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Social Class, Symptom Type and the Utilization of Children's Psychiatric Services

This paper examines three aspects of the distribution and use of children's psychiatric services in Canada under National Health Insurance. These are: 1) Class disparities in the utilization rates of these services; 2) The extent to which those children most in need of treatment are receiving it; and 3) The extent of unmet need for psychiatric services for children 17 years of age and under in the Ottawa-Carleton region. The subjects of this investigation were 96 children between the ages of 6.5 and 12 years who have attended the Children's Services at the Royal Ottawa Hospital. The results indicate that class disparities in the distribution of services were the reverse of those typically found under private fee-for-service arrangements. The high social class had the lowest proportionate use and the welfare classes the highest. In addition, there was a significant association between social class and age for the boys only; the higher the social class, the younger the boy at the time of referral. Almost two-thirds of this sample were found to have antisocial and aggressive disorders. Consistent with estimates of the high rates of these disorders in the general population, this suggests that a proportionate number of those children most in need of treatment are receiving it. For children 17 years of age and under, the one-year treated prevalence of disorder in the Ottawa-Carleton region was estimated to be .95%. Though higher than reports from other sources, it is clear that free medical care alone is not sufficient to bridge the gap between estimates of the true prevalence and treated prevalence of childhood psychiatric disorder. These findings are discussed in terms of the importance of non-economic factors as determinants of the distribution and use of children's psychiatric services. As well, the importance of referral practice, especially for the lower social classes is commented upon. Finally, suggestions are made for further research.