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Mental health must be “centre stage” in child welfare
  1. Chair, National Children's Bureau, 8 Wakley Street
  2. London EC1V 7QE, UK
  3. email:

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The size of the problem

The alarmingly high incidence of behaviour and emotional disorders in children in the United Kingdom was established 30 years ago.1 A minimum annual incidence of 5–10% for children living in relatively stable semirural communities and 10–20% for those in inner cities was found. Recently, an overall annual national incidence of 10% has been reported.2 Authoritative reviews suggest that there has, if anything, been a rise in the incidence of at least some of these disorders over the past 40 years.3 Illustrative case reports have shown that, among mainly undiagnosed, young, untreated children identified with psychiatric disorders in the community, even those with less serious levels of disturbance are suffering major impairment of social functioning.4

The community response

Until about five years ago, the official response to these striking epidemiological findings was disappointing. From 1970 to 1995, there was a slow increase in the number of consultant posts in child and adolescent psychiatry and in the number of training positions, but the need to improve services for mental health problems in the school setting, for children receiving paediatric care, and for children in contact with social services (especially those in public care), and for young offenders was not clearly recognised, and, insofar as it was, the measures taken to improve the situation were inadequate and sometimes, as in the case of young offenders, calculated to do more harm than good.

However, in the past five years there has been a very substantial change in the attitudes of central government, beginning with the previous administration and gathering pace under the present one. The degree to which the change in attitude will be reflected in willingness to bring about improvement in the relevant structures, tackle difficult interprofessional issues, and provide increased resources is unclear, but a definite and promising start has been …

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