ArchivesofDiseaseinChildhood 1992; 67:971-975 TYPES OF PSYCHIATRIC TREATMENT

The Court report in 1976 laid down the classic blueprint for the organisation of children's mental health services.' Since then the priorities of health and other services have changed.2 Social services in some parts of the country have had to redirect social workers from child guidance to child protection work, often because of the major increase in reporting of child sexual abuse, and now also have to consider the implications of the Children Act.3 Education services have had two major education acts to deal with,4 5 and they are subject to the turbulence of further continued reform. This paper looks at dynamics more than structures and offers observations on how modern approaches, especially of health economics, are shaping an inner London child psychiatry service in the new context of the NHS reforms.6