Aj. Dalrymple et al., COMPARATIVE-ANALYSIS OF NATIVE ADMISSIONS AND REGISTRATIONS TO NORTHWESTERN ONTARIO TREATMENT FACILITIES - HOSPITAL AND COMMUNITY SECTORS, Canadian journal of psychiatry, 40(8), 1995, pp. 467-473
Objective: To study Native and non-Native admissions to acute psychiat
ric care in the northwestern region of Ontario in 1992. Method: To rep
licate a 1986 to 1987 study comparing Native to non-Native admissions
to acute psychiatric care in the northwestern region of Ontario in 199
2 and examine Native registrations to community mental health agencies
in the first 6 months of 1993. Results: The comparative analysis of h
ospital admissions revealed that. Natives are still being admitted at
33% more than the rate expected on the basis of population; depression
appears to be underdiagnosed for Natives, they continue to be admitte
d mainly for reasons other than major psychiatric conditions, substanc
e abuse and forensic history are commonly involved; they stay in hospi
tal for twice as long as their non-Native control; they more often com
e from rural settings; and they are less likely to be followed by the
outpatient service and more likely to be followed by the criminal just
ice system. The examination of registrations to community mental healt
h agencies revealed that. the same overrepresentation of Natives, mood
- and thought-presenting problems of Natives in this sector were ident
ical to non-Natives; and their length of stay was similar. The psychia
tric hospital appears to be providing acute care treatment, not for th
e serious psychiatric illnesses for which it is mandated, but for atyp
ical admissions that result from economic, social and cultural disloca
tion. There may be underdiagnosis of a typical depression in the Nativ
e hospitalized population. When asked what they are being treated for
the diagnostic profile of Natives and non-Natives is identical on mood
and thought dimensions. Conclusion: No appreciable change has occurre
d over the 5 years in the way hospital psychiatric services are used b
y Natives. Cultural stereotypes may be influencing the diagnosis of Na
tives in inappropriate ways. Enhancing Native control of treatment pro
grams and community development may provide a partial solution. Proper
ly mandated and accountable community agencies (both generic- and cult
ure-specific) will help reduce unnecessary hospitalization.