The increasing number of children using psychiatric services: analysis of a cumulative psychiatric case register.

Psychosocial problems of children have received increasing attention in the pediatric literature, but it remains unclear to what extent psychiatric services are available and used for the treatment of these problems. This paper examines the utilization of psychiatric services by children over an 18-year period in Monroe County, NY, where a psychiatric case register monitors utilization since 1960. Reporting to the register is estimated at more than 90% of utilization for the child population. By 1977, the last year for which reasonably complete data are available, enough information had accumulated to study the lifetime utilization of all children up to 17 years of age. During the last three years of the study period, the lifetime prevalence of illness treated in psychiatric facilities including private psychiatrists' offices was 3% for children aged 5 to 9 years, 5.5% for children aged 10 to 14 years, and 7.3% for those aged 15 to 17 years. The incidence of newly recognized and treated illness was approximately .7% per year in the age range 5 to 14 years and 1.0% for those aged 15 to 17. Community mental health centers brought a marked increase in treated incidence especially for the nonwhite population. Utilization rose during the first 15 years of the study period and reached a plateau by the mid-1970s. Two interpretations of this stabilization of utilization are offered. The first one suggests that needs and utilization are still increasing, but that this rise is masked in the data by a drop in reporting providers. The second interpretation suggests that supply and demand for services have become balanced since the establishment of four community mental health centers.