Tag: depression

Why students are packing Prozac in their lunch boxes

Published by Danni Miller on February 4, 2016

This post was first published by RendezView, 31/1/16

Laptop? Check. Lunch box? Check. Prozac? Check.

For more and more young people, the preparation for back to school this year will include making sure they have their anti-depressants close at hand.

Australia has one of the highest rates of use of these medications in the world and a recent University of Sydney study found that there has been a particularly marked increase in the use of these drugs in children and adolescents.

In fact, over the four-year period from 2009-2012, researchers found that the largest increase in use was amongst children aged between 10-14 years.

Dr Emily Karanges, now a research fellow in the Medicines Policy Unit at the University of NSW and lead author of the paper based on the study’s findings, suspects the rates of usage would be even higher amongst those who are school-aged today: “There is no reason to think this trend would have reversed. Given the steep upward trajectory in the rate of antidepressant use at the time of our research, especially among young people, I’d expect the figures now would be significantly higher again.”

Yet the therapeutic guidelines from the US, UK and Australia recommend that psychological therapies rather than medication be used to manage depression and anxiety of a mild or moderate severity, and that anti-depressants should only be used for severe disorders or when all other treatments have first proved ineffective. This is because these drugs are often less effective in depressed children and adolescents than in adults, and come with increased risk of self-harm and suicidal thinking.

Karanges also advocates for caution as: “The brain is still developing up to the age of 25 and antidepressants are a pretty blunt instrument. We know very little about how they might be changing the development of the brain and whether they might have long-term effects into adulthood.”

So what is driving this eagerness to medicate kids who need support?

Although counsellors and psychologists can’t prescribe medication, many are quick to suggest young people visit a GP to access these (it is not uncommon for this to be suggested as a solution even during an introductory counselling session). Concerned parents may then go to their GP specifically requesting drugs.

And many time-poor GPs report feeling ill equipped to treat mental health issues; according to the Black Dog Institute, in Australia GPs don’t have to have any specific training in mental health to practice.

Karanges points out that these types of medications are also heavily marketed to the medical community: “It is perhaps no coincidence that the anti-depressants that were most rapidly increasing in use were also the newest ones and the ones most likely to be advertised to doctors.”

GP’s may also have the misguided view these types of medications are relatively safe. A Danish study published in The British Medical Journey this week found that the harms reported in antidepressant trials were often seriously misrepresented and underreported, this included suicide attempts and suicidal idealation being coded in reports by pharmaceutical companies as “emotional lability” or “worsening depression”.

Reports issued by drug companies were, the authors said, “even more unreliable than we previously suspected”. The study concluded by recommending “minimal use of antidepressants in children, adolescents, and young adults, as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant”.

Instead, treatments such as psychotherapy and exercise were suggested.

It may also be that culturally, we are not always comfortable with the full spectrum of human emotions and are too eager to seek a quick fix.

Psychologist Jacqui Manning says she would be reluctant to suggest medication, particularly with a young person, until a range of other strategies had been tried first.

“I may see teens during highly stressful life events like the HSC exams or a breakdown or death in the family,” she said.

“Sometimes parents will say, ‘my child isn’t coping — do you think they need meds?’ I’ll respond that there are many things we can try first and that their son or daughter’s feelings are a normal human response to an extremely stressful situation.”

Whilst it is important not to stigmatise or alienate those young people who do genuinely need medication, Iain McGregor, Professor of Psychopharmacology at the University of Sydney, has called for time out on making medication our default response when supporting children and teens in crisis.

“We need to have a national debate about what is driving this phenomenon,” he said.

“Why are we so reliant on pills for the mental wellbeing of our young people?”

And what is happening that is making our kids feel so desperately sad in the first place?

Rage and despair: Positive, helpful ways to support girls in crisis

Published by Danni Miller on August 2, 2012

Trigger warning: This blog post contains references to suicide. If you or anyone you know has suicidal thoughts or behaviour, seek help immediately. These help lines are open 24 hours a day:
Australia
Lifeline: 13 11 14
Kids Help Line: 1800 55 1800
Salvation Army 24-hour Care Line: 1300 36 36 22
New Zealand
Lifeline: 0800 543 354

All of us at Enlighten have been heartbroken to see a number of media reports recently of teens taking their own lives. Cath Manning, one of Enlighten’s Victoria workshop presenters, is concerned about the high rates of depression and suicide in her area. Interviewed along with Steve Biddulph this week by her local media, Cath made this great point:

I think we sometimes forget that teen girls are going through the same things we went through when we were growing up, however, today there is even more pressure on them due to the relentless media images and messages they are bombarded with, and the added complications with social media. Of course, social media is here to stay, and there really are great benefits that come with that, but young girls just need to be given the tools to engage with the medium in a positive, helpful way.

