet in the past year, even he has recommended withdrawing care from a man who had lain in a coma for eight weeks after a cardiac arrest. “I was wrong,” he says. “This man is now back at work.”

Parashkev Nachev has not changed his view since he first criticised Owen’s work, and spelt out the basis of his unease in a more detailed paper published in 2010. “For every relative of a living PVS [persistent vegetative state] patient given (probably false) hope, another is burdened with the guilt of having acquiesced in the withdrawal of treatment from someone who – he has been led to believe – may have been more alive than it seemed,” he says. “There are moral costs to false positives as well as to false negatives.

“I find the whole media circus surrounding the issue rather distasteful. The relatives of these patients are distressed enough as it is.”

Laureys, Owen and Schiff spend a great deal of time with the families and understand these sensitivities only too well. Owen counters that, from his years of experience dealing with the families, they are grateful that doctors and scientists take an interest and are doing everything they can. “These patients have been short-changed over the years,” he insists.

Owen is adamant that doctors have a moral duty to provide a correct diagnosis, even if the results cause guilt, unease or distress. “We must give every patient the best chance of an accurate diagnosis, so we can give them the appropriate care that goes along with that diagnosis.”

Under the umbrella classification of “vegetative” lies a vast array of brain injuries and, as a result, even some of the most vocal critics accept that some vegetative patients are not as diminished as traditional measures suggest. Professor Lynne Turner-Stokes chairs a group for the Royal College of Physicians that is revising UK guidelines on “Prolonged Disorders of Consciousness”. She remains unconvinced that the exceptional cases identified by Owen, Laureys and Schiff are particularly common or that enough has been done to establish brain scanners as a standard tool for routine diagnosis, particularly when the cost and convenience of these methods are taken into account. When it comes to extending these tests to all patients in a vegetative states as standard practice, “The evidence is just not there yet,” she says.

But she stresses that she is simply being cautious, not sceptical, describing the work of Owen, Laureys and Schiff as “important and exciting”. “We are only just beginning to scratch the surface,” she says. “But I have no doubt [these techniques] will have a place, eventually, in the evaluation of patients.”

Back on Skype, Owen smiles, considering whether to tell me what he is planning next. His partner, Jessica Grahn, also a neuroscientist, became pregnant at the start of 2013. What happens when consciousness winks on in the developing brain? He emails me a video of their unborn child, a montage of fMRI slices through their baby’s head, as it twists and turns in Jessica’s womb. “My colleagues have been doing fMRI on my wife’s tummy every week for a few weeks now to see if we can activate the foetus’s brain,” he writes. “It is amazing.”

Some names have been changed to protect identities. Adrian Owen’s friend Anne remains in a vegetative state. Adrian Owen and Jessica Grahn’s baby boy was born on 9 October 2013.

Teachers: ‘Our pupils are targeting us’ with more than a quarter victims of abuse on social media

Teachers: ‘Our pupils are targeting us’ with more than a quarter victims of abuse on social media

Teachers are facing an increasing barrage of “vile” sexual abuse, unfair allegations of incompetence and videos of themselves taken without their consent being posted online by their pupils, according to a report seen by The Independent.

The survey of 7,500 teachers revealed that more than one in five (21 per cent) reported having adverse or derogatory comments posted about them on social media – from parents as well as children.

In one case highlighted by the report, a pupil tweeted: “You are a paedo and your daughter is a whore.” Another pupil said on Facebook that he wanted to kill his teacher – and invited fellow pupils to join in. The majority of comments by pupils, 61 per cent, came from 14- to 16-year-olds. However, there were two recorded from four- to seven-year-olds. The sites used by the pupils included Facebook, Ratemyteacher, Twitter, YouTube, Instagram and Snapchat.

In one case, a picture of a drunk person who had passed out and resembled a teacher was posted, with a comment telling fellow pupils it was their teacher.

Of the comments posted by pupils, 47 per cent included insulting words or phrases, 50 per cent had comments made about their performance as a teacher, and 26 per cent had videos or photographs posted without their consent.

Of the parents’ comments, 57 per cent were insulting, 63 per cent criticised the teachers’ performance, 7 per cent involved threatening behaviour, and 7 per cent were videos or photographs taken without the teachers’ consent.

In addition to this, 6 per cent involved allegations of inappropriate behaviour with children and 3 per cent inappropriate behaviour with parents.

One teacher said of the abuse: “I was so upset by the allegations and comments from kids who had seen it all… that I ended up being off work with stress, on antidepressants and having to see a counsellor.”

Union leaders are urging schools to support staff in approaching social media websites to secure the removal of offensive material and encouraging them to go to the police.

Of those who complained, 11 per cent went to the police  – but three-quarters of these said no further action had been taken against either pupils or parents, although they had received a sympathetic hearing.

“Teachers are often devastated by the vile nature of the abuse they are suffering,” said Chris Keates, general secretary of NASUWT. “Teachers are often traumatised by the attacks made on them through social media.

“Some have lost their confidence to teach once they see foul and personal remarks made by pupils in their classes and have left the profession.

“Others have been so disturbed by the comments that their health has been affected.”

Meanwhile, teachers’ leaders will warn today that they face a “home invasion” of emails from heads and senior management, which sometimes arrive in the early hours and demand that action be taken by the recipient before the start of the school day.

Ms Keates cited one case where a teacher received an email at 2.15am demanding action by 8am, describing it as “unacceptable harassment and pressure”.

“Teachers even report receiving emails from school management at midnight on New Year’s Eve with a message reminding them of the work they must have completed by the time the new term starts,” she added.

She urged all schools to adopt a policy and protocol on the appropriate use of emails to avoid further stress being placed on teachers.

