Some Factors Influencing the Placement of a Child in Treatment

This paper was given at one of the weekly general conferences of the Department of Psychological Medicine at The Hospital for Sick Children, Great Ormond Street, which are attended by a number of people belonging to different disciplines. There are many factors which ought to be considered when deciding on the disposal of a child who has been referred for psychiatric help. This paper was a review of these factors, aimed at showing and stimulating thought about the complexity of the problem, rather than discussing in depth any particular form of disposal or treatment. It was an attempt to raise questions rather than to answer them and represents no more than one way of looking at a very complex problem.

In practice we are always concerned with a child as an individual. When we think about whether a particular child should be placed in treatment, probably the first consideration which comes to mind is the needs of this child who has been brought to see us, or about whom we are being consulted. This however, is not the only consideration, for this child is a member of a social group within wider groups, and we ourselves are members of groups within wider groups. We all know this, and I have the feeling we very often forget it. If I am right then perhaps this group factor is the first factor we should consider.

We are familiar with the sort of remark that some teachers will write on a report: “Peter will do better when he learns to concentrate”; or with the parent who says—as was actually said to me once—“Peter is lazy. You can't get him interested in anything. He spends hours in his room listening to pop records. I want him to be a normal boy so he can take over my business after me.” In this instance the problem has been placed firmly on Peter's shoulders and teacher and parent have said in effect, “This is nothing to do with us, it is to do with Peter.” Therapy begins, or should begin at this point with the consultant asking those sort of questions which will enable th