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Conferences and discussion with colleagues in the field of child care, teachers, social workers and probation
officers, have also aimed at defining social and individual pathology. These colleagues, like members of the
team, have increasing awareness and thus greater potential for helping cases which otherwise might need the
more specialised care of the psychiatric team. It is only by increasing such awareness that the very small
available resources of a part-time psychiatric service can hope to cover the vast extent of disturbance in the
child population. Tottenham is a microcosm of all the problems affecting the country as a whole. The need
for special provision for disturbed children is the first and paramount priority. The absence of a Day Maladjusted
School for the disturbed who cannot be contained in school, of a group for the school phobics who break
down under the stress of their lives into depression and withdrawal, is one which must be met, if constructive
therapeutic approach is to continue. Research has indicated one in fifteen of women and one in twenty men
need to be in institutional or hospital care, because of mental illness. Of these a very great proportion present
in early childhood and adolescence as school phobics and refusers.
It remains only to say that the year has been a fruitful one: the numbers indicate the extent of our labours.
In this year, 163 children have been referred. The parents of 197 were seen by the Psychiatric Social Workers,
many of them regularly over a long period of time. 109 children were seen for diagnostic interview and
assessment by the Psychiatrist. Of these the psychotherapist has treated 38 children intensively, by weekly
sessions in the first instance, and later fortnightly or monthly. We have dosed 155 cases, of which 78 improved
with help; of 20 the Health Visitor or Mother reported improvement, 10 moved away, 10 were non-co-operative,
and to 14 we received no response for offered appointments; 2 were dosed under Educational Psychologist
supervision in the last year. In the present year it appears this last number will be far higher."
Dr. K. Graf reports on the year's work at Tetherdown —
"This is my sixth annual report as Medical Director of Tetherdown Child Guidance Clinic. The establishment
and the demands made on the sessions of this clinic have progressively increased, but the psychiatric sessions
have remained unaltered for the past 20 years. It is now to be hoped that in the near future the North West
Metropolitan Regional Hospital Board will agree to an additional appointment of a part-time Senior Psychiatric
Registrar.
The number of children referred for child guidance investigation in 1970 was 231. The majority were referred
from schools through teachers (with parental consent), the Chief Education Officer and Educational Psychologists
(87); the Principal School Medical Officer has sent us 68 children, while we were particularly pleased that 39
children reached us through their parents and 15 from General Practitioners. Other sources of referrals were
from hospital specialists, Probation Officers, Children's Officers and the N.S.P.C.C., (including reports for the
Court).
Our advice, with a view to treatment, was sought for a multiplicity of complaints including emotional disturbance
(69); behaviour disorders (67); School phobia, school refusal and truancy (14); delinquency (13); physical
complaints explainable by emotional factors, including bed-wetting (11) and learning problems (27). The
remaining 30 referrals were mostly cases of minor psychiatric significance. Boys predominated over girls
and the peak age for referrals was 11 years (28), the youngest children being 2 years (7) and the oldest 16(3).
The majority of cases required only counselling and advice to the parents or child (71), change of school or
educational modification (22), while specialised treatment by one of our highly qualified and experienced
child psychotherapists, often more than once weekly and extending over very prolonged periods, was arranged
for 27 referrals. There were many other forms of help we were able to provide for the distressed parents
and exasperated teachers, but 46 children improved spontaneously, left the district or were prevented by their
parents or other circumstances from accepting help we had offered. 18 of the children sent for investigation
were still on our diagnostic waiting list at the end of the year. Not every child who was referred required
to be seen by all members of the team.
The length of the investigations necessary in dealing with disturbed children is responsible for the long
waiting lists for diagnosis and treatment which are common in all Child Guidance Clinics in the country.
Nevertheless, we have been able to reduce our diagnostic waiting list to really negligible proportions but
unfortunately, owing to the shortage of available psychotherapists and the limited time at the disposal of
the psychiatrist for treatment, our treatment waiting list remains quite formidable. We continued to employ
the well tried out team approach to our clients' problems, and nearly every child is seen by the Psychiatrist,
who investigates his emotional stability, and the Educational Psychologist who is particularly interested in
his intellectual endowment and his special needs in school, while the Psychiatric Social Worker explores the
situation within the family where she tries to contact the parents and to improve the domestic situation,
when necessary, by skilled casework. We are in dose co-operation with the school psychological service
which is predominantly responsible for educationally subnormal children and educational problems of
pupils which are not explainable by emotional disturbance."
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