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18. In recent years the need for preventive mental health work has been increasingly
realised by doctors and health visitors in the Council's service. A survey carried out
by one of the Council's psychiatrists in one Health Division during 1952 shows that
3.5 per cent. of young children seen in child welfare centres during a period of six
months were sufficiently disturbed to require some form of treatment. In the two
centres which have child guidance clinics on the same premises, the corresponding
figure was even higher, i.e., 5.6 per cent.
19. A child psychiatrist from the Brixton child guidance unit has paid regular
visits to selected child welfare centres during the last two years for the dual purpose of
seeing cases referred by the centre doctors and of giving centre staff some insight into
the psychological aspect of their work, by regular contact and discussion. Group
discussions between child psychiatrists and local divisional medical staff were held
concurrently.
20. During the autumn of 1953 two child psychiatrists held courses on preventive
mental health with a strong emphasis on pre-school age problems. Attended by doctors,
nurses and social workers from all parts of the County, they were conducted on the
basis of group seminars, and aroused considerable interest and comment.
21. Concurrently with our meetings experimental case conferences were held
regularly each week in a child welfare centre. These were attended by a medical officer
and a health visitor, a psychiatrist and a psychiatric social worker, all of whom were
members of the Study Group. At these conferences the clinic doctor and health visitor
brought up cases for discussion with the consultant team; the latter did not themselves
interview the mother or examine the child, but discussed the information contributed
by the centre staff. One of the cases which came before this conference was also followed
through by our Group and we discussed the technique which was employed by the
case conference for this and other cases.
22. The experience gained in this pilot experiment has convinced us that the use of
the child welfare centre as a base for preventive mental health work has many advantages
because of the established relationship between staff and mothers and the knowledge
concerning individual families which has accumulated there over a period of time,
often as far back as the mother's first pregnancy. We believe that the normality of the
setting in a child welfare centre is important, for mothers of well babies are as welcome
as those of disturbed babies so that medical officer and health visitor are not regarded
by the mothers as people who are only interested in failures. In such a setting it is possible
to employ a flexible technique which is not dependent on regular appointments, but
takes maximum advantage of those occasions on which a mother's anxiety leads her to
seek help and renders her most receptive to it. The mother's feeling of independence
can also be more readily preserved in that the choice of coming is her own. Conversely,
the health visitor can bring before the case conference problems of families who, for
one reason or another, rarely, if ever, attend the centre.
23. The medical officer and health visitor who took part in the case conference
found that the insight gained by this method was not confined to the cases actually
discussed, but could be generally applied in their day-to-day work in the centre. This
experience was borne out by other members of the Group, both doctors and health
visitors, working in the field, who found that they were quite spontaneously devoting
increasing attention to mental health factors in their day-to-day contacts in the centre
and the home. We were concerned about the time factor which would undoubtedly
arise if work of this nature were added to the established functions of the centre. The
field workers among our members, however, found that the expected difficulties did
not materialise in practice to the extent to which they had been anticipated and that
the mental health features of their work became increasingly merged with the traditional
approach.
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