Jolie to seek end to sexual violence as war weapon at London summit


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Jolie to seek end to sexual violence as war weapon at London summit

Angelina Jolie has said she hopes a global summit on sexual violence she will co-host in London with the UK government will bring lasting change to global peacekeeping and war crimes prosecutions, deterring the use of mass rape as a weapon in future conflicts.

The four-day summit, beginning on 10 June, will bring together governments from 141 countries to discuss how to improve and standardise the investigation of large scale sexual violence in wartime, to bring an end a culture of impunity that has severely limited prosecutions up to now.

Speaking to The Guardian during a visit to Bosnia, Jolie said: “I would hope that years down the line when war breaks out, people who are considering raping a man, woman or child would be very aware of the consequences of their actions, and that a woman crossing a checkpoint would be aware there was someone collecting evidence and that evidence would have a … result for her.”

“When that begins to happen on masse, then things will change. That’s why its important that this effort isn’t just one single [approach]. We are working with everyone who has worked on this issue for years, with every NGO and every government, to assist these people on all fronts.”

Jolie visited Bosnia at the end of last week with Britain’s foreign secretary, William Hague, as part of a two-year partnership aimed at preventing sexual violence in conflict. In the course of the trip they spoke in private to several women survivors of the 1995 massacre in Srebrenica, where the slaughter of 8,000 Muslim men and boys has overshadowed another crime against humanity committed at the same time, the systematic rape of women and girls.

The meeting with the Srebrenica women took place in a disused battery factory where in July 1995, thousands of Bosnian Muslims sought the shelter of Dutch UN peacekeepers. The UN promise of protection proved hollow and the factory is now echoing and empty apart from a sombre memorial – two black boxes each as big as a house. In a cemetery outside a stone monument records the names of the 8,000 men and boys slaughtered by General Ratko Mladic’s Serb army.

One of the women, Edina Karic, was taken from her family by Serb soldiers and held at a nearby lead and zinc mine, where she was repeatedly raped.

“I was taken to the mine, where I was raped many times along with two other girls. Then we were eight days in an abandoned house where we were raped again,” Karic said. “When these things were happening to me, it was as if I wasn’t there in my body. I was looking at it from outside.”

None of Karic’s rapists has been prosecuted, even though she could definitively identify at least three of them, and has followed their lives, in a town a few miles away, through Facebook.

More than 20,000 Bosnian women and girls were raped. Over a decade in the Democratic Republic of Congo there are thought to have been 200,000 victims. There were up to half a million rapes in Rwanda in 1994, and there are widespread reports of systematic sexual violence in Syria.

The silence surrounding rape as a war crime is deepened because the victims are often shunned by their own communities. Edina Karic is a rarity in that she is prepared to speak openly about what happened to her.

“I realised I’m not the one who should feel shame. It’s for the perpetrators to feel ashamed,” she said.

In Sarajevo, Hague and Jolie spoke to a hall full of Bosnian army officers who have, with British assistance, developed a training course meant to equip peacekeeping contingents from around the world to detect and prevent the commission of mass rape. As part of the Hague-Jolie campaign, every UN peacekeeping mission is now supposed to provide for the protection of civilians against sexual violence in conflict.

“At times, you may be all that stands between a child and violence that will scar him or her forever,” Jolie told the soldiers in Sarajevo. You may sometimes be the first person outside their family that a survivor of rape encounters. Your actions may make the difference between a successful prosecution, or aggressors going unpunished.”

So far, for the 20,000-50,000 wartime rapes in Bosnia, there have been 30 convictions at the Hague war crimes tribunal and another 33 at the Bosnia state court. Thousands more perpetrators, like Edina Karic’s rapists, remain at liberty.

“There is no forensic evidence, often no medical reports. All you have usually are witness statements, and in a very conservative society, most victims don’t want people to know what happened to them, so most rapes are not reported,” said Dubravko Campara, a Bosnian war crimes prosecutor.

The Bosnian state court has hundreds of open investigations on its docket and just 17 prosecutors. But with the help of UK funding, another 15 are going to be added to the staff to ease the backlog. The court now has a witness support unit to ease the pressure on women witnesses.

The global Preventing Sexual Violence Initiative was launched two years ago after Hague saw Jolie’s 2012 film about the Bosnian rape camps, Land of Blood and Honey. The hardest part of the effort is likely to be translating goodwill at the summit into real change in future conflicts. When Hague and Jolie visited Goma in DRC last March, they heard that women fleeing the fighting with their families were being frequently raped when they ventured out of refugee camps to look for firewood, despite the proximity of thousands of UN peacekeepers nearby. Keeping the women safe was not part of the soldiers’ mandate.

Hague conceded that progress in changing UN peacekeeping practices had been slow, but added: “The UN will be heavily involved in the summit. A big ally of ours is Zainab Bangura, the UN special representative on sexual violence. I think we are getting somewhere with that, but it means systematically building our objectives into all peacekeeping training.”

“There is a lot of goodwill,” Jolie said. There is a lot of understanding of what’s right and wrong, but there is a disconnect. So if we can try to put the pieces together and fill the holes, then maybe there can be a real change.”

War is over – now Serbs and Bosniaks fight to win control of a brutal history


War is over – now Serbs and Bosniaks fight to win control of a brutal history

After survivors and bereaved families put up a memorial to the mass slaughter in 1992 of Muslims in Višegrad, the response of the Serb authorities in the eastern Bosnian town was as unsubtle as it was symbolic. They ordered the word “genocide” chiselled off the stone monument.

A group of Višegrad widows soon restored the word in lipstick, only for it to be obscured by municipal white paint a few days later. This is a battle the town hall is not prepared to lose. When it sent a surveyor and workman into the town’s Muslim cemetery with an angle grinder to erase the offending term on 23 January, they were accompanied by 150 policemen in riot gear. The message was clear.

