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CHILD GUIDANCE CLINIC
I am indebted to Dr. S. Fahmy, Consultant Psychiatrist for the
following report:-
During this year there were no changes in the administration or
staffing of the Clinic even though the call on the services continued
on approximately the same level as in previous years.
As stated in a previous report, the staff working on the psychiatric
part of the Clinic remains at one consultant (7 sessions a week) and
secretarial assistance. As the number of new referrals kept a steady
average of 11 - 13 per month and as the initial diagnostic assessment
takes anything from 4-8 hours of clinical work, one had to choose
between (a) making assessments and refraining from under-taking any
intensive or regular treatment or (b) taking on treatment cases that could
be managed by one therapist and allowing an everlengthening waiting list.
Since both alternatives appeared unsatisfactory, the compromise actually
taken left much to be desired, particularly with regard to the treatable
responsive cases who could not be taken on and also for the number of
crisis situations that could have been materially helped if seen on
demand.
This situation, though marginally allayed by the ready co-operation
and help offered by educational psychologists and remedial teachers,
would not be expected to improve until the required auxiliary staff
(2 experienced social workers and a child psychotherapist) are found and
encouraged to work in this Clinic.
The attached tables covering the four quarters of the year indicate
the current call on the psychiatric services. The total number of
adolescents referred is levelling with 5-12 year referrals. Unfortunately
the majority of the former are referred for anti-social behaviour that
has reached the Courts or else on account of school refusal. In both
cases the nature and circumstances of first contacts undermine any therapeutic
endeavour that could be theoretically exploited, given a different
set up i.e. more therapists and workers. Hence, the services were confined
to advice, support and consultations offered to different agents and
authorities. In this respect credit is owed to the devoted work of
social workers who, despite their case load, have seldom rejected requests
for help for these distressed and distressing children and their families.
In view of this demand, the psychiatrist's time in the Clinic and
the absence of staff to whom some work could be delegated, a number of
projects and work with institutions e.g. schools, nurseries, play groups
etc., had to be postponed for the time being.
Needless to add, that in addition to the cases actually referred, a
much greater number of children and families are in distress and do not
receive much help because they do not disturb others around them (or
else because of the passivity or insensitivity of the environment).
However, these "silent" disturbances frequently erupt in adolescence or
later. This is an area of prophylactic psychiatry which can hardly be
approached before improvement of staff shortage.
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