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The pattern of this year has been like those in the past — one of the increasing seriousness of referred cases.
School refusals have increased, which may be related to the raising of the school leaving age and to environmental
pressures on children of many cultures, who are ill-adapted to the educational demands made upon them. The
need for greater flexibility in providing different kinds of schooling is agreed, for example, for children who come
to join their families from abroad, and who have had a different background from the one they are expected to
meet on attending school here.
The Day Maladjusted Unit and "Opportunity Classes" have met some needs, and other solutions, such as the
new Northumberland Park School, seem to be moving in the right direction, with smaller classes and greater
personal contact. Here, in this school, apparently problems are markedly less.
On the psychiatric side, depression undoubtedly plays an increasing part in the pathology of children referred to
us. This takes many forms, from behaviour disorder to psychosomatic disturbance and retardation of development;
finding the causation of the stress is often of itself of therapeutic help. We need greater amenities in the form of
in-patient units and short-term hostels, at times of family crises.
One of the initiations the Psychotherapist has brought to the Clinic has been to treat family groups - mothers,
fathers and children together — and this has been extremely rewarding in suitable cases, particularly with
adolescents, who are precocious physically, but immature emotionally, and who have difficulties of communication
with their families; in their lives outside their families, their attempts at self-expression are seen as anti-social
acts.
With the growth of greater centralisation of Social Services, one may hope that the work of the Child Guidance
Clinic will be able to give an increasingly significant service to this work in the field.
/ would like to thank my colleagues for the help they have given me over the years; this work succeeds only
with the help and support of a devoted team."
Dr. Graf reports as follows on the year's work at Tetherdown:—
"As requested, / have pleasure in presenting my report on the function and organisation of the Tetherdown
Child Guidance Clinic during 1972. This is my 11th Annual Report since / was seconded by the North-West
Regional Hospital Board to serve in this area and my 8th report as the Medical Director of the Tetherdown Child
Guidance Clinic, which was established in 1965.
Since the time of my appointment the scope of work and the non-medical establishment of the Clinic have
considerably expanded, which reflects to some extent in the opening of the Wood Green Child Guidance Clinic
as an independent unit. However, the consultant psychiatrist at Tetherdown, who as Medical Director has the
ultimate clinic responsibility for all the psychiatric assessments and psychotherapy conducted at this centre,
remains as before, unassisted by a junior medical colleague and is expected to continue to carry a vast case-load
and considerable managerial responsibility, as he and his predecessors have done for the past twenty-two years
in their two weekly sessions. Consequently, he has to rely unduly and unfairly on the support, efficiency and
loyalty of his non-medical colleagues and being inundated with work of a clinical nature he is completely unable
to take his knowledge and his expertise into the community as much as he would wish to do in order to assist
and advise the social care worker in the field, the hospital services or in other institutions dealing with children.
He has to spend much of his time with routine work well within the scope of a less experienced psychiatrist
and when called to emergencies elsewhere or requested to do a domiciliary visit in homes, his routine work at
the clinic suffers and is interrupted unless he invokes the help of colleagues working in other centres. In spite
of the fact that there are at present, four psychotherapists attached to the Clinic to assist him, who attend on a
sessional basis, who have about 20 children in treatment, which may last for months, or even years, he is
unable to help in the treatment of the almost equal number of children who are still on the treatment waiting
list, some of whom he would see if he had more medical assistance and time at his disposal.
However, fortunately, only a minority of the children referred to the Clinic really require the lengthy and
extensive psychotherapy which has to be given to the more disturbed child and some can be helped by more
limited and superficial supportive treatment, advice given to parents and teachers, or other less time consuming
therapeutic measures which include also the placement in special day or boarding schools for maladjusted pupils.
In fact, there are currently 63 children, ascertained as maladjusted and annually reviewed by the psychiatrist,
who following his recommendation are attending boarding schools recognised by the Department of Education
and Science according to the Education Act of 1944. During the past year 22 of these children were reviewed,
while 5 children were sent to our new day school for maladjusted pupils which is not yet able to receive its full
complement.
The number of children referred for child guidance investigation at the Tetherdown Clinic in 1972 was 180, of
which 140 were seen by the Consultant Psychiatrist in 72 diagnostic and 66 review sessions. The majority (58)
were referred from schools through teachers, some came to us at the request of their parents (35) while the
Chief Education Officer and the Educational Psychologist sent us 19 children. A large number of referrals came
from Medical Officers (41), General Practitioners (11) and Hospital Specialists (10), while other cases reached us
through Probation Officers and the Social Services Department.
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