The graveyard spat is a skirmish in a much bigger battle being fought in Bosnia – the continuation by bureaucratic means of the murderous four-year war of two decades ago. It is a struggle over collective memory and the power to write history.

“Those who committed the war crimes against us are still winning. They are killing our truth,” said Bakira Hasečić, a Višegrad survivor who was raped multiple times by Serb paramilitaries at her home and in the local police station in 1992. Her sister was raped and killed. Her 18-year-old daughter was raped and had her head smashed by a rifle butt, but survived.

Hasečić now runs the Association of Women Victims of War. She and other Višegrad rape victims tried to protect the monument last month but failed because the town authorities turned up an hour earlier than announced, and in force.

“The huge numbers of police in their uniforms and caps brought back the memories of 1992. You relive those moments. My legs were shaking. When we arrived, we had no idea they had already done that to the monument. People started crying when they found out. I couldn’t bring myself to look at it.”

However, the same morning and less than 200 yards away, Hasečić and other Bosniak survivors were successful in stopping another act of demolition. The Serb authorities want to knock down a house on Pionirska Street, where 59 Muslim women, children and pensioners were locked into a single room and incinerated on 14 June 1992. Relatives of the dead, with Hasečić’s help, are trying to restore the house as a memorial.

The town council has countered by expropriating the building, claiming the road needs to be widened. Yet the house is set well back from the existing road and the immediate Serb neighbours – who have mostly been supportive of the Bosniaks’ restoration attempts, offering to help with water and electricity connections – say no other houses on the street have been targeted in the same way.

But no one in the neighbourhood believes the issue is really about town planning. Serb nationalists are striving to suppress reminders of atrocities committed in the name of separatism, mostly against the country’s Muslims (known as Bosniaks) and to construct an alternative history in which Serbs were the principal victims. Many Bosniaks and outside observers fear that this refusal to come to terms with the past means there are few guarantees that such acts will not be repeated.

Bosniaks and Croats have also been slow to allow memorials to civilian victims from other ethnicities, but it is in the Republika Srpska, the Serb-run half of Bosnia, where the scale of the killing was by far the greatest, and where the culture of denial is now the deepest.

Višegrad is a grim example. An eastern Bosnian town set dramatically along a break in the white limestone ravines of the River Drina, it is home to Bosnia’s best-known cultural artefact, the 16th century Mehmed Paša Sokolović bridge, a graceful span of 11 masonry arches made legendary by the Yugoslav Nobel laureate Ivo Andrić.

In his 1945 novel, the Bridge on the Drina, it is silent witness to atrocities across generations. In 1992, it was spattered with blood once more. Serb paramilitaries calling themselves “The Avengers” and the “White Eagles” went on a killing spree through the town and surrounding villages, executing Muslims. Men, women and over a hundred children were slaughtered, many on the bridge itself, and their bodies dumped in the Drina.

The practice of barricading people into houses and setting them alight with grenades was reproduced several times. In another incident in nearby Bikavac, there were 60 victims, against mostly women and children.

A couple of miles outside Višegrad, young women and girls as young as 14 were held captive and repeatedly raped in the Vilina Vlas spa hotel. It was where the paramilitaries led by a pair of sadistic local cousins, Milan and Sredoje Lukić, made their wartime base. Muslim men were routinely tortured next door to where the women were raped and killed.

The estimates of the total number of victims in the Višegrad municipality range from 1,600 to 3,000. The rest of the area’s Muslims fled; most made their way south to Goražde, which became a Bosniak enclave and survived a three-year Serbian siege. Before the war, the Višegrad municipality had a population over 21,000, two thirds Muslim. Now the population is 12,000, 1,500 of them Bosniaks.

Today’s survivors are post-war returnees to the Višegrad outskirts, often living in villages or houses where their loved ones were executed. Twenty years after the bloodletting they remain a marginalised community, routinely denied the meagre social benefits doled out by Višegrad’s authorities.

After an interregnum in which slightly more moderate parties held sway, the Serb Democratic Party (or SDS for Srpska Demokratska Stranka) regained control of the municipality in October 2012. The extreme nationalist party of Radovan Karadzic, which hacked out the Republika Srpska and oversaw the “ethnic cleansing” of Muslims and Croats, is back in charge in Višegrad and 24 other Serb towns with its own version of what happened between 1992 and 1995, and its own way of doing things. Hence the municipal use of angle-grinders and bulldozers.

“With the old mayor we could co-operate much better. We had different opinions but it was discussed in a more civilised way,” said Bilal Memišević, the head of Višegrad’s Islamic community council. Both his parents were murdered in 1992, when he was studying abroad. “Since the SDS came to power, they started ignoring us. They don’t mention employment, or the economy. It’s all about the war and the manipulation of 1992. They have been able to target a vulnerable population and they have been successful. They have built an alternative reality.”

That alternative reality is visible everywhere in town. In the main square, there is large statue of a knight bearing a cross and a sword, dedicated to “the defenders of the Republika Srpska, with the gratitude of the people of Višegrad”. Nearby a large swath of land had been expropriated for a literary theme-park, Andrićgrad, masterminded by Emir Kusturica, Serbia’s most famous film director, twice awarded the Palme d’Or at Cannes.

The complex, a pastiche on the town’s history, due to be completed in June this year, is being built on the site of a former sports centre that was used as a detention camp by Serb paramilitaries.