Positive — that’s the key. There are positive things we can all do to help our kids cope. We can listen and look for the signs that all may not be well in their world, and we can offer our support. Due to the recent media coverage of teen suicides, a lot of parents and teachers have been asking my advice, so this seems a good time to share an excerpt from my book for parents, The Butterfly Effect, on how to identify and help teen girls in crisis. For the teen girls in your life, I have also written a version of the book specifically for them, The Girl with the Butterfly Tattoo. Both are available for purchase here.

Rage and Despair: Suicide

What many people who try to take their lives share is a sense of being trapped in a stressful or painful situation, a situation that they are powerless to change. Having depression or a mental illness raises a person’s risk of suicide. Stressful life events or ongoing stressful situations may fuel feelings of desperation or depression that can lead to suicide attempts. Examples of these stresses include the death of a loved one, divorce or a relationship breakup, a child custody dispute, settling in to a blended family, financial trouble, or a serious illness or accident. Any kind of abuse – physical, verbal or sexual – increases the risk. Substance abuse by any member of a family affects the other members of the family and can lead to suicidal feelings either directly or indirectly, through the loss of income and social networks or trouble with the law.

Bullying needs to be taken seriously as it has been known to make teens try to take their own life. Also, teens are right in the middle of forming their own individual identities and a major component of that is their sexuality. For a teenager who is questioning their sexual preference or gender, the pressure to be like everyone else, the taunting they receive because they clearly are not, or their own guilt and confusion can become unbearable. A relationship breakup can be a trigger for suicide in some teens. As adults, we have the ability to look at the bigger picture and know that in years to come, a teenage breakup will not seem anywhere near as important as it does at the time. A teenage girl, on the other hand, may not yet have the maturity to see beyond the immediate pain. If she seems unduly distressed about a breakup, pay attention. Another trigger for teen suicide is the recent suicide of someone close to them, or the anniversary of a suicide or death of someone close to them, so these are times when girls may need extra support.

Suicide is hard to talk about. It is almost taboo, simply too painful to touch on. But silence can be deadly. Often the parents of a teen girl at risk of suicide do not ask her the tough question of whether she is planning to take her own life. In part they may be in a state of denial, which is only human – after all, no parent wants to imagine that their daughter feels suicidal. They may also have a fear that seems to be ingrained in our culture: that if they mention suicide to their depressed or distressed daughter, they will be putting the idea in her head. But experts in adolescent mental health agree that it is more than okay to speak directly to your daughter about suicide. ‘Parents are often worried that by asking they may make matters worse. Well, I have never known a child to suicide because someone asked whether they were thinking about it,’ says child and adolescent psychiatrist Dr Brent Waters.

Another unhelpful myth about suicide is that a teen who talks about suicide is simply seeking attention and won’t actually take her life. In fact, four out of five young people who commit suicide tell someone of their intentions beforehand. Besides, I have never understood the point of making a distinction between attention seeking, a cry for help or a genuine intention to commit suicide. Even if a teen is not actually going to go through with a plan to take her life, if she is distressed enough to cry out for help, her voice needs to be heard and she needs our support.

What you can do

Number one: if anyone – child, adolescent or adult – says something like ‘I want to kill myself’ or ‘I’m going to kill myself’, seek help straightaway. Remove anything they might be tempted to use to kill themselves with and stay with them. Dial 000 in Australia or 111 in New Zealand or a crisis line. The following phone counselling services are available 24 hours a day:

Australia

Lifeline: 13 11 14
Kids Help Line: 1800 55 1800
Salvation Army 24-hour Care Line: 1300 36 36 22

New Zealand

Lifeline: 0800 543 354

Another valuable thing you can do to help someone you fear is having suicidal thoughts is to listen. These pointers are adapted from the Victorian Government’s excellent ‘Youth suicide prevention – the warning signs’ on www.betterhealth.vic.gov.au:

