Mental health problems of children: analysis of a cumulative psychiatric case register.

The advent of community mental health centers has brought a marked increase in treatment of mental health problems of children, especially for minorities. The number of children receiving care and the prevalence and the utilization rates by age, sex, and race from 1960 to 1977 in a large metropolitan county in upstate New York have been described previously. For the same time and community, the episodes of care by diagnostic grouping, type and length of treatment, and health status at the end of an episode have now been examined. An increase in treatment occurred in two areas: situational disorders and behavioral disorders. The number of treatments for psychotic, neurotic, and personality disorders remained stable. Affective and psychotic disorders emerged as qualitatively unique problems which often required multiple treatments and predicted high adult utilization. The average length of treatment for all episodes was 110 days. One third of the treatment episodes were associated with an improved health status. Most contacts were for first episodes, but a few patients had an extraordinarily large number of treatment episodes. A comparison with mental health problems seen in pediatric practice is presented.