In mid-March each year, hundreds of Serbs come from around the region to parade through the town to commemorate Draža Mihajlović, the leader of the ultra-nationalist Chetnik movement during the second world war, who carried out a series of atrocities against Muslims in the Drina valley. They come as Chetniks, with long wild beards, fur hats, and black skull-and-crossbone flags. Many of the killers in 1992 dressed exactly the same way. It is a terrifying annual spectacle for Višegrad’s remaining Bosniaks, all the more so in 2010 when Mitar Vasiljevic, a Lukić henchman sentenced 15 years by the Hague war crimes tribunal for his part in the 1992 killings, made a triumphant return after early release. He paraded in full Chetnik garb and was given a hero’s welcome, complete with patriotic music and a motorcade through the town.

Milan Lukić himself was transferred from the Hague this month to serve his life term in Estonia. His cousin Sredoje is serving 27 years in Norway.

The most powerful man in town now is Miroslav Kojić, a soldier and secret policeman for Republika Srpska during the war and now Višegrad’s SDS representative in the Republika Srpska parliament.

He provides a legal defence of the municipality’s actions, arguing that there have been no convictions at the Hague tribunal specifically for genocide that would justify the disputed memorial. (Višegrad was taken from the list of municipalities in Karadzic’s genocide indictment to slim the charge sheet and speed up his trial, but the tribunal has declared the town was subjected to “one of the most comprehensive and ruthless campaigns of ethnic cleansing in the Bosnian conflict”). As for Pionirska Street, Kojić says the issue is a long-running non-political town planning matter.

Of his own wartime role, Kojić – an energetic man with a piercing stare – is heated, launching into a strangely inverted version of Višegrad’s wartime history, in which Bakira Hasečić supposedly tortured Serb policemen and soldiers, and Višegrad’s Serbs withstood a brutal Bosniak siege in 1992 and 1993.

The narrative of Serb victimhood is pieced together from sporadic Bosniak acts of resistance during the war. After the former Yugoslav National Army bombarded Muslim areas of Višegrad at the outbreak of conflict in the first week of April 1992, a group of armed Muslims took some Serb policemen hostage and threatened to blow up a nearby hydroelectric dam if shelling continued. The dam was retaken by the army which then withdrew on May 19, handing the town over to Serb nationalists and paramilitaries that carried out the atrocities against Bosniak civilians.

In summer 1992, survivors of the concentration camps helped form a Bosniak First Višegrad Brigade which fought a guerrilla campaign for a year in the wooded hills on the west bank of the Drina, but never came close to surrounding or threatening the city before being driven back into the Bosniak enclave of Goražde in 1993. After surviving multiple rapes, Hasečić, did join the Bosnian army, but there is no evidence of her mistreating Serbs.

Today the Bosniak resistance effort is the justification for public memorials in central Višegrad for Serb soldiers and even Russian volunteer fighters on the Serb side, and the absence of equivalent monuments to Bosniak civilians. It is a pattern repeated around the Republika Srpska. Further up the Drina is the town of Foca which became a byword for mass rape during the war. Bosnian Serbs imprisoned Muslim women and girls and raped them on such a scale the town made legal history. As a result of what happened in Foca, such systematic rape was finally classed as a crime against humanity.

There is no sign of such a grim history in Foca now, just another granite and marble monument to the Serb fallen. There is also no plaque at the most notorious concentration camp at Omarska, now within an iron ore mine run by a Luxembourg-based multinational steel corporation, ArcelorMittal, which says it is a matter for the Serb-run local authority in Prijedor to decide. In the neighbouring camp, at Trnopolje, where torture and rape were rife and where hundreds of Bosniaks and Croats were killed, a concrete memorial to fallen Serb soldiers has been placed at the entrance inscribed with an ode to “freedom”.

In Višegrad, the remaining Bosniaks have become accustomed to the official state of denial. Omar Bosankić and Elvedin Musanović, two Muslim men in their mid-30s out strolling one recent afternoon on Višegrad’s bridge, insist that relations with their Serb neighbours are fine as long as the war is not mentioned.

“No one wants to admit anything. They never want to talk about it,” Bosankić said. As a 14-year-old boy, he helped fish bodies of murdered Muslims out of the Drina at night in his home village of Barimo, five miles downstream. “I still have images that come back all the time. There a woman with her hands tied behind her back and a man with a screwdriver still stuck in his neck.”

Musanović says that Bosniaks on the bridge were slaughtered with whatever the Lukićs’ “Avengers” or “White Eagles” could find, often blades of broken glass. A water tanker would come in the evening to wash away the gore from the ancient stones of the bridge where they now take their daily walk. In the absence of any jobs, there is not much else to do.

The two men are unimpressed by the municipality’s legal objections to the Bosniak memorial.

“What else happened here but genocide?” Bosankić asked. Twenty-six people were murdered in his village in August 1992, the youngest, Emir Bajrić, was only 12 years old. He points out that the fact that no one has so far been convicted for the crime does not mean it did not happen. “Everybody who lives here knows what happened.”

Another stolen generation: how Australia still wrecks Aboriginal families


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Another stolen generation: how Australia still wrecks Aboriginal families

The tape is searing. There is the voice of an infant screaming as he is wrenched from his mother, who pleads, “There is nothing wrong with my baby. Why are you doing this to us? I would’ve been hung years ago, wouldn’t I? Because [as an Aboriginal Australian] you’re guilty before you’re found innocent.” The child’s grandmother demands to know why “the stealing of our kids is happening all over again”. A welfare official says, “I’m gunna take him, mate.”

This happened to an Aboriginal family in outback New South Wales. It is happening across Australia in a scandalous and largely unrecognised abuse of human rights that evokes the infamous stolen generation of the last century. Up to the 1970s, thousands of mixed-race children were stolen from their mothers by welfare officials. The children were given to institutions as cheap or slave labour; many were abused.