Listen and encourage her to talk
Tell her you care
Acknowledge her feelings
Reassure her
Gently point out the consequences of her suicide, for her and the people she leaves behind
Stay calm; try not to panic or get angry
Try not to interrupt her
Try not to judge her
Don’t overwhelm her with too much advice or stories about your own experiences

Suicide warning signs

Loss of interest in activities she used to enjoy
Giving away her prized possessions
Thoroughly cleaning her room and throwing out important things
Violent or rebellious behaviour
Running away from home
Substance abuse
Taking no interest in her clothes or appearance
A sudden, marked personality change
Withdrawal from friends, family and her usual activities
A seeming increase in her accident proneness, or signs of self-harm
A change in eating and sleeping patterns
A drop in school performance, due to decreased concentration and feelings of boredom
Frequent complaints about stomach aches, headaches, tiredness and other symptoms that may be linked to emotional upsets
Rejection of praise or rewards
Verbal hints such as ‘I won’t be a problem for you much longer’ or ‘Nothing matters anyway’
Suddenly becoming cheerful after a period of being down, which may indicate she has made a resolution to take her life

(Heart image by Seyed Mostafa Zamani, licensed under the Creative Commons Attribution 2.0 Generic license.)

Girls in crisis: self-harm, and what you can do to help

Published by Danni Miller on June 26, 2012

Increasingly I am being asked by concerned parents and girls about the issue of self-harm, so this week I’m bringing you an abridged version of the section in my book The Butterfly Effect that looks at what drives some girls to hurt themselves, the warning signs to look out for, and what we can do to help girls in crisis.

Trigger warning: The following post contains references to self-harm that may be a trigger for some people.

What is self-harm?

Self-harm is when a girl purposely injures herself, usually in secret. There are many different ways that a girl might do this, including cutting, burning, biting or branding her skin; hitting herself or banging her head; pulling her hair out; picking and pulling at her skin; or picking at old sores to open them up again.

Self-harm warning signs

Cuts – especially small shallow parallel cuts on the arms or legs – for which there is no adequate explanation
Other frequent and unexplained injuries, such as burns or bruises
Starting to wear long sleeves or pants all the time, even in warm weather
Sudden aversion to going swimming or getting changed in front of other girls
Hair missing, where it has been deliberately pulled out
Mood changes, depression, anxiety
Spending a lot of time alone
Notable difficulty dealing with stressful or emotional situations
A drop in school performance

Why do girls self-harm?

While each girl’s situation at home, school, with friends and in the community influences her life in a unique way, there are underlying factors in our culture that are putting more teenage girls at risk than ever before. Being part of society means meeting certain expectations; around adolescence girls begin to be more fully aware of the pressure to fulfil these expectations, which were mapped out before they were even born. Girls can hardly miss the messages about what it takes to be an ideal girl or the ideal woman. Unable to match the ideal no matter how they try, many girls begin to loathe themselves for falling short.

To try to meet the expectations of who they should be, teenage girls may have to tame themselves, blunt themselves. They learn that if they express anger, they will turn people off, because feminine, good girls are agreeable, not cranky. Even though on the surface a girl may appear sad, happy or indifferent, she may really be bottling up rage. Where does girls’ suppressed anger go? For some, it may become depression, drug or alcohol abuse, or self-aggression such as anorexia, bulimia, self-harm or suicide.

In some cases, self-harm is a form of risk-tasking and rebelling, or even of being accepted into a peer group. In others, it is a sign of deep psychological distress, a way of coping with painful, overwhelming feelings. If a girl finds it hard to express emotions such as anger, sadness or grief, marking her body in this way may be her desperate attempt at self-expression. A girl numbed by depression or trauma may self-harm in order to feel something again. It can also be a cry for help. A girl who doesn’t know who to ask for help, or how, may be using her injured body to send a message. And as with eating disorders, there are girls who self-harm because they feel that they are not in control of aspects of their life; for them, self-harm is a way of asserting control.

During the act of hurting herself, a girl may feel as though she is releasing pent-up steam, as if opening the valve on a pressure cooker; the act brings a temporary sense of relief. But self-harm also brings with it guilt, depression, self-loathing, anger, fear, and isolation from friends and family.

