Background Adolescent self‐harm is a major public health concern. To date there is a limited evidence‐base for prevention or intervention, particularly within the school setting. To develop effective approaches, it is important to first understand the school context, including existing provision, barriers to implementation, and the acceptability of different approaches. Methods A convenience sample of 222 secondary schools in England and Wales were invited to participate in a survey, with a 68.9% (n = 153) response rate. One member of staff completed the survey on behalf of each school. Participants responded to questions on the existing provision of adolescent self‐harm prevention and intervention, barriers to delivery, and future needs. Results Adolescent self‐harm is an important concern for senior management and teachers. However, emotional health and well‐being is the primary health priority for schools. Health services, such as Child and Adolescent Mental Health Services, and on‐site counselling are the main approaches schools currently use to address adolescent self‐harm, with counselling cited as the most useful provision. Fifty‐two per cent of schools have received some staff training on adolescent self‐harm, although only 22% rated the adequacy of this training as high. Where schools do not have existing provision, respondents stated that they would like staff training, specialist student training, external speakers, posters and assemblies, although the latter four options were infrequently ranked as the most useful approaches. Key barriers to addressing adolescent self‐harm were: lack of time in the curriculum; lack of resources; lack of staff training and time; and fear of encouraging self‐harm amongst adolescents. Conclusions Adolescent self‐harm is a priority for schools. Intervention might focus on increasing the availability of training to teaching staff.

The findings of this study offer an explanation on the exclusion of adolescent self-harm from preventative work in secondary schools. The stigma model demonstrates that adolescent self-harm is excluded from the socio-cultural norms of the institutional setting. Applying the UK Equality Act (2010), this is discrimination. Further research on the institutional-level factors impacting adolescent self-harm in the secondary school context in England and Wales is now urgently needed.

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16 JULY 7, 1956 CEREBRAL ANGIOGRAPHY MEDICALJOURNAL angiography many admissions.to a neurosurgical department for purely diagnostic measures are avoided. With over half our angiograms performed as an out-patient procedure the occupancy of beds by patients not requiring operation is reduced and the volume of operative surgical work increased. Both air encephalography and Yentriculography necessitate admission to hospital.Angiography can provide the early, accurate, and safe diagnosis of emergencies, a,nd that applies particularly to subarachnoid haemorrhage. It is a relatively safe procedure in brain tumours with high intracranial pressure. The benign may be distinguished from the malignant, and in the above series the pathological type of tumour was correctly diagnosed in 39%. Angiography has given us the accurate situation in 74% of brain tumours and in a further 14% has indicated their presence. That compares well with pneumoencephalography. In the remainder the use of ethyl iodophenylundecylate and air as contrast media was necessary.The mortality of 0.2% has not involved any case of raised intracranial pressure. These cases where the intracranial pressure is extremely high as a result of obstructive hydrocephalus, and mistakenly investigated at first by angiography, are in our experience less disturbed by that and the ethyl iodophenylundecylate ventriculogram that follows than by air ventriculography in the first instance alone.