Described by a chief protector of Aborigines as “breeding out the colour”, the policy was known as assimilation. It was influenced by the same eugenics movement that inspired the Nazis. In 1997 a landmark report, Bringing Them Home, disclosed that as many 50,000 children and their mothers had endured “the humiliation, the degradation and sheer brutality of the act of forced separation … the product of the deliberate, calculated policies of the state”. The report called this genocide.

Assimilation remains Australian government policy in all but name. Euphemisms such as “reconciliation” and “Stronger Futures” cover similar social engineering and an enduring, insidious racism in the political elite, the bureaucracy and wider Australian society. When in 2008 prime minister Kevin Rudd apologised for the stolen generation, he added: “I want to be blunt about this. There will be no compensation.” The Sydney Morning Herald congratulated Rudd on a “shrewd manoeuvre” that “cleared away a piece of political wreckage in a way that responds to some of its own supporters’ emotional needs, yet changes nothing”.

Today, the theft of Aboriginal children – including babies taken from the birth table – is now more widespread than at any time during the last century. As of June last year, almost 14,000 Aboriginal children had been “removed”. This is five times the number when Bringing Them Home was written. More than a third of all removed children are Aboriginal – from 3% of the population. At the present rate, this mass removal of Aboriginal children will result in a stolen generation of more than 3,300 children in the Northern Territory alone.

Pat (not her real name) is the mother whose anguish was secretly recorded on a phone as four department of child services officials, and six police, descended on her home. On the tape an official claims they have come only for an “assessment”. But two of the police officers, who knew Pat, told her they saw no risk to her child and warned her to “get out of here quick”. Pat fled, cradling her infant, but the one-year-old was eventually seized without her knowing why. The next morning a police officer returned to apologise to her and said her baby should never have been taken away. Pat has no idea where her son is.

Once she was “invited” by officials to bring her children to “neutral” offices to discuss a “care plan”. The doors were locked and officials seized the children, with one of the youngest dragging on a police officer’s gun belt. Many Indigenous mothers are unaware of their legal rights. A secretive children’s court has become notorious for rubber-stamping removals.

Most Aboriginal families live on the edge. Their life expectancy in towns a short flight from Sydney is as low as 37. Dickensian diseases are rife; Australia is the only developed country not to have eradicated trachoma, which blinds Aboriginal children.

Pat has both complied with and struggled bravely against a punitive bureaucracy that can remove children on hearsay. She has twice been acquitted of false charges, including “kidnapping” her own children. A psychologist has described her as a capable and good mother.

Josie Crawshaw, the former director of a respected families’ support organisation in Darwin, told me: “In remote areas, officials will go in with a plane in the early hours and fly the child thousands of kilometres from their community. There’ll be no explanation, no support, and the child may be gone forever.”

In 2012 the co-ordinator general of remote services for the Northern Territory, Olga Havnen, was sacked when she revealed that almost A$80m (£44m) was spent on the surveillance and removal of Aboriginal children compared with only A$500,000 (£275,000) on supporting the same impoverished families. She told me: “The primary reasons for removing children are welfare issues directly related to poverty and inequality. The impact is just horrendous because if they are not reunited within six months, it’s likely they won’t see each other again. If South Africa was doing this, there’d be an international outcry.”

She and others with long experience I have interviewed have echoed the Bringing them Home report, which described an official “attitude” in Australia that regarded all Aboriginal people as “morally deficient”. A department of family and community services spokesman said that most removed Indigenous children in New South Wales were placed with Indigenous carers. According to Indigenous support networks, this is a smokescreen; it does not mean families, and it is control by divisiveness that is the bureaucracy’s real achievement.

I met a group of Aboriginal grandmothers, all survivors of the first stolen generation, all now with stolen grandchildren. “We live in a state of fear, again,” they said. David Shoebridge, a state Greens MP, told me: “The truth is, there is a market among whites for these kids, especially babies.”

The New South Wales parliament is soon to debate legislation that introduces forced adoption and “guardianship”. Children under two years old will be liable – without the mother’s consent – if “removed” for more than six months. For many Aboriginal mothers like Pat, it can take six months merely to make contact with their children. “It’s setting up Aboriginal families to fail,” said Shoebridge.

I asked Josie Crawshaw why. “The wilful ignorance in Australia about its first people has now become the kind of intolerance that gets to the point where you can smash an entire group of humanity and there is no fuss.”


Self-harm sites and cyberbullying: the threat to children from web’s dark side


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Self-harm sites and cyberbullying: the threat to children from web’s dark side

“Some of the images do scare me, especially if it’s my friends. Once my friend cut lines down the side of his face as a ‘Chelsea Smile’, he put it online and it was the worst thing I had ever seen. He’s my friend, I don’t want to see him that upset. He got so much hate for it and ended up going into hibernation, nobody heard from him for over a week and we honestly thought he had killed himself.”

Frankie* is 15 and lives in the Midlands. For the past year or so she has updated her Tumblr blog most days. On other social networks she uses her real name, but on Tumblr – a blogging platform – she shares her darkest thoughts about depression, anxiety and self-harm anonymously. “The other day I put up a self-harm picture,” she says. “I was alone and in a dark place. […] Of course, nobody would help, but posting it boosted my confidence a little; finding it buried in amongst all the other self-harm posts reminded me I’m not alone.”

Fears about self-harm sites have been growing since the suicides of two teenagers who, it emerged, were obsessed with self-harm and depression blogs, with mental health campaigners and experts warning that the UK’s teens are at risk of becoming a lost generation if parents and adults cannot reach out to them across the digital divide.

Tallulah Wilson, a 15-year-old who killed herself in 2012, was caught up in a “toxic digital world”, according to her mother, while the parents of Sasha Steadman, a 16-year-old who died from a suspected drug overdose in January after looking at self-harm sites, said her “impressionable mind” had been filled “with their damning gospel of darkness”.