Self-harm doesn’t necessarily mean that a girl is suicidal, but all cases of self-harm need to be taken seriously. Self-harm can be related to mental health issues including depression, psychosis, bipolar disorder and borderline personality disorder; to a trauma such as physical or sexual abuse; or to some other source of deep psychological pain. Self-harm may also do lasting physical damage. While girls rarely need hospitalisation because of self-harm, they may give themselves lifelong scarring as well as nerve damage.

What can be done to help?

In the short term, if a girl self-harms she needs to learn ways to cope when the urge strikes. Her therapist is likely to suggest ideas such as counting to ten or waiting 15 minutes, to give the feeling a chance to pass; saying ‘No!’ or ‘Stop!’; relaxation techniques such as yoga; or going for a run or doing some other kind of hard physical exercise. Another accepted short-term solution is to choose an alternative to self-harm, such as squeezing ice cubes between her fingers until they go numb, eating a chilli, standing under a cold shower, having her legs waxed or drawing in red on her body instead of cutting. Crucially, the underlying reasons why she self-harms need to be uncovered and worked through with a professional, who will also help her to develop healthier ways of identifying, coping with and expressing painful emotions.

There is much we can do to help prevent girls finding themselves at crisis point; and no matter how troubled a girl is, she can turn her life around. The key is communication. By strengthening a girl’s connections – to her parents, the rest of her family, her friends, community and school – we can give her the best chance.

Girls regularly tell me that what they want more of is their parents’ time. They want their parents to listen. Sometimes when we ask our daughters what’s wrong, we get a blank gaze or a huff or a slammed door, and we give up. Don’t give up too quickly. Your girl may be sending out all the signals to push you away while actually she needs you to keep asking, giving her attention, showing her you care. Therapist Martha B. Straus urges: ‘When she’s at a loss for words, guess and guess again.’ Many teen girls have a limited vocabulary for expressing their feelings, but we can help them. It can take something as simple as ‘I feel really angry about this – do you?’ to open the floodgates.

One of the most helpful things you can do is allow her to express all her emotions, rather than choking on her darker feelings until they turn into despair. ‘When girls can be angry,’ Straus writes, ‘they can also be reassured they are worth such powerful feelings – there is someone in there worth being mad about.’

Action Plan

Seek professional help. A good starting point is your GP, for a referral to a relevant specialist, local adolescent mental health team, counsellor or community health centre.
Be consistent. Set consistent boundaries, but also be consistent in your loving. Even if she takes a drastic backslide in her recovery, she needs to know that you still love her.
Banish secrecy. Maintaining a shroud of secrecy around a crisis is not helpful to girls.
Build networks of support. A girl’s networks may include doctors, therapists, adult mentors, relatives, school counsellors and friends.
Celebrate. When a girl is on the path to recovery there may be frustrating and disappointing setbacks, but there will be victories, too. Take heart in them. And celebrate.

Should we be asking young women to “get your tits out for the girls”?

Published by Danni Miller on December 2, 2010

This week I’m bringing you another great guest post by Enlighten Education’s program manager for New Zealand, Rachel Hansen. For some time now I’ve been growing tired of what Rachel calls the “prettifying” and “sexifying” of breast cancer in fundraising and awareness campaigns, and this week I was as outraged as Rachel by a campaign in NZ that is encouraging girls and young women to post pictures of their breasts on the internet. Rachel’s blog post clearly struck a chord with a lot of people, because she received 1,000 hits in 24 hours! It has been picked up by numerous bloggers and by MSN news.

There was widespread discussion about the “I like . . .” Facebook craze last month. While I felt that this campaign sexualised breast cancer in a weird kinda way, NZGirl’s latest campaign has left me (nearly) speechless. Viewers are invited to “get your tits out for the girls . . . and don’t forget to check out the other lovely pairs, beautiful boobs and pretty titties already uploaded.”

For every 50 pairs of “titties” uploaded by viewers, NZGirl will donate $1000 to breast cancer awareness. This campaign began yesterday [30 November] and already there is a gallery of over 49 pairs of breasts to peruse, rank and comment on.

Hmm, a gallery of “titties” ranked according to popularity and the ability for me to leave comments about them. How exactly is this different to a crude pornography site?

NZGirl is exploiting women and girls in order to drive traffic to their website. It is making light of a horrific disease in order to gain popularity. It is belittling the experience of breast cancer sufferers, many of whom are left scarred or have had to have their breasts removed. But in marketing terms, this campaign has been a resounding success — over 25,000 people visited the site this morning, crashing it.

