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51
they are usually severe cases of mental disturbance and many are
already chronic. Consequently, preventive work needs either to
start with much younger children or in general dissemination of the
principles of mental health among the parents and teachers of the
apparently normal child. This type of preventive work is an
inevitable accompaniment of the therapeutic work that is done by
Child Guidance workers but since the pressure of the work leaves
it to be done in an incidental and accidental way rather than
systematically, its importance is not, perhaps, sufficiently
appreciated.
In the eight years since 1946 we have seen on the average 16
children under five each year—approximately 8% of our intake
from approximately one third of the child population. It is the
exception rather than the rule to be sent a problem, the onset of
which is at a later period of the child's life. The average age of
referral this year has been eight and a half, consequently, many
problems have been incubating for five years or more before we
are asked to deal with them.
Finally it should be mentioned that Child Guidance is still an
experimental and growing service and there is a great need for
research. There are still many questions not yet answered but
which could be answered by a careful analysis of our records. Every
Child Guidance Clinic contains a most valuable store of material—
few have time to make use of it.
5. The relationship between the clinic, local general practitioners,
local hospitals, local organisations, Area Authorities and the
Middlesex County Council.
(a) General Practitioners.
General Practitioners have free access to the clinic and refer
children of any age from birth to school leaving. The number so
referred in 1953 was 47. An effort is now being made to inform
General Practitioners when one of their patients is referred from
another source.
(b) Local Hospitals.
The clinic is in contact with the Central Middlesex Hospital,
West Middlesex Hospital and King Edward Memorial Hospital,
whose psychiatric staff have been most co-operative in seeing adult
patients and adolescents who have left school. In every year a
certain number of children have been referred to hospitals for
further medical investigation and treatment and there has been no
difficulty in getting children seen and admitted for some physical
disease or for mild mental disorder. It is, however, very difficult
to get severely disturbed children admitted for observation and
treatment.