For the uninitiated, self-harm blogs present a surreal world of fantasy and pain. Countless sites dedicated to self-harm and depression are filled with images of bleeding wounds juxtaposed with pixelated gifs, flickering eerily with snippets of Hollywood angst. Helen, who is now 18, visited them regularly, before stopping to help herself move on from self-harming. “You have people asking you how to cut yourself deep enough because their therapist said it wasn’t bad enough,” she says. “I have had people tell me to kill myself. I think the most traumatic is when you find someone’s suicide note online and there is no way to actually get in contact with the person.”

Isolated and lonely, she used the blogs because they gave her a sense of belonging. “You want to find people who are similar to you. That is what humans do,” she says. “It starts off as trying to help, but then it becomes competitive and dangerous. You get sucked into this world of who can cut the deepest/be the skinniest and avoid notice by the outside world. You end up spending hours a day searching these sites for reassurance, but it just makes it harder.”

Keeping children safe online is the “child protection challenge of this generation”, according to Peter Wanless, head of the NSPCC. ChildLine, part of the organisation, registered an 87% rise in calls about cyberbullying last year, a 41% increase in calls about self-harm, and a 33% increase in calls about suicide, with the biggest increase among 12- to 15-year-olds.

While the internet provides unprecedented opportunities for young people to communicate and learn, it can be a dangerous place for vulnerable teenagers, says Sue Minto, the head of ChildLine. “Children are communicating in a way we have never seen before – all the time and instantly,” she says. “Personally, I think this kind of relentless exposure is the biggest challenge we have ever faced.”

Minto notes that while peer pressure and bullying have been around for a long time, the ability to be contacted at all times is new. The cloak of anonymity can lead children to make comments they would shy away from in “real” life, she says. “The pressure on children is immense and very worrying – there is no break for these young people, it is quite relentless. Children who are being bullied tell us there is no point in turning off their phone, because the messages will just be there waiting for them.”

recent survey carried out by youth charities ChildLineSelfharm.co.uk,YouthNet and YoungMinds revealed that 61% of the 4,000 young people who responded said they self harmed because they felt alone, while 25% cited bullying. Almost 40% said they had never spoken to anyone in the “real world” about it.

Rachel Welch, director of Selfharm.co.uk, which supports young people affected by self-harm, says there is a huge gap between what adults see of the online world and their children’s experience. “So many young people are drifting into a world where they are completely disconnected,” she says.

But how dangerous are self-harm sites? Do they simply show teenage angst and creative expression, or highlight a worrying deterioration of teenage mental health?

Mary Hassell, the coroner presiding over the inquest of Tallulah Wilson, was concerned enough to write to Jeremy Hunt, the health secretary, to warn him of a risk of future deaths without a greater understanding of children’s online worlds. Although Tallulah was treated by healthcare professionals, they didn’t have “a good enough understanding of the evolving way that the internet is used by young people, most particularly in terms of the online life that is quite separate from the rest of life”, she wrote.

A study into possible links between suicide and the internet has just been commissioned by the Department of Health and will report in two and a half years: a department spokeswoman said children’s mental health was a priority for the government and pointed to the introduction of “family-friendly filters” and internet safety into the national curriculum.

But for Sarah Brennan, chief executive of the youth mental health charity Young Minds, the real issue is ignorance of the scale of the problem, or even denial that the problem exists. The current NHS commissioning of youth mental health services is based on data collected in 2004 – the year Facebook launched.

“It is shocking that the government is allowing NHS commissioners to plan services based on out of date and inaccurate data,” Brennan says, adding that a Young Minds freedom of information request recently revealed that 34 out of 51 local authorities in England have reduced the budget for their children and adolescent mental health services since 2010, while a Community Care/BBC investigation this week showed that a growing number of seriously ill children are being admitted to adult psychiatric wards or sent hundreds of miles from home for hospital care.

“We are sitting on a ticking time bomb here,” says Brennan. “At the same time that we are seeing an increase in need, youth mental health services are being cut. There is an explosion of bullying online and young people struggling to cope with mental health issues, anxiety, eating disorders. If we don’t do something about it we could have a lost generation.”

What can be done? Since Tallulah Wilson’s suicide, Tumblr has introduced a warning that pops up when users search for terms related to self-harm, directing them towards sites offering support and calling on users to report blogs with “inappropriate content” so they can be taken down. A Tumblr spokeswoman said the site was “deeply committed to protecting our users’ freedom of expression”, but that it draws lines “around a few categories of content we consider damaging to our community, including blogs that encourage self-harm”.

And while there have been calls to shut down certain sites, such as Ask.fm – which allows users to ask anonymous questions and has been linked to teen suicides – teenagers and professionals spoken to by the Guardian agreed that simply banning sites or “dangerous” search terms was futile. Regulation can also backfire – recent efforts to impose opt-out “objectionable content filters”, backed by the prime minister, have resulted in sites such as ChildLine and Refuge also being blocked.

“We cannot put our head in the sand, simply blame these sites or hope to regulate our way out of this,” says Minto. “We are playing catch-up, but we need to take responsibility. You wouldn’t let your child cross the road without talking to them about road safety and the same goes for the risks of the internet – if we don’t tackle this it’s like opening the door and letting them walk through this cyberworld completely unequipped.”

Welch at Selfharm.co.uk agrees: “Calling for any type of ban is just missing the point. What we have to do is make sure our young people are emotionally resilient, emotionally aware and they know where to go to get help if they need it.”

Others say that while parts of the internet can be dangerous for vulnerable children, it can also provide the means to keep others safe and let them talk about their problems. As many young people contact ChildLine online as call its helpline. Online friends can be a force for good.

