Education And Debate

Child and adolescent mental health services: purchasers' knowledge and plans

BMJ 1994; 309 doi: (Published 23 July 1994) Cite this as: BMJ 1994;309:259
  1. M Vanstraelen,
  2. D Cottrell
  1. Department of Psychiatry, London Hospital Medical College, London E1 2AD
  1. Correspondence to: Professor David Cottrell, Academic Unit of Child and Adolescent Mental Health, 12A Clarendon Road, Leeds LS2 9NN.
  • Accepted 11 April 1994

All purchasers in the North East Thames Regional Health Authority were contacted by telephone and questioned systematically about their purchasing plans for child and adolescent mental health. Purchasers' knowledge of the services they were purchasing was very limited. They had made little or no attempt to set quality standards or to monitor them. It is concluded that information about these services is so limited that purchasers would be unable to make informed decisions concerning changes in service patterns.

The scale of psychological problems in children in the community is often not realised. Depending on prevailing levels of socioeconomic deprivation, between 7% and 20% of children and teenagers will have a child psychiatric disorder,1 and although some of these are relatively mild, development or functioning, or both, will be significantly impaired in 5-10%. The table shows the numbers of children with disorders in a typical district of 300 000 people, where about a quarter of the population will be aged up to 18 years. Such figures are intended only as a rough guide. When there is considerable comorbidity these figures will be inflated; presenting data for only a few common conditions and only at certain age ranges (no figures are presented for children under 4 years with emotional and behavioural difficulties) will distort in the opposite direction.

View this table:

Prevalence of child psychiatric disorder in a population of 75 000 children and adolescents (up to the age of 18 years)

Only about 10% of children in the community with disorders are in contact with helping agencies at any one time.2 This would matter less if these were the most severely disturbed children, but there is evidence that this is not the case, suggesting that large numbers of children with psychiatric disorder are slipping through the net. Tower Hamlets, a very deprived …

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