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71
Our conventional casework approach and playtherapy techniques require considerable
modification and new thinking on our part. The parents' hours of work, the
language barrier, and above all the completely different pattern of intra-familial
relationships, which is based on the concept of an extended family circle where the
grandmother assumes the maternal role and other relatives may take over near-parental
responsibilities, make traditional methods of treatment and concepts of theory invalid.
Many of the problems are fundamentally caused by the difficulties the child has in
coping in the changed physical and social environment, and his frustration in making
himself understood. The result is that often very little can be done for these cases
at the child guidance clinic, apart from explaining the position to everybody concerned
and stressing the need for the child to have time to adjust.
This year we had a fair number of referrals from private schools, and the
co-operation with the staff and attention given to parents and children was in no way
different to the schools administered by the Local Authority.
The child psychiatrist can probably observe certain side effects on the community
due to the Mental Health Act 1959 better than his colleagues in the mental hospital,as
he observes at close range the disturbing effect in the home on the emotional stability
of the children who are living with mentally unbalanced adults, who often suffer from
florid delusions or severe agitated depressions. This is a comparatively new
development of Community Mental Health Therapy and remains an unsolved problem in an
otherwise progressive and most welcome approach to mental illness. It appears to me
that the concept of the modern Community Mental Health Service could break down if more
support for families with mentally unbalanced members, by increasing the number of
trained caseworkers, is not forthcoming. An interim solution would seem to be, as has
been shown in other areas, to base the Community Mental Health Service on a greatly
extended local child guidance clinic, which would have the advantage of its considerable
experience in working within families and co-ordinating different social agencies.
The fact that child psychiatry provides treatment for the family could be extended to
the community.
The number of cases of school phobia, a complaint more fully explained in the
previous report, remained at a high level, and many children presented themselves with
severe psychosomatic symptoms, particularly vomiting, diarrhoea and abdominal pain,
which at first conceded the underlying problem of separation anxiety which required
psychiatric attention. In a few cases there has been a tendency to mental and
physical collapse and in one case even a suicidal attempt was made. The circumstances
and symptoms allow a sharp distinction from truancy, and intensive psychotherapy is
called for in all cases, even if this means more absence from school, since research
has shown that such children without the expert treatment are liable to remain misfits
in society with severe personal and social disturbances in later life. The cases at
this clinic were roughly divided equally between boys and girls, and the age range
spread from six years to sixteen years, with at least half being of secondary school
age. This corresponds with the general observation that school phobia can occur
independently of sex at any age during the child's scholastic career. Intelligence
levels ranged from very low average to one very superior.
On the whole, school phobia tends to occur in more intelligent children and seems
fairly independent from failure or success in school, while truancy is more frequent
in backward children who find the requirements of the school difficult. In almost
every case of school phobia we found parental problems of an emotional nature involving
the child. More than half thechildren were thought to be over-indulged or lacking