Samantha, a 17-year-old who started self-harming when she was 14, says her Tumblr site helped her recover from depression. “I felt like I belonged somewhere, they understood me in a way I felt I had never been understood before,” she says. At one point, she was off school with depression and spent all day online, answering 10-15 messages from other troubled teenagers every day. Now she “has a life” again and is online less frequently. “I’ve been told that I’ve saved lives and it made me feel good about myself that I was helping other people,” she says. “It’s really odd – but it works for me.”

Frankie, who is still working towards recovery, has mixed emotions. While she recognises that some blogs might encourage self-harmers, or make them feel worse, she still believes they can help. “I think for [people] like myself it can be reassuring just to know there are others out there that do it too [but] what scares me is thinking how many there are, how they are all posting it online, are they all cries for help? If that many people are crying for help then something needs to be done, and fast.”

*Names of young people have been changed. If you face any of the issues in this piece, you can call ChildLine on 0800 1111

UK launches £500,000 fund to help male victims of rape and sexual abuse


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UK launches £500,000 fund to help male victims of rape and sexual abuse

A £500,000 fund to provide help, including counselling and advice, to male victims of rape and sexual violence is to be launched on Thursday.

The creation of the fund comes as the latest set of crime figures showed there were 2,164 rapes and sexual assaults against men and boys aged 13 or over recorded by the police in the 12 months to last November.

The crime survey for England and Wales estimates that there are as many as 72,000 male victims of sexual offences every year, whether they are reported to the police or not.

The victims minister, Damian Green, said the new fund would also help “historic victims” who were under 13 at the time. He said: “We believe around 12% of rapes are against men. Yet many choose not to come forward, either to report the crime or seek the support they need. I am determined to help break the silence on a subject still seen as a taboo.”

Green said the average sentences for male rape had increased but there was still more to do: “That is why we are toughening up sentencing and have introduced a mandatory life sentence for anyone convicted of a second very serious sexual or violent crime.”

Duncan Craig of Survivors Manchester, which specialises in helping male survivors of rape and sexual abuse, welcomed the new funding. He said: “In the past, there has not been enough support in the UK for male victims of sexual violence. But in the future I would like to see both the government and society begin talking more openly about boys and men as victims and see us trying to make a positive change to pulling down those barriers that stop boys and men speaking up. This funding will help to raise awareness of the issue and ensure that male victims are no longer ignored.”

The launch of the fund comes as the justice ministry starts a social media #breakthesilence campaign to encourage male victims to speak about their experiences. The Channel 4 teenage soap Hollyoaks recently featured a male rape storyline.

A Firm Grasp on Comfort


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A Firm Grasp on Comfort

“Where’s your baby?” said the mother to her sobbing 3-year-old daughter. “You need your baby!”

Her older daughter began digging through the two large diaper bags, and triumphantly extracted a fuzzy pink blanket. The 3-year-old grabbed the blanket and tucked it up under her chin, gripping it tightly. “There’s your baby!” the mother and the older sister said in unison. The crying subsided, and we went on with the medical exam.

So-called transitional objects — beloved blankets, tattered stuffed animals, irreplaceable garments — are frequent in the pediatric exam room. Some children clutch them to ease the stress of being examined or immunized, while others simply never leave the house without their favorites. Ask any small group of parents about transitional objects — or blankies, or lovies — and you’ll get a good story, usually of a precious item misplaced or lost at some critical juncture.

Ask adults, and the most unlikely people tell you the names of their treasured childhood blankets or get misty-eyed about a stuffed bear.

The British experts who first wrote about the term mentioned Winnie the Pooh and Aloysius, the teddy bear in “Brideshead Revisited”; a recent literary incarnation is Knuffle Bunny, in the series of three picture books by Mo Willems. But the formative American take on transitional objects is probably Linus, with his blanket, in Charles M. Schulz’s Peanuts cartoons, which date to the 1950s and the moment of the original psychoanalytic discussion of the phenomenon.

In 1953, Dr. Donald Woods Winnicott, a prominent pediatrician and psychoanalyst, presented a paper to the British Psycho-Analytical Society: “Transitional Objects and Transitional Phenomena — A Study of the First Not-Me Possession.” The paper, published in The International Journal of Psychoanalysis, combines psychoanalytic theory with a clear pediatric familiarity with children and their blankies.

“The parents get to know its value and carry it round when travelling,” Dr. Winnicott wrote. “The mother lets it get dirty and even smelly, knowing that by washing it she introduces a break in continuity in the infant’s experience.” In Dr. Winnicott’s view, the object, together with what he called a “good enough mother,” helps the young child navigate the essential problem of separation.

“The baby knows the teddy bear is not Mom, but the baby can get a certain satisfaction. It is neither Mom nor totally just a stuffed animal,” said Steve Tuber, a clinical psychologist and professor of psychology at City College, and the author of a book on Winnicott.

The specificity of the child’s preference — and affection — parallels the developing ability to feel a strong specific attachment to particular people. The transitional object is “a bridge between the mother and the external world,” said Alicia Lieberman, an expert in infant mental health and a professor at the University of California, San Francisco.

Arietta Slade, a professor of clinical and developmental psychology at the City University of New York, said: “It’s a very adaptive mechanism, if you think about it, that there are things other than mother that kids can hang on to that help them retain that comforted and comforting feeling.”

Some parents are able to “suggest” a convenient object (and buy multiples to keep in reserve), but children are guided mostly by their own mysterious and passionate preferences, and they do not necessarily accept substitutes — witness all those stories about turning the car around to go back for the one true blankie.

The transitional object “has to be created by the baby,” Dr. Tuber said. “A child has to pick the one that really becomes theirs.”

