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Programme of action
24. In the Public Health service of London then, a number of tentative approaches
have been made which have prepared the ground for the introduction of preventive
mental health work into the maternity and child welfare field, and we believe that the
time has now come to prepare a programme of action. Prevention has traditionally
been the main function of the public health services and a widening of the range of
preventive work, in the light of modern thought, to include the field of mental health
should on first principles be the concern of the maternity and child welfare service.
25. Two methods present themselves for the introduction of such a programme :
in the first, the child psychiatrist himself—assisted by the other members of his specialist
team—would be directly responsible for most of the work, and the staff employed in
maternity and child welfare work would act merely by referring any cases which they
may recognise as requiring speciahst guidance. The second method is to offer to the
maternity and child welfare staff themselves an active and growing share in this work.
26. It is the considered and unanimous opinion of the Group that, because of the
size of the problem, it cannot possibly be tackled effectively by child guidance staff
alone; their number is at present—and is likely to remain for some considerable time—
far too small for a radical extension of services. Besides, it would in any case be entirely
impractical to depend on psychiatrists for the recognition of all potential problems in
mothers and children attending child welfare centres, and doctors and health visitors
would, therefore, have to acquire considerable knowledge in this field. We believe
that the only practical solution is not only to accept preventive mental health as the
responsibility of the existing public health service, but also to recognise it as a proper
sphere of interest for non-specialist staff engaged in the maternity and child welfare
field. How then can this new approach be introduced into the existing service and
public health personnel assisted to acquire the insight which they will need for their
fresh tasks.
27. It is already noticeable that many of the more recently trained health visitors
show an increased understanding of human relationships and a lively interest in the
psychological aspects of their work. This, no doubt, is due to the greater emphasis
which is nowadays being placed on such studies during their training, and a further
extension of such activities might well be considered by the Working Party on the
Training of Health Visitors which was recently set up.
28. In the training of the public health doctor, on the other hand, child psychology
and psychiatry have not so far been given their proper share, though there seems no
reason why more systematic post-graduate training in this field should not be offered,
e.g., as an elective subject in courses for the Diplomas of Public Health and Child
Health.
29. Our immediate problem, however, concerns the large body of existing personnel
within the service, both doctors and health visitors. Naturally, not all of them will be
equally interested to develop this side of their work, and any training must obviously
be based on the principle of voluntary acceptance. We have already referred to the
wide interest with which the subject has recently been received within the service and
have confidence that the offer of training facilities would receive a ready response.
We go further into questions of training and administrative aspects in later sections of
this report.
30. No plan of action can be envisaged which does not include close co-operation
with the family doctor. This, in any case, is very much on the increase in the present-day
practice of preventive medicine and without it not only may essential etiological factors
be overlooked but also confusion and misunderstanding aroused.
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