Boganette has written a great post on why NZGirl’s campaign is oh-so-wrong:

Celebrate breasts, of course. But don’t do it in the name of breast cancer. Breast cancer isn’t about breasts. It’s not something you should have a laugh about on Twitter. It’s not something you should joke about on Facebook. It shouldn’t be a reason for posting photos of your breasts or flashing them or “getting them out” . . . Breast cancer is a horrible, miserable, horrifying disease — that’s it. It’s cancer — it’s not motivation for you to be happy with your body.

I hate the prettifying of breast cancer. The sexifying of breast cancer. Breast cancer is not sexy images of pert wee breasts. If you want to see the realities of breast cancer, check out The Scar Project. It’s raw and it’s real. There is nothing funny about it.

According to Stuff:

NZgirl editor and general manager Tee Twyford said the campaign wasn’t about driving traffic to their site, but about raising awareness. “The reason for it was twofold. There was a desire to have readers feel really good about their breasts and we wanted to align it with a breast cancer cause to get greater awareness and funding,” Twyford said.

So, according to Tee Twyford, women need to share photos of their breasts with the world in order to feel good about themselves. We all need to seek external validation to make sure that our breasts are up to scratch, that they’re OK. Dear Tee, please explain how being in the lower half of the rankings is going to help 50% of those women feel good about their breasts? Because Tee, in a rankings system, there is always a loser. And are the “winners” in the top half of the rankings supposed to feel great about themselves because a whole bunch of strangers have critiqued their breasts and given them a thumbs-up?

Tee Twyford, I am not going to send your website a photo of my breasts. They are beautiful and I love them. But I don’t need NZGirl to rank them and I don’t need strangers to give me their comments about them. Because those strangers don’t know that my breasts and I have been through lots together. Those strangers don’t know or care that my breasts fed my baby and that I love them in all their uneven, stretch-marky, increasingly-less-pert glory. Or that it took me quite some time to learn to love them.

Disturbingly, but not surprisingly, many of the breast photos that have been uploaded seem to be of teenagers. Through Enlighten Education I work with teen girls throughout New Zealand. I often have tears of sadness when talking with them about the immense pressures they face with regards to their bodies. New Zealand’s rates of eating disorders and depression amongst teenagers are skyrocketing. Just yesterday I spent a morning with 150 gorgeous year 10 girls who all told me that they felt that they were not beautiful enough, not skinny enough and not perfect enough. It is campaigns such as this one that add to the overwhelming pressure and sense for girls that they are just not enough. As soon as I have posted this I am going to email Tee Twyford to invite her to sit in on one of these sessions. Perhaps then she would realise the effects that such media campaigns have on our girls.

Once photos are uploaded onto the internet, the owners cease to have any control over how they are used. To assume that these photos will not be used for pornographic purposes is naive. We teach girls to never upload sexual photos of themselves — why is a (previously) respected organisation encouraging them to do exactly this?

Women, why are we doing this to each other? Are men rushing to upload photos of their penises to raise money for “cancer awareness”?

NZGirl, if your motivation really is to raise money for breast cancer research I can think of a million more positive ways to do this. Even simpler: if you really want to donate to a good cause, just get out your credit card and donate. Simple.

Updates: Since I wrote this blog post on Wednesday, many of the photos of breasts are now on porn sites such as xtube and others that you can see listed here. If NZgirl had a tick box on the website that said “If you upload this photo then we will donate $5 to ‘breast cancer awareness’ and your photo will probably appear on an unlimited number of porn sites, forever” how many women would have gone ahead and uploaded photos?

NZgirl has claimed that they are rotating the “favourites”. However, I have checked the site a number of times in the past 24 hours and the same breasts have been rated number one all day today: a perky youthful pair that are the result of a breast enlargement operation. The age of the person in the photo is indicated by her final comment: “As my Mum put it, ‘they were meant to be yours.’”

There is no way for the site to screen out girls under 18 from posting images of their breasts. NZGirl states in its terms and conditions: “If you are under 18 and you decide to post or send personal information to us or to other areas on the Internet, make sure you ask your parents if it’s okay.” Regardless of parental consent, sexual photos of children are never legal. Is NZGirl potentially breaking New Zealand law in terms of child pornography?

