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The services of Dr. Danos and Dr. Masani, locum psychiatrists,
were discontinued and Dr. Fahmy commenced duty in September, 1969. I
am indebted to him for the following report:-
As I took over the psychiatric service of the clinic on 22.9.69 this
report will be a second hand account of the work done in the first 9 months
and my experience in the last three.
The clinic is very adequately staffed for educational services (three
educational psychologists and five remedial teachers), very poorly staffed
for psychiatric services (2 locum consultants providing four and one
sessions per week respectively in first 9 months and later one consultant
appointed for nine sessions per week with no assistants nor auxiliary
staff) and under-staffed on the secretarial side.
The following table covering the 4 quarters of the year should give
an idea about the size of the demand for and the call on psychiatric
service. The largest number of referrals has come from schools, a great
number of which are children from disturbed or broken homes with histories
of early psychological traumata which have never properly healed. Indeed
in many cases very serious early deprivations have left an imprint that can
never be erased by any available treatment. An equal number of problems
are treatable if auxiliary staff (child therapists, psychiatric social
workers and case workers) and time were available. As it happened, no
consultant (past or present) could offer regular interviews of adequate
duration at weekly or fortnightly intervals, and thus very little
psychodynamic changes could take place. The natural process of emotional
maturation was bound to be hampered in some children and many would grow
into neurotic adults with varying degrees of character disorders.
Another result of the inadequacy of the services provided was the
chronicity of the disturbances-cases had to be left on the books for
years with little significant progress. This in turn increased demands
on the consultant's time, creating the problem of the waiting list (for
consultations and treatment) and reducing the value of the help that can
theoretically be offered to children and their families.
All these difficulties were somewhat ameliorated by the very ready
and eager co-operation of the educational psychologists, the remedial
teachers and social workers in the community e.g. the Children's Department
and Mental Welfare Officers. However, the social workers were found to be
quite overloaded with problem families and this overload created similar
difficulties to those experienced in this clinic. Another help was given
through the co-operation of the Special Services for boarding some children,
Dr. Little of Whipps Cross Hospital who accepted many of the children
referred and the E.E.G. Department at Goodmayes Hospital. Co-operation
of all these agents has helped me in reducing the waiting period for first
consultations from 7 months to 2. However, the quantity of the demands
on my time has not yet enabled me to start active therapy on any one case.
My work was thus limited to dynamically oriented counselling of parents
which did help the few who were eager, insightful, ready to accept some
unpalatable truths and change their attitude. I plan to set aside a few
hours per week for child treatment even though this is bound to lengthen
waiting intervals between referrals and first interviews.
To improve the situation I suggest increasing the psychiatric
establishment by adding one experienced psychiatric social worker, one
experienced family case worker, one therapist and a psychiatric registrar.
If and when this additional staff becomes available some of the consultant's
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