Inevitably, there are parents who worry that the object has become too important, and that caring for it and curating it has become a major burden — or that it’s being held on to past some age of expected maturity and independence.

“Parents get upset because they think they’re going to lose the transitional object, they think it collects germs, they think it looks babyish, which is a problem in American culture,” said Dr. Barbara Howard, a developmental-behavioral pediatrician at Johns Hopkins.

“The biggest problem is stigmatization. There is no ultimate age where it’s bad, but you can get teased for it,” she added.

As children get older, some transitional objects — especially stuffed animals — take on distinct personalities, moving toward a combined role as comforter and imaginary friend. Think of how Winnie the Pooh serves as Christopher Robin’s playmate, companion and sometimes problem child. Aloysius, the teddy bear in “Brideshead Revisited,” is taken along to Oxford.

Indeed, Dr. Howard suggested that as many as 25 percent of young women going to college take along something identifiable as a childhood transitional object. The young adult going off to college, with or without stuffed animals or scraps of a favorite old blanket, should be a reminder that the challenges of separation — and the consolations and complexities of attachment — are not developmentally confined to the first years of life.

The familiar image of the small child and the transitional object, generally sweet and mildly humorous, occasionally frantic and even desperate, reminds us that learning to negotiate, and even enjoy, partings and reunions is part of the whole assignment, for parents and for children.

France faces up to scandal of Réunion’s stolen children


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France faces up to scandal of Réunion’s stolen children

Jean-Jacques Martial was six years old when he arrived at Orly airport in Paris one November morning wearing flip-flops and shorts. He had been removed from his grandmother’s care in the French island territory of Réunion as part of an official scheme to help boost the falling population in the rural heart of the mother country. He had only one idea in his head: “I was going to cultivate myself and I would denounce what had happened to me,” he said.

Martial went on to do just that, and on Tuesday the French national assembly will address this shameful chapter of its history for the first time when members vote on a motion to formally recognise the state’s role in the scandal of Réunion’s “stolen children”. From 1963 to 1982 a total of 1,615 children were forcibly dispatched from the Indian Ocean territory, whose population was exploding, in order to repopulate rural areas.

“They took babies who were only six months old,” said Ericka Bareigts, one of the territory’s deputies who is behind the initiative. Poor and illiterate families were informed that their children would be sent to France, “and of course they imagined Paris and the Eiffel tower,” she said. “They were promised a home, schooling, and told they would succeed. The families were told the children would return for the holidays. But it was all a lie.”

Martial, who is now 55, was initially placed in a home before being transferred to Guéret, in the Creuse district of central France, where he was brought up by an elderly farmer and his wife. Martial has recounted his experiences in a memoir, Une Enfance Volée (Stolen Childhood), which describes how, after four years in the Creuse, he was fostered by a young couple in the Normandy harbour town of Saint Vaast la Hougue.

The scandal was only brought to the attention of the wider French public when Martial tried to sue the state for €1bn in 2002 for “kidnapping and sequestration of minors, roundup and deportation”.

“It’s a lot of money, but how much is a stolen childhood worth?” he asked. His case failed because the events took place outside the statute of limitations.

He returned to Réunion in 2006, but will be back in France for the debate, the final leg of a long journey for justice. “After the national assembly, I’m going to turn the page,” he said. “I’m tired.”

Another victim, Simon A-Poi, was 12 years old when he was driven to Guéret on 6 September 1966 with one of two coachloads of children from Réunion. “There were children of all ages – 12, 15, 17, even three,” he recalled on Sunday. He was an orphan who was removed from his grandmother’s care with four brothers and sisters, and 12 cousins. “We were the largest family to arrive in the Creuse.

“We thought we were going to Paris, to see the Eiffel tower, and the Arc de Triomphe. And we ended up in a home in Guéret. In October it was the first time we had seen snow, we thought it was cotton wool falling,” he told a local TV station in Réunion.

The children’s forced removal was the brainchild of Michel Debré, a former Gaullist minister who was then a deputy for Réunion. In 1963 he discovered an island suffering from a 60% redundancy rate and a booming population. “He must have thought that it was a logical solution to a problem of depopulation somewhere else in France. Never mind that it was a two-day journey from Réunion, where the temperature was 40 degrees. He completely denied the human aspect, and the diversity,” said Bareigts.

The resettlements were organised by the state-run Office for the Development of Migration in Overseas Territories, with most of the victims being sent to the Creuse. The children worked on the farms or became the servants of bourgeois families. Some took their own lives, while others were interned in psychiatric hospitals. The Office was disbanded in 1983, two years after the Socialist president François Mitterrand came to power.

The motion to be debated on Tuesday does not provide for compensation, but will carry a strong moral weight. The draft denounces the “forced migration” of the children from Réunion Island and describes their fate as “irreparable”.

France is not the only state to have sinned against its own children. The Australian government apologised in 2008 for the removal of an estimated 100,000 Aboriginal children who were forcibly assimilated from the 1890s to the 1970s. The United States and Canada had similar policies for their indigenous peoples.

Colonial Britain exported 100,000 children to populate Australia, New Zealand, South Africa and Canada under the “home children” programme. And the story of Philomena, now an Oscar-nominated film, highlights Ireland’s treatment of thousands of single mothers whose children were forcibly removed by the Catholic church.

Yvan Combeau, a historian from Réunion, noted that the French motion did not ask for an apology, but he said every word had been carefully weighed so that historical archives could be opened up. “The text seeks reparation through a recognition of the history of these exiles. Reparation must come through knowledge and recognition,” he said in an email.

“We need to analyse this from a political point of view,” said Bareigts. “Réunion used to be a colony. We have known slavery. We can’t sweep these things under the carpet. We need to recognise what happened so that we and the victims can move on.”


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