And a final word from Dannielle Miller: Awesome blog post, Rachel. I was so fired up about this ludicrous “campaign” that I went on Radio National New Zealand to say my piece on Afternoons with Jim Mora. Things got rather interesting when a spokeswoman from NZGirl called in to offer her defence of the site’s actions. The arguments she offered were, unsurprisingly, pretty weak, but the heated debate certainly made for great radio: NZ radio This MP3 Audio file has been uploaded with Radio National NZ’s permission.

Rachel Hansen is an experienced health and wellbeing educator who has a first-class honours degree in Psychology and a Masters degree in Criminology from Cambridge University (UK). Her research has focused on youth development, youth offending and women’s health.

I Just Want You To Be Happy

Published by Danni Miller on March 24, 2009

I am a long-time fan of Associate Professor David Bennett, Head of the NSW Centre for the Advancement of Adolescent Health.

We first met back in 2006. At the time, I was combining part-time work developing Enlighten Education with a senior role as an Education Officer responsible for developing enterprise education in Catholic Schools. I had just written a 60-hour one-unit Higher School Certificate (HSC) course suitable for Year 11 or 12 called Applied Enterprise Learning. The course, approved by the Board of Studies NSW, has a strong practical component; students apply their core learning to find local solutions to local community problems and contribute to community renewal. (An independent evaluation of the course is available here should you be interested: project-evaluation-report-no-course-outline.) This type of learning, which not only enhances a participant’s skills and knowledge base but also adds value to their community, is known as service learning.

David was also keenly interested in exploring innovative ways of engaging young people in their learning and was a member of the National Youth Careers and Transitions Advisory Group (NYCTAG). We were both invited to deliver presentations at a national conference exploring the merits of service learning. The final report, commissioned by the Department of Education, Science and Training, voiced our hopes for the service learning model. We bonded instantly as we shared an obvious enthusiasm for young people and passion for our work.

Since that time, I have had the opportunity to connect with David at various points in my career. He was an early supporter of Enlighten’s work with girls in schools. He is also the co-author of one of my favourite books on parenting teens, You Just Can’t Make Me. Recently, David was generous enough to act as a “critical friend” and read the draft of my own book on parenting teen girls (to be published by Random House Australia in September) and kindly agreed to write the foreword, too.

With this history of deep admiration and respect between us, you can imagine how excited I am to report that David has a second book, due to be released this month. This work has been co-authored with Associate Professor Leanne Rowe AM (the former chairman of the Royal Australian College of General Practitioners) and Professor Bruce Tonge (Head of the Centre for Development Psychiatry and Chairperson of the Division of Psychiatry at Monash Medical Centre, Melbourne).

The book’s media release follows:

In the lead up to National Youth Week, three specialists in the fields of teenage psychiatry, general practice and adolescent health broach the difficult and often underestimated subject of teenage depression in this new guide for parents, carers, teachers, social workers and doctors.

The Facts of Teen Depression…

· 1 in 5 teenagers will experience major depression before they are 18

· The chance of a child developing depression has tripled in the last 30 years

· Hundreds of thousands of prescriptions of antidepressants are written for under 18’s each year

· Those aged 15-24 have the highest prevalence of depression of any age group

· Hospitalisations for self harm by teenagers are escalating dramatically

One of the most challenging and problematic issues facing Australia today is the increasing rate of youth depression and the high rates of self harm by our young people. But these things can be prevented, identified and managed and I Just Want You To Be Happy is a much needed, practical, clear and highly accessible guide to show you how.

I Just Want You To Be Happy describes the factors contributing to the increasing depression in young people and discusses why our search for constant happiness is setting our children up for problems. It is important for all parents to know that, contrary to popular myth, depression can be prevented and treated. Alongside expert specialist advice, I Just Want You To Be Happy contains an invaluable contact list of mental health organisations, support groups and websites where parents and carers can seek further help.

Every school and every parent of a teen should read this important book. It combines solid research with practical, doable advice and, as always, reflects the writers’ deep affection and high regard for young people.

In fact, I love this book so much I really want to help generate a groundswell of support for it. I am going to offer a free copy of the book to a school or community group that can show me they have recommended it to their wider circle via their school website or newsletter. Simply email me a link or scanned copy of your recommendation, along with your postal address, and I shall randomly pick one submission and send them this book for their reference library.

Good luck!