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trists paid regular visits to the schools, solely for the purpose of advising the staff on the
management of the children in their care. However, as it became known to the Courts
that certain approved schools were visited by a psychiatrist, the practice grew up of committing
to these schools an increasing proportion of children who were considered in the
light of the remand reports to be in need of psychiatric treatment. Consequently, it became
necessary to make arrangements for a far greater provision of psychiatric services to the
approved schools than the purely advisory visits originally contemplated. Since it was
considered that a psychiatrist's visits to an approved school were for the purposes of
treatment or diagnosis with a view to treatment, arrangements were made for the specialist
work to be taken over by the National Health Service, whilst the Council provided the
psychiatric social workers.
While the opinion of the psychiatrist and that of the psychiatric social workers is needed
on the difficult problems posed by particular children and young persons, it is perhaps
in the education and help of the staff through the discussion of these problems that the
main contribution is made, and the staff encouraged to provide the atmosphere that the
child needs. The differences between 'delinquency' and 'maladjustment' are indeed
fine-drawn but as Dr. John Bowlby has said, it is not conceivable that we shall ever have
sufficient psychiatrists to treat all the psychological illnesses of the community, so that
everyone concerned with child-care has to feel able to play a part in the prevention, or
indeed in the treatment, of mental ill-health in these manifestations.
VI.—Mental health education
(a) Introduction—There is no doubt that mental health education will become increasingly
important in the future of public health. The problems before medical officers of
health in this direction were firmly put to them by Lord Adrian in his centenary oration,
delivered to their Society in May, 1956. The following paragraphs describe some of the
ways in which in London these problems of mental health education are being investigated.
(b) Maternity and child welfare services—In my annual report for 1954, Appendix B,
will be found the report of a study group, which was set up in 1953 under the leadership
of Dr. John Bowlby, of the Tavistock Clinic, to investigate the possibility of increasing
preventive mental health work in the maternity and child welfare service.
The proposals of the study group were accepted by the Council, and by the end of 1959
there were 10 case conference groups meeting regularly at which medical and nursing staff
of the child welfare centres received training and guidance from the psychiatrists and other
professional staff of local child guidance clinics.
Originally the conferences were intended to be part of a training course which was
expected to last about two years. It was anticipated that at the end of that period the child
welfare staff would feel competent to cope with mental health problems without specialist
advice. Experience has shown however that the disturbances in family relationships which
are manifest in behaviour disorders in young children have been very complex and often
serious, and that there is need for a continuous consultative service. At the end of the year
plans were being formulated for the scheme for consultation through case conferences to
be put on a permanent basis, and extended as far as the availability of child psychiatrists
permitted.
(c) Residential establishments—At any one time the Council accommodates, in various
boarding and residential establishments, about 12,000 children. The psychiatric services
for children in boarding special schools for the maladjusted and for children in remand
homes and approved schools have been dealt with earlier. There remains to be considered
a very wide range of other establishments, boarding schools, children's homes, residential
nurseries, etc.
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